Policies & Procedures Document Title:

Disinfection Procedures Guidelines

Originating Entity :
Prevention and Control of Infection
Date Originated: 1-8-2020 Document No.: 13
Approved By: Chairman of Prevention Date Revised: : 1-9-2020
and Control of Infection Committee
Date of Approval: Rev. No.: 00
Approved By: Chairman of Steering Next Revision Date : 1-8-2022
Committee.
Date of Approval: Page 1 of 14

1. Purpose:
1. The purpose of this guideline is to ensure items are appropriately cleaned and disinfected
or sterilized between different patients and after each patient use.

2. Policy:
1. Disinfectants and sterilization items should not be purchased without the prior agreement
of the PCI .
2. The advice in certain parts of the equipment decontamination section of this policy
recommends that decontamination is by autoclaving. Whenever possible, this should be
carried out by the Central Sterile Services Department (CSSD).
3. Reusable medical devices or patient-care equipment that enters normally sterile tissue or
the vascular system or through which blood flows should be sterilized before each use.
4. Heat stable reusable medical devices that enter the blood stream or enter normally sterile
tissue should always be reprocessed using heat-based methods of sterilization (e.g., steam
autoclave or dry heat oven).
5. Items that are designed by manufacturer to be single-use devices shall not be reprocessed
or re-used and shall be properly discarded after a single use.
6. Laparoscopic or arthroscopic telescopes (optic portions of the endoscopic set) should be
subjected to a sterilization procedure before each use; if this is not feasible, they should
receive high-level disinfection. Heat stable accessories to the endoscopic set (e.g., trocars,
operative instruments) should be sterilized by heat-based methods (e.g., steam autoclave
or dry heat oven).
7. Reusable devices or items that touch mucous membranes should, at a minimum, receive
high-level disinfection between patients. These devices include reusable flexible
endoscopes, endotracheal tubes, anesthesia breathing circuits, and respiratory therapy
equipment.
8. Medical devices that require sterilization or disinfection must be thoroughly cleaned to
reduce organic material or bio burden before being exposed to the germicide, and the
germicide and the device manufacturer's instructions should be closely followed.
 Except on rare and special instances (as mentioned below), items that do not ordinarily
touch the patient or touch only intact skin are not involved in disease transmission, and
generally do not necessitate disinfection between uses on different patients. These items
include crutches, bed boards, blood pressure cuffs, and a variety of other medical
accessories. Consequently, depending on the particular piece of equipment or item,
washing with a detergent or using a low-level disinfectant may be sufficient when
decontamination is needed.
 If noncritical items are grossly soiled with blood or other body fluids, it should be
 Policies & Procedures Document Title:
Disinfection Procedures Guidelines
Originating Entity :
Prevention and Control of Infection
Date Originated: 1-8-2020 Document No.: 13
Approved By: Chairman of Prevention Date Revised: : 1-9-2020
and Control of Infection Committee
Date of Approval: Rev. No.: 00
Approved By: Chairman of Steering Next Revision Date : 1-8-2022
Committee.
Date of Approval: Page 2 of 14
cleaned and then chemically decontaminated as a blood spill (described below in
procedures of decontamination of spills).
 Exceptional circumstances that require noncritical items to be either dedicated to one
patient or patient cohort, or subjected to low-level disinfection between patient uses are
those involving:
Patients infected or colonized with drug-resistant microorganisms e.g. MRSA,
judged by the infection control program, based on current state, regional, or
national recommendations, to be of special or clinical or epidemiologic
significance.
Patients infected with highly virulent microorganisms, e.g., viruses causing
hemorrhagic fever (such as Ebola or Lassa).

9. Surgical scrubs are not suitable environmental detergents.

 Relevant departmental safety policies should be followed when handling disinfectants,
which may be caustic. Any spillage of splashes of disinfectants should be dealt with
promptly.
 After applying a surface disinfectant, the area should be wiped with a cloth. This is
unnecessary after the use of alcohol sprays or wipes.
 Blood and body fluids spills shall be cleaned and decontaminated following the
described procedures below

3. Scope of Policy:
This policy is applicable to all 48M.H Care Provider employee

4. Responsibilities:
All personnel are responsible in exercising professional judgment in complying with the
infection control guidelines.

5. Definitions:
1. CSSD. Central Sterile Services Department
2. MRSA . Methicillin-Resistant Staphylococcus Aureus
3. Sterilization. Complete removal or destruction of all forms of microbial life, including
bacteria, viruses, fungi and spores. Principal sterilizing agents are steam under pressure,
dry heat, ethylene oxide gas, hydrogen peroxide gas plasma and liquid chemicals.

Chemicals used to destroy all microbial life, including fungal and bacterial spores, are
called chemo sterilizers.
4. Disinfection. Removal or destruction of pathogenic microorganisms, with the exception
 Policies & Procedures Document Title:
Disinfection Procedures Guidelines
Originating Entity :
Prevention and Control of Infection
Date Originated: 1-8-2020 Document No.: 13
Approved By: Chairman of Prevention Date Revised: : 1-9-2020
and Control of Infection Committee
Date of Approval: Rev. No.: 00
Approved By: Chairman of Steering Next Revision Date : 1-8-2022
Committee.
Date of Approval: Page 3 of 14
of spores, on inanimate objects. Some disinfectants, such as peroxyacetic acid used in
sterilization of endoscope processors, will kill spores. This is an example of chemo
sterilizer.
5. Cleaning. The removal of all foreign material, such as soil and organic matter, from
surfaces. Cleaning is normally done using water, soap, detergent or vacuum. Cleaning
must precede disinfection or sterilization.
6. Decontamination. The removal of pathogenic microorganisms from objects so that
they are safe to handle.
7. Germicide. Anything that destroys microorganisms, particularly pathogenic organisms
(germs). Usually refers to chemicals that will destroy pathogens but not necessarily
spores. Germicides apply to compounds used on both living tissue and inanimate objects
while disinfectants are applied only to inanimate objects. Similar terms are bactericide,
fungicide, virucide, tuberculocide and sporicide.
8. Antiseptic. A chemical used externally or on the skin or in around wounds in order to
control surface microbial contamination that could cause infection.

6. Procedure:
6.1. TYPES OF CHEMICAL DISINFECTANTS AVAILABLE are shown in details in this
policy as Attachment A (AA IC).
6.2. SPILLAGE PROCEDURE – BLOOD AND BODY FLUIDS (Use of Spillage Kits):
6.2.1. The blood spill kit contains:
6.2.1.1. Disposable plastic apron
6.2.1.2. Disposable Cloth/C-fold paper towel.
6.2.1.3. Non-sterile latex gloves.
6.2.1.4. Shoes cover.
6.2.1.5. Plastic eye goggles.
6.2.1.6. Yellow plastic bags (for biohazards).
6.2.1.7. 2 sprayer bottles ( one for detergent and a second for diluted bleach ).
6.2.1.8. Detergent
6.2.1.9. A container of Concentrated Sodium hypochlorite (Clorox)
6.2.2. Wet floor sign will be placed at the spill area to keep it away from passer by
people.
6.2.3. Disposable gloves and plastic apron must be worn; goggles should be worn if
splashing is anticipated. Shoe cover will be worn with large spills.

6.2.4. Absorb the spill with paper towels, and discard into yellow plastic bag.
6.2.5. Spray area with detergent starting from periphery to inside.
6.2.6. Put fresh paper towels to absorb and discard in yellow plastic bag
 Policies & Procedures Document Title:
Disinfection Procedures Guidelines
Originating Entity :
Prevention and Control of Infection
Date Originated: 1-8-2020 Document No.: 13
Approved By: Chairman of Prevention Date Revised: : 1-9-2020
and Control of Infection Committee
Date of Approval: Rev. No.: 00
Approved By: Chairman of Steering Next Revision Date : 1-8-2022
Committee.
Date of Approval: Page 4 of 14
6.2.7. Freshly prepare 1:10 dilution of Clorox using 1 volume of concentrated Clorox with 9
volumes of water aiming to obtain 10,000 ppm of free chlorine and fill 2 nd sprayer with
the diluted bleach.
6.2.8. Spread fresh paper towels over the spill area
6.2.9. Spray the spill area starting from periphery to inside over the paper towels.
6.2.10.Leave chlorine to act for (15 - 20 minutes).
6.2.11.Collect all paper towels from outside to inside and discard in yellow bag.
6.2.12.Rinse with water and dry.
6.2.13.Remove protective equipment and discard in yellow plastic bag
6.2.14.Wash hands with antimicrobial soap and warm water.
6.2.15.Write an incident report to be kept in department records.

7. Forms Required:
None

8. References:
 CDC Guideline for Handwashing and Environmental Control, 1985
 Guideline – Cleaning, Disinfection and Sterilizatio, Alfred Hospital, 2005
 Guidelines for Environmental Infection Control in Health-Care Facilities,
Recommendations of CDC and the Healthcare Infection Control Practices Advisory
Committee (HICPAC), MMWR June 6, 2003 / 52(RR10);1-42
 Andreas F.& Reno Feri. Decontamination ,Sterilization & Disinfection. In: Manual of
Clinical Microbiology, 1999; chapter 8:138-164. American Society for Microbiology.
Washington, DC.
 Rutala WA. APIC guideline for selection and use of disinfectants. Am J Infect Control
1996;24:313-342.
 Policies & Procedures Document Title:
Disinfection Procedures Guidelines
Originating Entity :
Prevention and Control of Infection
Date Originated: 1-8-2020 Document No.: 13
Approved By: Chairman of Prevention Date Revised: : 1-9-2020
and Control of Infection Committee
Date of Approval: Rev. No.: 00
Approved By: Chairman of Steering Next Revision Date : 1-8-2022
Committee.
Date of Approval: Page 5 of 14

ATTACHMENT A (AA IC)

GUIDELINES FOR SELECTION AND USE OF DISINFECTANTS AND STERILIZING

AGENTS

1.0. INTRODUCTION
The need for appropriate disinfection and sterilization of patient care items and the hospital
environment is well established. Not everything in the hospital can or should be sterile. It is
the item's intended use, together with cost and other factors, that determines whether
cleaning, disinfection or sterilization is indicated.

2.0. DEFINITIONS
For the purposes of these guidelines, the following definitions will be used:
2.1. Sterilization. Complete removal or destruction of all forms of microbial life,
including bacteria, viruses, fungi and spores. Principal sterilizing agents are steam
under pressure, dry heat, ethylene oxide gas, hydrogen peroxide gas plasma and liquid
chemicals.
2.2. Chemicals used to destroy all microbial life, including fungal and bacterial spores,
are called chemo sterilizers.
NOTE: Sterilization is an absolute term; something cannot be 'semi-sterile' or
'partially sterile' - it is either sterile or non-sterile.
2.3. Disinfection. Removal or destruction of pathogenic microorganisms, with the
exception of spores, on inanimate objects. Some disinfectants, such as peroxyacetic
acid used in sterilization of endoscope processors, will kill spores. This is an example
of chemo sterilizer.
2.4. Cleaning. The removal of all foreign material, such as soil and organic matter,
from surfaces. Cleaning is normally done using water, soap, detergent or vacuum.
Cleaning must precede disinfection or sterilization.
2.5. Decontamination. The removal of pathogenic microorganisms from objects so
that they are safe to handle.
2.6. Germicide. Anything that destroys microorganisms, particularly pathogenic
organisms (germs). Usually refers to chemicals that will destroy pathogens but not
necessarily spores. Germicides apply to compounds used on both living tissue and
inanimate objects while disinfectants are applied only to inanimate objects. Similar
terms are bactericide, fungicide, virucide, tuberculocide and sporicide.

2.7. Antiseptic. A chemical used externally or on the skin or in around wounds in

 Policies & Procedures Document Title:
Disinfection Procedures Guidelines
Originating Entity :
Prevention and Control of Infection
Date Originated: 1-8-2020 Document No.: 13
Approved By: Chairman of Prevention Date Revised: : 1-9-2020
and Control of Infection Committee
Date of Approval: Rev. No.: 00
Approved By: Chairman of Steering Next Revision Date : 1-8-2022
Committee.
Date of Approval: Page 6 of 14
order to control surface microbial contamination that could cause infection.

3.0. IMPORTANCE OF CLEANING

Organic matter in the form of serum, blood, pus or fecal material, can react with germicides
to produce a weaker disinfecting solution. Chlorine and iodine are particularly affected in this
way. Organic material may also protect microorganisms by acting as a physical barrier. For
these reasons, meticulous cleaning of medical devices and surfaces is critical before any
sterilization or disinfection procedure.

4.0. A PRACTICAL APPROACH TO DISINFECTION AND STERILIZATION

4.1. A well accepted classification scheme divides instruments and patient care items into
three categories based on the degree of risk of infection involved in the use of these
items. The three categories are critical, semi-critical and non-critical.
4.1.1. Critical Items. Critical items have a high degree of risk of infection if an
item is contaminated with any microorganism, including bacterial spores.
Objects which enter sterile tissue or the vascular system must, therefore, be
sterile. Most of the items in this category are either purchased sterile or are
sterilized by autoclaving if possible. Heat sensitive objects can be treated with
ethylene oxide, hydrogen peroxide gas plasma or chemo sterilizers. Included in
this category are surgical instruments, cardiac and urinary catheters, implants
and needles.

4.1.2. Semi-Critical Items. These will come into contact with mucous
membranes or with skin that is not intact. They must be free of all
microorganisms except bacterial spores. Intact mucous membranes are
generally resistant to infection by common bacterial spores but are susceptible
to tubercle bacilli and viruses. Respiratory therapy and anesthesia equipment,
gastro-intestinal endoscopes, vaginal specula, cystoscopes, urinary catheters
and thermometers are in this category. Semi-critical items require high-level
disinfection using wet pasteurization or chemical germicides. These items
should be rinsed with sterile water after disinfection.

4.1.3. Non-Critical Items. These items come into contact with intact skin but not
mucous membranes. Intact skin acts as an effective barrier to most organisms
and sterility is not critical. Bedpans, blood pressure cuffs, crutches, bed rails,
linen, some food utensils, bedside tables and patient furniture are examples of
non-critical items. Depending on the particular item and the nature and degree
of contamination during use, simple washing or scrubbing with a detergent and
 Policies & Procedures Document Title:
Disinfection Procedures Guidelines
Originating Entity :
Prevention and Control of Infection
Date Originated: 1-8-2020 Document No.: 13
Approved By: Chairman of Prevention Date Revised: : 1-9-2020
and Control of Infection Committee
Date of Approval: Rev. No.: 00
Approved By: Chairman of Steering Next Revision Date : 1-8-2022
Committee.
Date of Approval: Page 7 of 14
warm water may be sufficient. In some instances, however, the added assurance
of chemical disinfection with an intermediate to low level chemical germicide
may be considered appropriate.
4.2. Levels of Disinfectant Activity. The proposed levels of activity (high, intermediate and
low) are based on the fact that microorganisms can be categorized into several groups
according to their innate resistance levels to a spectrum of physical or chemical
germicidal agents.
4.2.1.High Level Disinfection is the minimum treatment for critical or semi-critical
instruments. An essential property of a high level disinfectant is a demonstrated
level of activity against bacterial endospores). If the contact time is long
enough, this type of germicide can be used as a sterilant.
4.2.2.Intermediate Level Disinfection does not necessarily kill bacterial spores, but
inactivates M. tuberculosis. It is also effective against fungi as well as lipid and
non-lipid medium sized and small viruses.
4.2.3.Low Level Disinfection rapidly kills most vegetative forms of bacteria and most
fungi as well as medium sized or lipid-containing viruses. Examples of low-
level disinfectants are quaternary ammonium compounds and certain iodophors
or phenolics.
5.0. PROPERTIES AND USES OF COMMONLY USED DISINFECTANTS :
5.1. Alcohol:
5.1.1.Effective against vegetative forms of bacteria; is tuberculocidal, fungicidal and
virucidal but does not destroy bacterial spores.
5.1.2.Not recommended for sterilizing medical and surgical materials due to lack of
sporicidal action and inability to penetrate protein-rich materials.
5.1.3.Fast acting, no residue.
5.1.4.Evaporates quickly; no residual action.
5.1.5.Requires wet contact of thirty minutes to achieve an intermediate level of
disinfection.
5.1.6.May dry and irritate skin; non-staining.
5.1.7.Inactivated by organic matter.
5.1.8.Damages shellac mountings of lensed instruments; swells and hardens rubber
and some plastic tubing after repeated use.
5.1.9.Damages tonometer tips.
5.1.10.Flammable, must be stored in a cool, well-ventilated area.
5.1.11.Uses:
5.1.11.1. Disinfect oral and rectal thermometers.
5.1.11.2. Disinfect external surfaces of stethoscopes, ventilators and
medication preparation areas, rubber stoppers of multiple dose
 Policies & Procedures Document Title:
Disinfection Procedures Guidelines
Originating Entity :
Prevention and Control of Infection
Date Originated: 1-8-2020 Document No.: 13
Approved By: Chairman of Prevention Date Revised: : 1-9-2020
and Control of Infection Committee
Date of Approval: Rev. No.: 00
Approved By: Chairman of Steering Next Revision Date : 1-8-2022
Committee.
Date of Approval: Page 8 of 14
medication vials.
5.1.11.3. Alcohol towelettes used to disinfect small surfaces such as rubber
stoppers of multi dose medication vials.
5.1.12. Precautions: Alcohol should be stored in a cool place. Alcohol-alcohol
mixtures are flammable. Do not allow contact with hot surfaces, flames,
electrical equipment or other sources of ignition. If an alcohol preparation is
used to disinfect pre-operative skin, caution must be exercised whilst using
diathermy as it may ignite, causing skin burns if incorrectly used. Therefore
all spirit-based skin cleaning and preparation fluids must have a cautionary
statement, e.g. 'This preparation contains spirit. When use is to be followed by
surgical diathermy, do not allow pooling of the fluid to occur and ensure
that the skin and surrounding areas are dry.
Do not leave bottles uncapped s alcohol vapors irritate mucous membranes,
especially in an enclosed spaced. It may cause eye and skin irritation if used in a
large quantity in an enclosed space, therefore its use should be avoided in a poorly
ventilated area. If inhaled in large quantities, it may cause headache and
drowsiness.

5.2. Chlorine-based disinfectants (Tablets or as Household Bleach contains 5.25%

Sodium Hypochlorite):
5.2.1. Extremely active as free chlorine; unstable.
5.2.2. Bactericidal, veridical, tuberculocidal, but NOT sporicidal.
5.2.3. Very effective against HIV and HBV.
5.2.4. Inactivated by organic matter.
5.2.5. Corrosive to metals; may damage some plastic.
5.2.6. Uses:
5.2.6.1. Disinfecting tonometer heads.
5.2.6.2. A 1:10 dilution of 5.25% sodium hypochlorite, i.e. household
bleach, (one part Clorox to nine parts water) is recommended for
cleaning blood spills other dilutions may be used for disinfection of
counter-tops, work surfaces and . Because hypochlorite and other
germicides are substantially inactivated in the presence of blood, the
surface should be cleaned before a disinfectant is used.
5.2.6.3. A 1:100 dilution used for 10 minutes is recommended for
decontamination of CPR training manikins.
 Policies & Procedures Document Title:
Disinfection Procedures Guidelines
Originating Entity :
Prevention and Control of Infection
Date Originated: 1-8-2020 Document No.: 13
Approved By: Chairman of Prevention Date Revised: : 1-9-2020
and Control of Infection Committee
Date of Approval: Rev. No.: 00
Approved By: Chairman of Steering Next Revision Date : 1-8-2022
Committee.
Date of Approval: Page 9 of 14

USES OF HYPOCHLORITE AND STRENGTHS OF SOLUTION

Users Dilutions Available Chlorine
(%) (ppm)
Blood spills 1:10 1.0 10,000
Laboratory discard jars 1:40 0.25 2,500
Genera environmental 1:100 0.1 1,000
disinfection
Disinfection of clean instruments 1:200 0.05 500
Infant feeding, utensils, catering 1:800 0.0125 125
surfaces and equipment

5.2.7. Precautions: Chlorinated disinfectants can cause irritation of the skin, eyes and
lungs if used frequently in a poorly ventilated area. They should not be used in
the presence of formaldehyde as some of the reaction products are
carcinogenic. Appropriate protective equipment must be worn when
hypochlorite is handled, whether in liquid or hypochlorite is handled, whether
in liquid or powdered/granulated form. Skin and eyes should be protected when
using undiluted hypochlorite solutions. Sodium hypochlorite should not be
mixed with ammonia or acid or acidic body fluids (e.g. Urine) as toxic chlorine
gas will be released.

5.3. Iodine and iodophors (Povidone-Iodine):

5.3.1. Rapid action.
5.3.2. Non-staining, non-toxic, non-irritating.
5.3.3. Good detergent action.
5.3.4. Bactericidal, virucidal and tuberculocidal, NOT sporicidal.
5.3.5. Inactivated by organic matter.
5.3.6. Uses:
5.3.6.1. Antiseptic and disinfectant.
5.3.6.2. Cleaning of hydrotherapy tanks and thermometers.
5.3.7. Precautions: Use gloves for prolonged handling of iodine/iodophors
preparation. An alcoholic iodhopor is less irritant than an alcohol/iodine
mixture. Tincture of iodine and aqueous iodine solutions can cause skin
reactions in some individuals; therefore iodophor solution is usually preferred.
 Policies & Procedures Document Title:
Disinfection Procedures Guidelines
Originating Entity :
Prevention and Control of Infection
Date Originated: 1-8-2020 Document No.: 13
Approved By: Chairman of Prevention Date Revised: : 1-9-2020
and Control of Infection Committee
Date of Approval: Rev. No.: 00
Approved By: Chairman of Steering Next Revision Date : 1-8-2022
Committee.
Date of Approval: Page 10 of 14

5.4. Ortho-Phthaldehyde (Cidex OPA).

5.4.1.High-level disinfection in twelve minutes at 20°C or above and hemosterilant in
32 hours.
5.4.2.Stable during storage at 15-30°C
5.4.3.Bactericidal, sporicidal, virucidal, tuberculocidal and fungicidal.
5.4.4.Effective in the presence of 5% organic soil.
5.4.5.Effective for up to 14 days during use and has a 30 day open bottle shelf life.
5.4.6.Requires no activation or mixing.
5.4.7.Has no offensive odor.
5.4.8.Compatible with a wide range of endoscopes and other medical devices.
5.4.9.Easily rinses from equipment, including lumened devices. Can be used for
automated reprocessing.
5.4.10.Uses – high-level disinfectant for items that cannot be sterilized by heat,
ethylene oxide or by plasma sterilizers.
5.4.11.Has a very low vapor pressure. Solution should be used in a well-ventilated
area and in closed containers with tight fitting lids. If adequate ventilation is
not provided by the existing air conditioning system, use of local exhaust hoods
or ductless fume hoods/portable ventilation devices that contain filter media
that absorb othophthaldehyde from the air is recommended. However, unlike
glutaraldehyde, does not need special ventilation requirements for areas where
adequate ventilation is provided.
5.4.12.Sterile water rinses necessary for equipment used in normally sterile areas of
the body. Literature states that high quality potable water can be used for
other devices but there is risk of recolonization due to bacteria in the water. A
final rinse with 70% isopropyl alcohol is necessary to speed the drying process
and to avoid recolonization.
5.4.13.Requires solution test strips to be used throughout its 14 day shelf life to
determine whether ortho-phthaldehyde concentration remains sufficiently high,
i.e., 0.3 % minimum effective concentration (MEC).
5.4.14.Must be discarded after 14 days even if test indicates an MEC above 0.3%.
5.4.15.Can be discarded down hospital drains in accordance with local regulations.
5.4.16.During usage, a thermometer and timer must be used to ensure that optimum
conditions are met.
5.4.17.Requires visual inspection of the solution throughout its shelf life for the
presence of precipitates that may result from the use of hard water. Discard
solutions if precipitation occurs.
5.4.18.Operators must wear appropriate personal protective equipment (gloves of
 Policies & Procedures Document Title:
Disinfection Procedures Guidelines
Originating Entity :
Prevention and Control of Infection
Date Originated: 1-8-2020 Document No.: 13
Approved By: Chairman of Prevention Date Revised: : 1-9-2020
and Control of Infection Committee
Date of Approval: Rev. No.: 00
Approved By: Chairman of Steering Next Revision Date : 1-8-2022
Committee.
Date of Approval: Page 11 of 14
appropriate type and length, eye protection and fluid resistant gowns).
When using latex gloves the user should double glove and/or change single
gloves frequently, e.g., following twelve minutes of exposure. Where users are
sensitive to latex gloves or components in latex gloves, 100% synthetic
copolymer gloves, nitrile gloves or butyl rubber gloves may be used. Contact
with Cidex OPA solution may stain exposed skin or clothing.

5.5. Phenolics :
5.5.1. Bactericidal, virucidal, fungicidal and tuberculocidal but NOT sporicidal.
5.5.2. Can cause skin irritation since phenolics are absorbed by porous materials.
5.5.3. Uses:
5.5.3.1. Decontamination of the hospital environment, including
laboratory surfaces, and for non-critical medical and surgical items.
5.5.3.2. Not recommended for semi-critical items due to lack of efficacy
data and because of tissue irritation even when thoroughly rinsed.
5.5.3.3. Not recommended for use in nurseries to clean infant bassinettes
and incubators because of the occurrence of hyperbilirubinemia in
infants.
5.5.4.Precautions: Respiratory irritation may occur if used at concentrations above
those listed in the disinfection policy. Appropriate protective clothing must be
worn when handling phenolic disinfectants. Skin and eyes must be protected
while 'making up' or discarding a phenolic solution. Phenolic disinfectants can
be absorbed through the skin, therefore skin must be protected during its use.
Use latex gloves for intermittent use; medium weight washing up gloves are
appropriate for more prolonged contract.

5.6. Quaternary Ammonium Compounds :

5.6.1. Good cleaning agents
5.6.2. Inactivated by organic materials (cotton, gauze pads, cork).
5.6.3. Not to be used as antiseptics.
5.6.4. Uses - Recommended for non-critical surfaces such as floors, walls and
furniture, and for disinfecting infant isolates and bassinettes.
5.6.5. Should not be used in operating theaters because of the danger that they
will permit growth of Pseudomonas spp.
5.6.6. Precautions: QAC inhibit the growth of bacteria (bacteriostatic) but do not
kill them. Gram-negative bacilli (e.g. Pseudomonas spp.) may cause
contamination and grow in diluted solution. Therefore, any unused solutions
should be discarded immediately after use. Decanting form one container and
 Policies & Procedures Document Title:
Disinfection Procedures Guidelines
Originating Entity :
Prevention and Control of Infection
Date Originated: 1-8-2020 Document No.: 13
Approved By: Chairman of Prevention Date Revised: : 1-9-2020
and Control of Infection Committee
Date of Approval: Rev. No.: 00
Approved By: Chairman of Steering Next Revision Date : 1-8-2022
Committee.
Date of Approval: Page 12 of 14
topping -up should be avoided. This can result in contamination and promote
growth of Gram-negative bacilli which may then colonize the wound. The
correct strength of solution should be obtained from the pharmacy. Single-use
sachets should be used, if possible. Liquid should be stored in closed bottles
until immediately before use. Benzalkonium chloride is one of the leading
allergens amongst health care personnel.

5.7. Aldehydes
5.7.1. Glutaraldehyde
5.7.1.1. Most preparations of glutaraldehyde are non-corrosive to metals and
other materials and inactivation by organic matter is very low. Alkaline
solutions require activation; once activated they remain active for 2-4
weeks depending on the brand or preparation used and the frequency of
use. Acidic solutions are stable and do not require activation, but
slower in activity than alkaline buffered solutions.
5.7.1.2. Uses: 2% glutaraldehyde is used to disinfect heat-sensitive items such
as endoscopes.
5.7.1.3. Precautions: Glutaraldehyde may be irritant to the eyes and nasal
pathway and may cause respiratory illness (asthma) and allergic
dermatitis. Glutaraldehyde should not be used in an area with little or
no ventilation, as exposure is likely to be at or above the current
Occupational Exposure Standards (OES: 0.2ppm/0.7mgm¯3, 10 min
only). Eye protection, a plastic apron and gloves must be worn when
glutaraldehyde liquid is made up, disposed of, or when immersing
instruments. Latex gloves may be worn and discarded after use if the
duration of contact with glutaraldehyde is brief, i.e. Less than 5 min.
For longer duration, nitrile gloves must be worn. It should be stored
away from heat sources and in containers with close-fitting lids.
5.7.2. Formaldehyde (Formalin):
5.7.2.1. Bactericidal, tuberculocidal, virucidal, fungicidal and sporicidal.
5.7.2.2. Carcinogenic; exposure should be minimal.
5.7.2.3. Uses - Should be limited to preserving anatomical specimens
disinfecting dialysis systems.
5.7.2.4. Precautions: Formaldehyde is a potent eye and nasal irritant and may
cause respiratory distress and allergic dermatitis. Gloves, goggles, and
aprons should be worn when preparing and disposing of formaldehyde
solutions. Monitoring may be required if formalin is used regularly as
disinfectant.
 Policies & Procedures Document Title:
Disinfection Procedures Guidelines
Originating Entity :
Prevention and Control of Infection
Date Originated: 1-8-2020 Document No.: 13
Approved By: Chairman of Prevention Date Revised: : 1-9-2020
and Control of Infection Committee
Date of Approval: Rev. No.: 00
Approved By: Chairman of Steering Next Revision Date : 1-8-2022
Committee.
Date of Approval: Page 13 of 14

5.8. Peroxyacetic (Per acetic Acid) :

5.8.1. Sterilizes fully immersible instruments such as lenses flexible and rigid
endoscopes and surgical instruments.
5.8.2. Sterilization cycle - rapid (twenty minutes).
5.8.3. Disadvantage - use for immersible instruments only.

5.9. Hydrogen Peroxide Gas Plasma :

5.9.1.Sterilizes metal and non-metal as well as heat- and moisture-sensitive
instruments.
5.9.2.Sterilizes rigid scopes.
5.9.3.Not approved for flexible endoscopes.
5.9.4.Hydrogen peroxide vapor cannot enter deeply into small lumens.
5.9.5.Packaging material is limited to special wraps, e.g. Tyvek.
5.9.6.Instruments must be thoroughly cleaned.
5.9.7.Precautions: A chemical irritation resembling pseudo membranous colitis has
been reported in a gastrointestinal endoscopy unit with use f 3% hydrogen
peroxide. As with other chemical sterilants, dilution of hydrogen peroxide must
be monitored by regularly testing the minimum effective concentration (i.e. 7.5-
6.0%) Hydrogen peroxide has not been widely used for endoscope disinfection
because of concerns that its oxidizing properties may be harmful to some
components of the endoscope. Manufacturer's approval should be obtained
before using on equipment where corrosion may present problems, such as
endoscopes or centrifuges.

5.10. Chlorohexidine
5.10.1. Chlorohexidine is inactivated by soap, organic matter and anionic
detergents. It also stains fabrics brown in the presence of chlorine-based
disinfectants.
5.10.2. Uses: Used exclusively as an antiseptic where contact with skin and
mucous membranes is involved. Chlorohexidine solutions are usually combined
with detergent which is used for hand disinfection or with alcohol which is
useful if rapid disinfection is required for physically clean hands. It is combined
with alcohol for pre-operative skin disinfection and with other antiseptics for
cleaning dirty wounds.
5.10.3. Precautions: Chlorohexidine is relatively non-toxic. It must not be allowed
to come into contact with the brain, meninges, eye or middle ear.
 Policies & Procedures Document Title:
Disinfection Procedures Guidelines
Originating Entity :
Prevention and Control of Infection
Date Originated: 1-8-2020 Document No.: 13
Approved By: Chairman of Prevention Date Revised: : 1-9-2020
and Control of Infection Committee
Date of Approval: Rev. No.: 00
Approved By: Chairman of Steering Next Revision Date : 1-8-2022
Committee.
Date of Approval: Page 14 of 14
5.11. Hexachlorophene
5.11.1.Hexachlorophene is a chlorinated bisphenol and one of the most useful of the
phenol derivatives. Unlike most phenolic compounds, hexachlorophene has no
irritating odour and has a high residual action. Hexachlorophene is not fast
acting and its rate of killing is classified as slow to intermediate. The major
advantage of hexachlorophene is its persistence. Soaps and other organic
materials have little effect. Hexachlorophene is more effective against Gram-
positive than against Gram-negative bacilli.
5.11.2.Uses: Hexachlorophene (0.33%) powder has good residual effect on the skin
and can be used as an anti-staphylococcal agent. Use of hexachlorophane on
broken skin or mucous membranes or for routine total body bathing is
contraindicated. Hexachlorophane should not be applied on neonates because
it can cause neurological damage.

5.12. Triclosan
5.12.1. Triclosan phenol or Irgasan is a diphenyl ether. It can be absorbed through
intact skin but appears to be non-allergenic and non-mutagenic with short term
use. Its speed of killing is intermediate but it has excellent persistent activity on
skin. Its activity is only minimally affected by organic matter. It is commonly
used in deodorant soaps and health care hand washes. It has a similar range of
antimicrobial activity as hexachlorophene but exhibits no documented toxicity
in neonates.
6.0. RECOMMENDATIONS
6.1. Processing Patient Care Equipment Contaminated with HIV or HBV:
6.1.1. The question is often raised as to the need for sterilization or high-level
disinfection of instruments or devices contaminated with blood or body fluids
from patients infected with Human Immunodeficiency Virus (HIV), Hepatitis B
Virus (HBV) or with respiratory secretions from a patient with pulmonary
tuberculosis (TB). HIV, HBV, and TB organisms are inactivated by
commonly used chemical germicides.
6.1.2. Current CDC recommendations remain valid; standard sterilization and
disinfection procedures for patient care equipment, as recommended in these
guidelines, is adequate.