DISINFECTION ROUTINE:
Name Disinfection method Frequency & other considerations
Baby linen, blanket cover Wash and autoclave Use autoclaved linen each time
Cotton gauze Autoclave As required.
Feeding utensils (paladai, Wash with soap and water Before each use
spoon & katories etc.) and then boil for 10 minutes
Swab container, injection Wash with soap and Daily morning shift use separate
and medicine tray water / autoclave swab containers for each baby
Sets for procedures Autoclave After each use ; every 72 hours
if not used
Cheattle forceps Autoclave Daily. Put in sterile autoclaved bottle
containing dry sterile cotton
Stethescope, measuring tape, Clean with alcohol swab Daily and before use
thermometer, BP cuffs, probes of
radiant warmer/incubator pulse oximeter
Laryngoscope Clean with alcohol swabs If used for an infected baby, wash
thoroughly daily and after with soap and water. Put the blade
each use. Wrap in in 2% gluteraldehyde after removing
autoclaved cloth, put date the bulb. Wash thoroughly after
on cover. removing from gluteraldehyde in sterile
water.
Syringe pumps and monitors Clean with wet clean cloth. If blood Daily in morning shift; if possible, in
stained, use soap and water. Can also each shift
Use alcohol based disinfectant.
Oxygen hood Wash with soap and water; Daily in morning shift.
dry with Clean linen
Face mask Clean with soap and water, immerse Daily and after each use
in gluteraldehyde for 20 min, rinse in
Distilled water, dry and wrap
with autoclaved linen
Resuscitation bag and Clean with detergent/soap and water Weekly for resuscitation bag
reservoirs, oxygen tubing, after dismantling. Immerse in and reservoir. Daily for
bottle and tubing of gluteraldehyde for 4-6 hours. others.
suction machine Rinse in distilled water. Dry, wrap
in autoclaved linen and put a date
Weighing machine Wipe with surface disinfectant Daily in morning shift and
Like bacillol 25 spray when required
Radiant warmer & Clean with bacillol 25 spray Daily
Incubator
HOUSEKEEPING ROUTINE:
Name Disinfection method Frequency & other considerations
Floors Wet-mopping with phenyl Once in each shift so thrice in a day
Or clean with 0.1% hypochlorite solution NO dry sweeping
Walls 2% Bacillocid Once in each shift
Fans Wipe with wet clean cloth Once a week
Window AC Surface and filters to be washed Once a week
with soap and water
Refrigerator Defrost and clean with soap and water Once a week
Buckets Soap and water Daily in the morning shift
Sinks Detergent or powdered soap Once in each shift or as required
STERILISATION AND DISINFECTION METHODS AND AGENTS:
METHOD/CHEMICAL AGENT PRINCIPLE RECOMMENDED USE &EXAMPLE
1.AUTOCLAVING Essential parameters: Steam (dry, used for steel instruments, baby linen,
saturated), time, temperature and dressing packs, cotton and gauze,
pressure. injection and medicine tray
Time to sterilize:
usual cycles: 121C x 30 minutes,
132 C x 4 minutes.
Most widely used and most reliable
method of sterilization
Can be applied only to thermo stable
products
2. ETHYLENE OXIDE (ETO) Essential parameters: Like all sterilization processes, the
effectiveness of ETO sterilization can
Gas concentration (450-1200 mg/L), be altered by lumen length, lumen
temperature (37-60C), relative humidity diameter, inorganic salts, and organic
(40-80%), vacuum, pressure and materials
exposure time (1-6 hours; aeration
requires an additional 8-12 hours). ETO is used in healthcare facilities to
sterilize critical items (and sometimes
semi critical items) that are moisture or
Advantages of ETO are:
heat sensitive and cannot be sterilized
by steam sterilization.
Low temperature
High efficiency – destroys resistant
spores also
Large sterilizing volume/ chamber
capacity
Non corrosive to: plastic, metal and
rubber materials
Disadvantages are:
Excessively Long cycle
Safety concerns - carcinogenic to
humans and toxic residues on
instruments
Not recommended for flexible scope
EtO is flammable
3.AlCOHOL Rapidly bactericidal, tuberculocidal, Used for hand hygiene and as skin
fungicidal, and virucidal but do not antiseptic
Available compounds: Ethyl alcohol, destroy bacterial spores. Alcohols/ alcohol impregnated wipes
Isopropyl alcohol (IPA), N-propanol are used for disinfection of small,
No product cleared by FDA for smooth, clean surfaces (eg trolley
HLD/sterilization tops).
Intermediate/ low level disinfectant Disinfection of rubbers stoppers of
Toxic and inflammable medication vials, thermometers,
No residual activity stethoscopes, scissors, manual
ventilation bags, manikins, ultrasound
instrument, and external surface of
ventilators, electrical / electronic
equipments, which can not be
immersed in disinfectants and
medication preparation areas.
Sterilium Hand rub
[ Each 100gm contain
2 propranolol 45gm &
1 propranolol 30gm ]
Microshield Blue
Each 100 g contains
2-propanol IP: 45 g
1-propanol: 30 g
Ethyl-hexadecyl-dimethyl-ammonium-
ethylsulphate: 0.2 g
Bacillol 25
[ Each 100gm contain
Ethanol 10gm
2 propranolol 9gm &
1 propranolol 6gm ]
4.POVIDINE IODINE Iodine tinctures are acquous solutions ILD for some equipment like
Intermediate / low level disinfectants of iodine in alcohol (0.5-10 % iodine). thermometers and hydrotherapy tanks.
Sometimes used for disinfection of
Iodophors are iodine releasing agents, blood culture bottles
consisting of combinations of iodine • LLD for hard surfaces and non-critical
and a carrier (Povidone-iodine & surfaces (I.V poles, wheel chairs, beds,
Poloxamer iodine). call bells etc.
• Iodine solutions (tinctures): antiseptics
Iodophors have the same antimicrobial on skin/ tissues
activity but are less toxic and non- • Iodophors : antiseptics and
staining. disinfectants
• FDA has not cleared any liquid
Must be diluted according to sterilant / HLD having iodophors as
manufacturer‟s direction since dilution active ingredient.
increases the activity MICROSHIELD® PVP Povidone-
of povidone/iodine (due to higher Iodine Surgical Handwash
availability of active free iodine Contains Povidone-Iodine 7.5%
molecules). equivalent to 0.75% w/v available
Iodine.
Ramadine 5%
Contains Povidone-Iodine 5%
equivalent to 0.5% w/v available Iodine
Ramadine 7.5%
Contains Povidone-Iodine 7.5%
equivalent to 0.75% w/v available
Iodine
Ramadine 10%
Contains Povidone-Iodine 10%
equivalent to 1% w/v available Iodine
5. CHLORHEXIDINE GLUCONATE Chlorhexidine as chlorhexidine Use as antiseptic. Apply alcoholic
gluconate is dissolved in 70% alcohol. chlorhexidine to the skin in the event of
accidental contamination.
Effective against Gram-positive
organisms and HIV. Microshield HAndrub
Not recommended as a general Contains Chlorhexidine Gluconate
disinfectant. 0.5% w/v in 70% v/v Ethanol.
Not active against sporulating bacteria
or non-lipid-containing viruses. Bactorub
Active in pH range 5.5 - 8.0. Contains Chlorhexidine Gluconate
Incompatible with soap and anionic 0.5% w/v in 70% v/v Ethanol.
detergents.
Bactoprep
Contains Chlorhexidine Gluconate 2%
w/v in 70% v/v Ethanol.
MICROSHIELD® 4 Chlorhexidine
Surgical Handwash
Contains Chlorhexidine Gluconate 4%
w/v
Bactoscrub
Contains Chlorhexidine Gluconate 4%
w/v
SODIUM HYPOCHLORITE Preferably make fresh solutions daily Aqueous solution of 5.25-6.15 %
High/ intermediate/ low level for environmental disinfection since sodium hypochlorite is called house
disinfectant depending on diluted hold bleach.
concentration of free available chlorine solutions of hypochlorite are unstable A 1:10 dilution of bleach gives 5250-
and contact time. (there is a 50% reduction in the level 6150 available chlorine. Dilutions may
[e.g. Sodium of free be made according to intended use.
dichloroisocyanurate available chlorine at the end of one
(NaDCC)] month). Disinfection of blood/ body fluid spills
Decontamination of laboratory spills
Loss of free chlorine can be
HLD for selected semicritical devices:
minimized if diluted solutions are kept
dental equipments, CPR mannequins
at room temperature in closed,opaque
(500
plastic containers at pH 8.
ppm available chlorine x 10 minutes),
Kills fast and has broad spectrum Spot disinfection of counter tops and
actions against a wide range of gram- floors
negative and gram positive bacteria. Disinfection of water
Disinfectant in laundry
Precautions: Disinfection efficacy LLD for environmental surfaces and
reduces at alkaline pH. However, do hydrotherapy tanks, baby feeding
not mix chlorine releasing agents with bottles,
acids (including acidic fluids like urine) disinfection of table tops, food
as toxic chlorine gas is released. preparation areas, toilets
Disinfection of regulated medical
waste
Cleanup blood spills 1 part bleach to 9 parts water 0.5%
5000 ppm
Surface Disinfection 1 part bleach to 50 parts water 0.1%
approx. 1000 ppm
Food Surfaces 1 part bleach to 200 parts water 0.025%
approx. 200 ppm
Instruments/surfaces contaminated 1 part bleach to 1 part water / 2.5 to 5%
with tissue infective for CJD undiluted 20000 to 50000 ppm
GLUTARALDEHYDE Optimal Concentration: 2-3.2%; Low temperature disinfection/
Liquid chemical sterilant/ High level generally used as a 2 % activated sterilization of medical equipments like
disinfectant alkaline solution at room temperature endoscopes, anesthetic & respiratory
equipments,
Modified formulations (have reuse life Method of use: Aqueous solutions are .
of 28-30 days): acidic and not sporicidal. They are
Activated dialdehyde solutions activated by alkalinizing to pH 7.5-8.5 Should not be used for cleaning non-
containg 2.4-3.5% glutaraldehyde for sporicidal effect. Activity depends on critical surfaces (toxic & expensive).
Glutaraldehyde phenate pH, temperature, use concentration,
Potentiated acid glutaraldehyde presence of inorganic ions and age of Cidex activated solution
Phenol + 2 % glutaraldehyde solution. 2.4% glutaraldehyde
Stabilized alkaline glutaraldehyde Shelf life: Shelf life of the activated
chemical is approximately 14 days.
QUATERNARY AMMONIUM Commonly used in general
COMPOUNDS Good cleaning agent. environmental cleaning of noncritical
Low level disinfectant Only to be used for environmental surfaces, such as floors, furniture, and
sanitation of non-critical surfaces walls.
Available compounds: (floors, furnitures, walls, food
Benzalkonium chloride preparation areas, key boards). Baccilocid Extra
Ethyl benzyl chloride Each 100gm contains
Dimethyl benzyl ammonium chloride EPA registered compounds can be 1 6 dihydroxy 2 5 dioxahexane
Dodecyl dimethyl ammonium chloride used for non- critical items like BP cuffs Glutaraldehyde 5 gm
& cleansing dirty wounds. Benzalconium chloride 5gm
Alkyl urea derivative 3gm
Precautions: Discard left over solution.
Do not top up stock bottles. Use screw Corsolex Rapid
capped bottles for storage Each 100gm contains
1 6 dihydroxy 2 5 dioxahexane 19.7gm
Relatively non toxic and less corrosive Glutaraldehyde 15.2 gm
Dilutions in use may get
contaminated and grow gram negative
bacteria These are combination of
glutaraldehyde plus quaternary
ammonium compound
PHENOLICS
Intermediate/ low level disinfectant Many phenolic germicides are EPA could be used to pre-clean or
depending on concentration of active registered as disinfectants for decontaminate critical & semi critical
compound environmental surfaces devices before terminal sterilization/
(bed side tables, bed rails, laboratory high level
Available compounds and use surfaces, floors, furnishings and non disinfection
concentrations: Ortho-phenyl phenol, critical medical Commercially available with added
Ortho- benzyl para chlorophenol, p-tert- devices). detergents to provide one- step
amylphenol. Especially useful if surface is cleaning and
contaminated with sputum/ feces disinfection.
Follow manufacturer‟s instructions for
use dilution; general concentrations Use on environmental surfaces (e.g.
range from 0.5-2% Precautions Effective and good for locker,bedrails) and on noncritical
aqueous solutions. general use on vegetative bacteria, lipid medical devices.
containing viruses and Mycobacterium
tuberculosis. Have limited or no
efficacy for use against spores
