Sterilization in Management of Medical Waste

Sanitizing vs Disinfection

Cleaning a surface simply removes visible debris, dirt and dust. Sanitizing a surface makes that surface sanitary or free of visible dirt contaminants that could affect your health. Sanitizing is meant to reduce, not kill, the occurrence and growth of bacteria, viruses and fungi. Disinfecting a surface will deactivate most of the microscopic organisms.

The verb "to clean" means different things in different contexts. The commonplace meaning involves removal of dirt which is obvious to the naked eye. A place or object that is clean in this sense might still have a lot of microorganisms present, including harmful ones. Sanitizing is an attempt to get to a higher level of cleanliness. What do commercial kitchens attempt to get to? The attempt to sanitize, especially surfaces where food is kept or processed outside of a refrigerator.

Industrial hygienists have drawn a distinction between sanitizing and disinfecting. Both are employed to destroy germs - bacteria, viruses, fungi, and molds that may cause infectious disease. When a janitor cleans a public bathroom, his job is to sanitize the toilets. Janitors and restaurant cleaners are not out to disinfect.

Sanitization means to remove or deactivate pathogens to a level considered healthy for general public use. Disinfection means to remove or deactivate almost all pathogens. A dishwasher sanitizes. If you don’t have a dishwasher you can sanitize your dishes with hot soapy water in the sink. Nobody says that plates that come out of a dishwasher are "disinfected."

Both items (e.g. surgical equipment) and rooms (floors, counters) can be sterilized. There are over 20 methods of sterilization including moist heat, dry heat, radiation, liquid chemical solutions, and gaseous sterilization.

There is a middle classification between disinfection and sterilization. This is called "high-level disinfection" and the CDC says it is "complete elimination of all microorganisms in or on an instrument, except for small numbers of bacterial spores." True sterilization involves killing the spores, too, and that is usually accomplished with high temperature.

The FDA says glutaraldehyde, hydrogen peroxide, ortho-phthalaldehyde, and peracetic acid with hydrogen peroxide can be used a high-level disinfectants.

Levels of sterilization

The State and Territorial Association on Alternate Treatment Technologies (STAATT) a “not-for-profit professional and education organization.” put out guidelines on levels of cleanliness. Rather than trying to draw an arbitrary line between the old terms disinfection and sterilization (which were created before we understood microbiology), the STAATT system denotes levels of “microbial inactivation.” These levels give everyone in the industry a common vocabulary for when it comes to figuring whether treatment processes are good enough. The levels defined for microbial inactivation are:

Level I: 6 log10 reduction of vegetative bacteria, fungi and lipophilic viruses. 6 log10 means 999999/1000000 organisms are killed, deactivated, or removed. 0.0001 percent or fewer remain.

Level II: Level I plus 6 log10 reduction of parasites, mycobacteria, and hydrophilic viruses.

Level III: Level II plus 4 log10 reduction of Geobacillus stearothermophilus spores and Bacillus atrophaeus spores.

Level IV: Level II plus 6 log10 reduction of Geobacillus stearothermophilus spores at a 6 log10 reduction or greater.

A 6 log 10 level is also called Sterility Assurance Level - or SAL - of 10-6.

More on cleaning.