CONCURRENT & TERMINAL DISINFECTION

TERMINAL DISINFECTION Concurrent & Terminal Disinfection – Steps and Procedure

UPDATED 2024

Terminal disinfection typically refers to the thorough disinfection of surfaces and equipment in a healthcare setting, particularly in areas such as patient rooms, operating rooms, and other high-risk areas where the spread of infections can occur. The goal is to eliminate or reduce the presence of pathogens, including bacteria and viruses, to prevent the transmission of infections.

Here are some general steps and considerations for terminal disinfection in healthcare settings:

1. Personal Protective Equipment (PPE): Ensure that individuals performing the disinfection process wear appropriate PPE, including gloves and, if necessary, masks and gowns.
2. Cleaning: Before disinfection, surfaces should be cleaned to remove any visible dirt or organic material. Use a detergent or cleaning solution appropriate for the surfaces being cleaned.
3. Disinfection Agents: Choose an appropriate disinfectant based on the type of pathogens you are targeting. Common disinfectants include quaternary ammonium compounds, hydrogen peroxide, and bleach. Follow the manufacturer’s instructions for dilution and contact time.
4. Application Method: Apply the disinfectant according to the recommended method. This could involve using wipes, sprays, or other application devices. Ensure thorough coverage of all surfaces, especially high-touch areas.
5. Contact Time: Allow the disinfectant to remain on surfaces for the recommended contact time. This is the time the disinfectant needs to be in contact with the surface to effectively eliminate pathogens.
6. Ventilation: Ensure proper ventilation in the area being disinfected. This helps to reduce the concentration of disinfectant fumes and aids in the drying of surfaces.
7. Equipment and Furniture: Disinfect all movable equipment and furniture in the room, including bedrails, tables, and medical devices. Pay extra attention to high-touch surfaces.
8. Waste Disposal: Dispose of disposable items, cleaning materials, and any waste generated during the disinfection process according to established protocols.
9. Post-Disinfection Inspection: After the disinfection process, perform an inspection to ensure that all surfaces are adequately disinfected. Re-clean and re-disinfect any areas that may have been missed.
10. Documentation: Maintain records of the disinfection process, including the disinfectant used, concentration, contact time, and any issues encountered during the process.

DISINFECTION OF ARTICLES

Disinfection means destroying of all the pathogenic organisms. It is done either by physical or chemical method.

Types of Disinfectants

• Alcohols
• Ethanol
• Isopropanol

Advantages: wide microbicidal activity, noncorrosive

Disadvantages: not universally sporicidal, limited residual activity, fire hazard

Recommended for: hand disinfection in outpatient clinics

• Aldehyde
• Glutaraldehyde
• Orthophthaldehyde

Advantages: wide microbicidal activity and are sporicidal and fungicidal

Disadvantages: glutaraldehyde is potentially a toxic health hazard

Recommended for: 2% glutaraldehyde with alkaline pH used for disinfecting laminated non-autoclavable equipments

Orthphthaldehyde replacing glutaraldehyde as a nontoxic disinfectant

• Oxidizing agents
• Sodium hypochlorite

Advantages: wide microbicidal activity and are sporicidal and fungicidal

Disadvantages: corrosive

Recommended for: useful for disinfecting surfaces, water contamined equipments

• Hydrogen peroxide

Advantages: wide microbicidal activity and are sporicidal and fungicidal

Disadvantage: unstable compound; to be used in correct concentration

Recommended for: used for logging – high level disinfection of Operation Theater when used in concentration of over 6%

• Phenolics

Advantage: easily available, cheap

Disadvantage: corrosive to the skin and sometimes toxic to sensitive people. Household disinfectants

Recommended for: resistant organisms are common

Suitable for surface disinfection of residential premises

• Quaternary ammonium compounds

Advantages: active against enveloped viruses

Disadvantages: low sporicidal activity

Recommended for: low level disinfectants

Disinfectant

• Should be efficient
• Should be used in the correct strength
• Should be applied for a sufficient length of time
• Should not be injurious to the articles
• The article should be fully immersed in it

CONCURRENT DISINFECTION

Concurrent disinfection is the immediate disinfection of all contaminated articles and bodily discharges during the course of the disease

Concurrent disinfection of the contaminated articles immediately, then and there during the course of illness. It includes cleaning the isolation unit daily with effective disinfectant

• Urinals and bedpans: after emptying clean with brush soak in carbolic solution 1:40 for disinfection of articles: 10 minutes
• Sputum mugs: collect the sputum in a sputum mug with disinfectant lotion. When container is full, it should be boiled or buried
• Linen: keep the linen in a carbolic solution or any other effective disinfectant for 4 hours rinse, dry and send to laundry
• Blankets: autoclaving is the best
• Mattresses and pillow: place in direct sunlight for 6 hours for two consecutive days
• Mackintosh: soap in Lysol or phenol 1:40 or 4 hours. Wash and dry in shade
• Paper, cotton swabs, books: burn in disposal of all wastes by incineration
• Disposal of excreta: especially for enteric isolation the urine and stool should be mixed with equal quantity of ( 1 part of lime to 4 parts of water) and allowed to stand for two to four hours. Then disposed by burial

Disinfectant should not be added in stool and discarded in septic tank as the disinfectant hinders the natural biological action

TERMINAL DISINFECTION

Terminal disinfection means disinfection of the patients unit and all the articles used after the discharge, transfer or death of the patient who was suffering from the contagious disease

It means after the patient has recovered from a communicable disease, the disinfection of the room and articles used by him is done after his discharge from the unit or transfer or death

Fumigation with sulfur: fumigation is disinfection by exposure to the fumes of a vaporized disinfectant or use of fumes or gases to destroy organisms. Fumigation with sulfur- the room should be filled with steam form a kettle. Sulfur in an earthen ware which is kept in a large container with water. Pour methylated spirit over the sulphur, put the sulphur afire and close the room

Fumigation with formalin: it is done with potassium permanganate crystals and formalin is used for this purpose. Mix and place them in a metal bowl. For 100 cu feet, 140 gm of KMO₄ and 250 ml of formalin are to be used then room should be closed completely and seated for 24 hours for effective disinfection

Isolation technique, a medical aseptic practice, inhibits the spread and transfer of pathogenic organisms by limiting the contacts of the patient and creating some kind of physical barrier between the patient and others. In isolation techniques, disinfection procedures are employed to control contaminated items and areas.

Disinfection is described as the killing of certain infectious (pathogenic) agents outside the body by a physical or chemical means. Isolation techniques employ two kinds of disinfection practices, concurrent and terminal