Chapter 11 : Decontamination, Disinfection, and Sterilization

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Most disinfectants were introduced to the market more than 30 years ago and little is known about their modes of action and the mechanisms of resistance. In addition, a few basic procedures in decontamination, disinfection, and sterilization have been tested in randomized clinical trials. This chapter cites highest level of evidence available. Even the definition of sterilization as the absence of any viable microorganisms must be revised to address the prions responsible for Creutzfeldt-Jakob disease (CJD) and variant CJD (vCJD). Semicritical equipment should be processed with a high-level disinfectant such as glutaraldehyde, stabilized hydrogen peroxide, peracetic acid, or a chlorine compound. The chapter discusses use of peracetic acid for chemical sterilization of instruments and endoscopes. Studies of sheep naturally infected with scrapie demonstrated that the infectious agent first appears in lymphatic tissue of the tonsils and gastrointestinal tract, suggesting the oral route may be the principal mode of transmission. Numerous studies underline the importance of the B cell in transmission of the bovine spongiform encephalopathy (BSE) agent. In May 2005, British officials published an excellent assessment of the risk for contaminating surgical instruments with prions. The key observation in this report is that on average 0.2 mg of protein remains on surgical instruments despite “standard cleaning and disinfection,” which was sufficient to cause an experimental case of CJD. Therefore, more research and new methods of cleaning and disinfection are needed for surgical instruments.

Citation: Widmer A, Frei R. 2011. Decontamination, Disinfection, and Sterilization, p 143-173. In Versalovic J, Carroll K, Funke G, Jorgensen J, Landry M, Warnock D (ed), Manual of Clinical Microbiology, 10th Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816728.ch11

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Herpes simplex virus 1
Severe Acute Respiratory Syndrome
Herpes simplex virus 2
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Microorganisms' resistance to disinfectants. HSV, herpes simplex virus; CMV, cytomegalovirus; RSV, respiratory syncytial virus.

Citation: Widmer A, Frei R. 2011. Decontamination, Disinfection, and Sterilization, p 143-173. In Versalovic J, Carroll K, Funke G, Jorgensen J, Landry M, Warnock D (ed), Manual of Clinical Microbiology, 10th Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816728.ch11
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