1. 소독과 멸균 Disinfection & Sterilization

2. Terminologies 소독 (disinfection) 살균 (sterilization /disinfection)
멸균상태 (sterility)
무균상태 (asepsis)

3. 항미생물제 (Antimcrobial agent)
Disinfectant (소독제)
Antiseptic (방부제?)
Sterilant (멸균제)
Germicide (살균제)
Antimicrobial agent (항미생물제)
• Static agent (정균제)
정균작용 (-stasis) : 생육 정지/억제
Bacteriostatic agent, Fungistatic agent, Viristatic agent
• Cidal action (살균제)
Bactericidal agent (Bactericide), Fungicide, Viricide

4. 항미생물제의 선택적 독성 (Selective toxicity)
Antimicrobial agents should kill/inhibit pathogens in vivo
without harming the host
최소저해농도 (MIC, Minimum Inhibitory Concentration)
The smallest amount or concentration of agent needed
to inhibit the growth of a test organism

5. 감염 위험에 따른 의료기구의 분류 고위험기구 준위험기구 비위험기구 무균 상태의 조직 또는 혈관계에 삽입 멸균 상태이어야 함
점막 또는 손상된 피부에 접촉
살균/멸균 상태이어야 함
비위험기구
손상이 없는 피부와 접촉
살균/소독 상태이어야 함

6. 소독제의 작용기전 단백질 응고 또는 변성에 의한 세포 기능 장해 산화에 의한 세포 기능 장해 단백질과 결합하여 세포 기능 장해
세포막과 세포벽 파괴에 의한 세포 기능 장해
효소 저해에 의한 세포 기능 장해

7. 소독제의 조건 살균력 안정성 용해성 선택적 독성 부식성, 표백성 없을 것 침투력 경제성 사용의 편리성
최소저해농도 (MIC, Minimum Inhibitory Concentration)
석탄산 계수 (Phenol coefficient)
안정성
용해성
선택적 독성
부식성, 표백성 없을 것
침투력
경제성
사용의 편리성

8. 소독제의 종류 Alcohols Phenols Ethanol (70%), Isopropanol (30 - 70%)
Bacteria including Mycobacterium, fungi, virus (no endospores)
Low penetration, Evaporation
Phenols
Phenol (3-5%)
Cresol
Hexylresocinol
Hexachlorphene
Creosote

9. Halogens Chlorine compounds Chlorine
Sodium hypochlorite (NaOCl, 차아염소산나트륨)
Calcium hypochlorite (Ca(ClO)2, 표백분)
Chloramine T
Iodine compounds
Iodine tincture
Povidone-iodine
Lugol’s solution

10. Aldehydes Oxidizing agents Formalin (Formaldehyde) Glutaraldehyde
Opthalphthalaldehyde
Oxidizing agents
Hydrogen peroxide
Unstable : used with benzoic acid (3% stabilized solution)
* Catalase
Potassium permanganate (KMnO4)

11. Surface active agents Heavy metals Anionic detergent : soap
Cationic detergent (Invert soap) : disinfectant
Heavy metals
Mercury bichloride (HgCl2)
MerchrochromeTM (Merbromin) ; organomercuric compound
Silver nitrate (AgNO3)
Copper sulfate (CuSO4)

12. Others
Chlorhexidine
MerthiolateTM (Thiomersal): cyclohexidine digluconate
Acrinol (Rivanol TM) : Ethylacridine lactate
Boric acid (H3BO3)

13. 멸균 (Sterilization) Heat sterilization Radiation sterilization
Dry heat sterilization : Flaming, Dry heat sterilization
Moist heat sterilization : Boiling, Pasteurization, Autoclaving
Intermittent heat sterilization
Radiation sterilization
Microwave, UV, X-ray, Gamma ray, Neutron, Cathode ray
Gas sterilization
Ethylene oxide, Ozone, Formaldehyde, β-propiolactone (BPL)
Hydrogen peroxide gas plasma (Sterrad unit™ )
Filtration
Depth filter, Absolute (membrane) filter

14. 가열멸균 (Heat Sterilization)
고압증기멸균 (Autoclaving)
Moist heat sterilization (습열멸균) : More effective than dry heat
Designed to destroy bacterial endospores
High pressure steam ( > 15 min at 121℃ (15 lb/in2, 1.1 kg/cm2)
건열멸균 (Dry heat sterilization)
Hot air ( > 2hr at ℃)
Less effective than moist heat sterilization

15. 저온살균 (Pasteurization)
Moist heat sterilization at low temperature
저온처리법 (holding method) : 62.9℃, 30 min
순간살균법 (flash method) : 71.6℃, 15~30 sec
고온순간살균법 (ultraflash method) : 82℃, 3 sec
Designed to kill vegetative cells
Most pathogens are killed, but no bacterial endospores

16. 방사선 멸균 (Radiation Sterilization)
Microwave
Due, at least in part, to thermal effect
Ultraviolet radiation (UV)
Cause breaks in DNA (Pyrimidine dimer formation)
260 nm
Can not penetrate solid, opaque, light-absorbing surface
Only for exposed surfaces, air, water
Gamma ray
From 60Co and 137Cs
Medical & laboratory supplies, drugs, & tissue grafts

17. 가스 살균 (Gas Sterilization)
Ethylene oxide gas (C2H4O)
With non-inflammable gas (CO2, Freon)
Medical & laboratory supplies (plastic & rubber)
Ozone
Liver toxicity

18. 여과제균 (Filter Sterilization)
Sterilization of heat-sensitive liquids or gases
Depth filter
Membrane filter (Absolute filter)
cellulose acetate, nylon
0.2 – 0.5 ㎛ (no virus)

19. Monitoring 멸균 모니터링 ▪ 기계적 ∙ 물리적 지표 (Instrumental, physical indicator)
Temperature, Pressure, Time
▪ 화학적 지표 (Chemical indicator)
멸균 테이프
▪ 생물학적 지표 (Biological indicator)
Bacterial endospore : Bacillus stearothermophilus
Clostridium botulinum