Disinfection Processes and Procedures

Disinfection

Disinfection Processes

  • Chemical Disinfectants are categorized into two main types:
    • Environmental Disinfectants
    • Used only on non-living surfaces.
    • Should not be used on devices that come into contact with a patient’s tissue.
    • High-Level Disinfectants (HLDs)
    • Used on devices intended for patient contact.
    • Capable of killing most microorganisms, but not necessarily bacterial spores.

High-Level Disinfection Area

  • Location and Environment
    • Should be situated separate from cleaning areas.
    • Must not be in patient procedure areas.
    • Proximity to a sink is necessary due to wet processes involved in high-level disinfection activities.
  • Process Overview
    • Devices complete the decontamination process and are then passed through the prep and pack area before undergoing high-level disinfection.
  • Environmental Requirements:
    • Temperature Range: 60°F - 65°F.
    • Humidity Range: 30% - 60%.

Design Features of High-Level Disinfection Area

  • Engineering Controls
    • Mechanisms for reducing hazardous chemical and/or vapor exposure.
  • Space Requirements
    • Adequate space for containers used for soaking and rinsing items.
    • Sufficient area for supplies, equipment, and instruments being processed.
    • Designated space for both manual and automated high-level disinfection equipment.
    • Space with restricted access to prevent unauthorized entry.
    • Efficient workflow design to facilitate operations.
    • Storage capabilities for PPE (Personal Protective Equipment).
    • Separate areas for donning and doffing PPE.
    • Specific hand-hygiene facilities.
    • Unobstructed access to eyewash stations for emergencies.
    • Facilities for the disposal of hazardous materials.
    • Adequate space for both chemical storage and supply levels.
    • Controls in place for temperature and humidity.
    • Minimum of 10 air exchanges per hour.
    • Non-porous flooring, walls, and ceilings, built to withstand frequent cleanings and wet conditions.

Selection of Disinfectants

  • Factors Influencing Disinfectant Selection
    1. Type of Microorganism to be eradicated.
    • Hierarchy of Disease-Producing Agents:
      • Prions: Require extended sterilization.
      • Bacterial Spores: Require sterilization.
      • Mycobacteria (e.g., Tuberculosis): Require high-level disinfection.
      • Nonlipid, small viruses: Require intermediate-level disinfection.
      • Fungi: Require intermediate-level disinfection.
      • Vegetative bacteria: Require low-level disinfection.
      • Lipid, medium-sized viruses (e.g., HBV, HIV): Require low-level disinfection.
    1. Intended Use of the Item to be disinfected.
    • Spaulding Classification of Medical Devices (1972):
      • Critical: Items that enter sterile tissue require sterilization.
      • Semicritical: Items that come into contact with intact mucous membranes require high-level disinfection (at least).
      • Noncritical: Items that come into contact with intact skin require sanitization.

Personal Protective Equipment (PPE) for Working with Disinfectants

  • Purpose of PPE
    • Designed to safeguard an employee's eyes, skin, mucous membranes, and clothing.
  • Essential Components of PPE:
    • Eye and face protection, such as full-face shields or goggles with complete coverage.
    • Impervious gloves to protect hands.
    • Elbow-length gloves or sleeves for extra protection.
    • Impervious gowns or aprons to prevent contamination of clothing.
    • Respiratory protection as needed during disinfection processes.
  • Compatibility Considerations
    • The material of PPE must be compatible with the disinfectants being used.

Guidelines for Use & Disposal of Disinfectants

  • Key considerations include:
    • Number and Location: Of microorganisms present.
    • Resistance: Level of resistance to the disinfectant being used.
    • Concentration and Potency: Ensure appropriate levels for effectiveness.
    • Physical and Chemical Factors: Evaluate all relevant properties.
    • Organic and Inorganic Matter: Presence can affect disinfectant effectiveness.
    • Duration of Exposure: Time item is exposed to the disinfectant is critical.

Environmental Disinfectants

  • Quaternary Ammonium Compounds (“QUATS”).
  • Halogens: Commonly used disinfectants.
  • Phenolics: Effective disinfectants under certain conditions.
  • Alcohols: Valuable for various disinfecting applications.
  • Hydrogen Peroxide: Used for high-level disinfection and has unique benefits.

High-Level Disinfectants (“HLDs”) Overview

  • Criteria for HLDs:
    • Shelf Life: Duration product remains effective without failing.
    • Use Life: Time period a product can be used once it has been prepared.
    • Exposure Time: Duration the device must remain in contact with the disinfectant.
  • Types of HLDs:
    • Glutaraldehyde: Common high-level disinfectant.
    • Ortho-Phthaldehyde: Another effective HLD option.
    • Hydrogen Peroxide: Utilized in numerous disinfection scenarios.

Minimum Effective Concentration Testing

  • Minimum Effective Concentration (MEC) Test: Determines the lowest concentration of disinfectant that achieves a specific level of disinfection.

Record Keeping Requirements

  • Essential records should include:
    • Results of MEC and MRC testing and subsequent actions taken.
    • Lot numbers, AER or soaking container identifiers, and/or cycle numbers.
    • Specific load contents with descriptions of items, quantities, and departments involved.
    • Details about procedure, attending physician, and serial/ID numbers for items (especially for flexible endoscopes).
    • Patient name and medical identification number (mandatory for flexible endoscopes).
    • Confirmation that the item was cleaned prior to disinfection.
    • Temperature of the disinfectant solution during treatment.
    • Duration the item was immersed in the disinfectant and time taken out.
    • Identification of personnel who performed the disinfection process, including names or initials.
    • Additional essential records include:
    • Shelf life date and lot number of disinfectant.
    • Activation or dilution dates of HLD containers.
    • Exposure times and temperatures if applicable, along with dates of manual processing or automated cycles.

References

  • Chobin, Nancy. The Basics of Sterile Processing. 6th ed., Sterile Processing University, 2016.