DISINFECTIONDISINFECTION GUIDELINESGUIDELINES

Produced & Distributed by:Infection Control Unit

Medical Care Quality SectionMedical Development Division

Ministry of Health Malaysia

DISINFECTIONDDISINFECTIONDISINFECTIONDISINFECTIONDISINFECTIONDISINFECTIONDISINFECTIONDISINFECTIONDISINFECTIONDISINFECTIONDISINFECTIONDISINFECTIONGUIDELINESGGUIDELINESGUIDELINESGUIDELINESGUIDELINESGUIDELINESGUIDELINESGUIDELINESGUIDELINESGUIDELINES

2nd Edition, 2019

Copyright © Ministry of Health MalaysiaAll right reserved. This book may not be reproduced, in whole or inpart, in any form or means, electronic or mechanical, includingphotocopying, recording, or by any information storage and retrievalsystem now known or here after invented, without writtenpermission from publisher.

Disinfection Guidelines

Second Edition 2019Printed 2020

Produced & Distributed by: Infection Control Unit Medical Care Quality SectionMedical Development DivisionMinistry of Health MalaysiaLevel 4, Block E1, Parcel E,Federal Government Administration Centre,62590, Putrajaya Malaysia

Printed by: Percetakan Tabah Sdn. Bhd.

ISBN : 9789672469056

LIST OF CONTRIBUTORS 4

SECTION A: INTRODUCTION 5

SECTION B: DEFINITION 7

SECTION C: DECREASING ORDER OF RESISTANT MICROORGANISMS AND 9THE LEVEL REQUIRED FOR DISINFECTION AND STERILIZATION

SECTION D: CLASSIFICATION OF DEVICES AND INSTRUMENTS ACCORDING 10TO CLINICAL USE (SPALDING CRITERIA)

SECTION E: GENERAL PRINCIPLES FOR DISINFECTANT USAGE 12

SECTION F: RECOMMENDATIONS FOR METHODS OF DISINFECTION 15

SECTION G: ADVERSE EFFECT AND CAUTION LEVELS 28

SECTION H: SAFETY PRECAUTIONS IN USE OF DISINFECTANT 30

SECTION I: DISINFECTANTS DILUTIONS AND THEIR CHARACTERISCTICS 34

APPENDIX I: PREPARING AND USING CHEMICAL DISINFECTANT 36

APPENDIX II: LIST OF DISINFECTANT CURRENTLY IN MOH DRUG 37FORMULARY

APPENDIX III: PREPARATION OF DISINFECTANT 39

REFERENCES 40

CONTENTS

4 Disinfection Guidelines

Dato’ Dr Mahiran MustafaConsultant Infectious Disease PhysicianHospital Raja Perempuan Zainab IIKota Bharu

Dr Nurahan ManingConsultant Clinical MicrobiologistHospital Raja Perempuan Zainab IIKota Bharu

Dr Hjh Zubaidah Abd WahabConsultant Clinical Microbiologist Hospital Selayang

Dr Noridah NordinInfectious Disease PhysicianHospital Raja Perempuan Zainab II, KotaBharu

Dr Suraya Amir HusinSenior Principal Assistant DirectorMedical Development DivisionMinistry of Health

Dr Puteri Fajariah Megat Mohd GhazaliSenior Principal Assistant DirectorMedical Development DivisionMinistry of Health

Puan Hasnah Ibrahim Senior Principal Assistant DirectorPharmacy Services DivisionKelantan State Health Department

Cik Hanan Hayati MamatPharmacistHospital Raja Perempuan Zainab II,Kota Bharu

Puan Kiren KaurPharmacistHospital Raja Perempuan Zainab II,Kota Bharu

Puan Suhaily OthmanNursing MatronMedical Development DivisionMinistry of Health

Puan Suriani Mohd RamliNursing MatronCSSU Unit,Hospital Raja Perempuan Zainab II,Kota Bharu

Puan Zawiah Mamat @ DerisNursing SisterNursing UnitKelantan State Health Department

LIST OF CONTRIBUTORS

5Disinfection Guidelines

In Malaysia, surgical procedures and even more invasive medical proceduresincluding gastrointestinal endoscopies are performed everyday. Each procedureinvolves contact by a medical device or surgical instrument with a patient’s steriletissue or mucous membrane. A major risk of all such procedures is the introductionof pathogens that can lead to infection. Failure to properly disinfect or sterilizeequipment carries not only risk associated with breach of host barriers but also riskfor persontoperson transmission eg hepatitis B virus and environmental pathogeneg. Pseudomonas aeruginosa.

Disinfection is essential for ensuring that instruments and environment do nottransmit infectious pathogens to patients. Because sterilization of all patientcareitems is not necessary, healthcare policies must identify, primarily on the basis ofitem intended use, whether cleaning, disinfection, or sterilization is indicated.

Multiple studies in many countries have documented lack of compliance withestablished guidelines for disinfection. Failure to comply has led to numerousoutbreaks.

Factors that affect the efficacy of both disinfections and sterilization include priorcleaning of the object; organic and inorganic load present; type and microbialcontamination; concentration of and exposure time to germicide; physical nature ofthe object, presence of biofilms, temperature and pH of the disinfection process andin some cases, relative humidity of the sterilization process (e.g., ethylene oxide).

INTRODUCTION

SECTION A


This guideline will assist healthcare facilities in the practices for disinfection of allitems used. Refer to Standardization of Sterilization MOH for sterilization ofequipment guidelines.

Factors that affect the efficacy of both disinfections and sterilization includes:

1. Prior cleaning of the objects

2. Organic and inorganic load present

3. Type and microbial contamination

4. Concentration and exposure time to germicide

5. Physical nature of the object

6. Presence of biofilms

7. Temperature and pH of the disinfection process

8. Humidity of the sterilization process (e.g. ethylene oxide)


A process which removes or destroys microorganisms torender an object safe for further use. It includes cleaning,disinfection and sterilization. The choice of method dependson a number of factors including type of material of object,number and types of organisms involved and risk ofinfection to patient and staff.

DEFINITION

DECONTAMINATION

A process which removes foreign material (e.g. dust, soil)and organic matter (e.g. faeces, blood) from an object.Cleaning is an essential prerequisite to disinfection andsterilization. Equipment shall be rinsed under running wateror moistened at point of use, then send it in a cleancontainer to the CSSU where proper cleaning can beperformed. Enzymatic detergent or surfactant is highlyrecommended for endoscopy disinfection.

CLEANING

A process eliminates/reduces many or all pathogenicmicroorganisms, except bacterial spore.DISINFECTION

A process, which destroys all types of microorganismsincluding spores. STERILISATION

SECTION B


A chemical compound used to inactivate vegetativemicroorganism but not all microbial forms. DISINFECTANT

Level of disinfection required when processing semi criticalitems. High level disinfectant destroy vegetative bacteria,mycobacteria, fungi, enveloped (lipid) and nonenveloped(nonlipid) viruses but not necessarily bacterial spores. Itemsmust be thoroughly cleaned prior to highlevel disinfection.

HIGH LEVELDISINFECTION

Level of disinfection required when processing non criticalitems or some environmental surfaces. Low leveldisinfection kills most vegetative bacteria and some fungi aswell as enveloped (lipid) viruses but do not kill mycobacteriaor bacterial spores. Low level disinfectants are used to cleanenvironmental surfaces.

LOW LEVELDISINFECTION

A lowlevel disinfectant formulated for use on skin or tissue.Should not be used to decontaminate inanimate objects. ANTISEPTIC

Level of disinfection required for some semi critical items.Intermediate level disinfectant kills vegetative bacteria, mostviruses and most fungi but not resistant bacterial spores.

INTERMEDIATELEVEL DISINFECTION


Prion Reprocessing*

Sterilization / High Level Disinfectant**

High Level Disinfectant

Intermediate Level Disinfectant

Low Level Disinfectant

Resistant

Prions (Creutzfieldt – Jacob Disease)

Bacteria with spores(Bacillus anthraxis, cereus, Clostridium botulinum etc)

Coccidia (Cryptosporidium)

Mycobacteria (M tuberculosis etc, H pylori)

Non lipid or small viruses (polio, coxsakie etc)

Fungi (Asperfillus, candida)

Vegetative bacteria (including MDRO)

Lipid or medium sized viruses(HIV, HSV, HBV, HCV, Corona etc)

Susceptible

DECREASING ORDER OFRESISTANT MICROORGANISMSAND THE LEVEL REQUIRED FOR DISINFECTION AND STERILIZATION

* Prion Reprocessing combination of Sodium Hydroxide and steam sterilization**High Level Disinfectant e.g. for endoscopy procedure, bronchoscopy

ORGANISM LEVEL

SECTION C


SECTION D

CLASSIFICATION OFDEVICES AND INSTRUMENTS

ACCORDING TO CLINICAL USE (SPALDING CRITERIA)

Critical items

Semi criticalitems

An object that enters steriletissue or vascular system

Items should be purchased assterile or should be sterilized

An object that comes incontact with mucousmembranes or non intact skin

a.High level disinfection

• Surgical instrument

• Flexible/Rigid scopes(Recommended to use preferred disinfectantoption)

• Laryngoscope blades• Respiratory therapy

equipments• Nebulizer cups• Anaesthetic delivery system• Nasal specula• Ear syringe nozzles

CATEGORY OFDEVICES CRITERIA EXAMPLE OF ITEMS


Non criticalitems

b Intermediate level disinfection

An object that comes incontact with intact skin butnot mucous membranes.

• Vaginal specula• Vaginal probes

• Glass thermometer• Electronic thermometer• Hydrotherapy tanks• Bath tubs in burn units• Tonometer head

• Stethoscope• Bedpans• Urinals• Blood pressure cuffs• Ear specula• Equipment surfaces e.g.

incubator, trolley, monitor• Floors, walls and furniture• Intravenous poles• Wheelchairs• Beds• Basinets

CATEGORY OFDEVICES CRITERIA EXAMPLE OF ITEMS


SECTION E

GENERAL PRINCIPLESFOR DISINFECTANT USAGE

a. RULES FOR THE USE OF DISINFECTANTS:

• Follow the manufacturer’s instructions (concentration/dilution, usage) • Check the expiry date of the solutions • Ensure that the optimum dilution is used. • Always wash and clean instruments before disinfection• Gross soil (e.g. faeces, sputum, blood) shall be removed immediately at point

of use • Adequate contact time and complete immersion • Do not refill disinfectant containers topping up is NOT allowed • Where disinfectants are indicated for use on surfaces, WIPE DO NOT SOAK

b. WHEN DISINFECTANT SHOULD NOT BE USED:

• Where cleaning is sufficient • Where sterility is mandatory• Where heat treatment is possible. • On singleuse (disposable) items which should be discarded after use• For the storage container of sterile instruments (sterile instruments shall be

placed in sterile container)• As cleaning agent or deodorant


c. WHEN DISINFECTANTS MAY BE USED:

Disinfectants should only be used if reduction in microbial load is needed, disinfection by heat is impossible and cleaning is insufficient. These are usually applicable for: • Treatment of skin and mucous membranes (use antiseptics only) • The disinfection of instruments when physical methods cannot be used • Making potentially infective items safe for subsequent handling • The decontamination of surfaces where indicated

d. THE FOLLOWING POINTS MUST BE CONSIDERED WHERE DISINFECTANTS ARE USED:

i. Making up the disinfectantsDisinfectants must be used at their correct recommended inuse dilutions (as recommended by manufacturers). All dilution should take place preferably in the pharmacy or ready to use preparation with expiry and date of issue clearly stated. All diluents added shall be in sterile condition. Written Instructions for preparing solutions should be posted in all areas where this work is done. The instructions should state the concentration to be made up and give a detailed description of the way in which that concentration is to be measured. Disinfectants should not be mixed with detergents, as they may be incompatible with each other.

ii. Containers (including stoppers) Containers, including stoppers used for making up, distributing and storing disinfectants should be maintained in a hygienic condition. They should preferably be made of plastic which can withstand 100% boiling water. The containers when empty should first be cleaned with low lather detergent before heat treatment (i.e. autoclave if autoclavable or filled up with boiling water, allowed to stand for 20 minutes, then pour the water away) before refilling. Cleaning alone is insufficient. Containers shall be cleaned regularly and should NOT be topped up with fresh disinfectants as the level drops. Containers which cannot easily be cleaned or which cannot withstand heat treatment shall not be used for disinfectants. Large drums, stone jars and wooden tubs are unsuitable. Suitable sized containers should be used. Wards should ask for required quantity of necessary disinfectant and use it judiciously.


iii. Supervision In every department where disinfectants are used, a disinfectant record bookshould be kept to show the number of containers, the names of disinfectantsand their concentration in use. The containers should be as few as possible and extra unofficial ones should not be allowed. In each department, a senior member of the staff should be responsible for the disinfectant record book, and for monitoring the use of the solutions once a week, preferably late in the week. The containers in the department should be counted and recorded in the book. The book should be available for regular inspection and it should be signed after inspection.

iv. MonitoringInUse testing is not recommended routinely to monitor the proper use of disinfectants. It should only be done during outbreak or investigation thereof. For inuse testing: collect aseptically about 2ml of disinfectant from containers into sterile bottles, label them and send promptly to the microbiology laboratory.

v. Usage This guideline deliberately limits the number of types of disinfectants to be used so as to increase costeffectiveness, enhance safety, encourage familiarity with the products and ensure adequacy of supplies. This guideline should be strictly adhered and only the recommended disinfectants should be used for their specific purposes.

vi. Choice All disinfectants i.e. self prepared or commercially prepared shall seek approval by the hospital committee. For all medical items e.g endoscopes or bronchoscope, the vendor shall submit to the committee, the range of disinfectants that are compatible and approved by MOH.


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leve

l disi

nfec

tant

e.g

.0.

1% h

ypoc

hlor

ite, P

heno

lics o

rQ

uate

rnar

y am

mon

ium

com

poun

ds

•W

ipe

with

low

leve

l di

sinfe

ctan

t e.g

. 70%

alc

ohol

an

d dr

y•

High

leve

l disi

nfec

tant

•Da

ily•

In b

etw

een

patie

nts

After

eac

h us

e

•Da

ily•

Whe

n so

iled

•In

bet

wee

n pa

tient

s

•Da

ily•

In b

etw

een

patie

nts

•W

hen

soile

d

•In

bet

wee

n pa

tient

s•

Whe

n so

iled

ITEM

SRE

COM

MEN

DATI

ON

MIN

IMU

M F

REQ

UEN

CY/

CLEA

NIN

G P

ROCE

SSRE

MAR

KS


Matt

ress

es a

ndpi

llow

s

Neb

ulise

rs

Hum

idifi

er

Opt

halm

osco

pe

Ort

hopa

edic

equ

ipm

ent

e.g

crut

ches

, tra

ction

etc

.

Oto

scop

e•

Hand

le

•Pr

otec

t with

wat

erpr

oof p

lasti

c co

vers

, use

matt

ress

with

PVC

co

ver

•W

ipe

the

plas

tic c

over

s with

1%

hyp

ochl

orite

•Si

ngle

use

•Di

scar

d flu

id. C

lean

with

de

terg

ent a

nd w

ater

. Rin

se

with

hot

wat

er

Wip

e w

ith lo

wle

vel d

isinf

ecta

nte.

g. 7

0% a

lcoh

ol o

r Hyd

roge

npe

roxi

de 0

.5%

wip

es

Use

low

leve

l disi

nfec

tant

e.g

.0.

1% h

ypoc

hlor

ite, P

heno

lics o

rQ

uate

rnar

y am

mon

ium

com

poun

ds

•W

ipe

with

low

leve

l di

sinfe

ctan

t e.g

. 70%

alc

ohol

or

Hydr

ogen

per

oxid

e 0.

5% w

ipes

Clea

n in

bet

wee

n pa

tient

In b

etw

een

patie

nts

In b

etw

een

patie

nts

Ort

hopa

edic

equ

ipm

ent

crut

ches

, tra

ction

etc

.

In b

etw

een

patie

nts

Chan

ge th

e pl

astic

cov

er o

npa

tient

disc

harg

e

Dry

befo

re re

used

ITEM

SRE

COM

MEN

DATI

ON

MIN

IMU

M F

REQ

UEN

CY/

CLEA

NIN

G P

ROCE

SSRE

MAR

KS


•Ea

r spe

culu

m•

Oto

acou

stic

Emiss

ion

scre

enin

g tip

s

Oxi

met

er p

robe

Resu

scita

tion

cart

/ tr

olle

y (in

clud

ing

defib

rilla

tor

and

tray

s)

Razo

rs fo

r sha

ving

Sucti

on m

achi

nes

Stet

hosc

ope

Syrin

ges

•W

ipe

with

70%

alc

ohol

•Di

spos

able

s

Low

leve

l disi

nfec

tant

follo

win

gm

anuf

actu

rers

inst

ructi

on o

rdi

spos

able

Use

low

leve

l disi

nfec

tant

e.g

.0.

1% h

ypoc

hlor

ite, P

heno

lics o

rQ

uate

rnar

y am

mon

ium

com

poun

ds

Sing

le u

se o

nly

Use

low

leve

l disi

nfec

tant

e.g

.0.

1% h

ypoc

hlor

ite, P

heno

lics o

rQ

uate

rnar

y am

mon

ium

com

poun

ds

•W

ipe

with

70%

alc

ohol

•O

ption

: disp

osab

le st

etho

scop

e co

ver

Use

ster

ile d

ispos

able

syrin

ges

•Da

ily•

In b

etw

een

patie

nts

•Da

ily

•Aft

er e

ach

use

•In

bet

wee

n pa

tient

s•

Whe

n so

iled

In b

etw

een

patie

nts

Avoi

d ta

king

Car

t int

o co

ntac

tpr

ecau

tion’

s roo

m. H

ave

ade

signa

ted

pers

on to

pas

ssu

pplie

s as r

equi

red

Use

des

igna

ted

stet

hosc

ope

for

infe

ctiou

s or h

igh

risk

patie

nts

ITEM

SRE

COM

MEN

DATI

ON

MIN

IMU

M F

REQ

UEN

CY/

CLEA

NIN

G P

ROCE

SSRE

MAR

KS


Tabl

es•

Card

iac

•Be

dsid

e

Tele

phon

e

Ther

mom

eter

Tour

niqu

et

Tran

spor

t Equ

ipm

ent

•W

alke

r•

Whe

elch

air

•St

retc

her

Wal

ls

Wal

l mou

nted

Oxy

gen

and

Sucti

on F

ixtu

res

Use

low

leve

l disi

nfec

tant

e.g

.0.

1% h

ypoc

hlor

ite, P

heno

lics o

rQ

uate

rnar

y am

mon

ium

com

poun

ds

Wip

e w

ith 7

0% a

lcoh

ol

Use

shea

th c

over

or w

ipe

with

70%

alc

ohol

Advi

se fo

r disp

osab

le b

and

Use

low

leve

l disi

nfec

tant

e.g

.0.

1% h

ypoc

hlor

ite,

Phen

olic

s or

Qua

tern

ary

amm

oniu

mco

mpo

unds

Wip

e w

ith c

lean

dam

p cl

oth

with

dete

rgen

t and

wat

er

Use

low

leve

l disi

nfec

tant

e.g

.0.

1% h

ypoc

hlor

ite, P

heno

lics o

rQ

uate

rnar

y am

mon

ium

com

poun

ds

•Da

ily

•Be

twee

n pa

tient

s•

Whe

n so

iled

Daily

After

eve

ry u

se

After

eac

h us

e

•W

eekl

y•

In b

etw

een

patie

nts

•In

bet

wee

n pa

tient

s•

Whe

n so

iled

•Us

e an

indi

vidu

al th

erm

omet

erfo

r eac

h pa

tient

if p

ossib

le•

Stor

e dr

y

•W

allp

aper

is n

ot re

com

men

ded

•Hi

ghr

isk a

reas

e.g.

ICU,

SCN

,O

T sh

ould

be

carr

ied

out o

nce

a w

eek

ITEM

SRE

COM

MEN

DATI

ON

MIN

IMU

M F

REQ

UEN

CY/

CLEA

NIN

G P

ROCE

SSRE

MAR

KS


Sem

i criti

cal E

ndos

cope

s:•

Sigm

oido

scop

es•

Gast

rosc

opes

•Co

lono

scop

e•

Bron

chos

cope

•Se

lect

HLD

that

is c

ompa

tible

w

ith th

e en

dosc

ope

•M

onito

r the

effi

cacy

with

test

st

rips

•M

aint

ain

a w

ritten

log

of

mon

itorin

g te

st re

sults

•Fo

llow

the

man

ufac

ture

r’s

dire

ction

s reg

ardi

ng a

mbi

ent

tem

p an

d ex

posu

re ti

me

of

the

disin

fect

ant

•Co

mpl

etel

y im

mer

se th

e en

dosc

ope

and

com

pone

nts i

n th

e HL

D an

d en

sure

all

chan

nels

are

perf

used

•O

nce

com

plet

ed, r

inse

the

endo

scop

e an

d flu

sh th

e ch

anne

ls•

Disc

ard

rinse

wat

er a

fter e

ach

use

/ cyc

le

•Cl

ean

imm

edia

tely

aft

er e

ach

proc

edur

e•

Flus

h an

d w

ipe

the

endo

scop

e at

poi

nt o

f us

e w

ith a

soft

lint

free

clo

th/ ti

ssue

or

endo

scop

ic sp

onge

•U

se e

nzym

atic

clea

ning

so

lutio

n•

Plac

e in

a c

over

ed le

ak

proo

f con

tain

er a

nd

tran

spor

t to

the

desig

nate

d de

cont

amin

ation

are

a•

Follo

w m

anuf

actu

rers

re

com

men

datio

ns

clea

ning

and

cle

anin

g pr

oduc

ts•

Perf

orm

leak

testi

ng a

fter

each

use

, prio

r to

clea

ning

•Di

scon

nect

and

diss

embl

een

dosc

ope

com

pone

nts

(if p

ossib

le),

com

plet

ely

imm

erse

in e

nzym

atic

clea

ner

ITEM

SRE

COM

MEN

DATI

ON

MIN

IMU

M F

REQ

UEN

CY/

CLEA

NIN

G P

ROCE

SSRE

MAR

KS


Criti

cal E

ndos

cope

:•

Arth

rosc

opes

•La

paro

scop

es•

Cyst

osco

pes

•Ch

oled

ocos

cope

(Ent

ers

join

ts a

nd

ster

ile c

aviti

es)

Criti

cal e

ndos

cope

s sha

ll be

ster

ilize

d (a

utoc

lave

) prio

r to

use

•Fl

ush

and

brus

h al

l ch

anne

ls an

d lu

men

s of

endo

cope

s whi

le

subm

erge

d to

rem

ove

debr

is an

d m

inim

ize

aero

sols

•Th

orou

ghly

rins

e en

dosc

ope

and

com

pone

nts w

ith c

lean

, fr

esh

tap

wat

er a

nd

rem

ove

exce

ss w

ater

fr

om c

hann

el b

y pu

rgin

g w

ith fo

rced

air.

•Di

scar

d en

zym

atic

clea

ner a

fter e

ach

use

Sim

ilar

ITEM

SRE

COM

MEN

DATI

ON

MIN

IMU

M F

REQ

UEN

CY/

CLEA

NIN

G P

ROCE

SSRE

MAR

KS


Types ofEndoscope

Invasivepassedinto normallysterile bodycavities orintroduced intothe body througha break in the skinor mucousmembrane

Noninvasive incontact withmucousmembrane, butdoes not entersterile cavities

Rigid endoscopeexample

ArthroscopeLaparoscopeCystoscope

Bronchoscope

Flexible endoscopeexample

NephroscopeAngioscopeCholedochoscope

GastroscopeColonoscopeBronchoscope

Level ofcontamination

Sterilization bysteam or a lowtemperaturemethod.e.g.gas plasma

High leveldisinfection.e.g.immersion inglutaraldehyde,paracetic acid,chlorine dioxide

TYPES OF ENDOSCOPIC PROCEDURE

Disinfectant for Hand:a. Alcohol based disinfectant (ethanol, isopropanol, npropanol) b. Alcohol chlorhexidine


Steps of High Level Disinfection (HLD)

1. Pre cleaning:

a. `Remove gross soil from instruments at the point of use:i. Rinse off or wet the surfaces with a damp clean dry cloth.ii.Endoscope channels flushed with enzymatic detergent

b. During transport, soiled instruments should be opened and kept moist (to prevent drying)i. Spray with an enzymatic sprayii.Do not transport in containers with water as water is a splash hazard

2. Manual cleaning

3. Inspection

4. Rinsing after cleaning to remove detergent residues that may affect the performance of the disinfectant (tap water)

5. Drying to expel excess fluid that may dilute the disinfectant

6. Disinfection

7. Rinsing after HLD to remove disinfectant residues that could cause a harmful effect to the patient. What to use is controversial and has not resolved (suggest: drinking water quality tap water/ sterile/ RO/ filtered (0.2m filter)

8. Flush all channels with alcohol (7080%) and purge all channels with compressed air after high level disinfection

9. Drying


Alcohol 70%

Alcohol 90%

Chlorhexidine Gluconate

• Dry skin• Skin, eye and respiratory

tract irritation• Central nervous system

depression

• Skin,mucous membrane and respiratory irritation

• Volatile• Harmful if swallowed or

inhaled• Evaporation may diminish

concentration• Inactivated by organic

material• May harden rubber or

cause deterioration of glues

• Use in the OR is contraindicated

• Do not use undiluted solution

• Very hazardous in case of ingestion

• May be combustible at high temperature

DISINFECTANTS ADVERSE EFFECT CAUTION LEVELS

SECTION G

ADVERSE EFFECT ANDCAUTION LEVELS


Glutaraldehyde

Orthophthaldehyde0.55%

Hydrogen Peroxides20 Volume

Hydrogen peroxide7.35% with Peraceticacid 0.23%

Peracetic acid

Sodium hypochlorite2.5g and 5g tab

• Nausea, headache, eye irritation, dermatitis

• Hypersensitivity

• Nausea, headache, eye irritation, dermatitis

• Hypersensitivity

• Nausea, vomiting • Skin, eye, respiratory,

gastrointestinal irritation

• Skin and mucous membrane irritation

• Corrosive to eyes, skinand instrument

• Vapor/mist will irritate nose, throat and lungs

• Eye and respiratoryirritation

• Use complete PPE gloves, masks/ respirators, goggles are compulsory

• Room must have adequateventilation exhaust fan or fume hood

• Small spills can be neutralized with ammonia (Larger spills require trained personnel)*

• Should not be disposed of by draining into a sewer system or natural waterways

• Avoid contact with eyes• Keep container closed• Wash thoroughly after

handling

• Can be corrosive with aluminium

• Handle tablets or granules with dry gloves

• When using the solution, avoid formation of spray or aerosols

DISINFECTANTS ADVERSE EFFECT CAUTION LEVELS


ALCOHOLSE.g. IsopropylAlcohol

Workplaceexposure limit

OSHA:PEL 400 ppm over10hour workshift

NIOSH:PEL 400 ppm over10hour workshiftPEL 500 ppm, notto exceeded duringany 15 minuteswork period

• Gloves• Face shields• Suits• Footwear• Headgear• Splashproof

safety goggles• Respirators (if

local exhaust ventilation or enclosure is not available)

• Enclose operations

• Local exhaust • Ventilation at

site of chemical release

• Eyewash fountains

• Emergency shower facilities

• Ongoing education and training

• soap• Mild detergent• Tap water

COMPOUND PPE PREPARATIONROOM OTHERS

SECTION H

SAFETY PRECAUTIONS IN USEOF DISINFECTANTS


CHLORHEXIDINEGLUCONATE

CHLORINE

WorkplaceExposure LimitOSHA:1 ppm (not to beexceeded at anytime)

NIOSH:0.5 ppm(0.3mg/m3)

IODINE/IODOPHOR

WorkplaceExposure Limit

• Safety goggles/glasses

• Gloves• Footwear• Fulllength

clothing• Respirators (if

local exhaust ventilation or enclosure is not available)

• Splashproof safety goggles

• Gloves• Face shields• Fulllength

clothing• Footwear• Headgear• Respirators

(if local exhaust ventilation or enclosure is not available)

• Rubber Gloves• Face shields• Apron• Chemical goggles• Full length

clothing• Safety shoes• Respirator

equipped with cartridge for organic/acid vapours if use condition generate mist/vapour

• Local exhaust• Eyewash

fountains










• Use adequate ventilation

• Wash thoroughly after handling


• soap• Mild detergent• Tap water


• Soap• Mild detergent• Tap water


PHENOLICS


QUATERNARYAMMONIUMCOMPOUND


GLUTARALDEHYDE


NIOSH:0.2 ppm (shouldnot be exceededat any time)When skin contactoccurs, you may beover exposed, eventhough air levelsare less than thelimit listed above

• Gloves• Face shields• Splashproof

safety goggles• Respirators

recommended if TLVS are exceeded

• Waterproof gloves

• Splash proof goggles

• Apron

• Gloves• Apron• Clothing• Footwear• Head gear• Mask

• Exhaust • Ventilation• Process

enclosure• Eye wash facility• Emergency

shower facilities

• Normal room ventilation

• Eye wash facility




• Respirators should be wornif local exhaust ventilation or enclosure is not use

• Emergency shower facility

• Eye wash facility• Post hazard and

warning information in the work area

• Label the chemical use in the workplace**Engineering controls are the most effective way of reducing exposure










PERACETIC ACID


• Goggles• Gloves• Safety glasses

• Normal room ventilation




PEL permissible Exposure Limitppm – parts of a substance per million part of air


SECT

ION

I : D

ISIN

FECT

ANTS

DIL

UTI

ON

S AN

D TH

EIR

CHAR

ACTE

RISC

TICS

Chlo

rine

100

1000

ppm

Hi

gh/ L

ow+

++

++

±+

++

++

++

+fr

ee c

hlor

ine

Chlo

rhex

idin

e 0.

1%

4%In

term

edia

te/L

ow+

++

+

++

++

++

+Gl

ucon

ate

Form

alde

hyde

3

8%Hi

gh/I

nter

med

iate

++

++

+±

+

++

+

+Gl

utar

alde

hyde

2%

High

/ CS

++

++

++

+

++

++

Hydr

ogen

per

oxid

e 3

25%

CS+

++

++

±

±

++

+

+Io

doph

ors

305

0 pp

m

Inte

rmed

iate

++

+±

±

±±

+±

+

++

free

iodi

neIs

opro

pyl A

lcoh

ol60

95%

Inte

rmed

iate

+

+

++

±

+

±+

+

+Pe

race

tic a

cid

0.00

1%0

.2%

High

++

++

++

++

+

+

+

Phen

olic

0.

45%

Inte

rmed

iate

/Low

++

±

±

±

++

+

++

Qua

rten

ary

0.4

1.6%

Low

++

±

+

+

+

++

Amm

oniu

m

CS=c

hem

osta

biliz

erIn

activ

ates

all

indi

cate

d m

icro

orga

nism

s with

con

tact

tim

e of

30

min

utes

or l

ess,

exc

ept b

acte

ria sp

ores

whi

ch re

quire

61

0 ho

urs o

f con

tact

tim

e.

Disinfectant Group

Use dilution

Level of Disinfection

Bacteria

Lipophilic Viruses

Hydrophilic Viruses

M. tuberculosis

Mycotic Agent

Bacteria Spores

Corrosive/ Deleterious EffectInactivated by organic matter

Residue

Skin irritant

Eye irritant

Respiratory irritant

Toxic

Easily obtainable

Impo

rtan

t cha

ract

eris

tics

Inac

tive

APPENDIX


APPE

NDI

X I

: PRE

PARI

NG

AN

D U

SIN

G C

HEM

ICAL

DIS

INFE

CTAN

T

Disi

nfec

tion

(com

mon

solu

tion

orbr

and)

Chlo

rine

Form

alde

hyde

(35

40%

)

Glut

aral

dehy

de

Hydr

ogen

Per

oxid

e(3

0%)

Alco

hol (

ethy

l or

isopr

ophy

l)

Iodo

phor

s (10

%po

vido

neio

dine

) (PV

I)

Effec

tive

conc

entr

ation

0.1%

8% Varie

s (2

4%)

6% 609

0%

Appr

oxim

atel

y2.

5%

How

to d

ilute

Dilu

tion

proc

edur

es v

ary

1 pa

rt 3

40%

solu

tion

to4

part

s boi

led

wat

er

Add

activ

ator

Use

full

stre

ngth

1 pa

rt 1

0% P

VI to

3 p

arts

wat

er

Corr

osiv

e

Yesc

No

No

Yes

No

Yes

Leav

esre

sidu

e

Yes

Yes

Yes

No

No

Yes

Tim

e ne

eded

for H

LD

20 m

inut

es

20 m

inut

es

20 m

inut

es a

t 25°

Cd

20 m

inut

es

Do n

ot u

se

Do n

ot u

se

Activ

ated

She

lf Li

fea

Chan

ge e

very

14

days

, soo

ner i

f clo

udy

Chan

ge e

very

14

days

, soo

ner i

f clo

udy

Chan

ge e

very

14

28 d

ays,

soon

er if

clou

dy

Chan

ge d

aily,

soon

er if

clo

udy

If co

ntai

ner (

bott

le) k

ept c

lose

d, u

seun

til e

mpt

y

If co

ntai

ner (

bott

le) k

ept c

lose

d, u

seun

til e

mpt

y

CHEM

ICAL

FO

R HI

GH

LEVE

L DI

SIN

FECT

ION

a .Al

l che

mic

al d

isinf

ecta

nts a

re h

eat a

nd li

ght s

ensiti

ve a

nd sh

ould

be

stor

ed a

way

from

dire

ct su

nlig

ht a

nd in

a c

ool p

lace

(<40

°C)

b .Co

rros

ive

with

pro

long

ed (>

20 m

inut

es) c

onta

ct a

t con

cent

ratio

n >0

.5%

if n

ot ri

nsed

imm

edia

tely

with

boi

led

wat

er.

c .Di

ffere

nt c

omm

erci

al p

repa

ratio

n of

glu

tera

ldeh

ydes

are

effe

ctive

at l

ower

tem

pera

ture

s (20

°C) a

nd fo

r lon

ger a

ctiva

ted

shel

f life

. Alw

ays c

heck

m

anuf

actu

rers

’ ins

truc

tions

.

Adap

ted

from

: Rut

ala

1996

CHEM

ICAL

S FO

R DI

SIN

FECT

ION

(alc

ohol

and

iodo

phor

s are

not

hig

hle

vel d

isin

fect

ants

)


APPE

NDI

X II

: LI

ST O

F DI

SIN

FECT

ANT

CURR

ENTL

Y IN

MO

H DR

UG

FO

RMU

LARY

Alco

hol 7

0% so

lutio

n

Chlo

rhex

idin

e Gl

ucon

ate

5% S

oluti

on

Chlo

rhex

idin

e Gl

ucon

ate

2% in

Alc

ohol

70%

solu

tion

Chlo

rhex

idin

e Gl

ucon

ate

4% S

crub

Chlo

rinat

ed L

ime

Pow

der

Use

as a

ntise

ptic

and

disin

fect

ant

i.Pr

eope

rativ

e sk

in

disin

fecti

onii.

Wou

nds o

r bur

nsiii

.Em

erge

ncy

disin

fecti

on

of in

stru

men

ts

Use

as d

isinf

ecta

nt in

cent

ral v

enou

s cat

hete

rsca

re b

undl

e

Surg

ical

han

dsc

rub/

disin

fecti

on, p

reo

psk

in p

repa

ratio

n

Antis

eptic

and

disi

nfec

tant

s

Appl

y to

the

skin

und

ilute

d or

whe

n ne

eded

i and

ii u

sed

in d

ilutio

n of

1:1

0 in

70%

alc

ohol

iii u

sed

in d

ilutio

n of

1:1

00

•Sk

in p

repa

ratio

n: U

se C

hlor

hexi

dine

Glu

cona

te 2

% in

Alc

ohol

70

% so

lutio

n an

d al

low

to d

ry•

Cath

eter

acc

ess:

app

ly to

cat

hete

r por

ts o

r hub

s prio

r to

acce

ssin

g th

e lin

e fo

r adm

inist

erin

g fl

uids

or i

njec

tions

•Su

rgic

al h

and

disin

fecti

on: A

pply

5m

l to

clea

n ha

nds a

nd

fore

arm

s for

1 m

in. R

inse

and

repe

at w

ith a

noth

er 5

ml f

or a

fu

rthe

r 2 m

ins a

nd th

en ri

nse

and

dry

•Ge

nera

l ski

n di

sinfe

ction

: App

ly a

ppro

pria

te q

uanti

ty to

wet

ar

ea a

nd sc

rub

for 1

min

. rin

se th

orou

ghly

& d

ry

Not

app

licab

le

DISI

NFE

CTAN

TIN

DICA

TIO

NHO

W T

O U

SE


Glut

aral

dehy

de S

oluti

on 2

%

Hydr

ogen

per

oxid

e 20

volu

me

solu

tion

Pera

cetic

aci

d an

dHy

drog

en p

erox

ide

Sodi

umDi

chlo

roiso

cyan

urat

e 2.

5g&

5g

tab

Succ

indi

alde

hyde

11%

&Di

met

hoxy

tetr

ahyd

rofu

ran

3% Sodi

um H

ypoc

hlor

iteSo

lutio

n

High

leve

l disi

nfec

tion

for

heat

sens

itive

equ

ipm

ents

such

as e

ndos

cope

s

Skin

disi

nfec

tion,

par

ticul

arly

clea

nsin

g an

d de

odor

izing

wou

nds a

nd u

lcer

s

High

leve

l disi

nfec

tant

or

ster

ilant

for h

eat l

abile

endo

scop

es

Low

and

med

ium

leve

ldi

sinfe

ctan

t

High

leve

l disi

nfec

tion

for

endo

scop

es, u

ltras

ound

prob

es, a

naes

thes

iaeq

uipm

ent,

etc

Low

leve

l disi

nfec

tant

and

antis

eptic

20 m

ins o

r mor

e im

mer

sion

is re

com

men

ded

for e

ndos

cope

sbe

fore

the

sess

ion

and

betw

een

patie

nts a

fter t

horo

ugh

clea

ning

bas

ed o

n m

anuf

actu

rer r

ecom

men

datio

n

•Fo

r cle

ansin

g w

ound

s: 1

.5%

to 6

% so

lutio

n, a

pply

23

tim

es

daily

or w

hen

nece

ssar

y•

Disin

fecti

ng c

lean

ed e

quip

men

t: Im

mer

sion

for 3

0 m

inut

es in

6%

solu

tion

Imm

erse

d tim

e ba

sed

on m

anuf

actu

rer r

ecom

men

datio

n

501

0,00

0 pp

m a

v ch

lorin

e

Imm

ersio

n tim

e is

base

d on

man

ufac

ture

rs r

ecom

men

datio

n

•An

tisep

tic: l

ess t

han

0.5%

•Di

sinfe

ctan

t: 5%

DISI

NFE

CTAN

TIN

DICA

TIO

NHO

W T

O U

SE


REFERENCES

1. A.R. Wikes 2010.Heat and moisture exchangers and breathing system filters: their use in anaesthesia and intensive care. Part 2 – practical use, including problems, and their use with paediatric patients

2. CDC Guidelines for Disinfection and Sterilization in Healthcare Facilities, 20083. Decontamination and Reprocessing of Medical Devices for Healthcare

Facilities; WHO 20164. European Gastroenterology & Endoscopy Nurses and Associate (ESGENA)

Guideline 20155. European Society of Gastrointestinal Endoscopy (ESGE) Guideline 20156. Guideline for Use of High Level Disinfectants & Sterilants for Reprocessing

Flexible Gastrointestinal Endoscopes, 20137. Lorente L1, Lecuona M, Málaga J, Revert C, Mora ML, Sierra A. Bacterial filters

in respiratory circuits: an unnecessary cost?8. Malaysian Standards of Sterilization Process by Malaysia Sterile Service

Association 9. Ministry of Health Drug Formulary 201710. MOH Guideline for Selection and Use of Disinfectants, 200711. Provincial Infectious Diseases Advisory Committee (PIDAC):Best Practices For

Cleaning, Disinfection And Sterilization of Medical Equipment/ Devices In All Health Care Settings, 3rd Edition, 2013

12. Standards of Practice for The Decontamination Of Surgical Instruments, Association Of Surgical Technologist (AST) 2009

13. The APSIC Guidelines for Disinfection and Sterilisation of Instruments In Health Care Facilities, 2017

14. WHO Infection Control Guidelines for Transmissible Spongiform Encephalopathies, Report of a WHO Consultation, 1999

15. World Gastroenterology Organisation (NGO) Guideline 2015

Documents

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