PRINCIPLES OF DECONTAMINATION :HOW CLEAN IS CLEAN?

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PRINCIPLES OF DECONTAMINATION HOW CLEAN IS CLEAN?

• Tina Bradley
• Laboratory Manager
• Hospital Infection Research Laboratory
• Queen Elizabeth Hospital
• Birmingham

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INFECTION CONTROL OBJECTIVE

• To prevent potentially pathogenic micro-organisms
  from reaching a susceptible site on a patient in
  sufficient numbers to cause infection

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THE CHAIN OF INFECTION
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DECONTAMINATION

• Decontamination is a process which removes or
  destroys contamination and thereby prevents
  micro-organisms, or other contaminants, reaching
  a susceptible site in sufficient numbers to
  initiate infection or some other harmful
  response. It includes cleaning, disinfection and
  sterilization.

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OPERATIONAL MANAGEMENT

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Code of practice for the prevention and control
of HCAI 2008

• The Decontamination Lead should have
  responsibility for ensuring that a
  decontamination programme is implemented in
  relation to the organisation and that it takes
  proper account of relevant national guidelines

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Code of practice for the prevention and control
of HCAI 2008

• The decontamination policy should demonstrate
  that
• It complies with guidance establishing essential
  quality requirements and a plan is in place for
  progression to best practice
• Decontamination of reusable medical devices takes
  place in appropriate dedicated facilities
  designed to minimise the risks that are present
• Appropriate procedures are used for the
  acquisition, maintenance and validation of
  decontamination equipment

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Code of practice for the prevention and control
of HCAI 2008

• Continued .
• Staff are trained in decontamination processes
  and hold appropriate competencies for their role
• A record keeping regime is in place to ensure
  that decontamination processes are fit for
  purpose and meet the required quality systems

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CATEGORIES OF INFECTION RISK TO PATIENTS
TREATMENT OF EQUIPMENT

• HIGH RISK
• Items in close contact with break in the skin or
  mucous membranes or introduced into a sterile
  body cavity
• STERILIZATION REQUIRED
• INTERMEDIATE RISK
• Items in contact with intact mucous membranes
  DISINFECTION (OR STERILIZATION) REQUIRED

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SELECTION OF DECONTAMINATION METHOD

• Patient safe
• Staff safe
• Equipment safe
• Cost effective
• Practical

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DECONTAMINATION POLICY (1)

• Is the item intended for reuse? i.e. establish
  that it is not described as single use
• For what purpose is the device used? i.e. is it
  invasive? Is it in contact with mucous
  membranes, skin, body fluids or potentially
  infectious material?
• How do manufacturers recommend it is cleaned,
  disinfected and sterilized?

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DECONTAMINATION POLICY (2)

• Can it be disassembled to facilitate cleaning?
• Is decontamination required at the point of use?
• Will it withstand an automated cleaning
  processes?
• How soon will it be needed?

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DECONTAMINATION POLICY (3)

• Can it be wrapped to protect it from
  recontamination?
• How many times can it be reprocessed?
• Does processing constitute a hazard to patients
  and/or staff? If so, is COSHH hazard data and
  monitoring equipment available?

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PROCESS OPTIONS

• Off site processing
• Local processing SSD
• Local processing point of use
• Use of single use items
• Combination

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SSD PROCESSING

• Established process validation
• Porous load (vacuum) steam sterilizers available
  for packaged lumened devices
• Tracking systems in place
• Turnaround times increased
• Services not always available locally
• Staff may be unfamiliar with instrumentation

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LOCAL PROCESSING

• Point of use processing
• Reduced turnaround times
• Fewer instruments required
• Staff more familiar with instrumentation
• May be no suitable (vacuum) sterilizer
• Poor facilities
• Poor process validation
• Tracking system often inadequate

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GOOD CLEANING IS ESSENTIAL

• It removes -
• Potentially infectious micro-organisms
• The organic material on which micro-organisms
  thrive
• Soil which protects micro-organisms during
  sterilization and disinfection
• Soil which may inactivate the disinfectant

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CLEANING

• Facilities
• Water temperature
• Detergent concentration
• Validation of method

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STEAM STERILIZATION

• Items can be packaged to prevent recontamination
• No toxic processing residues
• Validated, controlled process with reproducible
  cycles
• Items must be heat tolerant

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TESTING OF STEAM STERILIZERS

• Temperature and automatic control test
• Air removal test
• Leak rate test
• Thermocouple test
• Air detector test
• Chemical indicators

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THERMAL WASHER DISINFECTORS

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THERMAL WASHER DISINFECTORSTYPICAL CYCLE

• Low temperature first wash lt35oC
• Main wash gt55oC
• Disinfection rinse
• 71oC for 3 mins
• 80oC for 1 min
• 90oC for 12 secs
• Optional stages final cold rinse, dry

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MEDICAL DEVICES

• Effective cleaning and disinfection/
  sterilization using a properly validated washer
  disinfector and/or sterilizer will
• Protect patients and staff from infection
• Prolong the life of the equipment
• Ensure the quality of the diagnostic/ therapeutic
  procedure

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CONSIDERATIONS WHEN CHOOSING A CHEMICAL
DISINFECTANT

• Purpose instrument, skin, environment
• Range of activity
• Rate of kill/turnaround time
• Health and safety issues
• Compatibility
• Inactivation by organic matter
• Ease of use
• Cost

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IMMERSION IN CHEMICALS

• Suitable for heat sensitive instruments
• Items cannot be packaged to prevent
  recontamination
• Disinfectants often toxic and sensitizing
• Thorough rinsing is necessary to remove toxic
  residues
• Often inadequate process controls/validation
• Traceability

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RANK ORDER OF RESISTANCE TO DISINFECTANTS

• Bacterial spores
• Mycobacteria
• Non enveloped viruses
• Fungi
• Gram negative bacteria
• Gram positive bacteria
• Enveloped viruses

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ENVIRONMENTAL SURFACES

• Smooth, easily cleaned and appropriately wear
  resistant
• Carpets are not advised in any clinical areas
• Soft furnishings covered in impervious materials
  in any clinical areas
• Curtains able to withstand disinfection
  temperatures
• NHS Estates Infection Control in the Built
  Environment

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ENVIRONMENTAL CLEANING

• Maintain patient confidence
• staff morale
• Minimise infection risk
• infestation
• Removes organic material on which micro-organisms
  thrive

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THE ENVIRONMENT

• Surfaces that do not make direct contact with the
  patient e.g. floors, walls
• Surfaces that do make direct contact with the
  patient e.g. beds, mattresses, chairs etc.

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USE OF ENVIRONMENTAL DISINFECTANTS

• Body fluid spills to protect the remover
• Surfaces in contact with infected patients or
  carriers of multi-resistant strains e.g.
  mattresses, supports, baths, trolley tops
• Surfaces in contact with a vulnerable site e.g.
  damaged or broken skin, highly susceptible patient

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ENVIRONMENTAL DISINFECTION

• When an area is occupied by infected and
  non-infected patients, routine disinfection of
  the general environmental may have a role in
  infection control.
• Disinfection of communal equipment after each use
  is of far greater value.

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SUMMARY ENVIRONMENT

• Should be hostile to the multiplication of
  pathogens i.e. clean, dry, well ventilated and
  maintained. All potentially infectious material
  e.g. sharps, dressings, clinical waste, dirty
  linen and body fluid spills, should be suitably
  contained and removed.

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THANK YOU FOR LISTENING

• tina.bradley_at_uhb.nhs.uk