AORN answers questions about disinfection
AORN answers questions about disinfection
To help our readers, Same-Day Surgery newsletter is printing advice in the top 10 areas that receive the most questions at the Center for Nursing Practice, Research, and Health Policy at the Association of Operating Room Nurses (AORN) in Denver. The first topic, addressed in the June issue, was surgical attire. This month’s topic is disinfection with glutaraldehyde:
Items to be sterilized or disinfected should be categorized as critical, semicritical, or noncritical. Critical items, those that enter sterile tissue or the vascular system, should be sterile when used. Semicritical items, those that come into contact with nonintact skin or mucous membranes, should receive a minimum of high-level disinfection. Examples of semicritical items include respiratory and anesthesia equipment, bronchoscopes, and gastrointestinal endoscopes.
According to the AORN Recommended Practices for Chemical Disinfection, items should be thoroughly cleaned before being subjected to a disinfection process. The activity of chemical germicides can be lowered in the presence of organic material. When using a chemical germicide to achieve high-level disinfection, an agent that is registered with the Environmental Protection Agency and that has cleared the U.S. Food and Drug Administration should be selected. Activated glutaraldehyde is a chemical germicide commonly used in the health care arena to achieve high-level disinfection.
AORN suggests a 20-minute soak in activated glutaraldehyde for high-level disinfection. AORN bases this recommendation on guidelines published by the Association for Professionals in Infection Control and Epidemiology and the studies cited in those guidelines.1 In one of the studies cited, some species of Mycobacterium were more resistant to disinfection by 2% activated glutaraldehyde than others.2 Using membrane filters for measurement of mycobactericidal activity of the 2% glutaraldehyde solution, complete inactivation of a test inoculum of Mycobacterium tuberculosis 106 was achieved in 20 minutes at 20 degrees Centigrade (68 degrees Fahrenheit).3 These findings were corroborated using a 105 Mycobacterium bovis exposed to the 2% activated glutaraldehyde solution for 20 minutes at a temperature of 20 degrees Centigrade (68 degrees Fahrenheit).4
20 minutes at 20 degrees Centigrade
Given these studies, AORN supports the position that the minimum time to reliably kill Mycobacterium tuberculosis with a 2% activated glutaraldehyde solution is 20 minutes at 20 degrees Centigrade (68 degrees Fahrenheit).
AORN is aware that at least one commercially available brand of 2% activated glutaraldehyde solution carries a manufacturer recommendation for a 45-minute soak to achieve high-level disinfection. Upon investigation, AORN has learned from the manufacturer that this recommendation is based on the time necessary to achieve high-level disinfection of items that have not been precleaned. To subject an item to the disinfection process with no precleaning is contrary to the AORN recommended practices as cited above. Therefore, AORN continues to recommend a 20-minute soak period at 20 degrees Centigrade (68 degrees Fahrenheit) for high-level disinfection of precleaned semicritical items.
AORN also recommends a sequence of three rinses for items subjected to the glutaraldehyde disinfection process. Residual glutaraldehyde can be harmful to tissue, causing chemical burns. To ensure all glutaraldehyde has been eliminated from the disinfected items, three sequential rinses are recommended. That is, following the 20-minute soak, items should be immersed in a container of sterile water. Items should be removed from the first rinse and immersed in a second container of sterile water.
After being removed from the second container of sterile water, the items should be immersed in a third container of sterile water. Following the third rinse, the items should be safe for use. Each time the rinse sequence is used, the first container of rinse water should be discarded, as it will contain the greatest concentration of residual glutaraldehyde solution. Containers two and three may be moved up into the one and two positions and a new container of sterile water added each time for the third rinse. Using this method, each item has an uncontaminated bath of sterile water as its final rinse before use.
[Editor’s note: Information in this article was reprinted with permission from AORN Online (http://www.aorn.org/), 1997. AORN Inc., 2170 S. Parker Road, Suite 300, Denver, CO 80231.]
References
1. Martin MA, Reichelderfer M. APIC guideline for infection prevention and control in flexible endoscopy. Am J of Infect Control 1994; 22:19-38.
2. Collins FM. Bacterial activity of alkaline glutaraldehyde solution against a number of atypical mycobacterial species. J of Appl Bacteriol 1986; 61:247-251.
3. Collins FM. Use of membrane filters for measurement of mycobactericidal activity of alkaline glutaraldehyde solution. Appl Environ Microbiol 1987; 53:737-739.
4. Ascenzi JM, Ezzell RJ, Wendt RM. A more accurate method for measurement of tuberculocidal activity of disinfectants. Appl Environ Microbiol 1987; 53:2,189- 2,192.
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