Element V-Cleaning, Disinfection, & Sterilization

1
Element V-Cleaning, Disinfection, Sterilization

• Problem Choosing reprocessing methods for
  safety and integrity of patient care equipment
• Controlling the Problem Professional
  responsibility for maintenance of safety
  environment

2
Universal Principles

• Instruments, medical devices and equipment should
  be managed and reprocessed according to
  recommended/appropriate methods regardless of a
  patients diagnosis except for cases of suspected
  prion disease.
• Industry guidelines as well as equipment and
  chemical manufacturer recommendations should be
  used to develop and update reprocessing policies
  and procedures.
• Written instructions should be available for each
  instrument, medical device, and equipment
  reprocessed.

3
Potential for contamination

• Type of medical device, equipment or
  environmental surface.
• Frequency of hand contact with instrument medical
  device, equipment, or environmental surface.
• Potential for contamination with body surfaces or
  environmental sources of microorganisms.
• Level of contamination.

4
Steps of Reprocessing

• Pre-Cleaning
• Cleaning
• Disinfection
• Sterilization

5
Choice of Reprocessing Methods

• Intended use
• Critical instruments and medical devices
• Semi-critical instruments and medical devices
• Non-critical instruments and medical devices
• Manufacturers recommendations
• Compatibility among equipment, materials and
  chemicals
• Equipment heat and pressure tolerance
• Time and temperature requirements for reprocessing

6
Critical instruments and devices

• Enter a sterile body site or bloodstream
• Must be sterile
• surgical instruments
• Implants
• Plasma
• Must be cleaned prior to processing
• Steam, heat, ethylene oxide gas
• Monitor time, temperature, pressure,
  concentration
• Maintain an autoclave log

7
Semi-Critical Instruments Devices

• Have contact with mucous membrane or non-intact
  skin
• Need sterilization or high-level disinfection
• scopes
• tonometer
• speculum
• Chemical sterilization techniques. Use full time
  mandated for agent selected

8
Non-Critical Instruments Devices

• Have contact with intact skin
• blood pressure cuff, tub, electrode
• Have low risk of transmitting infection
• may cause colonization
• Use detergent or low-level germicide

9
Cleaning Environmental Surfaces

• Use EPA registered disinfectants in accordance
  with manufacturers instructions.
• Follow manufacturers instructions for cleaning
  and maintaining noncritical medical equipment.
• Keep housekeeping surfaces (e.g., floors, walls,
  and tabletops) visibly clean on a regular basis
  and clean spills promptly.
• CDC Guidelines for Environmental Infection
  Control in Health-Care Facilities

10

• BC Centre for Disease Control

11
Effectiveness of reprocessing instruments,
medical, devices and equipment

• Cleaning prior to disinfection
• Disinfection
• Selection and use of disinfectants
• Presence of organic matter
• Presence of biofilms
• Monitoring
• Post-disinfection handling and storage

12
Effectiveness of sterilization process

• Effectiveness of the sterilization process is
  dependent on
• Selection and use of sterilization methods
• Monitoring the sterilization process
• Post sterilization handling and storage

13
How Equipment Gets Contaminated

• Contamination can occur at any point in handling
  or reprocessing
• Failure to reprocess or dispose of items between
  patients
• Inadequate cleaning
• Inadequate disinfection or sterilization
• Contamination of disinfectant or rinse solutions
• Improper packaging, storage and handling
• Inadequate/inaccurate record keeping of
  reprocessing requirements

14
Preventing Cross-Contamination

• Identify surfaces or equipment which require
  between patient cleaning.
• Identify practices which contribute to hand
  contamination and the potential for
  cross-contamination.
• Implications of reuse of disposable equipment or
  devices.

15
Disinfection and sterilization methods and
agents based on practice setting and
responsibilities

• All health professionals must
• Understand core concepts and principles
• Standard and Universal Precautions
• Cleaning, disinfection, and sterilization
• Appropriate application of safe practices in
  handing instruments, medical devices and
  equipment
• Designation and physical separation of patient
  care areas from cleaning and reprocessing areas
  is strongly recommended by NYSDOH

16
Disinfection and sterilization methods and
agents based on practice setting and
responsibilities

• Health professionals in settings where handling,
  cleaning and reprocessing is performed elsewhere
• Verify with those responsible for reprocessing
  what steps are necessary prior to submission
• Pre-cleaning
• Soaking

17
Disinfection and sterilization methods and
agents based on practice setting and
responsibilities

• Health professionals with primary or supervisory
  responsibilities for equipment or device
  reprocessing
• Must also know the consequences of reuse of
  single-use/disposable instruments, medical
  devices or equipment
• Determine Appropriate reprocessing practices

18
Selection Criteria

• Antimicrobial efficacy
• Time constraints
• Compatibility among equipment/material
• Toxicity
• Residual effect
• Ease of use
• Stability
• Odor
• cost
• Monitoring

19
FDA regulations for reuse of medical devices

• Medical devices rented/leased from third parties
  may not be adequately disinfected
• Follow manufacturers specifications
• Follow FDA/ANSI/AAMI sterilization standards
• Do initial cleaning in procedure room
• Devices should not be placed in disinfectant
  prior to cleaning
• Devices should be dry before gas sterilizing
• Report adverse events