URINARY DISEASES

There are various urinary diseases and conditions that can affect the urinary system, which includes the kidneys, bladder, ureters, and urethra. Here are some common urinary diseases:

1. Urinary Tract Infections (UTIs): UTIs are infections that can occur in any part of the urinary system, including the bladder, urethra, and kidneys. They are often caused by bacteria, and common symptoms include pain or burning during urination, frequent urination, and cloudy or strong-smelling urine.
2. Kidney Stones: Kidney stones are hard deposits that form in the kidneys and can cause severe pain when passing through the urinary tract. They may result from the accumulation of minerals and salts in the urine.
3. Interstitial Cystitis (IC): Also known as painful bladder syndrome, IC is a chronic condition characterized by bladder pain, urinary urgency, and frequency. The cause of interstitial cystitis is not well understood.
4. Bladder Infections: Infections of the bladder, also known as cystitis, can cause symptoms such as frequent urination, urgency, and pain or discomfort in the lower abdomen.
5. Urinary Incontinence: This is a condition characterized by the loss of bladder control, leading to involuntary urine leakage. It can be caused by various factors, including age, childbirth, and neurological disorders.
6. Prostatitis: Inflammation of the prostate gland, known as prostatitis, can cause urinary symptoms such as pain or discomfort during urination, increased frequency, and urgency.
7. Urinary Infections in Children: Children can also experience urinary tract infections, which may present with symptoms like fever, abdominal pain, and changes in urinary habits.
8. Polycystic Kidney Disease (PKD): PKD is a genetic disorder that causes the growth of fluid-filled cysts in the kidneys, leading to kidney enlargement and potential kidney function decline.
9. Renal Failure: Chronic kidney disease (CKD) or acute kidney injury (AKI) can result in the gradual or sudden loss of kidney function, affecting the body’s ability to filter waste and maintain fluid and electrolyte balance.

Urinary elimination, a natural process in which the body excretes waste products and materials those exceeded bodily needs, usually is taken for granted. When the urinary system fails to function properly, virtually organ systems can be affected. Persons with alternations in urinary elimination may also suffer emotionally from body image changes. The proper functioning of the urinary system is vital to the body’s physical well being, to life itself, and a person’s general sense of well bring.

Nursing therapies promote or minimize factors that influence urinary elimination. Each client has a different pattern of elimination. The nurse must assess this pattern and design therapies to promote normal urinary elimination when necessary. The nurse uses devices such as a condom or an indwelling catheter to assist the client with urinary elimination. The nurse assisting a client with urination or intervening to resolve health related to urinary needs may have specialized abilities

DEFINITION

Urinary elimination is defined as expulsion of waste products from the body through the urinary system.

Elimination from the urinary tract helps to remove the waste products from body. It is essential to the body’s physical well-being

PHYSIOLOGY

Urinary elimination depends on the function of the kidneys, ureters, bladder, and urethra. Kidneys remove waste from the blood to form urine. ureters transport urine from the kidneys to the bladder. The bladder holds urine until the urge to urinate develops

Growth and development of individual: it influences urination. Usually infants or children with 6 to 8 kg excrete 400 to 500 ml per day and child cannot withhold urination. The adult normally voids 1500 to 1600 ml per day and has normal urine color; also has control over urination. Aging impairs urination, e.g. elder adults

Food and fluid: foods high in water content increased urine production. Certain foods affect the color and odor of urine. Certain fluid needed to urinate develops. Urine leaves the body through the urethra. All organs of the urinary system must be intact and functional for successful removal of urinary wastes

The process of emptying the bladder is known as micturition or voiding or urination. The bladder normally holds as much as 600 ml of urine. However, the desire to urinate can be sensed when the bladder contains only a small amount of urine (150 to 200 ml in adults and 50 to 200 ml in a child). As the volume increases, the bladder walls stretch, sending sensory impulses to micturition center in the sacral spinal cord. Parasympathetic impulses from the micturition center stimulate the detrusor muscle to contract rhythmically. The internal sphincter also relaxes so that urine may enter the urethra, although voiding does not yet occur. As the bladder contracts, nerve impulses travel up the spinal cord to the midbrain and cerebral cortex. A person is thus conscious of the need to urinate. If the person chooses not to void, the external urinary sphincter remains contracted, and the micturition reflex is inhibited. However, when a person is ready to void, the external sphincter relaxes, the micturition reflex stimulates the detrusor muscle to contract and urination occurs. The act of micturition normally is painless

Factors Influencing

Developmental Considerations: infants are born without voluntary control of urination and with the little ability to concentrate urine. Older children and adults have general control of urination voluntarily. Physiological may affect urination

Lifestyle: many individual’s families and sociocultural variables influence a person’s normal voiding habits. For some individuals voiding is a very personal and private act

Fluid and food intake: the healthy body maintains a sensitive balance between the amount of fluid ingested and the amount of fluid eliminated. When fluid intake increases, the output also increases

Environment: during summer, due to excessive perspiration urine output is less. During winter, due to lack of perspiration, urine output is more

Psychological factors: stress can also interfere with the ability to relax external urethral sphincter as a result, emptying the bladder completely becomes difficult or impossible

Medication: Many medications interfere with the normal urination process and may cause retention. Diuretics, e.g. frusemide, increase urine formation by preventing the reabsorption of water and electrolytes from the tubules of the kidney into the bloodstream

Muscle tone and activity: People who exercise regularly will have good muscle tone increased body metabolism and good urine production

Pathological conditions: endocrine disorders such as diabetes insipidus increase urine formation. Diseases of the kidney themselves can reduce kidney function and perhaps eventually result in renal failure

Surgical and diagnostic procedure: surgery on structures adjacent to the urinary tract can also voiding because of swelling in the lower abdomen and often necessitates the use of retention catheter for a short time

DIAGNOSTIC EXAMINATION

Diagnostic examination of the urinary system can also influence micturition, for example, intravenous pyelogram

Conditions Which Alter Urinary Elimination

The most common conditions which alter urine elimination encountered by the nurse, involve disturbance in the act of micturition. These disturbances result from impaired bladder function, obstruction to urine outflow, or inability or voluntary control of micturition. The common renal conditions causing alternation in urinary elimination are as follows:

Prerenal Conditions

• Decreased intravascular volume, dehydration, hemorrhage, and burns shock
• Altered peripheral vascular resistance; sepsis, anaphylactic shock and reactions
• Cardiac pump failure; congestive heart failure, myocardial infarction, hypertensive heart disease, valvular disease, and pericardial tamponade

Renal Conditions

• Use of nephrotoxic agents (e.g. gentamicin)
• Transfusion reactions
• Diseases of the glomeruli (e.g. nephritis)
• Neoplasms
• Systemic diseases (e.g. diabetes)
• Hereditary diseases (e.g. polycystic kidney)
• Infections

Postrenal Conditions

• Ureteral, bladder or urethral obstructions, due to calculi, blood clot, tumors, and strictures
• Prostatic hypertrophy
• Neurogenic bladder
• Pelvic tumor
• Retroperitoneal fibrosis

ROLE OF NURSE

The role and responsibilities of nurse, when managing the urinary elimination in their clients include the following:

• Taking nursing history pertaining to client with partial emphasis on urinary elimination
• Conducting or assessing physical assessment of kidneys, bladder, urethral orifice, skin integrity and hydration and urine
• In addition, carrying out the following assessment measures like measuring urine output, collecting urine specimens, determining the presence of abnormal constituents, assisting with diagnostic procedure

COMMON URINARY DISEASES

Anuria: technically, no urine is voided for 24-hour-urine output is less than 100 ml

Dysuria: difficulty in voiding, may or may not be associated with pain, a feeling of warm local irritation occurring during voiding is called “burning”

Frequency: increased incidence of voiding

Glycosuria: presence of sugar in the urine. it may be due to an unusually large intake of sugar or to marked emotional disturbance and is temporary

Hematuria: presence of blood in the urine

Incontinence: inability to voluntarily control the discharge of urine

Nocturia: frequency of urination during the nights

Oliguria: scanty or greatly diminished amount of urine voided in a given time (24 hours urine output is 100-400 ml)

Orthostatic albuminuria: presence of albumin in urine that is voided after periods of standing, walking or running. It is the phenomenon of circulatory systems

Pneumaturia: passage of urine containing gas

Polyuria: excessive output of urine (diuresis)

Proteinuria: presence of protein, usually albumin, in the urine

Pyuria: pus in the urine. Urine appears cloudy.

Enuresis: it is defined as repeated involuntary urination in children beyond 4 to 5 years of age, when voluntary bladder control is normally acquired

Enuresis can be nocturnal (night time) and diurnal (day time) or both

Urinary incontinence: it is the ability to control passage of urine to continence may be caused by stress. Neurological impairment and injury to urethral sphincter

Urinary retention: it is the accumulation of urine in the bladder associated with inability of the bladder to empty itself

BLADDER IRRIGATION

INSERTION OF A FLATUS TUBE

USE OF URINAL

CATHETERIZATION OF THE URINARY BLADDER

URINARY BLADDER CATHETERIZATION

Urinary catheterization is a medical procedure in which a thin, flexible tube called a catheter is inserted into the urinary bladder through the urethra to drain urine. This procedure may be necessary for various reasons, and it can be performed in different settings, such as hospitals, clinics, or even at home under certain circumstances.

Here are some common reasons for urinary catheterization:

1. Urinary Retention: When a person is unable to empty their bladder naturally, either due to a medical condition, surgery, or other factors, a catheter may be inserted to allow for the drainage of urine.
2. Surgery: Catheterization is often performed before, during, or after certain surgical procedures, especially those involving the genitourinary system or pelvic area.
3. Monitoring Urine Output: In critically ill patients or those undergoing surgery, healthcare providers may use catheters to closely monitor urine output and assess kidney function.
4. Urinary Incontinence: In some cases, especially in individuals with severe urinary incontinence, catheters may be used as a means of managing and collecting urine.

There are different types of urinary catheters, and the choice depends on the specific needs of the patient and the medical situation. The main types include:

• Indwelling Catheters (Foley Catheters): These are left in place for an extended period and have a balloon at the tip to hold them in the bladder. They are often used for patients who are unable to void on their own.
• Intermittent Catheters: These are inserted and removed several times a day to empty the bladder. They are commonly used for short-term purposes or in cases where regular emptying is needed.
• External Catheters (Condom Catheters): These are used in males and are attached externally to the penis to collect urine. They are typically used for managing urinary incontinence.

Urinary catheterization is the introduction of a tube (a catheter) through the urethra into the urinary bladder to drain the bladder

Urinary catheterization is an aseptic method of introducing the catheter into the urinary bladder through the external urethra for withdrawal of urine

Purpose

• To obtain a clear specimen for diagnostic purpose
• To relieve distension of bladder caused by retention of urine
• To determine whether the failure to void is due to retention or suppression
• To determine the amount of residual urine present in the bladder
• To empty the bladder prior to surgery, bladder, irrigation or before instillation of a drug
• To avoid soiling and infection of the wound following operations on the genital region
• To manage incontinency, when all other measures to prevent skin breakdown have failed
• To provide for intermittent or continuous bladder drainage and irrigation
• To prevent urine from passing over a wound, e.g. after repair of the perineum

Principle Involved

• Pathogenic organisms are transmitted from the source to a new host directly on by contaminated articles
• Urinary bladder is a sterile cavity and the urinary meatus act as a portal of entry for pathogenic organisms
• Cleaning an area minimize the spread of organisms
• A break in the integrity of the skin and mucus membrane provides ready entrance for microorganism
• Lubrication reduces friction
• Through knowledge of anatomy and physiology of the genitourinary system facilitates catheterization of the urinary bladder
• Systematic ways of doing saves times, energy and material
• Unfamiliar situation produce anxiety

General Instruction

• Apply all the nursing measures to induce urination before the catheterization of the bladder
• Observe strict aseptic techniques to prevent the urinary tract infection
• Catheterization should be done slowly and never use force
• Always catheterize in a good light
• Clean the perineum from the pubis downwards to the anal region
• Use one cotton ball for one swabbing
• Do not touch the portion of the catheter that is going into the urinary tract
• Lubricate the catheter well before introducing into the urinary tract
• Keep the patient relaxed by providing privacy and adequate explanations

Preliminary Assessment

Check

• Doctors order for any specific precautions
• Identify the purpose of catheterization
• Level of consciousness
• Any contraindications
• General condition of the patient
• Mental status to follow instructions
• Articles available in the unit

Preparation of Patient and Environment

• Explain the sequence of the procedure
• Arrange the articles at the bed side locker
• Provide privacy
• Position the patient in dorsal recumbent
• Place the Mackintosh and towel under the buttocks
• Provide adequate light by placing extra spotlight

Types of Urinary Catheters

• Round-ended catheter
• Double lumen catheter
• Triple lumen catheter
• Tirmann catheter
• Whistle-tipped catheter

Equipment

A sterile tray containing:

• Catheter of correct size
• Small bowl containing an antiseptic
• Cotton swabs
• Pair of gloves
• Thumb forceps and artery forceps-one each
• Sterile kidney tray – 1 prefilled syringe with sterile water
• Sterile towel, sterile drainage tubing and collection bag
• Test tube or specimen bottle
• Small cup containing lubricant

A clean tray containing

• Mackintosh and towel
• Flashlight or spotlight
• Bath blanket
• Kidney tray
• Adhesive tape and scissors
• Bed pan to empty the urine from the kidney tray
• Measuring jar
• Urobag or collection bag

Procedure

• Scrub hands as for a surgical procedures
• Lift the draping sheet back towards abdomen
• Open the sterile tray with aseptic techniques
• Place the sterile towel and the slit in position
• Place the sterile kidney tray on the sterile towel in front of the patient
• Lubricate the catheter and place it in the sterile tray ready for insertion
• Clean the perineum with the cotton balls dipped in the antiseptic lotion using the forceps
• Discard the swab in the paper bag and discard the forceps in an unutterable kidney tray
• Pick up the catheter with the gloved hand, holding it about 7.5 cm from the tip and place the distal end in the sterile kidney tray
• Gently insert the catheter about 5 to 7.5 cm (female) the urine will flow into the kidney tray
• Collect the urine specimen if required. Attach the drainage tubing if an indwelling catheter is put in

Clean the Perineum in Female Patients

• Clean only in one direction
• Use one swab for one swabbing
• Clean labia majora on both sides
• Clean the inside of the labia majora on both sides
• Clean the labia minora on the both sides
• Clean the vulva

Cleaning the Perineum for Male Patients

• Retract the foreskin during the cleaning process
• Draw the penis upward and forward at 90 degree angle to the patients leg in order to straighten the urethra before the catheter is introduced
• Foreskin is replaced as quickly as possible after the insertion of the catheter

After Care

• Wash and dry the perineum
• Remove the drapes, replace the garments and bed covers
• Place the patients comfortably
• Take all the articles to the utility room, clean it and replace it
• Send specimen to the laboratory immediately
• Wash hands
• Record the procedure in the nurse’s record sheet

Types of catheterization

• Intermittent catheterization
• Short-term indwelling catheterization
• Long-term indwelling catheterization

USE OF URINAL IN HOSPITALS

Urinals in hospitals serve several purposes, contributing to the overall functionality and hygiene of healthcare facilities. Here are some ways in which urinals are used in hospitals:

1. Patient Care and Convenience: Hospitals often use urinals as a convenient way for patients to urinate while in bed or when mobility is limited. This is particularly important for patients recovering from surgery, those with medical conditions affecting mobility, or those who are bedridden.
2. Postoperative Recovery: After certain surgeries or medical procedures, patients may have difficulty getting to a bathroom. Portable urinals can be used to collect urine, providing a more comfortable and convenient option for patients during the recovery period.
3. Bedside Care: Healthcare professionals use urinals as part of bedside care, assisting patients who may have difficulty reaching the bathroom independently. This is common in situations where patients are weak, recovering from surgery, or have mobility limitations.
4. Incontinence Management: Urinals are utilized in hospitals to manage urinary incontinence. Patients who may have difficulty controlling their bladder function can use urinals as a means of maintaining hygiene and dignity.
5. Patient Monitoring: Monitoring urine output is an essential aspect of patient care. Urinals can be used to collect urine for measurement, helping healthcare providers assess kidney function, fluid balance, and other aspects of a patient’s health.
6. Emergency Situations: In emergency situations, such as when a patient cannot be moved quickly to a bathroom, urinals provide a practical solution for immediate waste elimination.
7. Preventing Falls and Injuries: For patients at risk of falls or injuries during bathroom trips, using urinals in the bedside setting can reduce the likelihood of accidents and improve overall patient safety.

Urinal is used for male patients to void the urine the nurse should insist the bedridden to void into a urinal (a plastic or metal receptacle for urine) in bed

In case of female patients nurse should provide bed-pan for bedridden to collect the urine

Purposes

• To promote comfort
• To assist the void
• To prevent bed wetting
• To maintain the urinary output record
• To minimize the physical strain

Factors Influences

• Normal urinary elimination habits
• Nature of disease condition
• Environment (privacy)
• The amount of intake (food and fluids)
• Availability of equipment and personal

Preliminary Assessment

Check

• Doctors order for specific precautions such as movements and position
• Level of consciousness
• Self-care ability of the patient
• Frequency of urination
• Articles available in the unit

Preparation of the Patient and Environment

• Provide adequate privacy
• Arrange the article (urinal) ready at bed side
• Place the Mackintosh and draw sheet
• Place the patient in proper body alignment

Equipment

• Clean urinal
• Disposable gloves
• Clean linen if required
• Hand washing basin, mug and water
• Soap with soap dish
• Measuring jar

Procedure

• Wash hands thoroughly
• If the patient is conscious, allow him to place or else position penis into urinal
• Prevent soiling of urine on bed or patients body
• Remain with helpless patient; get assistance from relatives if needed
• Remove urinal after patient has voided
• Measure and empty the urine in sluice room

After Care

• Assist the patient to wash perineal area and hands
• Place the patient in a proper body alignment
• Change the bed linen, if required
• Replace the articles used after cleaning
• Wash hands
• Record the procedure in nurse’s record sheet and the amount in intake output chart

BLADDER IRRIGATION

Bladder irrigation is a medical procedure commonly used to flush out the bladder with a sterile solution. This procedure is typically performed for therapeutic or diagnostic purposes and is carried out by healthcare professionals.

Here are some common reasons for bladder irrigation:

1. Hematuria (Blood in the Urine): Bladder irrigation may be used to treat or prevent blood clot formation in the bladder in cases of significant hematuria. The irrigation helps remove clots and blood from the bladder, reducing the risk of obstruction.
2. Postoperative Care: After certain urological surgeries, such as transurethral resection of the prostate (TURP) or bladder tumor removal, bladder irrigation may be performed to prevent blood clot formation and ensure clear urine drainage.
3. Infection Control: Bladder irrigation with an antimicrobial solution may be used to manage or prevent urinary tract infections (UTIs) in some cases.
4. Chemotherapy or Immunotherapy: Bladder irrigation may be employed in the treatment of bladder cancer. Medications, such as chemotherapy or immunotherapy agents, can be instilled into the bladder and then drained out to target cancer cells.
5. Diagnostic Procedures: Bladder irrigation may be part of diagnostic procedures, such as cystoscopy, to provide clear visualization of the bladder lining.

The procedure involves the insertion of a catheter into the bladder through the urethra. A sterile irrigation solution is then introduced into the bladder, and the fluid is allowed to drain out, carrying away debris, blood, or other substances. The process is typically repeated until the drained fluid is clear.

Bladder irrigation requires careful monitoring to avoid complications, and it should only be performed by trained healthcare professionals. Patients undergoing bladder irrigation may experience temporary discomfort, urgency, or increased frequency of urination.

Bladder irrigation or wash is defined as washing of the urinary bladder by directly a stream of solution into the bladder through the urinary meatus by means of a catheter tubing and funnel

Purpose

• To cleanse the bladder from decomposed urine bacteria, excess mucus and pus
• To medicate the lining of the bladder of antiseptic irrigation
• To prepare the bladder for surgery as a preoperative measure
• To promote healing
• To relieve congestion and pain in case of inflammatory conditions of cystitis
• To arrest bleeding and prevent clothing of blood

Solution Used

• Normal saline 0.9%
• Boric acid solution 2%
• Sterile water
• Acetic acid 1:4000 to treat pseudomonas infection
• Sodium nitrate 1:8000 to prevent clot formation
• KMO₄ 1:5000 – 1:10,000
• Acriflavin 1:10,000
• Silver nitrate 1:5,000
• Mercury compounds in low concentration

General Instructions

• The temperature of the solution needed for cleaning purpose body temperature in enough
• The temperature of the solution needed for therapeutic purposes ranging from 100-110 degree F
• The maximum amount of solution used for cleaning is 2 pints and also depends on the patient’s condition

Methods of Administration

• Funnel and tubing method (open method)
• Irrigation can, rubber tubing and Y connection
• Asepto syringe (open method)

Preliminary Assessment

Check

• Doctors order for specific precautions and instructions
• General condition of the patient
• Diagnosis of the patient
• Self care ability of the patient
• Mental status to follow instructions
• Articles available in the unit

Preparation of the Patient and Environment

• Explain the sequence of the procedure
• Arrange the articles at the bed side
• Provide privacy
• Place the patient in comfortable position
• Place the Mackintosh under the buttocks

Equipment

Sterile Catheterization Pack

A sterile tray containing:

• Funnel, tubing 3 feet long which fits the connection screw clip and glass connection
• A small mug or pint measures to pour solution
• A sterile pint jug with required solution
• Solution thermometer kept in antiseptic solution in a bottle if available
• Medication if ordered
• Bucket for emptying the return flow
• Litmus paper

Procedure

• Wash hands thoroughly
• Wear gloves and empty the bladder keeping outlet of catheter uncontaminated
• After urine withdrawal, attach glass, connection, tubing and funnel to the catheter
• Place bucket or kidney tray conveniently near the meatus
• Hold the funnel lowered with one hand and with other hand pour 75-100 ml of solution along sides of the funnel
• Raise the tube and keep the funnel 30 cm above bed level
• Never allow the funnel to be empty, lower the funnel and slowly invert in over the bucket
• Repeat procedure until the return flow is clear
• At the end of the procedure, clamp tubing disconnects glass connection, tubing and funnel, gently remove catheter and complete
• In case of self-retaining catheter connect it to the drainage bag

After Care

• Provide catheter care
• Remove the Mackintosh and position the patient comfortably
• Cover the patient with bed sheets
• Replace the articles after cleaning
• Wash hand thoroughly
• Record the procedure and observations in the nurse’s record sheet

Sterilization in hospitals is a critical process designed to eliminate or destroy all forms of microbial life, including bacteria, viruses, fungi, and spores, from surfaces, instruments, and equipment. Sterilization is essential to prevent the transmission of infections between patients and to maintain a safe and sanitary healthcare environment.

STERILIZATION – Definition, Purpose, Scientific Principles, Methods of Sterilization

Sterilization in hospitals is one of the important processes in order for prevention of hospital acquired infections. Bacterial spores are the most resistant of all living organisms because of their capacity to withstand external destructive agents. Although the physical or chemical process by which all pathogenic and microorganisms, including spores, are destroyed is not absolute, supplies and equipment are considered sterile when necessary conditions have been met during a sterilization process

DEFINITION

• Sterilization is the process by which an object becomes free of all the microorganisms. By sterilization, both the pathogenic and non-pathogenic organisms are destroyed
• Sterilization is a process by which the pathogenic as well as spores and viruses are destroyed
• Sterilization is the process by which an article, a surface or a medium free from all microorganisms, both in vegetative and sporing states, by removing or killing them

PURPOSE

• To render the supplies/articles free from pathogens
• To make complete destruction of microorganism
• To sterilize instruments and equipments used in the surgical practice
• To keep the articles in such a condition that they are ready for use at any time
• For the safety of the patients

SCIENTIFIC PRINCIPLES

• Dust and dirt harbors microorganisms which adversely affect the well-being of patients and retards recovery
• Proper care of articles prolong its life ensures their utility and provides a neat and finished appearance which promotes a feeling of comfort
• Selection of appropriate simple methods of sterilization saves energy, time and material
• Water is a universal solvent and so produces surface tension
• Friction helps in removing dirt and microorganisms from surface
• Unpleasant odor, sight and noise are disturbing to the patient

METHODS OF STERILIZATION

• Natural method of sterilization: this method is used to sterilize contaminated linen and bedpans. Direct sunlight will have an effect on acid-fast microorganism. Place the linen or bedpans in direct sunlight for 6 hours for two consecutive days
• Physical method of sterilization: heat kills all types of bacteria. Boiling is the most commonly used method, but spore forming bacteria and viruses are not killing by boiling
• Chemical method of sterilization: it is also called as cold sterilization or disinfection by the disinfectants. A chemical disinfectant is used which acts by coagulating the bacterial protein or by changing the composition of protein so that is no longer exists in the same form
• Radiation or ultraviolet light sterilization: this method is expensive. But nowadays, it is used for the sterilization of plastic items such as disposable saline sets, catheters, Ryle’s tubes, disposable syringes, etc

STERILIZATION IN THE HOSPITAL

CENTRAL STERILE SUPPLY DEPARTMENT (CSSD)

CHEMICAL DISINFECTANTS

RADIATION METHOD OF STERILIZATION

HOT AIR OVEN

AUTOCLAVING

PHYSICAL METHODS OF STERILIZATION

Physical methods of sterilization involve the application of heat, radiation, or filtration to eliminate or destroy microorganisms and their spores.

Here are some common physical methods of sterilization:

1. Autoclaving:
   • Method: Autoclaving utilizes steam under pressure.
   • Process: The items to be sterilized are exposed to high-pressure saturated steam at temperatures typically ranging from 121 to 134 degrees Celsius (250 to 273 degrees Fahrenheit).
   • Application: Autoclaving is effective for sterilizing surgical instruments, laboratory glassware, and other heat-resistant materials.
2. Dry Heat Sterilization:
   • Method: Dry heat sterilization involves hot air.
   • Process: Items are exposed to high temperatures (e.g., 160 to 180 degrees Celsius) for an extended period.
   • Application: Dry heat is suitable for items that may be damaged by moisture, such as powders, oils, and certain glassware.
3. Incineration:
   • Method: Incineration involves burning materials.
   • Process: The items are exposed to high temperatures until they are completely burned.
   • Application: Incineration is often used for the disposal of contaminated waste, particularly in laboratories.
4. Pasteurization:
   • Method: Pasteurization uses heat.
   • Process: This method involves heating liquids or food products to a specific temperature for a predetermined time to kill or reduce the number of pathogenic microorganisms.
   • Application: Commonly used in the food and beverage industry for items like milk and juices.
5. Radiation Sterilization:
   • Method: Radiation includes gamma radiation and electron beams.
   • Process: Items are exposed to ionizing radiation, disrupting the DNA of microorganisms.
   • Application: Gamma radiation is used for sterilizing medical devices, pharmaceuticals, and certain disposable items.
6. Filtration:
   • Method: Filtration uses porous materials.
   • Process: Liquids or gases are passed through filters with pore sizes small enough to trap microorganisms.
   • Application: Filtration is common for sterilizing liquids, especially in pharmaceutical and biotechnology industries.

PHYSICAL METHODS OF STERILIZATION

Heat kills all types of bacteria. Boiling is the most commonly used method in day-to-day working

Heat is the safest and most useful agent for sterilization in hospitals. Methods of applying heat for sterilization are exposure to steam under pressure, boiling, etc

Boiling (Moist heating): boiling an instrument/article immersed fully in boiling water (100 degree Celcius) for 10 minutes will kill most of the pathogenic organisms

General Instructions

• The articles should be clean
• The articles should be fully immersed in water
• Close the sterilizer lid tightly
• Note the time after the water has started to boil
• Boil it for 7 to 10 minutes
• Remove the articles with chattel forceps

Precautions

• Do not pick articles in between, when the boiling is in process
• Do not boil sharp instruments such as scissors, knives, needles, etc. because boiling blunt them

Advantages

• Boiling can be used in the home environment and other situation
• It is one of the economic ways of sterilizing articles

Disadvantages

• Some bacteria and viruses and all spores are resistant to boiling
• Boiling method cannot be used for the articles which are destroyed by moisture and heat
  

Autoclaving is a widely used and effective method of sterilization that involves the use of steam under pressure to kill or eliminate microorganisms, including bacteria, viruses, and spores.

AUTOCLAVING or AUTOCLAVE

Autoclaving is the most common method used for sterilizing surgical instruments. It accomplishes sterilization dependably without damage to most of the instrument

It is the best, safest and effective method of sterilization. It destroys the spore forming microorganisms. In this method, high temperature, pressure and humidity is used to destroy the bacteria

Mechanism of Autoclave

• In autoclaving, the sterilization is done by steam under pressure. In an autoclave water boils and its vapor pressure equals that of the surrounding atmosphere.
• When pressure increases inside a closed vessel the temperature at which boils also increases. Saturated steam has better penetrating power
• When steam comes into contact with a cooler surface, it condenses into water and given up its latent heat to that surface

Temperature: 121 degree celcius

Pressure: 15 pounds per square inch (PSI)

Time: 15-45 minutes

Instruments Used for Sterilization

• Surgical instruments
• Syringes and needles
• Linen including gowns
• Masks
• Abdominal swabs and dressing

General Instructions

• All articles must be clean and dry
• The wrapper and container should allow penetration of the steam into the article
• The drum should not be too full nor the contents arranged too compactly
• Cans and jars must be opened and turned to their sides so that steam can penetrate the contents
• The temperature and pressure of the steam must be 121 degree Celcius and 1.05 kg/cm². So that it will kill all types of microorganisms
• The destruction of bacteria depends upon the length of time the articles are exposed to steam under pressure. The minimum time is 30 minutes
• While operating an autoclave, all the air in the chamber must be driven out and replaced by steam
• When the autoclaving is over, wait for half an hour to dry the materials

Autoclave Uses:

1. Sterilization of Surgical Instruments:
   • Autoclaves are commonly used in healthcare settings to sterilize surgical instruments, medical devices, and equipment.
2. Laboratory Sterilization:
   • Research laboratories use autoclaves for sterilizing glassware, media, and other laboratory supplies.
3. Pharmaceutical Industry:
   • Autoclaves are utilized in the pharmaceutical industry to sterilize production equipment and ensure the sterility of pharmaceutical products.
4. Waste Disposal:
   • Autoclaving is employed in the disposal of laboratory waste and certain medical waste to render it non-infectious.
5. Food Industry:
   • In the food industry, autoclaves may be used for canning and preserving food by eliminating harmful microorganisms.

Autoclaving Tips:

1. Proper Loading:
   • Items must be properly arranged to ensure effective steam penetration.
   • Avoid overloading the autoclave to allow for adequate sterilization.
2. Use of Indicators:
   • Chemical and biological indicators are often used to monitor and confirm the effectiveness of the autoclaving process.
3. Regular Maintenance:
   • Autoclaves require regular maintenance to ensure proper functioning and calibration.

A hot air oven is a type of dry heat sterilization device commonly used in laboratories, research facilities, and industries. It operates by using hot air to achieve high temperatures, effectively eliminating microorganisms and achieving sterilization. Here are key features and uses of hot air ovens:

Features:

1. Design:
   • Hot air ovens typically consist of an insulated chamber made of metal, with a heating element to generate heat.
2. Temperature Control:
   • They are equipped with a thermostat or temperature controller to regulate the internal temperature accurately.
3. Timer:
   • Ovens often include a timer to set the duration of the sterilization cycle.
4. Air Circulation:
   • Efficient air circulation is important for even heat distribution throughout the chamber, ensuring uniform sterilization.
5. Ventilation:
   • Some ovens have ventilation systems to release excess moisture during the sterilization process.

Working Principle:

1. Heating Element:
   • The heating element in the oven generates heat.
2. Thermostat Control:
   • The thermostat controls the temperature, maintaining it at the desired level for the specified duration.
3. Sterilization Cycle:
   • Items to be sterilized are placed inside the oven. The sterilization cycle begins when the set temperature is reached.
4. Cooling:
   • After the sterilization process, the oven may include a cooling phase before the items can be safely removed.

HOT AIR OVEN

High temperature and comparatively long exposure times are required for hot air oven. Various types of powders, glass materials, etc. are sterilized by this method

Mechanism of Hot Air Oven

• It works on the principle of sterilization by dry heat

Temperature: 160 degree celcius

Time: one hour

• Articles sterilized include glassware, forceps, scissors, scalpels, syringes, liquid paraffin and dusting powder

Advantages

• All types of microorganisms including spores are killed by this method
• It is safest method of sterilization

Disadvantage

• It is costly method of sterilization

General Instructions

• Glassware should be perfectly dry before placing in the oven
• Oven must be allowed to cool down for 2 hours before door is opened after sterilization
• It should not be overloaded
• Articles should be arranged in such a manner that free circulation ofd air is possible

Uses:

1. Laboratory Sterilization:
   • Hot air ovens are commonly used in laboratories for sterilizing glassware, instruments, and other equipment that can withstand dry heat.
2. Pharmaceutical Industry:
   • In pharmaceutical manufacturing, hot air ovens are used for sterilizing equipment and containers used in drug production.
3. Dental Clinics:
   • Dental instruments that are heat-resistant can be sterilized in hot air ovens.
4. Research Facilities:
   • Research laboratories use hot air ovens for sterilizing media, instruments, and other materials.
5. Textile Industry:
   • Some textile materials and products may be subjected to hot air oven treatment for sterilization.

Advantages:

1. Dry Sterilization:
   • Hot air ovens provide dry heat sterilization, which is suitable for items sensitive to moisture.
2. Ease of Use:
   • They are relatively simple to operate and do not require water or other chemicals.
3. Uniform Heating:
   • Efficient air circulation ensures uniform heat distribution, contributing to effective sterilization.
4. Economical:
   • Hot air ovens are generally cost-effective compared to other sterilization methods.

Radiation sterilization is a method that uses ionizing radiation, such as gamma rays or electron beams, to eliminate or reduce the microbial load on various products, surfaces, or materials. This process disrupts the DNA and other cellular components of microorganisms, rendering them unable to reproduce or cause infections. Here are key aspects of radiation sterilization:

Types of Ionizing Radiation:

1. Gamma Radiation:
   • Source: Gamma radiation is often emitted from a radioactive isotope, such as cobalt-60.
   • Penetration: Gamma rays penetrate deep into materials, making them suitable for the sterilization of dense or bulky items.
   • Application: Commonly used for the sterilization of medical devices, pharmaceuticals, and certain disposable items.
2. Electron Beam (E-beam) Radiation:
   • Source: E-beam radiation is generated using an electron accelerator.
   • Penetration: Electron beams have limited penetration and are suitable for surface sterilization or treating thin materials.
   • Application: Used for sterilizing medical devices, packaging materials, and some pharmaceutical products.

Radiation Sterilization Process:

1. Preparation:
   • Products or items to be sterilized are prepared and packaged appropriately.
2. Irradiation:
   • The items are exposed to ionizing radiation in a controlled environment, either by gamma radiation from a gamma source or by passing through an electron beam.
3. Dose Control:
   • The dose of radiation is carefully controlled based on the type of material and the required level of sterilization.
4. Dosimetry:
   • Dosimeters are used to measure the absorbed dose of radiation, ensuring that the products receive the necessary amount for effective sterilization.
5. Post-Irradiation Handling:
   • After irradiation, the products are handled carefully to avoid recontamination.

Advantages of Radiation Sterilization:

1. Cold Sterilization:
   • Radiation sterilization is a cold process, meaning it doesn’t involve high temperatures that could damage heat-sensitive materials.
2. Uniform Sterilization:
   • Radiation provides uniform sterilization, even in complex or densely packed materials.
3. No Residue:
   • Unlike some chemical sterilization methods, radiation leaves no residues on the sterilized items.
4. Time Efficiency:
   • The process is relatively quick, allowing for efficient sterilization on a large scale.

Applications:

1. Medical Devices:
   • Single-use medical devices, implants, and surgical instruments.
2. Pharmaceuticals:
   • Sterilization of pharmaceutical products and ingredients.
3. Packaging Materials:
   • Sterilization of packaging materials for medical and pharmaceutical products.
4. Cosmetics:
   • Sterilization of cosmetic products to ensure safety and shelf life.
5. Food Industry:
   • Used for sterilizing certain food products, spices, and packaging materials.

RADIATION STERILIZATION

Radiation or ultraviolet light sterilization: this method is expensive. But nowadays it is used for the sterilization of plastic items such as disposable saline set, catheter, Ryle’s tubes, etc

Gas sterilization: ethylene oxide gas is employed as a sterilizing agent in especially designed chambers in which temperature and humidity can be controlled and from which air can be evacuated

After exposure period of 3 to 6 hours is needed. Other gases employed for sterilization are formaldehyde and betapropiolatone

Articles Sterilized

• Surgical instruments with optical lenses
• Tubing and plastic parts of heart lung machines
• Ventilator tubes
• Disposable syringe
• Pillows and mattresses

Advantages

• Exposure to formaldehyde gas under conditions of controlled humidity, temperature, and the time exposure will destroy all vegetative forms of bacteria, viruses, and most of the spores
• The best results can be obtained with high concentration of gas humidity above 60% and temperature of not less than 180 degree celcius

Disadvantages

• Ethylene oxide has a pungent smell
• It is an irritant to eye, mucous membrane and skin

Radiation Method

There are two type of radiation are non-ionizing radiation and ionizing radiation

Non-ionizing radiation methods are infra-red and ultra-violet radiation

Ionizing radiation methods include X-rays, gamma rays; and cosmic rays are highly lethal to DNA and other vital cell constituents

Advantages

• Instruments like disposable syringe catheters hypo-dermic needles and sharp instruments that cannot withstand heat, can be sterilized by this method
• Instruments which are covered in plastic packs or aluminum foils can be sterilized by this method

Disadvantages

• Since radiation in a straight line and do not penetrate only the surface of an object in straight line is irradiated
• The bacteria in shadows are unaffected, so all the surfaces should be exposed to the radiation