NIMHANS Nursing Officer - 2019
Applied Microbiology & Infection control
Hard
Which of the following are solutions available for high level disinfection of soiled instruments like bronchoscope?
Appeared in: NIMHANS Nursing Officer - 2019
Explanation
- Glutaraldehyde is a high-level disinfectant (HLD) specifically recommended for heat-sensitive medical devices like bronchoscopes.
- It possesses a broad spectrum of antimicrobial activity, effectively killing vegetative bacteria, mycobacteria, fungi, and viruses.
- With sufficient contact time, it is also sporicidal, which is a requirement for HLD.
- A bronchoscope is a semi-critical device under the Spaulding classification because it contacts intact mucous membranes, mandating at least HLD.
- Unlike other options, glutaraldehyde is non-corrosive and compatible with the complex materials used in flexible endoscopes.
Why Other Options Were Wrong
- Option A: Alcohol is an intermediate-level disinfectant, not a high-level one. It is not effective against bacterial spores.
- Option B: Chlorine (bleach) is highly corrosive and can damage the delicate metal, plastic, and adhesive components of a bronchoscope. Its efficacy is also reduced in the presence of organic material (soil).
- Option D: Formaldehyde is a high-level disinfectant but is rarely used for instrument processing today due to its status as a potential carcinogen and its highly irritating fumes, which pose a significant health risk to staff.
Related Visual
Clinical Relevance
- Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain High-level disinfection and Spaulding classification as background academic context rather than a clinical decision trigger.
- Proper reprocessing of bronchoscopes is a critical patient safety issue. Failure to perform HLD correctly can lead to the transmission of serious healthcare-associated infections (HAIs) like Pseudomonas aeruginosa or Mycobacterium tuberculosis.
- Nurses and technicians responsible for reprocessing must strictly follow the manufacturer's instructions for use (IFU) for both the endoscope and the disinfectant, paying close attention to concentration, contact time, and temperature.
- Personal protective equipment (PPE), including gloves, gowns, eye protection, and appropriate respiratory protection, is mandatory when handling chemical disinfectants like glutaraldehyde to prevent occupational exposure.
How to Approach the Question
- First, identify the key components of the question: the instrument ('bronchoscope') and the required process ('high level disinfection').
- Recall the Spaulding classification. A bronchoscope contacts mucous membranes, classifying it as a 'semi-critical' item.
- Understand that semi-critical items require, at a minimum, high-level disinfection (HLD), which destroys all microorganisms except large numbers of bacterial spores.
- Evaluate each option's properties. Consider both its disinfection level and its compatibility with a delicate, heat-sensitive instrument.
- Eliminate Alcohol because it is only an intermediate-level disinfectant (not sporicidal).
- Eliminate Chlorine because it is corrosive and damaging to endoscopes.
Concept Tested & Keywords
- Concept Tested: High-level disinfection and Spaulding classification
- Stem keywords: high level disinfection, soiled instruments, bronchoscope
- Lead-in keywords: Which of the following
- Negative lead-in flag: false
Question ID
QD0T_nedC3uDd_XXU6DO5G
Reference Book
E6 Pharmacology Katzung 16e pp. 1397-1399, 1395-1397
Practise the full NIMHANS Nursing Officer - 2019
Attempt every question from this paper in a timed mock, then review the full solution for each one.
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