Groups of disinfectants. Means of chemical disinfection in medical institutions

16.10.2020 -

Fungus

abstract

"modern disinfectants »

1st year student

Group 131

specialties: Medicine

Fedin A.D.

teacher

Panasenkova T.S.

Introduction

Classification of disinfectants

Modern range of disinfectants

Production control

experimental part

List of sources used

Introduction

Disinfection (fr. des - from, and late lat. infectio - infection) - these are measures aimed at the complete destruction of vegetative and dormant forms of pathogenic and opportunistic microorganisms on environmental objects (including medical products) in order to prevent transmission pathogen from an infected organism to a healthy organism (breaking the epidemic chain).

Disinfection methods:

1) physical - boiling, treatment with hot air, steam under pressure, sonication;

2) chemical - the use of chemicals for the purpose of processing pathological material, utensils, tools, equipment.

Types of disinfection:

1) focal;

2) preventive.

Preventive disinfection is carried out if the source of infection is not identified, but its occurrence is possible. It is carried out in places of a likely source of infection: in medical institutions, at communal facilities (in swimming pools, baths, hairdressers), in transport, in children's institutions, etc.

Focal disinfection is carried out in the presence of a patient (source of infection) in the focus of an infectious disease.

There are two types of focal disinfection: current and final.

Current is called disinfection, which is carried out repeatedly in the focus during the entire time the source of infection stays in it.

The final disinfection is carried out in the outbreak after the source of infection has been removed (hospitalization, departure, recovery, death) once.

The actual chemical method of disinfection consists in the use of chemicals that have a detrimental effect on pathogens of infectious diseases. To date, a person uses a huge variety of chemical compounds as disinfectants, but does not stop there. The search for new chemical disinfectants is carried out in two main directions:

1) search for fundamentally new substances;

2) search for new biocidal mixtures.

Since chemical science has made great strides over the past century and it is not necessary to expect the emergence of new biocides, all scientific enthusiasm boils down to the search for new mixtures of known disinfectants.

Why is so much attention paid to the chemical method of disinfection, the search for new preparations for disinfection, why is disinfection so important in general? To answer these questions, we must first determine the significance of disinfection in the modern world. Firstly, disinfection is vital for institutions where there is a high risk of spreading infection, i.e., primarily for healthcare institutions. Currently, despite the expansion of the range of disinfectants, the problem of nosocomial infections is still acute. Why are nosocomial infections such a significant problem? Hospital patients are particularly susceptible to infectious diseases due to the weakening of the body as a result of a general illness, trauma or surgery, as well as due to reduced body resistance in children and the elderly. Increasing numbers of antibiotic-resistant bacteria, crowding of debilitated patients in a relatively small area, and difficulty in cleaning and cleaning modern complex equipment are also factors that contribute to the development and spread of infection in hospitals. In addition, according to epidemiological studies, 5% of all hospitalized patients develop infectious diseases. The risk of hospital-acquired infections increases dramatically as a result, unless proper measures are taken to prevent their spread. And the development of a nosocomial infection leads to additional costs for effective antibiotics and other therapeutic drugs, to additional costs for the bed fund, to additional suffering for patients from deterioration, the development of postoperative suppuration and, as a result, to a decrease in the effectiveness of treatment. Second, regular disinfection can greatly reduce the risk of epidemics. But lately the whole world has been shaken by epidemics of previously unknown infections, causing people to have a state close to panic, and forcing them to run to the pharmacy. Lined up for medicines, they, without suspecting it, contribute to the spread of infection, creating a vicious circle. Meanwhile, in the face of an epidemic threat, one should just try to avoid crowds of people. And in those places where they are inevitable, regularly carry out preventive measures. The most effective of these is disinfection. Thirdly, regular disinfection and ventilation of premises can significantly reduce the incidence among employees of the enterprise. This, in turn, will ensure that the workforce is maintained at a high level. Ultimately, the cost of these activities will be guaranteed to be lower than compensation for involuntary absence of employees and lost work. Fourth, regular disinfection is necessary to meet the requirements of sanitary legislation. For pharmacy organizations, this is primarily the Order of the Ministry of Health of the Russian Federation No. 309 “On approval of instructions for the sanitary regime of pharmacy organizations (pharmacies)”. Also, Article 11 of the Federal Law of March 30, 1999 No. 52-FZ "On the sanitary and epidemiological well-being of the population" establishes the obligations of legal entities and individual entrepreneurs to comply with the requirements of sanitary legislation. In particular, they are obliged to exercise production control, including through laboratory research and testing, over compliance with sanitary rules and the implementation of sanitary and anti-epidemic (preventive) measures in the performance of work and the provision of services, as well as in the production, transportation, storage and sale of products. . In pursuance of this requirement, the Decree of the Chief State Sanitary Doctor No. 18 of 13.07.2001 approved SP 1.1.1058-01 "Organization and implementation of production control over compliance with sanitary rules and the implementation of sanitary and anti-epidemic (preventive) measures." Clause 4.1 of this regulatory document states that when carrying out pharmaceutical activities and activities related to the provision of medical care to the population, in order to prevent infectious diseases, including nosocomial diseases, control over compliance with sanitary and anti-epidemic requirements, disinfection and sterilization measures in in accordance with the regulations issued by the Ministry of Health of the Russian Federation, state and industry standards, sanitary rules and hygiene standards.

From the foregoing, it follows that disinfection measures can significantly reduce the risk of infectious diseases, the damage from eliminating their consequences, that they are necessary for the proper organization of the work of an enterprise, including a pharmacy. Moreover, the most accessible, simplest and most versatile is the chemical method of disinfection. Physical disinfection methods, such as the use of high temperature, steam under pressure, boiling, UV radiation, ultrasound, require special equipment, specially trained personnel, spend a lot of time, are often unsafe for human health and must be carried out in their absence. Modern disinfectants used for the chemical disinfection method are safe for humans, do not damage the treated surfaces, have a pleasant smell and a washing effect. And this means that their use can be carried out in the "background" and allows you to combine cleaning with disinfection. Of course, it must be taken into account that infectious agents are able to change, increasing their resistance, so manufacturers are constantly developing new disinfectants.

Classification of disinfectants

Disinfectants of domestic and foreign production from the following main chemical groups are allowed for disinfection of products: chlorine-containing, agents based on active oxygen, based on alcohols, aldehydes, cationic surfactants (QAS). In addition, agents based on guanidines and tertiary amines have recently appeared.

They have long been used for disinfection and in the recent past were used everywhere for almost all objects of disinfection. They have a broad spectrum of antimicrobial activity, are inexpensive, have a relatively low exposure, and are compatible with soaps. However, high corrosive activity allows them to be used only for corrosion-resistant surfaces and products. In addition, chlorine-containing preparations cause discoloration and damage to tissues, have an irritating effect on the mucous membranes of the respiratory and vision organs. When working with solutions of high concentration, the use of protective equipment is required. In case of improper disposal, preparations from this group have an adverse effect on the environment and do not meet modern environmental safety requirements.

2. Disinfectants based on active oxygen.

Preparations based on hydrogen peroxide, peroxide compounds, over acids - the safest for the environment, decompose into oxygen and water. A wide spectrum of action allows the use of some drugs from this group for not only disinfection, but also for sterilization. Means are low toxic, without a specific smell, can be used in the presence of people, so they are used in obstetric hospitals, neonatal departments for the treatment of incubators. New preparations from this group are also used for the previous sterilization cleaning, since components with detergent properties have been added to the formulation. Available in the form of powder, granules, which simplifies the application, storage and transportation.

3. Disinfectants based on cationic surfactants.

Quaternary ammonium compounds are currently the most widely used. They have detergent properties and are used for sterilization cleaning of medical devices, including those combined with disinfection. When using HOUR for current and general cleaning, surfaces are washed and disinfected at the same time. Means from this group do not damage tools and equipment, are low toxic, do not irritate, do not have strong odors, therefore they are used for disinfection in places where staff and patients are constantly present. The disadvantages include the possibility of the emergence of resistant strains of microorganisms.

4. Disinfectants based on tertiary amines (amphotensides).

A completely new type of disinfectants, interest in which is due to their high microbiological activity - they are active against bacteria (including mycobacteria), fungi and viruses, have low toxicity and good detergent properties. A feature of tertiary alkylamines is that they combine the properties of surfactants and, under certain conditions, the properties of quaternary ammonium salts. And due to the presence of free amino groups and the tertiary nitrogen atom, they form an alkaline environment, which helps to increase their antimicrobial activity, especially in combination with other substances.

5. Disinfectants based on alcohols. Alcohol-based products based on ethanol, propanol and isopropanol are mainly used as skin antiseptics. For disinfection of the skin, 70% alcohol is used, since 96% denatures proteins. In addition, it is used in combination with QAC, aldehydes in the form of aerosols for the treatment of small hard-to-reach surfaces, leaving no residue. All alcohols have a broad antimicrobial spectrum (except spores), evaporate quickly, and leave no traces when evaporating. Means containing alcohols fix organic contaminants, therefore, preliminary purification from blood, mucus, pus is necessary, or a combination with components that have detergent properties. Ethyl alcohol is recommended to disinfect metal products. Based on alcohols, preparations have been developed for the disinfection of some dental instruments. The disadvantages include fire and explosion hazard.

6. Disinfectants based on aldehydes.

Aldehyde-containing products based on glutaric, succinic, orthophthalaldehyde have a number of advantages: they act on all types of microorganisms, including spores, do not damage processed products, which makes it possible to use them for disinfection of equipment of complex configuration. Aldehyde-containing drugs are the drugs of choice in the processing of endoscopic equipment: high-level disinfection, sterilization of flexible endoscopes and instruments for them. A wide range of antimicrobial action allows them to be used in departments and offices that require aseptic working conditions and a low level of microbial contamination. However, they are highly toxic, which does not allow their use in the presence of patients, and the ability to fix organic contaminants requires thorough pre-cleaning of contaminated products.

7. Disinfectants based on guanidines. Guanidines are one of the promising developing groups of modern disinfectants with low toxicity, high stability and a gentle effect on objects. Means containing guanidines have a so-called residual effect, that is, they form a bactericidal film on the surface. The low level of toxicity allows the use of hand sanitizers in the food industry. Lacquers and paints with antimicrobial action have been developed on the basis of guanidines. Disadvantages of guanidine-containing agents: their solutions fix organic contaminants, the film is sticky and difficult to remove from surfaces.

8. Disinfectants based on phenols. One of the first disinfectants, but currently in its pure form is practically not used because of their high toxicity. A feature of phenols is their ability to create a residual film on disinfected surfaces. Preparations containing phenol derivatives are used to disinfect surfaces, are used in cosmetology and technical fields as preservatives. The drug "Amocid" - a concentrate based on a phenol derivative, is an active tuberculocide. Therefore, it is recommended for use primarily in anti-tuberculosis dispensaries and in foci of tuberculosis for disinfection of surfaces, linen and secretions of the patient, for current and final disinfection.

9. Combined disinfectants. Modern disinfectants are multicomponent formulations, often including several different active ingredients. They also include solvents, corrosion inhibitors, thickeners, antioxidants, dyes, fragrances. A huge variety of drugs allows you to use them for various purposes.

Disinfectants, antiseptics, preservatives - chemicals that can kill microbial cells or inhibit their growth, i.e. having a bactericidal or bacteriostatic effect on microorganisms.
. Disinfectants - used to treat premises, products or materials.
. Antiseptics - used to treat human skin and mucous membranes, so they should not be toxic in the concentrations used.
Factors that determine the choice of antimicrobial agent:
1. Properties of a chemical: the effectiveness of an antimicrobial agent is determined by its chemical nature, concentration, temperature, pH, duration of contact with an infected object.
2. The nature of the microbiota: the sensitivity of the microorganism to the substance and the level of microbial contamination determine the effectiveness of its action.
3. Influence of environmental factors: - water ensures the penetration of antimicrobial substances into the cell - organic substances reduce the activity of antimicrobial agents due to adsorption, inactivation - some polymeric materials (fabrics, rubber) adsorb antimicrobial agents, reducing their concentration
Requirements for chemical disinfectants and antiseptics
. Good solubility or miscibility with water to form stable mixtures;
. Low toxicity and no irritating effect on the skin and mucous membranes of personnel; Posted on site site
. A wide range of antimicrobial activity, its manifestation in the shortest possible time;
. The ability to wet objects well and not have a corrosive or other destructive effect on them;
. Ability to remove traces of substances from the object;
. Stability during storage;
. Availability of permission to use the substance as a disinfectant in the chemical and pharmaceutical industry.

The main groups of disinfectants

The main groups of antiseptics
.Alcohols: ethanol, propanol, isopropanol;
.Biguanidine derivatives: chlorhexidine bigluconate;
.Oxidants: hydrogen peroxide, potassium permanganate;
.Phenolic compounds: carbolic acid;
.Halogens: iodine;
.Nitrofuran derivatives: furatsilin;
.Dyes: brilliant green, methylene blue

Mechanism and targets of action of disinfectants and antiseptics. Combined disinfectants and antiseptics: purpose of creation, examples.

Combinations of antimicrobial agents
Reason for creation: there is no ideal antimicrobial agent that combines a wide range of antimicrobial activity, low toxicity, stability, and compatibility with other substances.
Combinations make it possible to improve the properties of disinfectants and antiseptics through their combined use.
Most commonly used combinations:
. Alcohols + biguanidine derivatives + surfactants + halogenated substances
.surfactants (quaternary ammonium compounds - QAC) + phenols + aldehydes
Examples of combined antimicrobial agents produced by the domestic industry
I Disinfectants:
.Polydez: contains benzalkonium chloride, a water-soluble polymer based on guanidine derivatives, a surfactant.
It has bactericidal (including mycobacterium tuberculosis), fungicidal, virucidal activity.
.Combined surface disinfectant (KDP): contains surfactant (QAS), glutaraldehyde and isopropyl alcohol. Shows a pronounced bactericidal (including mycobacterium tuberculosis), fungicidal, virucidal, sporicidal activity.
I Antiseptics:
. Septocide-Synergy: contains ethanol, cosmocyl. It has a pronounced bactericidal, fungicidal, virucidal effect.
. Septocide R Plus: contains three alcohols - isopropanol, butanediol, ethanol. It has a pronounced bactericidal, fungicidal, virucidal effect.,
The mechanism of action of disinfectants and antiseptics
Vital activity constants of microorganisms: temperature, osmotic pressure, ionic balance. Antiseptic and disinfectant substances change these constants and thereby disrupt the metabolic processes in the microbial cell, providing a bacteriostatic effect - a temporary suppression of the ability of microorganisms to reproduce in the body.
If an antiseptic or disinfectant penetrates into the protoplasm of a microbial cell and leads to the coagulation of its proteins, the death of the microbial cell occurs, which is referred to as a bactericidal action.
The targets of action of antiseptics and disinfectants are in:
. Cell wall (aldehydes, formalin, phenols disrupt the structure of the cell wall)
. Membrane - violation of the membrane potential (phenols) - inhibition of enzymes associated with the membrane, which leads to a violation of metabolic processes (chlorhexidine and ethylene oxide inhibit membrane ATPase) - violation of the membrane permeability, which is accompanied by leakage of the cytoplasm (surfactants, alcohols, phenols)
. Cytoplasm - the cytoplasm itself (chlorhexidine, phenol)
- ribosomes (hydrogen peroxide)
- DNA (acridine dyes)
- proteins (halogens, formaldehyde, glutaric
aldehyde).

Methods for determining the antimicrobial activity of disinfectants and antiseptics

Qualitative and quantitative tests, determination of the effect of bioburden, test with culture on a carrier, in vivo test.

Methods for testing the antimicrobial activity of antiseptics and disinfectants
1. Qualitative test: a suspension of a microorganism is introduced into a solution of an antimicrobial drug. After a certain exposure (2 - 60 min.), an aliquot (0.1 ml) is added to a test tube with a neutralizer and inoculated onto an agar medium to determine the viability of the test culture.
2. Quantitative test: a suspension of the microorganism is added to the antimicrobial solution. After a certain exposure (2 - 60 min.), an aliquot (0.1 ml) is added to a test tube with a neutralizer and inoculated onto an agar medium, followed by counting the grown colonies. Control - the same suspension of a microorganism that has not been exposed to an antimicrobial substance. Antimicrobial activity is determined by the formula:
MA = logN c - logN d
Where: N c - the number of colonies that grew when inoculating the control suspension N d - the number of colonies that grew when inoculated from the suspension with an antimicrobial agent
3. Determination of the effect of bioburden: - a certain amount of microbial suspension is added to the antimicrobial substance solution and kept for a certain time - seeding is done and the number of grown colonies is determined - after 10 minutes. a new dose of the microorganism is added to the same solution and kept for a certain time - seeding is done and the number of grown colonies is determined - the operation is repeated after another 10 minutes.
The method makes it possible to determine the ability of an antimicrobial agent to maintain activity in the presence of an increasing microbial load, as well as the time it takes to maintain its antimicrobial activity.
4. Qualitative test with a culture on a carrier (cloth, filter paper, etc.): allows you to evaluate the effectiveness of the drug when disinfecting surfaces and materials.
- standard carrier samples are placed in a microbial suspension, dried - added to an antimicrobial solution and incubated for 10 minutes.
- placed in a neutralizing solution
- transferred to a nutrient broth and visually determine the viability of the microorganism.
5. Determination of antimicrobial activity in soft and solid forms: carried out on a dense nutrient medium inoculated with a test culture.
- biocide samples are placed on the surface of the nutrient medium or in wells, incubated
- measure the diameter of the zones of growth inhibition in comparison with the standard preparation.
6. Test close to the conditions of practical use (for antiseptics): carried out on human volunteers.
- a suspension of a microorganism (E. coli) is applied to the skin of the hands, dried for 3 minutes in air
- wipe the skin with the tested antiseptic solution
- make a wash from the hands with a liquid nutrient medium
- determine the number of viable cells in washings
Similarly, a microbial suspension is applied to the surface of the equipment, walls, floor of the room, followed by processing and determining the number of viable cells.

Resistance of microorganisms to the action of disinfectants and antiseptics. Natural and acquired resistance. Factors determining the development of resistance of microorganisms to the action of disinfectants and antiseptics.

Resistance of microorganisms to the action of disinfectants and antiseptics
According to the level of resistance to the action of antimicrobial drugs, microorganisms are distributed as follows (in descending order):
. prions
. Prokaryotic spores
. Mycobacteria
. Protozoan cysts
. Viruses
. Gram-negative bacteria, fungi
. Gram-positive bacteria
Types of resistance:
. Natural resistance
. Acquired resistance
Natural resistance - natural structural features of the microbial cell: the presence of protective covers, the ability to form biofilms;
- metabolism: the ability to enzymatically degrade biocides.
.Mechanism of spore resistance: - the structure of the cell membrane, which prevents the penetration of biocides into the cell.
.Resistance mechanism of Gram-negative bacteria:
- the presence of a cell wall
- the ability to adhere to surfaces with the formation of biofilms.
Biofilm is an organized community of cells united by a mass of exopolysaccharide - glycocalyx. Cells living inside the biofilm are limited in access to nutrients, grow slowly, which increases their resistance to adverse conditions.
The role of the glycocalyx in resistance:
- the upper layers of the glycocalyx protect the interior from the penetration of antimicrobial;
- extracellular enzymes of bacteria are located on the surface of the glycocalyx, which take part in metabolism, incl. can destroy antimicrobial substances present in the environment
Acquired resistance - appears as a result of changes in the genetic apparatus and the emergence of resistant variants of microorganisms in an environment containing biocides.
Causes (sources) of acquired resistance:
. Mutations that modify the target of the antimicrobial agent or change the permeability of the membrane;
. Propagation of resistance genes using plasmids and transposons.
Factors determining the development of resistance of microorganisms to the action of antimicrobial drugs (disinfectants and antiseptics):
.Using drug solutions with a concentration lower than recommended;
.Violation of biocide storage periods, which leads to a decrease in the content of active substances;
.Prolonged use of any antimicrobial agent;
.Phase of development and rate of cell reproduction (slow-growing cells are less sensitive to the action of biocides than fast-growing ones);
.Composition of the medium, temperature, time of cell cultivation.
For the effective implementation of all activities that ensure aseptic working conditions, rotation of antimicrobial drugs is carried out, i.e. use several chemicals, applying them in a specific order.

Lecture, abstract. Disinfectants and antiseptics. Requirements for chemical disinfectants and antiseptics. - concept and types. Classification, essence and features. 2018-2019.

book title open close

1. Pharmaceutical microbiology. Subject and tasks of pharmaceutical microbiology.
2. Pharmacy and pharmaceuticals: history of origin and development.
3. Drug: definition, classification.
4. The composition of medicines | pharmaceutical substance, excipient.
5. Original and generic medicines. Name of medicines.

10. The effect of damaging factors on microorganisms. The influence of the temperature factor and its use in pharmaceuticals.
11. Effect of radiation on microorganisms, types of radiation.
12. Influence of chemical damaging factors on microorganisms
13. Sterilization. Sterility Assurance Level (SAL). Criteria for choosing a sterilization method.
14. Thermal and chemical sterilization
15. Monitoring the efficiency of sterilizing devices.
16. Industrial disinfection
17. Disinfectants and antiseptics. Requirements for chemical disinfectants and antiseptics.
18. Preservatives and their use in pharmaceutical production
19. Quality assurance in pharmaceutical production.
20. Microbiological requirements for the organization of production of sterile and non-sterile products.
21. Control of microbial contamination of air, surfaces, personnel in the production of pharmaceutical products.

Chemical disinfectants

The chemical method is the treatment of hairdressing tools and accessories with alcohol, chloramine solution, incrasept, triacid, etc. Disinfection is carried out by soaking, immersing, wiping disinfection objects.

The use and preparation of solutions of disinfectants is carried out in accordance with the guidelines for their use.

Disinfectants include: chloramine, formalin, ethyl alcohol, carbolic acid, phenol. The choice of agent and its concentration depend on the material from which the instrument is made and a number of other conditions.

Chloramine is a white crystalline powder with a pungent odor, soluble in water. Use a 0.5% aqueous solution, which should be in a special vessel on the desktop. Disinfect plastic tools by immersing in the solution for 10-15 minutes. (Changes daily.)

Formalin is a colorless, transparent liquid with a sharp specific odor. Used as a 4% aqueous solution when disinfecting shaving or coloring brushes. For wet disinfection of the premises, formalin is not used because of the irritating odor; it is used for disinfection mainly in the gaseous state or for processing things in the cells.

Ethyl alcohol - use only technical 70% to disinfect metal instruments when placed in a solution or rubbed with a cotton swab. After finishing work, the alcohol is filtered. (Replace every three days.)

Phenol (carbolic acid) - 40% formaldehyde aqueous solution. A clear, colorless liquid with a characteristic odor. A 5% solution is also used to disinfect metal tools and combs.

Carboxylic acid is a crystalline substance with a pungent odor, its crystals are colorless but turn pink when exposed to air.

Hydrogen peroxide - for sterilization, a 1.6% solution of hydrogen peroxide is used, which kills microbes and their spores. At 18°C, a holding time of 6 hours is recommended, and at 50°C, 3 hours.

Alcoholic iodine solution (tincture of iodine) - contains active iodine. It is widely used as an antiseptic in the form of 5% solutions for the treatment of instruments.

Chloric lime - for processing objects, 0.5, 0.2, 0.05% working solutions are used, prepared from the main 10% solution of bleach or bleach. Processing is carried out by wiping, soaking, immersion.

As the best option, you should choose broad-spectrum products that do not have a strong, poorly weathered odor and do not leave marks on work surfaces.

Basic requirements for disinfectants. Must destroy all types of microbes. Must not damage instruments. Should not irritate or color the skin. Should not have a strong odor.

Physical disinfectants

The physical method includes boiling in distilled water for 30 minutes from the moment of boiling; boiling in distilled water with the addition of 2% sodium bicarbonate for 15 minutes from the moment of boiling; exposure to saturated water steam under pressure in a steam sterilizer at t-110°C for 20 minutes; exposure to dry hot air in an air sterilizer at t-120°C for 45 minutes. Metal tools are disinfected by burning. At the same time, the cutting part is immersed in alcohol and carried over the flame.

Disinfection by physical methods has a number of limitations - boiling leads to metal corrosion, sharp surfaces quickly become dull.

Of the physical methods of disinfection in a hairdresser, boiling and burning metal tools are used; from chemicals - chloramine, alcohol and formalin.

The most reliable disinfection of metal instruments is achieved by boiling in a sterilizer, which is a rectangular metal box with two; handles and a tight-fitting lid. Inside the sterilizer there is a metal mesh with handles on the sides, on which instruments are placed, poured with cold water and boiled for 10-15 minutes from the moment the water boils. Boiled storage tools are placed in a jar of alcohol. Alcohol quickly absorbs remaining water, protects instruments from rust and microbes from the air. Care must be taken that the cutting surface of the tools is completely immersed in alcohol. It is necessary to boil tools at the beginning of the working day and after serving each visitor. Hairdressing staff must have at least two sets of tools for alternate disinfection.

It is allowed to serve visitors only with disinfected tools.

Sterilizers are of 2 types:

1. Ultraviolet sterilizers (app.3)
2. Crystal sterilizers (app.4)

Sterilization is the complete destruction of all microbes. The difference between the concepts is primarily that not everyone perishes during disinfection. And just by the number of survivors, it is divided into 3 levels, and the 4th, at which the disinfection coefficient is 10 to the minus sixth power, otherwise 0.000001, is already called sterilization. For example, if we take a million contaminated cutters or nippers and subject them to a treatment that results in microbes being found on only one tool, then the process is called sterilization. And if, for example, out of the same number of treated instruments, viruses, bacteria, etc. are present on five, one hundred, etc., then here we are talking about disinfection. The effectiveness of sterilization depends on many factors, the main of which are temperature, duration of exposure, the concentration of the sterilizing agent, the initial number of microbes on the instrument.

Sterilization is carried out in order to kill all pathogenic and non-pathogenic microorganisms on them, including their spore forms.

Especially if the procedures that are carried out in a salon or a medical center are associated with a violation of the integrity of the skin (various injections, abrasion, some types of manicure and pedicure, rejuvenation systems, etc.), then we must also deal with sterilization. There are several ways to ensure that all harmful things are killed - physical and chemical.

The choice of an adequate sterilization method depends on the characteristics of the products to be sterilized and on the decision of the salon administration. Consider all the common methods of sterilization used in the salon business.

The sterilizer for hairdressing and manicure tools of these types is best suited for sterilizing tweezers, nail clippers, tweezers, scissors and other indispensable tools in a beauty salon.

During the glasperlene sterilizer, glass beads are heated to 200-250 degrees, which destroy all microbes and viruses. It takes 20-30 seconds to process

photo from bt-dez.ru

The chemical method of disinfection is most often used to combat hospital infections. Appropriate drugs are available in the form of soluble granules, tablets, powders, concentrates, emulsions, pastes, aerosols. The active compounds included in the composition remove and devitalize most of the pathogenic microorganisms, bringing their number to an acceptable level.

There are several types of agents (depending on which chemical is used as the main disinfectant agent).

1. Halogen-containing, iodine, bromine. They have a diverse spectrum of antimicrobial activity, but they have a strong irritant effect on the respiratory system and eyes, are toxic, if not properly disposed of, are harmful to the environment, provoke corrosion, and have a persistent odor. Despite a number of shortcomings, the means of this group (Chloramine, Chloreffect, DP-2T, Monochloramine, Chlorine, Calcium Hypochlorite) are often used in medical organizations. They are available, effective, but require strict adherence to the rules of use and disposal.

2. Preparations based on oxygen (as well as hydrogen peroxide, ozone, perborates) are low-toxic, safe for the natural environment, have no specific odor, and are active against most pathogenic microorganisms and pathogens. Their main disadvantage is high corrosivity, so they are not suitable for processing metal tools and equipment. Means of this group are often used in neonatal departments and obstetric hospitals.

3. Disinfectants based on aldehydes (formaldehyde, glyoxal, glutaric and orthophtholaldehyde). They have a complex bactericidal, sporicidal, virucidal effect, have high antimicrobial activity against all types of microorganisms, but they irritate the respiratory system and cannot be used in the presence of people. Suitable for disinfection of equipment, including those with a complex configuration (for example,). This group of drugs includes Glutaral, Bianol, Lysoformin.

4. Preparations based on alcohols (ethanol, isopropanol, propanol) are effective against most microorganisms. At a sufficient concentration (at least 60%), they provide a rapid fungicidal, virucidal, bactericidal and bacteriostatic effect. However, they are helpless against spores and vegetative forms of microorganisms. Suitable for debridement, scissors, rectal. Alcohol treatment of endoscopes, surgical materials, instruments is not effective enough and creates a threat of spreading infections. Alcohols are often found in aerosols in combination with aldehydes. Like aldehydes, alcohols fix blood, mucus, and other organic contaminants, so before using them, a thorough preliminary cleaning of inventory with detergents is necessary.

5. Cationic surfactants (Biodez-extra, Veltolen, Vapusan) act due to their constituent quaternary ammonium compounds, amines, ampholytic surfactants. They do not have a pungent odor, are inert to metals, but are effective only against a limited number of pathogens. Sometimes provoke the emergence of resistant strains. Due to its high detergent properties, this group is successfully used at the stages of pre-sterilization cleaning in combination with primary disinfection. HAS and tertiary amines do not damage equipment, have low toxicity, do not irritate mucous membranes and the respiratory system, and can be used in the presence of patients and personnel.

6. Guanidine-containing preparations based on polyhexamethyleneguanidine and chlorhexidine (Polysept, Demos, Bior) also have a narrow spectrum of bactericidal activity and a fixing effect. Their characteristic feature is a long period of action due to the formation of a bactericidal film on the treated surfaces. Combining low toxicity and a sparing effect on inventory, they are among the most promising drugs.

7. Disinfectants based on phenols (Amocid, etc.) are used as antimicrobial agents, but are useless in the fight against viruses and spore forms of bacteria.

8. Organic acids are used in medical facilities for disinfection of hemodialysis machines. Currently, scientists are studying the antimicrobial properties of peroxy acids - at low concentrations, preparations based on them exhibit high bactericidal properties.

To date, there are no comprehensive universal solutions for chemical disinfection. Each group of tools is a combination of strengths and weaknesses that must be considered and correlated with the intended scope.

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SBEE HPE "Ural State Medical University"

Ministry of Health of the Russian Federation

Faculty of medical and preventive

Department of Nursing

abstract

Modern disinfectants

Composer: Khareva Ekaterina Aleksandrovna,

student OLD-129 USMU

Scientific adviser: Luchinin Ivan Yurievich

Yekaterinburg, 2014

1. Introduction

2. Classification of disinfectants

2.1 Halogenated

2.2 Peroxides

2.3 Surfactants

2.4 Guanidine

2.5 Aldehyde, alcohol

2.6 Peracid, alkaline

2.7 Phenolic

3. Use of disinfectants

4. Modern disinfectants (examples)

infectious disinfection decontamination toxin

1. Introduction

Nosocomial infections are one of the most important problems faced by any medical institution. To ensure the prevention of possible complications associated with the activity of pathogenic microorganisms and viruses is the main task for medical workers. The purpose of this work is to expand the knowledge of medical staff about modern disinfectants and their correct use.

Disinfection is a set of measures aimed at the destruction of pathogens of infectious diseases and the destruction of toxins in environmental objects. It is performed by using antiseptics and disinfectants that eliminate the problem of infection even on the way to the human body. There are preventive, current and final disinfection:

preventive - is carried out constantly, regardless of the epidemic situation. This is the washing of hands, surrounding objects with the use of detergents and cleaning products containing bactericidal additives.

current - is carried out at the bedside of the patient, in the isolation wards of medical centers, medical institutions. Purpose: to prevent the spread of infectious diseases outside the focus.

final - is carried out after isolation, hospitalization, recovery or death of the patient to free the epidemic focus from pathogens scattered by the patient.

Antiseptics are broad-spectrum antimicrobial agents that have a detrimental effect on most microorganisms. They do not have selective activity and are relatively highly toxic to humans, which is why they are applied topically.

Disinfectants are analogous preparations already used for disinfecting external objects (room, patient care items, patient discharge, medical instruments, etc.).

It is not possible to draw a line between antiseptics and disinfectants, because many substances in lower concentrations are used as antiseptics, and in large concentrations for the purpose of disinfection.

It is important that all health workers know and are able to apply basic measures to prevent infectious diseases. A feature of nosocomial infections is that they can be caused by pathogens with a relatively low pathogenicity, especially in severe patients with pathological processes.

Nosocomial infections are usually caused by nosocomial strains of opportunistic Gram-positive and Gram-negative bacteria. They differ from community-acquired strains in their biological characteristics and have multiple drug resistance, higher resistance to adverse environmental factors - the action of ultraviolet rays, disinfectants. At reduced concentrations of disinfectants, nosocomial strains can persist and multiply in them.

Reservoirs of nosocomial pathogens in the external environment: water, equipment for artificial respiration, liquids for intravenous administration, reusable medical products (endoscopes, catheters, probes, etc.). The main reservoir in the human body is the hands, about 50% of nosocomial infections, according to WHO, are transmitted through the hands. The most common transmission mechanism is medical and diagnostic procedures, as well as natural routes: airborne, fecal-oral and household contact. According to the World Health Organization (WHO), the most common infectious diseases today are vaccine-preventable diseases:

Poliomyelitis, tetanus, measles, diphtheria, whooping cough;

intestinal infections;

acute respiratory infections;

· tuberculosis;

sexually transmitted diseases: syphilis, gonorrhea, chancre;

Chlamydia, genital herpes, AIDS, etc.;

malaria.

Most disinfectants that come into direct contact with humans are alcohol-based or contain alcohol and are absolutely safe, which is why such disinfectants are most common in medicine.

For disinfection of various premises, disinfectants with a chloride or acid chemical base are used. Use requires the protection of the person performing the decontamination: gloves, shoe covers, gauze masks, special or disposable clothing.

However, modern disinfectants are constantly being improved in their composition. Their modernization is necessary so that their inherent action does not weaken and allows them to continue to destroy a wide range of microorganisms and bacteria.

2. Classification of disinfectants

Chemicals used for disinfection belong to the following groups:

peroxide compounds;

guanidines

aldehydes, alcohols

peracids, alkalis;

phenols, cresols and their derivatives;

Derivatives of metal salts.

All substances have a different degree of activity, antimicrobial action spectra, toxicity and effect on the processed objects. As a consequence, the breadth of their application areas. Along with high antimicrobial activity, modern products have pronounced detergent and anticorrosion properties, do not damage the processed objects and do not discolor fabrics, do not have a fixing effect, and can be used repeatedly. Knowledge of the properties and characteristics of disinfectants is necessary for their proper selection and high-quality use.

2.1 Halogen products

Chloramine B contains active chlorine. It has antiseptic and deodorizing properties. Solutions of chloramine B are used to treat infected wounds (1-2%), to disinfect the skin of the hands (0.25-0.5%) and patient care items (1-3%).

Chlorhexidine is used in solutions for treating the surgical field and the surgeon's hands (0.5%), for wound infections, gingivitis, stomatitis, and also for sterilizing instruments.

Preparations containing elemental iodine include Lugol's solution (consists of 1 part of iodine, 2 parts of potassium iodide, and 17 parts of water), used to lubricate the mucous membrane of the pharynx and larynx during inflammatory processes.

Povidone-iodine (betadine) is a complex of iodine with polyvinylpyrrolidone. It has antibacterial, antifungal and antiprotozoal effects associated with the release of free iodine. Used to treat the skin of patients before and after surgery. In the form of 0.5-1% solutions, it is used to treat wounds, burns, and with infectious skin lesions. In vaginal suppositories, it is prescribed for acute and chronic vaginitis (trichomoniasis, candidiasis).

2.2 Peroxide compounds

The group of oxidizers from disinfectants includes hydrogen peroxide, which has a weak antiseptic and deodorizing effect associated with the release of oxygen.

It is widely used for disinfection, sterilization and pre-sterilization cleaning of objects, because it meets many requirements: it does not smell, quickly decomposes in the environment into non-toxic products (molecular oxygen and water), and does not cause allergization. Cons: unstable, has a pronounced local irritant and skin-resorptive effect, has a low bactericidal activity. In order to reduce toxicity, increase antimicrobial activity and stability, composite preparations are created based on hydrogen peroxide. The most convenient for practical use are solid forms of peroxide compounds (sodium peroxycarbonate - persalt, carbamide peroxide - Hydroperite, sodium peroxoborate). Compositions based on hydrogen peroxide in solid and liquid form are widely recognized (for example, apisin) due to their high efficiency, broad spectrum of action, low toxicity, environmental safety and ease of use.

2.3 Surfactants

Recently, disinfectants of the surfactant group - detergents - have become widespread. Anionic detergents include ordinary soaps (sodium or potassium salts of fatty acids). As antiseptics and disinfectants, cationic detergents are mainly used, in particular benzalkonium chloride, cetylpyridinium chloride, miramistin. Detergents should not be combined with anionic soaps, as this reduces their antimicrobial activity.

Benzalkonium chloride has antibacterial, antiprotozoal and spermicidal effects. It is used to treat the skin, mucous membranes, wounds, wash the bladder, urethra, and also for the purpose of contraception in women.

Cetylpyridinium chloride as part of the drug cerigel is used to treat hands before operations.

Miramistin is used in the form of a 0.01% solution for the treatment of infected wounds, burns, as an antiseptic in dental practice, in the treatment of infectious diseases of the ENT organs, the genitourinary system. Avoid contact with eyes.

2.4 Guanidine derivatives

From the group of guanidines, chlorhexidine bigluconate (gibitan) and polyhexamethylene guanidine hypochloride (polysept) are most widely used as antiseptics and disinfectants.

Gibitan has a wide spectrum of antibacterial action, however, virucidal activity is inherent only in its alcohol solutions.

Polysept causes the death of gram-positive and gram-negative microorganisms, many dermatophytes. Its positive quality is a long-term effect.

2.5 Aldehyde, alcohol products

From the group of aldehydes, two substances are used in the practice of disinfection (formaldehyde (FA) and glutaraldehyde (GA). Aldehydes are characterized by bactericidal, virucidal, fungicidal and sporicidal action, which allows them to be classified as high-level disinfectants. As disinfectants (and antiseptics) are use and alcohols.They are used both independently and as solvents that enhance the activity of other disinfectants and have bactericidal and virucidal properties.

Ethyl alcohol 70-95% denatures proteins and has a bactericidal effect. Used to treat the skin of patients and the hands of the surgeon.

Formaldehyde (formalin; contains 36.5-37.5% formaldehyde) acts on bacteria, fungi, viruses. Formaldehyde solutions of 0.5-1% are used as disinfectants and deodorizers for treating the skin of the feet, as well as for disinfecting instruments.

2.6 Peracid, alkaline agents

High antimicrobial activity and a wide spectrum of antimicrobial activity are distinguished by preparations from the group of peracids and alkalis. On the basis of peracetic acid, vofasteril and persteril are known (the content of the active substance is 40% and 20%, respectively). These preparations are recommended for disinfection of medical devices made of glass, metal, textiles, rubber, hygienic and surgical treatment of hands.

Deoxon-1 is a colorless liquid with a specific smell of vinegar, contains 5-8% peracetic acid: we will readily dissolve in water and alcohol. Solutions of the drug corrode products made of low-grade steel. Aqueous solutions quickly lose their activity and therefore are used immediately after preparation. It is highly active against all forms of bacteria, viruses and fungi.

Ammonia solution (ammonia) contains 9.5-10.5% ammonia. It has antiseptic and detergent properties. Used for washing the hands of medical personnel before surgical operations (25 ml per 5 liters of water - 0.5%).

2.7 Phenolic derivatives

Phenolic derivatives are active ingredients found in some household disinfectants. They can also be found in some mouthwashes, disinfectant soaps, and hand sanitizers.

Resorcinol acts on vegetative forms of bacteria and fungi, is used for bacterial and fungal skin lesions in the form of 2-5% solutions and 5-10% ointments.

Lysol (A-sanitary) is a brown-brown liquid with a pungent phenol odor. It is a mixture of phenols (50%) and liquid sodium soap. It dissolves well in water (preferably warm). Aqueous solutions are transparent or slightly opalescent, have soiling, bactericidal against vegetative forms of bacteria (except for tuberculosis), and at 5-10% concentration they also have an insecticidal effect. They are suitable for current and final disinfection, especially coarse disinfection in cases where soiling and a smell that remains for a while are not an obstacle.

2.8 Derivatives of metal salts

Salts of Hg, Ag, Zn, Bi and some other metals bind sulfhydryl groups (SH-groups) of enzymes of microorganisms and have a bactericidal effect. At higher concentrations, these compounds exhibit astringent and cauterizing properties for proteins.

Solutions of mercury dichloride (mercuric sublimate) are used to disinfect linen, patient care items. Mercury dichloride is highly toxic; easily absorbed through the skin. May cause severe poisoning.

Silver nitrate (lapis) at concentrations up to 2% has an antimicrobial effect, and at higher concentrations it acts as a cauterizing agent.

3. The use of disinfectants

Disinfectants should be used by medical personnel in accordance with the official guidance document. Disinfection of medical instruments can be carried out with hydrogen peroxide followed by cleaning of the instruments. For products and their parts that are not in direct contact with the patient, wiping should be carried out with a napkin soaked in a disinfectant solution and wrung out to avoid getting inside the product. If the product was immersed, it must be rinsed in running water until the odor is completely removed. Each disinfectant solution should be used once, and after disinfection, products made of rubber and polymeric materials should be packed in gauze.

Linen is boiled for 15 minutes in a 2% solution of sodium bicarbonate (soda) or soaked in a disinfectant solution at the rate of 4 liters per 1 kg of dry linen (linen must be completely immersed in the solution). At the end, the linen is washed and rinsed.

Tableware is freed from food debris, washed or boiled in a 2% soda solution for 15 minutes or immersed in a disinfectant solution. On average, 2 liters of solution are consumed per set of dishes (cup, saucer, deep and shallow plates, teaspoon and tablespoon, fork and knife).

Toys (plastic, rubber, wood, metal) are washed with a hot 2% soda solution or immersed in a container filled with a disinfectant solution, which is closed to prevent toys from floating up, or wiped with a rag previously moistened with a disinfectant solution. Metal toys are treated with non-corrosive solutions.

Premises (floor, walls, doors) and household items are irrigated with a disinfectant solution at the rate of 300 ml / m 2 or wiped with a cloth soaked in it (the average consumption is 200 ml / m 2).

Plumbing installations (toilet bowls, sinks, bathtubs) are irrigated or wiped with a disinfectant solution (500 ml / m 2) or wiped with a disinfectant powder, followed by rinsing.

Soft toys, upholstered furniture are cleaned with a brush dipped in a disinfectant solution; when processing things with colored upholstery, non-discoloring solutions of disinfectants should be used.

Cleaning equipment is boiled in a soda solution or soaked in a disinfectant solution.

The discharge of patients is covered with dry disinfectants or poured with concentrated solutions.

Most disinfectants can be irritating (when diluted and sprayed) on the mucous membranes of the upper respiratory tract and eyes, and some on the skin of the hands. Therefore, when working with them, personal protective measures (gowns, scarves, rubber gloves, glasses, respirators) should be applied.

4. Modern disinfectants (often used)

Disinfectant - a disinfectant with a wide spectrum of action. Its use is effective against viruses, fungi, gram-positive and gram-negative bacteria and spores, additionally it has detergent properties. The antimicrobial activity of the drug increases with increasing solution temperature. The washing properties of the solution increase with increasing temperature or with the addition of soda ash to it. Composition: a complex of 2 quaternary ammonium compounds - p-alkyldimethylbenzyl-ammonium chloride (4.5%), p-chloride (4.5%) and other components.

Lizafin is a preparation for disinfection of indoor surfaces, medical products. Active against gram-negative and gram-positive bacteria (including Mycobacterium tuberculosis), fungi of the genus Candida and Trichophyton, viruses (causative agents of viral hepatitis, HIV infections, herpes, rotavirus gastroenteritis, enterovirus infections, poliomyelitis, influenza and other acute respiratory viral infections). Has detergent properties. Ingredients: 30% alkyldimethylbenzylammonium chloride, 0.5% glutaraldehyde, 5% glyoxal, denatured alcohol, sintanol.

Lysoformin is a universal disinfectant for disinfection and sterilization of medical instruments of any composition. Properties: virucidal, bactericidal (including tuberculocidal and sporicidal) and fungicidal, as well as fixative, which requires prior removal of organic contaminants from medical instruments. Composition: includes 9.5% glutaraldehyde, 7.5% glyoxal and 9.6% didecyldimethylammonium chloride, auxiliary components; The pH of the concentrate is 3.7-0.6. The 10% solution "Lysoformin-3000" activator contains alkaline ingredients, inert additives and distilled water.

Sideks is a preparation for disinfection of medical devices made using heat-labile materials, as well as for their sterilization. It has bactericidal (including tuberculocidal), virucidal (including against pathogens of parenteral viral hepatitis and HIV infection), fungicidal and sporicidal properties. The composition of the disinfectant "Sydex": liquid component - 2% aqueous solution of glutaraldehyde, powder component - alkaline agent, corrosion inhibitor and dye.

Septodor-forte is a product used for disinfection of room surfaces, sanitary equipment, sanitary transport and laboratory glassware. It has antimicrobial activity against gram-negative and gram-positive bacteria (including mycobacterium tuberculosis, pathogens of especially dangerous infections - plague, cholera, tularemia, glanders, melioidosis, anthrax), viruses, pathogenic fungi of the Candida and Trichophyton rivers, as well as detergent and sporicidal properties. Composition: 37.5% of a complex of four Quaternary ammonium compounds (QAC) (alkyldimethylbenzyl ammonium chloride - 15.00%, octyldecyldimethylammonium chloride - 11.25%, dioctyldimethylammonium chloride - 4.50%, didecyldimethylammonium chloride - 6.75%) and 12.5% glutaraldehyde (GA), concentrate pH 5.9.

Alfadez-forte is a drug used for disinfection of medical devices, including surgical and dental instruments, as well as the tools of a medical institution. The agent has an antimicrobial effect against gram-negative and gram-positive bacteria (including mycobacterium tuberculosis), viruses, fungi of the genus Candida, Trichophyton, molds. Ingredients: benzalkonium chloride and didecyldimethylammonium chloride (QAC) - 12%, glutaraldehyde (GA) - 4%, glyoxal - 8%, auxiliary components isopropyl alcohol, neonol AF 9-10, ethoxylated fatty alcohol and distilled or deionized water up to 100% .

Fribak is a skin antiseptic and fast disinfectant for various objects, small in area, but difficult to handle. The agent has antimicrobial activity against gram-negative and gram-positive bacteria, pathogenic fungi (causative agents of dermatophytosis and candidiasis) and viruses of parenteral hepatitis B, C, D, HIV infection, influenza, incl. A H5NI, HINI, herpes infection. It contains in its composition as active ingredients isopropyl alcohol - 50.0%, hydrogen peroxide - 0.5%, chlorhexidine digluconate - 0.5%, as well as auxiliary components (glycerin - 0.1%, distilled water).

5. Output

Disinfection, as an event aimed at breaking the infection transmission mechanism, is used both for preventive purposes and for epidemic indications, and disinfectants are now a familiar element of the life of a medical institution. Future doctors need to know well and understand how various types of disinfection are carried out, because. for some types of infection, disinfection is carried out in the focus independently after instructing a pediatrician or therapist.

Unfortunately, to date, none of the drugs used does not immediately have all the necessary properties. With regard to health facilities, depending on the type of devices or the nature of the treated surfaces, it is necessary to use various disinfection technologies and various disinfectants.

List of literature and information sources

1. Prevention of infectious diseases during manipulations / Sanitary rules (SP 3.1.1275-03) entered into force on May 1, 2003, approved by the Chief State Sanitary Doctor of the Russian Federation on April 2, 2003 (registered in the Ministry of Justice on April 14, 2003 4417). 2 s.

4. Taits B.M., Zueva L.P. Infection control in medical institutions. St. Petersburg: SPbGMA im. Mechnikova, 1998. 295 p.

5. Tasks of modern disinfectology and ways to solve them / Proceedings of the All-Russian Scientific Conference. - Moscow: ITAR-TASS, 2003. 216 p.

6. Experience in implementing an infection control system in medical institutions. SPb: GOUVPO SPbGMA named after I.I. Mechnikov. 2003. 264 p.

7. http://www.deznet.ru/.

8. http://www.wikipedia.ru/.

9. http://www.ru.wikipedia.org/.

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