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 patient’s 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. Element 5 - Infection Control

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. Element 5 - Infection Control

4. Steps of Reprocessing • Pre-Cleaning • Cleaning • Disinfection • Sterilization Element 5 - Infection Control

5. Choice of Reprocessing Methods • Intended use: • Critical instruments and medical devices • Semi-critical instruments and medical devices • Non-critical instruments and medical devices • Manufacturer’s recommendations • Compatibility among equipment, materials and chemicals • Equipment heat and pressure tolerance • Time and temperature requirements for reprocessing Element 5 - Infection Control

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 Element 5 - Infection Control

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 Element 5 - Infection Control

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 Element 5 - Infection Control

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 Element 5 - Infection Control

10. BC Centre for Disease Control Element 5 - Infection 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 Element 5 - Infection Control

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 Element 5 - Infection Control

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 Element 5 - Infection Control

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. Element 5 - Infection Control

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 Element 5 - Infection Control

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 Element 5 - Infection Control

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 Element 5 - Infection Control

18. Selection Criteria • Antimicrobial efficacy • Time constraints • Compatibility among equipment/material • Toxicity • Residual effect • Ease of use • Stability • Odor • cost • Monitoring Element 5 - Infection Control

19. FDA regulations for reuse of medical devices • Medical devices rented/leased from third parties may not be adequately disinfected • Follow manufacturer’s 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 Element 5 - Infection Control