人卫7版微生物chapter3消毒灭菌.ppt

单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,Chapter 3 Sterilization and Disinfection,Outline,Basic terms of sterilization and disinfection,Physical sterilization and disinfection,Chemical sterilization and disinfection,The application of disinfection and sterilization,Factors affecting disinfectant potency,Biosafety,Section 1 Basic terms,Sterilization,（灭菌）,Disinfection,（消毒）,Antisepsis,（防腐）,Cleaning,（清洁）,Asepsis,（无菌）,Sterilization,（灭菌）,A physical or chemical process that,completely destroys all microbial life,including spores.,Sterilization results in absolute absence of all viable microorganisms,including vegetative forms(,繁殖体,)and spores(,芽胞,).,Disinfection,（消毒）,Disinfection is done to eliminate,as many,pathogenic microorganisms,from an item or from the environment as possible,but not so sure to eliminate nonpathogenic microorganisms and spores.,Sterilization,All micro-organisms,Disinfection,Pathogenic microbes,Antiseptic,（防腐剂）,A product or biotic that destroys or inhibits the growth of microorganisms in or on living tissue.,Asepsis,（无菌）,There are,no living microorganisms,exist,mostly resulted from sterilization.,Aseptic operation,（无菌操作）,refer to the operating techniques which prevent microbes from entering human bodies or other items.,Aseptic operation,（无菌操作）,In 1876 Lister,Invented the disinfection aseptic technique:Asepsis,Modern surgical operation,Section 2 Physical Methods,Heat,Radiation,（辐射）,Filtration,（滤过）,Low temperature and desiccation,（低温和干燥）,Heat,Dry Heat,Moist Heat,Incineration,（焚烧）,Cauterization,（烧炙）,Hot air drying,sterilization,Infrared,（红外线）,Pasteurization,（巴斯德法,),Boiling m,ethod,Flowing steam disinfection,Fractional sterilization,（,间歇蒸汽灭菌）,S,terilization by pressure,d steam,（高压蒸汽灭菌）,VS,Moist heat is more effective,than dry heat,In moist,bacterial,proteins,are more easily to coagulate,（凝结）,and denature,（变性）,.,Penetrating power,of moist heat is stronger than dry heat.,Steam has,latent heat,which can be released when gas transfer to liquid state and raise temperature rapidly,Steam provides a means for distributing heat to,all parts,of sterilizing vessel.,Incineration,（焚烧）,Characters:,simple,fast,thorough,Used for:,Contaminated wastes,（污染物）,pathologic specimens,（病理样本）,dressings and paper with purulent secretions,（脓性分泌物）,patients corpses,（尸体）,Method:,directly burn or burn in incinerator,（焚化炉）,Burning(incineration),Cauterization,（烧灼）,Sterilize with,flame directly,Additional use for,-,Inoculating loops,（接种环）,used in microorganism laboratory,And used when in dire need for,-some,metal instruments,(but sharp knives and scissors are exceptional to avoid blunting them),and kinds of,china,Cauterization,（烧灼）,Hot air drying,（干烤）,Hot air sterilization/Baking,（干烤）,171,1h,160,2h,121,16h,Make use of the specially made,hot air drying oven,to sterilize,the heat power spread and penetration depends on the air convection and medium conduction,and the effect of this method is reliable.,Suitable for,high temperature resistant articles,The articles that do not change in character,do not be damaged and do not evaporate,（蒸发）,at high temperature:oil,powder,glass products and metal products,etc.,Not suitable for,Fiber products,plastic products,Hot air drying,171 1h,、,1602h,or 121 16h,Hot air drying oven,（高温烘箱）,Infrared,（红外线）,The act or process of heating a beverage,（饮料）,or other food,such as milk or beer,to a specific temperature for a specific period of time in order to kill microorganisms that could cause disease,spoilage,（腐败）,or undesired fermentation,（发酵）,61.162.8 for 30min or 71.7 for 1530 s,This temperature,dose not sterilize,the food,but sufficiently kill most of the vegetative cells,（繁殖体）,.,It is widely used in disinfecting,milk,wine,and beer,etc.,Pasteurization,（巴氏消毒法）,Pasteurization,（巴氏消毒法）,Boiling method,（煮沸法）,One of the earliest used methods of disinfection.,Brush and clean the articles,drip them into the water thoroughly,then heat and boil the water.,Timing starts from the boiling,if anything added during the boiling,timing starts from the second boiling.,Boiling method,Suitable for the stuff which are,moist-stable and temperature proof,:metals,china,and glass,etc.,The temperature of boiling water is,100,.Normally,vegetative cells,will be killed in,5min,but,spores,（芽胞）,need,1-2h,to be killed.,Mix,sodium bicarbonate(,小苏打,),into water to make the concentration 1%2%,which can cause the boiling point to be,105.,摄氏度,Flowing steam disinfection,流动蒸汽消毒法,Arnold Sterilizer(Arnold,消毒器,),It applies water vapor,（水蒸气）,to disinfect,100 for 15-30min,.,Vegetative bacteria can be killed,but not spores,.,Chinese steamers and some feeding bottle,（奶瓶）,sterilizers have the same principles.,Arnold Sterilizer,Fractional sterilization,间歇蒸汽灭菌法,It takes,water vapor,intermittently to sterilize,at common pressure.,Commonly used for sterilizing the,medium,（培养基）,containing sugar or milk which can not bear high temperature.,Procedure of fractional sterilization,Steam heating(100,30 min),37 overnight for spores,（芽胞）,to germinate,（发芽）,100,30 min to kill germinated spores,37 overnight for remaining spores to germinate,100,60 min to kill last remaining germinated spores,Sterilization by pressured steam,高压蒸汽灭菌法,The,most effective,sterilizing method,Autoclaving,:When pressure is,103,.4kPa,the temperature in the autoclave,（高压消毒锅）,can reach,121.3,15-,20min,is enough for sterilization,Kill,both vegetative organisms and spores,Commonly used for the articles which are,heat-stable,pressure-proof,（耐高压）,and can bear damp,:ordinary medium,normal saline,surgical dressing,etc,Sterilization by pressured steam,Autoclave,（高压蒸汽灭菌器）,Autoclave,（高压蒸汽灭菌器）,Be careful,!,40cm,30cm,30cm,Date,：,2005.8.07,Best before,：,2005.8.21,Signal paper,Radiation disinfection,（辐射杀菌法）,Ultraviolet ray(UV),紫外线,Ionization radialization,电离辐射,Microwave disinfection,Ultraviolet(UV)radiation,Wave length,:240300nm,the most effective:265266nm,Mechanism:,blockage of DNA replication by forming,thymidine,胸腺嘧啶,dimmers,Very poor penetrating power,Ultraviolet rays can kill bacteria,viruses,fungi,Causing eye damage,burn and mutation,（突变）,in skin cells,Microwave disinfection,Electromagnetic wave,（电磁波）,(,1-1000mm),Used to sterilize food,metalloid,（非金属）,instrument,etc,微波干燥杀菌设备,微波药材灭菌干燥设备,Filtration,（滤过除菌法）,Sterilize solutions that may be damaged or denatured,（变性）,by high temperatures or chemical agents.,Filter,用于滤过除菌的各式滤器,层流室,laminar air flow unit,Low Temperature,（低温）,-20 -70,Inhibits microbial growth by slowing down microbial metabolism,Used to,conserve bacterial strains,（菌株）,Desiccation,（干燥）,High concentrations of salt or sugar,Microorganisms can not grow without water,The high osmotic,（渗透）,strength can damage cells by,plasmolysis,.,（质壁分离）,Not effective against spores,Used to conserve food,Desiccation,（干燥）,Lyophilization,（冷冻真空干燥法）,Used for,long-term reservation of bacteria stocks,Fast freezing+drying,Protecting agents(glycerol,serum),Chemical Disinfection and Sterilization,The chemicals used for disinfection are called as,disinfectants,（消毒剂）,.,The effects of some disinfectants are strong enough to sterilize,these disinfectants are also called as,sterilants,（杀菌剂）,.,Mechanisms of Chemical disinfectants,To facilitate bacterial,protein dissolution,（溶解）,or coagulation,（凝固）,To interfere the,enzyme,（,酶）,system and its,metabolism,（代谢）,destroy the radical mass of protein and nucleic acid,To damage bacterial,cell membrane,常用化学消毒剂的种类和作用机制,类别,作用机制,常用种类,酚类,蛋白变性，细胞膜损伤,石炭酸,醇类,蛋白变性,乙醇,氧化剂,氧化、蛋白沉淀,高锰酸钾、过氧乙酸,重金属盐,氧化、蛋白和酶变性,红汞、硝酸银,烷化剂,蛋白、核酸烷基化,甲醛,表面活性剂,蛋白变性，细胞膜损伤,新洁而灭,染料,干扰氧化、抑制繁殖,龙胆紫,高效消毒剂,含氯消毒剂,次氯酸钠、二氯异氰酸尿酸钠、漂白粉,过氧化物消毒剂,过氧化氢、过氧乙酸,醛类消毒剂,戊二醛、甲醛,环氧乙烷,中效,含碘消毒剂,碘酊、碘伏,醇类,乙醇、异丙醇,低,效,季铵盐类,苯扎溴铵（新洁尔灭）,氯己定,（洗必泰）,高锰酸钾,The effects of disinfectants,Chlorine compounds,（含氯消毒剂）,Peroxide disinfectants,（过氧化物消毒剂）,Aldehyde disinfectants,（醛类消毒剂）,Ethylene oxide,（环氧乙烷）,Alcohol disinfectant,（醇类消毒剂）,Iodine disinfectant,（含碘消毒剂）,Section 3 A,pplication of Disinfection and Sterilization,一,、,医疗器械物品的消毒灭菌,高危器械物品,需进入无菌组织,灭菌,中危器械物品,不进入无菌组织但接触黏膜,消毒,低危器械物品,只接触未损伤皮肤，不进入无菌组织、不接触黏膜,一般用后清洗、消毒即可,快速周转的医疗器械,快速消毒灭菌、不能损伤器械,二,、室内空气消毒灭菌,1,.,物理消毒法,紫外线照射（1.5,W,/m,3,，1h）,最常用,；,滤过除菌,2化学消毒法,过氧乙酸喷雾、熏蒸,过氧化氢喷雾,二氧化氯溶液,喷洒,中草药点燃烟熏。,三,、手和皮肤的消毒,用肥皂和流动水经常并正确洗手,病原微生物污染时应用消毒剂消毒。,四,、黏膜,的消毒,3%H,2,O,2,：口腔粘膜消毒,0.01%-0.1%,洗必泰或高锰酸钾：冲洗尿道、阴道、膀胱等,1%,硝酸银：新生儿滴眼以预防淋球菌感染。,（五）病人排泄物与分泌物的消毒灭菌,用等量的,200g/L,漂白粉搅拌均匀作用,2h,（六）病人污染物品的消毒,日常生活小用具：,0.5%,过氧乙酸浸泡,家具：,0.5%,过氧乙酸擦洗,衣服、被褥：流动蒸气消毒,30min,（七）饮水的消毒,自来水：氯气消毒；少量饮用水：漂白粉,（八）环境的消毒,厕所、阴沟：生石灰（氢氧化钙）,Factors influencing the performance,of disinfections and sterilization,Disinfectants,Microorganisms,Environment,Quality,Concentration,Time,Number,Type,Organic substance,Temperature,pH,Selection for proper disinfectants,Low,toxin,Cheap,Low,destroy,Easy,keep,Easy,use,Effective,第五节 病原微生物实验室生物安全,生物安全,的概念,生物安全（biosafety）是,生物技术安全,（,safety of biotechnology,）,的简称。,狭义,：,指现代生物技术的研究、开发、应用及转基因生物可能对生物多样性、生态环境和人类健康产生潜在的危害。,广义,：,指与生物有关的各种因素对社会、经济、人类健康及生态环境所产生的危害或潜在风险。,病原微生物实验室生物安全的,核心,：,防扩散和防感染,。,关于,病原微生物实验室生物安全,，,我国法令包括对病原微生物的分类管理，对实验室的分级管理,，,实验室感染的控制以及监督和法律责任等。,一、病原微生物的分类,第一类：是指能够引起人类或者动物非常严重疾病的微生物，以及我国尚未发现或者已经宣布消灭的微生物。,第二类：是指能够引起人类或者动物严重疾病，比较容易直接或者间接在人与人、动物与人、动物与动物间传播的微生物。,第三类：,是指能够引起人或动物疾病，但一般情况下对人、动物或环境,不构成严重危害，传播风险有限，,实验室感染后很少引起严重疾病，并且,具备有效治疗和预防措施,的微生物。,第四类：,是指在,通常,情况下,不会引起人或动物疾病,的微生物。如小鼠白血病病毒等。,第一类、第二类统称为,高致病性病原微生物,。,第一类,第二类,第三类,第四类,天花病毒,新疆出血热病毒,埃博拉病毒,猴痘病毒,亨德拉病毒,汉坦病毒,H5N1,HIV,乙脑病毒,脊髓灰质炎病毒,狂犬病毒,SARS,冠状病毒,炭疽芽胞杆菌,布鲁氏菌,结核分枝杆菌,霍乱弧菌,鼠疫耶尔森菌,腺病毒,肠道病毒,登革病毒,轮状病毒,肝炎病毒,风疹病毒,疱疹病毒,流感病毒,百日咳鲍特菌,伯氏疏螺旋体,沙眼衣原体,破伤风梭菌,致病性大肠埃希菌,脑膜炎奈瑟菌,伤寒沙门菌,志贺菌,表皮葡萄球菌,白假丝酵母菌,小鼠白血病病毒,国家根据实验室对病原微生物的生物安全防护水平（,BSL),，并依照实验室生物安全国家标准的规定，将实验室分为一级、二级、三级、四级。,二、病原微生物实验室的分级,级别,处理对象,一级,对人体、动植物或环境,危害较低,，不具有对健康成人、动植物致病的致病因子,。,二级,对人体、动植物或环境具有,中等危害,或具有,潜在危险,的致病因子，对健康成人、动植物和环境,不会造成严重危害,，,具,有有效的预防和治疗措施,。,三级,对人体、动植物或环境具有,高度危险性,，主要通过,气溶胶,使人类传染上,严重,的甚至是,致命,的疾病，或对动植物和环境具有高度危害的致病因子。,通常有预防治疗措施,。,四级,对人体、动植物或环境具有,高度危险,性，通过,气溶胶,途径传播或,传播途径不明或未知,的危险的致病因子。,没有预防治疗措施,。,一、二级实验室不得从事高致病性病原微生物实验活动。,三级、四级,实验室从事,高致病性病原微生物,实验活动。,从事高致病性病原微生物相关实验活动应当有,名以上的工作人员共同进行。,在同一个实验室的同一个独立安全区域内，,只能同时从事一种,高致病性病原微生物的相关实验活动。,实验室工作人员应掌握实验室技术规范、操作规程、生物安全防护知识和实际操作技能。应有符合要求的防护用品，应建立健康档案；进行预防接种。,实验室应有科学、严格的管理制度，定期对实验室设施设备、材料等进行检查、维护和更新，应对废水、废气以及其他废物进行合理处置，防止环境污染。,三、实验室感染的控制以及监督和法律责任,实验室感染控制工作,实验室感染控制工作包括定期检查实验室的生物安全防护、病原微生物菌（毒）种和样本保存与使用、安全操作、实验室排放的废水和废气以及其他废物处置等规章制度的实施情况。,高致病性病原微生物泄露后的措施,封闭被病原微生物污染的实验室或者可能造成病原微生物扩散的场所；,开展流行病学调查；,对病人进行隔离治疗，对相关人员进行医学检查；,对密切接触者进行医学观察；,进行现场消毒；,对染疫或者疑似染疫的动物采取隔离、扑杀等措施；,其他需要采取的预防、控制措施。,监督工作,县级以上地方人民政府卫生主管部门、兽医主管部门，应当主要通过检查反映实验室执行国家有关法律、行政法规以及国家标准和要求的记录、档案、报告，切实履行监督管理职责。,法律责任,承担造成传染病传播、流行或者其他严重后果的法律责任。,Important points,Definitions,Sterilization,Disinfection,Antisepsis,Asepsis,Pasteurization,Sterilization by pressured steam,