TIMING, SORTING & DISASSEMBLY, CLEANING, SOAKING, RINSING, CLEANING TOOLS. HLD,

TIMING OF DECONTAMINATION

• Blood and soil dry very quickly on instruments

• soil that is dry is difficult to remove

• ideally, cleaning should begin within 15mins to 1 hour after use.

CARE AND HANDLING OF INSTRUMENTS

• MDRTS SHOULD INSPECT FOR SHARPS THAT CAN CAUSE INJURY

• HANDLE ITEMS IN SMALL QUANTITIES

• DELICATE ITEMS SHOULD BE REMOVED AND SEPARATED FROM GENERAL ITEMS

• AVOID MIXING DIFFERENT MATERIALS.

SORTING

• Upon arrival in decontamination, items should be sorted and delivered to different stations for cleaning.

• follow manufacturers cleaning and reprocessing manual.

• bowls, basins, cups, containers, should be places on the appropriate racks for washers disinfector or cart washer.

• manually pre clean basins as required.

• if items cannot go through automated cleaning, they must be delivered to the counter of the hand wash sink such as Electric devices, telescopes, pneumatic drills.

• separate respiratory devices in a cleaning solution, clean with a soft brush. following manual cleaning, respiratory devices must be disinfected in the washer, disinfector or pasteurizer.

• Sharps- should be separated and placed in instruments pans to prevent damage/dulls.

• all other instruments should be placed in instrument pans disassembled or in open position prior to going through the washer disinfector.

DISASSEMBLY

• Items must be disassembled to their simplest components prior to cleaning

• box locks must be in the open position

• place small parts in a container for cleaning

• keep all medical devices together for cleaning.

• disassembly allows the cleaning agents to contact all surfaces of devices.

DECONTAMINATION OF PATIENT CARE EQUIPTMENT

• METAL BASINS, BEDPANS, URINALS

• INSPECT AND PRE CLEAN PRIOR TO LOADING ONTO MANIFOLD

• CLEAN USING WASHER DISINFECTOR OR CART WASHER

• POSITION SO WATER DRAINS OUT OF CONCAVE SURFACES.

CLEANING

• Most important step in reprocessing

• removal of visible and non visible soil.

• Cleaning can occur without disinfection or sterilization, but disinfection BUT disinfection and sterilization cannot occur without cleaning.

WHY IS IT IMPORTANT TO REMOVE GROSS SOIL

• TO REDUCE THE NUMBER OF MICRO ORGANISMS ON THE ITEM

• TO REDUCE GROWTH BY REDUCING MATERIAL MICROBES FEED ON

• TO REDUCE ENVIROMENTAL CONTAMINATION

• TO MINIMIZE DAMAGE TO DEVICES. BLOOD AND OTHER SUBSTANCES ARE CORROSIVE.

SOAKING

• USED WHEN SOIL HAS DRIED ON THE DEVICES. THIS REHYDRATES THE SOIL

• DEVICES SHOULD BE SOAKED FOR THE MINIMUM AMOUNT OF TIME NECESSARY

• EXCESSIVE SOAKING DAMAGES FINISHES ON DEVICES

• CHANGE SOLUTIONS FREQUENTLY

• EXCESS SOIL IN SOLUTIONS REDUCESS EFFECTIVENESS

• NEVER SOAK IN SALINE

WATER TEMPERATURE

• water temp above 60 degrees makes protein coagulate.

• may also deactivate enzymes

• cold temperatures may not activate enzymes.

• can also cause protein to congealing of fats, oils, grease.

BRUSHES CLEAINIG TOOLS-

• BRUSHES COME IN ALL SHAPES, SIZES AND LEGTHS, DIFFERENT STYLES FOR DIFFERENT PURPOSE.

• BRUSHES FOR CLEANING LUMENS BUST BE APPROPIATE SIZE( THIS ARE THE BRUSHES THAT GO INSIDE ENDOSCOPES)

• MULTIPLE BRUSHES MAY BE REQUIRED FOR CLEANING A SINGLE DEVICE.

• BRUSHES MUST BE DECONTAMINATED AT THEN END OF EAHC SHIFT MINIMUM.

• INSPECT BRUSHES BEFORE USING AND THROW OUT IF DAMAGED.

• ONLY SOFT BRUSHES

• LINT FREE CLOTHES SHOULD BE USED

• CHANGE REGULARLY

• REUSABLE CLOTHS MUST BE DECONTAMINATED BETWEEN USES, DISPOSABLE IS PREFERRED.

SPONGES. CLEANING TOOL

• Must be replaced daily, or as needed to ensure they do not become a source of contamination.

MANUAL CLEANING HAND WASHING.

• MANUAL cleaning is done when devices are not meant for automated cleaning .

• know which items are immersible and which ones are not.

• manual cleaning comes first. prior to washer or disinfector.

• manual cleaning is required for devices with lumens.

• items must be completely disassembled

• air bubbles must be removed- flushed with syringe or water pistol.

MANUAL CLEANING- IMMERSIBLE
(SUBMERGED IN WATER COMPLETELY NO DAMAGE)

• Fill the sink with correct water amount, add appropriate cleaning solution, in correct concentration.

• immerse device

• brush or remove all gross soil from device with soft brush

• all brushing done under water no splashing. ( this prevents aerosols)

• wipe device with soft, lint free cloth

• keep the device still submerged in the solution for recommended time.

• rinse equipment in a sink of clean tap water. THEN IN RO WATER.

• DRY device with a soft, lint free cloth and use force air are required.

• pass the device to the clean side through pass through window.

MANUAL CLEANING NON-IMMERSIBLE ( CANNOT BE SUBMERGED IN WATER)

• FILL SINK TO APPROPIATE WATER LEVEL. ADD CORRECT SOLUTION AMOUNT.

• SOAK- a J cloth with cleaning solution. Wipe all surfaces with the j cloth.

• IF using brushes, dip brush in the cleaning solution, then brush. Brush in a manner that minimizes aerosols. ( remember this is done outside the sink)

• keep the device wet with the cleaning solution and follow the manufacturers recommendation on how long to leave the solution on the devices,

• RINSING- wipe the device with the j cloth and clean water. use RO water after.

• Dry device with a soft, lint free cloth, use forced air if required.

• pass through the window to clean side.

RINSING

• RINSE WITH STERILE OR BACTERIA FREE WATER

• MINIMUM of 3 separate rinses

• LUMENS MUST BE RINSED WITH 3X THE VOLUME OF THE LUMEN.

• THOROUGH RINSING IS NECESSARY TO REMOVE CLEANING SOLUTION.

• LEFTOVER CLEANING SOLUTION CAN REACT WITH DISINFECTING SOLUTIONS AND ALSO STERILIZATION CHEMICALS.

• LEFT OVER CLEANING SOLUTION CAN CAUSE HARM TO PATIENTS

• RINSING ALSO PREVENTS SOIL SUSPENDED IN CLEAINING SOLUTION FROM RE DEPOSITING ONTO THE DEVICE.

• USING FILTERED WATER FOR RINSING TO AVOID SPOTTING, CORROSION DUE TO HARD WATER.

• HARD VOLUMES OF DETERGENT WILL BE DIFFICULT TO RINSE OF DEVICES. ALWASY USE RECOMMENDED CONCENTRATION.

DESCALERS

• USED TO REMOVE SCALE BUILD UP ON CLEANING EQUIPMENT

• ACIDIC DETEREGENTS CAN HELP REMOVE SCALE AS WELL.

• LESS DESCALER IS NEEDED WHEN ACIDIC DETERGENTS ARE USED.

LUBRICANTS ( instrument milk)

• Maintain the integrity of instrumentation.

• performed after cleaning.

• can be a part of automated cycle and manual cleaning process

• Instrument milk- used in automated or manually.

LIQUID CHEMICAL DISINFECTION (LCD) and down sides.

pros:

• chemical used to kill most pathogens but not spores

• cleaning removes the vast majority of soil and microorganisms

• LCD are used to further reduce micro organisms.

cons:

• sometimes leaves bioburden or soil on the instruments and this shelters micro organisms.

• soil can also cause dilution or inactivation of cleaning agents.

MECHANICAL DISINFECTION

• WASHER DISINFECTORS - used thermal disinfectant.

• after the wash cycle, instruments are exposed to high temperature rinse water.

• 81-91C

• this temperature is high enough to kill pathogens

• water hardness plays a plays a role on how effective the LCD works.

• the water temperature also plays a role in how effective lcds are.

• the ph range.

MANUAL DISINFECTION

• Disassemble device to simplest component

• fill all lumens with disinfectant solution.

• position to allow trapped air to escape.

• weigh down floating items.

LEVELS OF DISINFECTATNS.

THE LEVELS OF DISENFECTANT ARE ALSO DEPENDENT ON SPAULDINGS CLASSIFICATION.

1. LOW LEVEL DISENFECTATION ( NON CRITICAL) NOT FOR KILLING SPORES

   types of disinfectants you can use- Quaternary ammonium Compounds QUATS.

   H2O2( 05-3%), Iodophors, phenolics.

2. INTERMEDIATE LEVEL DISENFECTATION - used most on surfaces for non critical items. KILLS vegetative micro. not necessarily spores.

   types of disinfectants you can use- phenolics, alcohols, halogens ( chlorine, flourine and iodine)

3. HIGH LEVEL DISENFECTATION. (SEMI- CRITICAL ) sterilization is number one method preferred if not possible- HLD is the preferred method if sterilization is not possible. ( endoscopes)

   kill all vegetative micros. cannot kill high number of bacterial spores.

   some HLD can be used as sterilant ( longer contact time, just in time sterilization)

   Paracetic acid, h2o2 6^%, Gluteraldyhyde, opa

WHAT KINDS OF DISINFECTANT ARE THERE.

1. Vircidal- kill viruses

2. fungicidal-kill fungi

3. bactericidal-kills vegetative bacteria only

4. tuberculocidal- kills all forms of bacteria.

LOW AND INTERMEDIATE LEVEL DISINFECTANTS ( LLD)

• available as pre soaked wipes. ( No spray bottles discouraged aerosolization)

• used to disinfect non critical patient care equipment

• gross soil must be removed before disinfection ( CLEANING ALWAYS FIRST)

• make sure entire instrument all surface areas are covered in disinfectant.

• device must REMAIN WET with disinfectant solution for the full duration of the manufacturers required time.

• RESIDUE MUST BE REMOVED BY THROUGH RINSING FOLLOWING DISINFECTION.

QUATS ( Quaternary Ammonium Compounds)

• LOW LEVEL DISENFECTANT (LLD)

• Incompatible with soap.

• If there is lots of bioburden Germicidal action is reduced

• Not effective against Pseudomas, tuberculosis, hydrophelic viruses.

• quats cationic (negative -) and are not compatible with anionic (positive +) compounds like soap, water.

• QUATS are absorbed by cotton , wool fiber, paper and charcoal

PHENOLICS ( USED FOR LOW LEVEL DISINFECTION OR INTERMIDIATE LEVEL DISINFECTION) LLD or ILD

• contains phinal ( carbolic acid)

• penetrate cell walls and precipitate cell protein.

• most require wet contact for 20 mins

• TOXIC

• may be corrosive

• SOAP inactivates phenolics

• SLIGHTLY MORE EFFECTIVE than QUATS

ALCOHOLICS

• 70-90% ISOPROPYL alcohol is an effective disinfectant

• Alcohols change the structure of protein

• surfaces must remain wet for 5 mins contact time is 5 minutes

• evaporates quickly: contact time is difficult to achieve.

• flammable

• causes brittleness to silicone

• DOES NOT KILL BACTERIAL SPORES

• COUGULATES Protein and is DEACTIVATED in the presence of protein

• USED AS A DRYING AID IN THE DRYING OF LONG LUMENS ( FLEXIBLE ENDOSCOPES)

HALOGENS - CHLORINE (BLEACH)

• VERY TOXIC ( CAN MIX WITH ANYTHING.

• DECREASE ACTIVITY IN THE PRESENCE OF ORGANIC MATERIAL

• USED FOR WATER TREATMENT, IN FOOD INDUSTRY

HALOGENS- IODOPHORS- IODINE

• BUFFERED IODINE THAT IS WATER SOLUBLE ( Iodine + detergent + other indigrients = iodophor)

• used for skin preparation ( an antiseptic )

• gross soil and organic material inactivate iodophors.

FORMALDEHYDE ( FORMALIN) LLD ILD HID(ALDEHYDES)

• DIFFERENT CONCENTRATIONS USED AS LLD- ILD AND HID

• NOT corrosive to hemodialysis patients- 4% concentration then rinse thoroughly

• contact time is 24hrs

THERMAL DISINFECTION

• Uses HOT water to kill bacteria

• HOT water BOOSTED with STEAM is used in the WASHER DISINFECTOR

• TIME AND TEMP are KEY variables.

• A paper document must be signed and kept in record at the end of each day.

• ALWAYS inspect arms and drain screens at least once daily for clogs.

HIGH LEVEL DISINFECTION

• USED TO DISINFECT SEMI CRITICAL DEVICES ( ENDOSCOPES)

• PPE must be changed after HLD to avoid re-contaminating the devices.

• Containers must be covered to prevent evaporation, contaminates such as dust particles from entering the solution.

• MUST WEAR GLOVES

• container material must be compatible with disinfectant

• Some HDL can be used as sterilants if longer contact times are used.

MINIMUM EFFECTIVE CONCENTRATION FOR HLD ( MEC)

• HLD solutions may become diluted over time.

• MEC is the lowest concentration of HLD that achieves the claimed anti-microbial activity.

CONTACT TIME HLD

• MEASURES from the time the device achieves complete contact with HLD solutions ( lumens have to be completely submerged)

• paper copy must be documented and tracked.

ALDEHYDES HLD

• HIGH LEVEL DISINFECTATION ALDEHYDE

• Sterilization occurs at longer contact times

• ALDEHYDES some require special ventilation due to strong odor

PARACETIC ACID (PAA)

• effective as both an HLD and sterilant.

• HIGH POTENCY at LOW CONCENTRATION.

• NON- HAZADOUS, NON TOXICM, WATER SOLUBLEM.

• THE CONCETRATED FORM HAS A STRONG ODOUR.

Ortho-Phthalaldehyde (opa)

• HLD in 10 mins at 25c in AER

• effective against bacteria that is resistant to glutaraldehyde

• good penetration and active in the presence of organic material.

• TOXIC AGENTS require monitoring

• Residue on devices can cause patient harm.

PAA/ HYDROGEN PEROXIDE HLD

• CONPATIBLE WITH HEAT SENSITIVE DEVICES

• SINGLE USE HLD

• breaks down after use

• No exposure limit: Enviromentally responsible

• only available with one AER manufacturer.

• Effective sterilant and disinfectant

• potent at 2 percent concentrations and low temperature

• Non hazardous,non toxic to enviroment, water soluble

• corrosive to some material