Download Infection Prevention and Control Policy - Section C

CLEANING, DISINFECTION AND STERILIZATION
Medical and surgical devices may serve as a vehicle for the transmission of infectious disease to
susceptible hosts, Damani (1997).
•
•
The aim of these guidelines is to promote the removal of visible soil/dirt and invisible microorganisms thus making the patients’ equipment and environment safe to prevent cross infection
between patients and to protect personnel from potentially infected items and equipment.
Decontamination is a general term that is used for the destruction or removal of microbial
contamination to render an item safe. This will include methods of cleaning, disinfection and
sterilization, (Ayliffe 1993).
METHODS OF DECONTAMINATION
Cleaning and drying A process which removes soil, e.g. dust, dirt and organic matter along with a
large proportion of micro-organisms; a further reduction will occur on drying as micro-organisms
cannot multiply on a clean dry surface.
• Thorough cleaning with soap/detergent and hot water is adequate for most surfaces.
• Efficient cleaning removes a high proportion of any micro-organisms present including
bacterial spores.
• All cloths/towels used should be disposable.
• Cleaning is an essential prerequisite to disinfection and sterilization.
Disinfection by either heat or chemicals will destroy micro-organisms but not bacterial spores. The
process does not necessarily kill or remove all micro-organisms but reduces their level to one that is not
harmful to health.
• Disinfection can be achieved by moist heat (thermal disinfection).
• A combination of cleaning and thermal disinfection is used in bedpan washer disinfectors,
washing machines and dishwashers.
• Chemical disinfectants should only be used if heat treatment is impractical or may cause
damage to the equipment. This process may be described as high level disinfection.
• Chemicals used to kill micro-organisms on the skin or living tissue are known as antiseptics.
Sterilization is a process that can achieve the complete destruction or removal of micro-organisms
including bacterial spores.
• Equipment and materials used in procedures involving a break in the skin or mucous
membranes must be sterile, e.g. surgical instruments, products for parenteral use or
instillation into sterile body cavities.
• Sterilization can be achieved by physical methods such as heat, low temperature steam or
by the use of chemical such as Ethylene Oxide.
• Autoclaves are widely used throughout the Trust for sterilization. (page 10-C)
• Autoclaves are unsuitable for heat labile items of equipment such as flexible fibreoptic
endoscopes and many plastic devices.
The choice of methods used depends mainly on the type of material, level of decontamination required
for the procedure and micro-organisms involved.
REMEMBER: Appropriate protective clothing should be worn.
I C Guidelines
1-C
September 2000
CATEGORISING EQUIPMENT BY RISK
All equipment should be categorised as to the risk it poses for patients/clients. Single patient use
equipment must never be used on more than one patient/client and single use equipment should always
be used according to the manufacturers’ recommendations.
The risks of infection from equipment may be classified into four categories, (Coates and Hutchinson
1993). All items should be placed in one of the following categories to assist in ascertaining the
appropriate level of decontamination needed to protect the patients/clients and staff.
RISK CATEGORY
Minimal Risk
Low Risk
Intermediate Risk
High Risk
DEFINITION AND EXAMPLES
Items some distance away from the patient
such as environmental surfaces and fittings,
e.g. walls, floors, ceilings, sinks and drains.
Items in close proximity to the patient but
unlikely to be contaminated with a significant
number of pathogens,
e.g. bedframes, lockers, flower vases.
Items in contact with normal intact skin. e.g.
stethoscopes, wash bowls, crockery,
cutlery, mobile telephones.
Items in contact with intact mucous
membranes, e.g. respiratory equipment,
clinical thermometers, gastroscopes.
Items in contact with particularly virulent or
readily transmissable organisms. e.g.
commodes during an outbreak of
diarrhoea.
Items to be used on highly susceptible
patients.
Items in close contact with a break in the skin
or mucous membranes, e.g. dressings.
Items introduced into a normally sterile body
site, e.g. surgical instruments, needles,
implants, urinary catheters.
DECONTAMINATION
LEVEL
Cleaning and Drying
adequate
Cleaning and Drying
usually adequate
Disinfection
Sterilization
Legal requirements relating to the decontamination of equipment include :-
• Health and Safety at Work Act (1974).
• Health Service Circular HSC 1999/123 Controls Assurance Statements 1999/2000: Risk
•
•
•
•
Management and Organisational Controls.
Health Service Circular 1999/179 Controls Assurance, Infection Control. Decontamination of
Medical Devices.
Medical Devices Agency (1998) – MDA DB9804. The validation and periodic testing of Bench
top Vacuum Steam Sterilizers. MDA. London.
Personal Protective Equipment at Work Regulations (1992) – Health and Safety Regulations.
Control of Substances Hazardous to Health Regulations (1988) – Statutory Instrument No 1657.
HMSO. London.
I C Guidelines
2-C
September 2000
GUIDELINES FOR THE USE OF SKIN DISINFECTANTS
There are three principles for removing or reducing the number of micro-organisms present on the skin
or mucous membranes:
• To reduce the number of skin micro-organisms present prior to an invasive procedure.
• To remove or destroy potentially pathogenic micro-organisms present on the hands of staff.
• Occasionally to treat a carrier or disperser of a resistant, virulent or highly communicable
strain of bacteria.
AGENT
Alcohol
70% impregnated swab
Alcohol 70% with glycerol
TRADE NAME
Steret/Mediswab
Alcohol gel
Spirigel
Chlorhexidine 4%
Hydrex Surgical Scrub
Skin cleanser
Chlorhexidine 0.5% with alcohol Chlorhexidine/Hibitane
tincture
Chlorhexidine 0.5% with
Savlodil/Ti-sept
Cetrimide 0.015%
Chlorhexidine Acetate
Hexachloraphane dusting
powder
Industrial Methalated Spirit
CX Antiseptic dusting
powder
Sterzac
IMS BP
INDICATION FOR USE
Rapid disinfection of skin, e.g. prior to
injection.
Swabbed area must be allowed to dry
prior to injection being administered.
Disinfection for physically clean hands
where handwashing facilities are
unavailable or unsuitable.
Hand disinfection for surgery or
aseptic procedures.
Pre operative preparation.
Cleansing of site prior to insertion of a
urinary catheter.
Skin and wound disinfection but not
routinely.
Umbilicus of neonates and some cases
of S.aureus skin colonization.
Umbilicus of neonates and some cases
of S.aureus skin colonization.
Disinfection for physically clean hands
where handwashing facilities are
unavailable or unsuitable.
Hand disinfection for surgery or
aseptic procedures.
Pre operative skin preparation.
Povidone iodine skin cleanser
Betadine surgical scrub
Povidone iodine 10%
Betadine Antiseptic
Solution
Betadine Alcohol Solution Pre operative skin preparation.
Povidone iodine 10% with
alcohol
Triclosan 2% skin cleanser
Aquasept skin cleanser
Treatment of S. aureus skin
colonization.
NOTE: All areas should be physically clean (i.e. cleaned with soap and water) prior to being
disinfected, (Ayliffe et. al. 1993).
I C Guidelines
3-C
September 2000
ENVIRONMENTAL DISINFECTANTS
It is essential that any equipment or surface is physically clean prior to a disinfectant being applied,
(Wilson 1995).
Environmental disinfectants can be used for a wide range of tasks including:-
•
•
•
•
Rapid disinfection of equipment and surfaces.
Treatment of spillages of potentially hazardous matter, (wear gloves and apron).
Disinfection of re-usable items of equipment that are heat labile.
Cleaning during outbreaks on the advice of the Infection Control Team.
The properties of disinfectants vary from one product to another and also the concentration of
disinfectant being used.
DISINFECTANTS SHOULD BE MADE UP AS REQUIRED AT THE TIME OF USES
AGENT
Alcohol 70%
Hypochlorites
TRADE NAME
Sterets/Mediswabs
Alcowipes
Azowipes
Chloros, Domestos, Milton
Sodium
Dichloroisocyanurates
(NaDCC)
Presept granules, Sanichlor,
Actichlor and Covchlor
Clear soluble phenolic
Clearsol 1%
INDICATION FOR USE
Rapid disinfection of certain items of
equipment and hard surfaces.
Chlorine based solutions should be
used for blood spillages in non
carpeted areas, terminal cleaning of
an isolation area, cleaning during
outbreaks of infection and for
disinfecting surfaces and equipment
in some cases. Dilutions are shown
on page 7-C.
Must only be used for terminal
cleaning of an isolation room after
confirmed Tuberculosis or clearing
up sputum from a known
Tuberculosis patient.
DISINFECTANTS FOR INSTRUMENTS
Instruments must be physically clean prior to being disinfected.
AGENT
Glutaraldehyde
I C Guidelines
TRADE NAME
Cidex, Asep, Totacide
4-C
INDICATION FOR USE
A useful disinfectant for equipment that
cannot be heat sterilized such as
endoscopes. It has a wide range of
bacterial, viricidal and fungicidal activity.
Slow activity against spores.
IRRITANT TO EYE AND SKIN
Refer to page 9-C and Trust Health and
Safety Policy.
September 2000
CHEMICAL DISINFECTANTS GUIDELINES FOR GENERAL USE
There are a number of important factors that must be considered when using chemical disinfectants:
•
The efficacy of chemical disinfection is often uncertain and, wherever possible, disinfection by heat
is preferable to chemical methods.
•
All chemical disinfectants must be clearly labelled and used within the expiry date. They should be
freshly prepared. They must be used at the correct concentration and stored in an appropriate
container.
•
Chemical disinfectant solutions must not be mixed or detergents added unless they are compatible.
•
Disinfectant or detergent solutions must not be prepared and stored in multi-use containers for
occasional use. Solutions prepared and stored in this manner may easily become contaminated
with micro-organisms; using such solutions will therefore readily contaminate a surface rather then
clean it.
•
Manufacturer’s instructions must be consulted on compatibility of materials with the method of
sterilization or disinfection.
•
Alcohol does not penetrate well into organic matter it should therefore only be used on surfaces
that are physically clean.
USE OF SINGLE USE DEVICES (MDA 1995)
The expression “Single Use”* on the packaging of medical devices indicates that the manufacturer:
• intends the item to be used once and then discarded; and
• considers that the items are not suitable for use on more than one occasion.
The term “Single Patient Use” refers to items that are used by an individual patient only throughout
the course of their course of treatment. They should only be re-used according to the manufacturer’s
recommendations and must be kept in a clean condition, stored appropriately and only re-used by the
same patient.
Some devices are intended by their manufacturers to be used more than once and with different
patients provided that they are appropriately decontaminated in between each use. Where reprocessing may affect the performance and safety of the device the manufacturer should supply details
of the recommended cleaning process to be followed and the number of re-uses which may be
undertaken.
* As an alternative to the expression “single use”, other statements may be used, these include “Do not
re-use”, or a symbol comprising of the figure 2 with a diagonal line drawn through it which may appear
on packaging.
All Trust staff who use medical devices/equipment should follow the manufacturers guidelines on use
and re-use.
I C Guidelines
5-C
September 2000
CLEANING OF A SIDE WARD POST ISOLATION NURSING
Terminal cleaning of a room is indicated when a patient/client has been under source isolation and is
discharged or transferred to another area. The following procedure should be followed.
When special cleaning arrangements are required the domestic services supervisor should be informed
of the risk of infection not the patient’s/client’s diagnosis.
1. Domestic staff must wear a disposable plastic apron and use appropriate colour coded household
gloves.
2. Terminal cleaning should commence only after the patient/client and his/her belongings have been
removed from the room or the area.
3. Any disposable items or equipment should be discarded as clinical waste.
4. Seal yellow clinical waste bags before leaving the room and discard as clinical waste for
incineration.
5. Place all linen including bed linen, screens, curtains etc. into the appropriate bags and ensure they
are sealed prior to leaving the room or area.
6. Remove any items of nursing equipment to the dirty utility area for cleaning and disinfection. All
autoclavable items should be processed appropriately or sent to CSSD.
7. The bed mattress should be wiped with warm water and general purpose detergent (GPD) and
dried thoroughly. If disinfectant is indicated, wipe with a freshly prepared hypochlorite (1000 ppm)
solution.
8. Dust the high ledges, windows and curtain tracks. Vacuum clean fixtures, fittings and floor.
9. Wet clean all ledges, fixtures and fittings, including taps and door handles.
10. Wash sink with hypochlorite (1000 ppm) or a detergent cleanser, rinse and dry thoroughly.
11. Wash floor with hypochlorite (1000 ppm) or steam clean carpet clean with appropriate detergent
solution. Spot clean walls as necessary. Rinse and ensure all areas are thoroughly dry.
12. The room may be used again for patients/clients when all surfaces are clean and dry.
If the patient is isolated in an open ward, then the entire surrounding area up to the next bed should be
cleaned as above. Seek advice from the Infection Control Nurse if you require specific advice or
information.
I C Guidelines
6-C
September 2000
MANAGEMENT OF BLOOD OR BODY FLUIDS SPILLAGE
Spillages of blood and body fluids must be disinfected and cleaned promptly. Spillage kits can be
purchased but the use of a chlorine based solution (or Presept granules) is recommended for blood
spillages in areas that will not be damaged by the use of bleach. The alternative method should be used
for blood spills in areas where a chlorine based solution cannot be used or when the spillage is of urine.
(Lewis and Meese 1997).
Gloves and Plastic Apron must be worn.
RECOMMENDED METHOD
ALTERNATIVE METHOD
• Cover spill with NaDcc powder,
(Saniclor/Precept) or 1%
Hypochlorite (bleach)solution.
• Remove as much of the spillage as
possible with paper towels.
• Clean the area with a detergent
solution.
• Leave for a few minutes, then mop
up with paper towel.
• Leave as dry as possible .
• Clean area with a detergent solution
Dispose of Waste into a Yellow Clinical Waste bag.
RECOMMENDED METHOD:- For use on spillages of blood or vaccines that are on surfaces not
damaged by bleach based products.
ALTERNATIVE METHOD:- For use on spillages of urine, vomit or diarrhoea. Also to be used for
spillages of blood/vaccine on surfaces that are damaged by bleach based products.
USE OF HYPOCHLORITE AND STRENGTHS OF SOLUTION
Prior to using Hypochlorite solutions, surfaces/equipment should be physically cleaned with hot water
and General Purpose Detergent (GPD) except in the case of blood spills.
USE
Blood spills
Laboratory discard
Environmental disinfection
Disinfection of clean instruments
Infant feeding utensils, catering
surfaces and equipment
DILUTION OF STOCK
SOLUTION
Undiluted
1 in 10
1 in 40
1 in 100
1 in 200
1 in 800
AVAILABLE CHLORINE
%
P.P.M.**
10*
100000*
1.0
10000
0.25
2500
0.1
1000
0.05
500
0.0125
125
*Approximate value of some brands, e.g. Chloros, Domestos
** PPM – parts per million
I C Guidelines
7-C
September 2000
I C Guidelines
PREPARATION AND USE OF HYPOCHLORITE BASED SOLUTIONS
Hypochlorite
Preparations
Strength
To prepare
Uses
Decontamination of blood and bloody body fluid spills,
especially if the spill may contain a pathogenic virus, eg
Hepatitis B, HIV
To make dilute solution (1,000
Decontamination of surfaces that may be lightly (ie not visibly)
4 tablets in 5 litres of water
PPM)
contaminated with pathogenic viruses
Decontamination of blood and bloody body fluid spills,
To make concentrated solution
10 tablets in 1 litre of water
especially if the spill may contain a pathogenic virus, eg
Actichlor tablet (10,000 PPM)
Hepatitis B, HIV
1.7 g
To make dilute solution (1,000
Decontamination of surfaces that may be lightly (ie not visibly)
1 tablet in 1 litre of water
PPM)
contaminated with pathogenic viruses
To make concentrated solution
Decontamination of blood and bloody body fluid spills,
(10,000 PPM)
Add 50 mls water
especially if the spill may contain a pathogenic virus, eg
Milton tablet
Hepatitis B, HIV
(800 mg)
To make dilute solution (1,000
Decontamination of surfaces that may be lightly (ie not visibly)
Add 500 mls water
PPM)
contaminated with pathogenic viruses
To make concentrated solution
Dilute 1:10 in water (Add bleach Decontamination of blood and bloody body fluid spills,
(10,000 PPM)
solution to water and not vice
especially if the spill may contain a pathogenic virus, eg
Domestos
versa)
Hepatitis B, HIV
solution
To make dilute solution (1,000
Decontamination of surfaces that may be lightly (ie not visibly)
Dilute 1:100 in water
PPM)
contaminated with pathogenic viruses
Decontamination of blood and bloody body fluid spills,
To make concentrated solution
1 tablet in 100 mls of water
especially if the spill may contain a pathogenic virus, eg
(10,000 PPM)
Covchlor tablets
Hepatitis B, HIV
To make dilute solution (1,000
Decontamination of surfaces that may be lightly (ie not visibly)
1 tablet in 1 litre of water
PPM)
contaminated with pathogenic viruses
Always check dilutions with product instructions. If in doubt, follow manufacturer’s guidelines. Use preparation as soon as it is made up.
Actichlor tablet
2.5 g
(not 5g or 500
mg tablet
To make concentrated solution
(10,000 PPM)
7 tablets in 1 litre of water
8-C
September 2000
GUIDELINES FOR THE SAFE USE AND HANDLING OF GLUTARALDEHYDE
Glutaraldehyde is a hazardous substance, it is toxic if used incorrectly. Care should be taken to avoid
inhalation, skin and eye contact.
1. Wear suitable gloves, e.g. Nitrile for prolonged exposure.
2. Wear a plastic apron to prevent penetration through clothing.
3. Improve ventilation by using low level extraction ventilation or activated charcoal filters.
4. Wear eye protection e.g. safety glasses, during decanting or when splashing is likely.
Respirator/mask for use with gas/vapour should be available for use.
3M
5. Following immersion, rinse items thoroughly.
6. Replace rinse water frequently.
7. Dilute with further water prior to discharge to drain.
8. Do not spray or use liberally on environmental surfaces.
9. Ensure containers are secure during storage.
10. Do not subject to extremes of temperature.
11. Ensure lids remain in place on immersion tanks.
12. Ensure items are thoroughly cleaned before immersion, glutaraldehyde is a fixative.
13. Preferably do not use in busy densely populated areas.
14. Position exhaust outlet away from inlets or windows.
15. Once activated the solution must only be used for the recommended period, i.e. number of cycles
or time period.
16. Never use glutaraldehyde when safe alternatives are available, e.g. heat, chlorine releasing agents or
alcohol. Advice on safe alternatives and processing of equipment is available from the Infection
Control Team.
Following accidental contact with the skin or splashing to the eye or mouth, wash with large
quantities of cold water for 10 – 15 minutes and obtain medical advice. Complete an
incident/accident report form and notify Occupational Health.
All staff should be aware of the Trust’s Glutaraldehyde policy in the Health and Safety Policies binder.
This page can be photocopied and displayed in staff areas.
I C Guidelines
9-C
September 2000
THE USE OF BENCH-TOP AUTOCLAVES
There are many factors to be taken into account when considering the provision of sterile equipment.
Where possible equipment should be decontaminated and sterilised by a recognised Sterile Services
Department. The following guidance is intended to promote the safe and effective use of bench-top
autoclaves. All practitioners using bench-top autoclaves should comply with this guidance.
•
Instruments used for vaginal examination and the insertion/removal of intrauterine devices should be
decontaminated after use by steam sterilisation. Disposable instruments used for these purposes
should be discarded as clinical waste immediately after use, (MDA 1995).
•
Instruments to be used in minor surgical procedures must also be decontaminated after use, using
steam sterilisation and MUST be sterile at the time of use.
PRE CLEANING OF INSTRUMENTS
Pre-cleaning is an essential part of the decontamination process. The sterilisation process will not be
effective if the item is contaminated with organic matter.
•
A dedicated sink should be used for pre-cleaning instruments.
•
Protective clothing (heavy duty gloves, plastic apron and eye protection) should be worn.
•
General purpose detergent and hot water is sufficient for pre-cleaning. Instruments should be
submerged whilst being cleaned, rinsed thoroughly and dried with disposable paper towel prior to
placement in the autoclave. Care should be taken throughout these procedures to avoid splashing
and/or the creation of aerosols.
•
Ultrasonic cleaning baths are an effective way of cleaning fine bore instruments and may be
useful for delicate instruments, eg those used in dentistry or some minor surgery. Ultrasonic baths
must be used in accordance with the manufacturer’s instructions. The following points should also
be considered:
•
•
•
A detergent solution should be used in ultrasonic baths. The detergent solution should be
changed according to the manufacturer’s recommendations. This may be at least twice
daily or more often if heavily contaminated.
On removal from ultrasonic baths instruments should be rinsed in water and inspected for
residual debris. The cleaning process should be repeated if residual debris is present.
Ultrasonic baths should be emptied, cleaned and left dry at the end of each session.
Instruments should be checked for wear or damage (e.g. joints move freely but are not loose, scissors
are sharp, forceps align correctly etc.). Items identified as defective should be immediately taken out of
use, sent for repair or discarded and replaced.
I C Guidelines
10 - C
September 2000
OPERATION
•
Bench-top autoclaves should not be situated in staff areas, and ideally not in rooms where staff are
working during their operation.
•
Bench-top autoclaves should be positioned so as to facilitate the movement of instruments from a
“dirty” to clean area after autoclaving.
•
Bench-top autoclaves should only be operated by designated personnel, who have an
understanding of the principles involved.
•
Bench-top autoclaves are only suitable for unwrapped instruments and equipment of a non-porous
nature unless using a vacuum cycle.
•
The basket/tray should not be overloaded. Instruments should not overlap and be open so all
surfaces are exposed to steam.
Instruments should be autoclaved for:
Temperature (oC)
Minimum Hold Time
Pressure Bar
134
3 minutes
2.25
126
10 minutes
1.50
121
15 minutes
1.15
Please note that these temperatures must be reached before timing commences.
MAINTENANCE
•
Autoclave pressure, temperature and cycle time should be checked daily and these details
recorded in a log book, by designated personnel. The operating manual should be kept next to the
autoclave in a protective folder. A quarterly service should be carried out by a qualified technician,
(most manufacturers will provide this service).
•
Maintenance records and operating manual entries should be retained for 11 years.
NB: Requirements for the servicing of bench-top autoclaves are set out by the Department of Health in
Health Technical Memorandum (HTM) 2010. The autoclave will also need servicing by the Trust
insurers every 14 months as a pressure vessel.
A designated operating manual is available for every Trust owned autoclave.
STORAGE OF INSTRUMENTS
•
Instruments should be stored dry and covered to protect them from dust.
•
Instruments which are required to be sterile at the time of use (eg those used in minor surgery, coil
insertion) must be used within 3 hours of removal from the autoclave.
I C Guidelines
11 - C
September 2000
PURCHASE
•
When purchasing a bench-top autoclave always seek independent advice regarding the autoclave’s
compliance with British Standard and Department of Health guidance prior to purchase.
Independent advice can be obtained from the Infection Control Team or the Facilities Department
Inability to comply with any of this guidance indicates the need to have equipment sterilised by a local
Sterile Services Department.
I C Guidelines
12 - C
September 2000
DECONTAMINATION OF MEDICAL OR LABORATORY EQUIPMENT
Action in response to HSG 93/26 Decontamination of Equipment prior to
Inspection, Service or Repair
• Anyone who inspects, services or repairs medical and laboratory equipment either on NHS
premises or elsewhere has the right to expect that articles have been properly treated so as to
remove or minimise the risks of infection.
• Equipment and articles used for invasive procedures, analysis and diagnosis which comes into
contact with blood, body fluids/tissue or other pathological specimens will require decontamination
prior to examination.
• Equipment which is visibly soiled with blood/body fluids and is accessible to cleaning must never be
presented or sent to a third party for maintenance or repair.
• All decontamination procedures should be undertaken by suitably qualified staff. The method of
decontamination used must be one that does not damage the article or any of its components. In
cases of doubt about the appropriate method, advice can be sought from:
•
•
•
•
The manufacturer or agent
Facilities Department/EBME
Sterile Services Department
A member of the Infection Control Team.
Where appropriate Hospital Engineers/EBME technicians should have sight of equipment before any
further action is taken.
• A Declaration of Contamination Status (page 14-C) must be fully completed by an authorised
person in the department before the equipment is sent for repair. This should be given to the
porter/technician when equipment is collected for repair/service, and remain with the equipment
until it reaches its final destination.
If equipment is being sent to an outside company/agency for repair/service:-
• A Declaration of Contamination Status (page 14-C) must be completed by an authorised person in
the department before the equipment is collected for repair/service. The declaration should be
attached to the outside of the equipment and marked “examine enclosed document before
unpacking”.
User department must always ensure safe packaging and despatch of goods with official order to repair
company and enclose a Declaration of Contamination Status form.
In certain situations equipment may not be decontaminated prior to inspection, service or repair, either
because the equipment is subject to investigation as the result of a complaint or it may not be
adequately decontaminated without engineering assistance. In such cases the advice of the investigating
body should be sought. If such an item is to leave the Trust, the following precautions must be taken:-
• A prior warning should be given to the intended recipient.
• The condition of the item should be clearly labelled on outer packaging.
• The packaging must be suitably robust to ensure contamination will not occur
during transportation.
• The agreement of the transporter may be required.
I C Guidelines
13 - C
September 2000
WORCESTERSHIRE COMMUNITY AND MENTAL HEALTH NHS TRUST
DECLARATION OF CONTAMINATION STATUS
prior to the inspection, servicing, repair or return of medical and laboratory equipment
To:
Make and description of equipment/items:
Model/Serial/Batch number:
Other distinguishing marks:
Has this equipment been exposed internally or externally to hazardous materials as indicated
below?
Blood, body fluids, respired gases or pathological samples.
Other biohazards
YES
YES
NO
NO
Chemicals or substances hazardous to health
Other Hazards
YES
YES
NO
NO
COMMENTS:
Has this equipment been cleaned?
YES
NO
Has this equipment been decontaminated?(Disinfected or sterilized after cleaning)YES
Please give details of methods and materials used for cleaning/decontamination:
NO
If the equipment could not be cleaned/decontaminated please indicate why:
Such equipment must not be returned/presented without the prior agreement of the recipient
whose reference or contact name must be given above.
Has the equipment been suitably prepared to ensure safe handling/transportation?
YES
Signature:
Unit:
Name:
Tel. no.
Position:
Date:
I C Guidelines
14 - C
NO
September 2000
DECONTAMINATION GUIDELINES
Equipment
Agent/Method
Comments and Instruction for Use
Manufacturer’s guidelines must always be checked prior to carrying out the
Decontamination process
Airways
Disposable
Discard as clinical waste immediately
after use.
Auriscope
General Purpose Detergent
Clean between each patient/client.
(GPD) then 70% alcohol wipe.
Clean speculum with hot water and GPD,
using a cotton bud for the inside. Wipe
with alcohol. Allow to dry. Store dry.
Baby Changing Mats
General Purpose Detergent
Cover with disposable paper towels.
(GPD)
Change these between each baby. Mats
should be washed with hot water and
GPD at the end of each session, using a
disposable cloth. If visibly soiled, treat as
a spillage (see Spillages page 7-C). If
the plastic covering becomes torn or
damaged, the mat should be thrown
away. Hard surface wipes could be used
for extra decontamination between each
use.
Baby Scales
General Purpose Detergent
Cover with disposable paper towel.
(GPD)
Change between each baby. Clean with
GPD and hot water at the end of each
session. Use a disposable cloth. If
visibly soiled treat as a spillage (see
Spillages page 7-C).
Baths
Detergent Solution/Cream
Wipe with detergent solution and rinse.
Cleanser
Cream cleanser may be used for stain
and scum removal.
Bed Frames
General Purpose Detergent
Wash with GPD and hot water. Rinse,
(GPD)
dry thoroughly with disposable towels.
Bed Pans, Urinals,
General Purpose Detergent
Empty contents down toilet. Wash with
Commode Pans
(GPD)
hot water and GPD to remove visible
contamination. Rinse. Avoid splashing.
- in client’s home
Dispose of cloth after use. Store dry.
If disposable bed pans are used, contents
should be emptied as above. Place
empty container in clinical waste sack.
Arrange clinical waste collection through
Facilities Department.
Cracked/damaged equipment should be removed from service. Report any malfunction immediately
to the Facilities Department.
I C Guidelines
15 - C
September 2000
Equipment
Agent/Method
Comments and Instruction for Use
Manufacturer’s guidelines must always be checked prior to carrying out the
decontamination process
Bed Pans, Urinals,
Commode Pans
-
on return from
client
Bed pan washer
Place in bed pan washer for routine cycle
if available. Wash with General Purpose
Detergent if bed pan washer not
available. Store dry.
-
In hospital
Bed pan washer
Place in bed pan washer for routine
cycle. If disposable items are used they
should be placed in a macerator. If this
is not possible, contents should be
emptied down toilet.
Bed railings, monkey
poles, cradles
General Purpose Detergent
(GPD)
Wash with GPD and hot water. Rinse.
Dry thoroughly with disposable paper
towel.
Bowls
- surgical
Autoclave
Return to Sterile Services Department or
use a bench-top autoclave (see Use of
Bench-top Autoclaves page 10-C). Prior
to autoclaving wash with general purpose
detergent to remove visible organic
matter. Avoid splashing.
General Purpose Detergent
(GPD)
General Purpose Detergent
(GPD)
Clean with GPD and hot water. Store
dry and inverted.
Allocate BP cuff for patients in isolation.
Wipe over with detergent and warm
water if soiled and after use on infected
patients.
-
for washing of
patients/clients
BP cuffs
Breast Pumps
loaned out in
community settings
-
pump box
Wipe over with a clean damp
cloth between each loan
-
accessory kit/pump
collection kit
Send to be autoclaved at a sterile
supplies department
-
hand pumps
Between each individual loan
Whilst equipment is on loan it is the
responsibility of the user to ensure it is
adequately decontaminated. Trust staff
should ensure users have been given the
correct instructions for this and the
importance of adequate cleaning prior to
disinfection or steam sterilisation.
ALWAYS check suitability of equipment
for autoclaving. Contact ICN for further
advice
Cracked/damaged equipment should be removed from service. Report any malfunction immediately
to the Facilities Department.
I C Guidelines
16 - C
September 2000
Equipment
Agent/Method
Comments and Instruction for Use
Manufacturer’s guidelines must always be checked prior to carrying out the
decontamination process
Carpets
Avoid carpeting clinical areas.
-
clinical areas
Detergent
-
clients’ homes
General purpose Detergent (GPD) Deal with spillage then use General
Purpose Detergent not hypochlorite to
avoid damaging the carpet.
Single Use (Disposable)
Overnight drainage bags should be nondrainable and discarded each morning. It
is not recommended to re-use drainable
bags after washing them each morning.
Autoclave after each use
Return to Sterile Services Department or
use a bench-top autoclave (see Use of
Bench-top Autoclaves page 10-C).
Catheter Drainage Bags
Cervical Caps
(Practice Caps)
Vacuum clean. Washing should be by
hot water extraction using approved
detergent. Spillages of blood/body fluid
should be dealt with using the principles
outlined in Spillages of Blood or Body
Fluids on page 7-C.
Prior to autoclaving, either place in
ultrasonic cleaner or wash with General
Purpose Detergent to remove visible
organic matter and rinse. Avoid
splashing.
Cleaning cloths
Dispose of daily
Wash daily at 90o C. If not disposable in
(domestic)
isolation rooms use a clean cloth per bed
space.
Commode Chairs
General Purpose Detergent
Clean with GPD and hot water. Use
(GPD)
disposable cloth. If visibly soiled, treat as
spillage (see Spillages page 7-C). During
outbreaks of gastroenteritis clean as
normal then wipe with a 1000 ppm
chlorine solution.
Crockery and Cutlery
General Purpose Detergent
Use dishwasher if available. If not, hand
(GPD)
wash in GPD and hot water. Dry
according to local policy.
Curtains
Routine change 6 monthly and
Routine change may be advised by
- bed and window
when soiled.
infection control when a disperser of
MRSA or known infection has been
nursed on the open ward.
Cracked/damaged equipment should be removed from service. Report any malfunction immediately
to the Facilities Department.
I C Guidelines
17 - C
September 2000
Equipment
Agent/Method
Comments and Instruction for Use
Manufacturer’s guidelines must always be checked prior to carrying out the
decontamination process
Dental Mirrors for
Autoclave after each use
Return to Sterile Services Department or
School Inspection
use a bench-top autoclave (see Use of
Bench-top Autoclaves page 10-C).
Diaphragms
-
Autoclave after each use
vaginal (Practice
Caps)
Drains
Dressing Trolleys and
Attachments
General Purpose Detergent
(GPD)
Duvets
- water-impermeable
cover
General Purpose Detergent
(GPD)
Ear Syringe Nozzle
Autoclave
ECG electrodes
Endoscopes
Examination Couches
Use of disposable electrode pads
See separate policy
General Purpose Detergent
(GPD)
Prior to autoclaving wash with General
Purpose Detergent to remove visible
organic matter. Avoid splashing during
this process. If mirrors will not withstand
autoclaving they should be cleaned with
with GPD and then soaked in
Chlorhexioline Gluconate.
Return to Sterile Services Department or
use a bench-top autoclave.
Prior to autoclaving wash with General
Purpose Detergent to remove visible
organic matter. Avoid splashing during
this process.
Clean regularly. Chemical disinfection is
not advised.
At beginning of each session and/or
when visibly soiled wash with GPD. Use
disposable cloth. Ensure surface is dry
before placing sterile pack on top. Hard
surface wipes can be used if physically
clean.
Wash with detergent and warm water,
and dry. If heavily contaminated, wash
with chlorine releasing solution 1000 ppm,
rinse and dry. NB bleach will damage
the cover if used too often.
Wash in hot water and General Purpose
Detergent. Squirt hot water and GPD
carefully through nozzle. Autoclave after
cleaning. Please refer to section on Use
of Bench-top Autoclaves (page
10-C).
None
Cover with disposable paper roll. Wash
with hot water and GPD at the end of
each session. If visibly soiled treat as a
spillage. (See Spillages page 7-C). If the
plastic covering becomes torn or
damaged it should be replaced. Couch
can be wiped with hard surface wipes
between clients/patients.
Cracked/damaged equipment should be removed from service. Report any malfunction immediately
to the Facilities Department.
I C Guidelines
18 - C
September 2000
Equipment
Agent/Method
Comments and Instruction for Use
Manufacturer’s guidelines must always be checked prior to carrying out the
decontamination process
Floors
General Purpose Detergent
Wash with GPD and hot water.
- wet clean
(GPD)
Allow to dry. Disinfection not routinely
required. If necessary chlorine releasing
agent may be used.
- dry clean
Vacuum Clean
Dust attracting mop
Flower Vase
General Purpose Detergent
Change water and wash vase with GPD
and hot water weekly.
Hands
See Handwashing.
Headphones
General Purpose Detergent
Wash with GPD and hot water. Dry
(GPD)
thoroughly.
Disposable
Ice making machines
Switch machine off and discard all ice. Wipe over with warm water and
General Purpose Detergent (GPD). Rinse thoroughly to ensure no detergent
remains. Ice should be handled using the scoop provided. The scoop should
be cleaned with warm water and GPD daily, rinsed and left in a clean, dry
uncovered container after each use. NEVER return unused ice to the ice
storage chest. NEVER use patients’ water jug, glasses or other utensils as a
scoop. Access door must be kept shut when not removing ice. (Refer page
13-B).
Instruments
Autoclave
Where possible use disposables. If not
- forceps etc
possible return to Sterile Services
if not disposable
Department for cleaning or use a benchtop autoclave (see page 10-C).
IV stands/pumps
General Purpose Detergent
Damp dust after each patient or if soiled.
(GPD)
Hard surface wipes
Laryngoscope
General Purpose Detergent
After use remove bulb. Wash bulb and
(GPD) then 70% Alcohol wipe.
blade with GPD. Wipe thoroughly
(including hand piece) with 70% alcohol
wipe. Re-assemble. Store dry.
Linen
Clean linen should be stored in a cupboard or on a covered trolley. It should
- health centre stocks not be stored on exposed shelves.
Mattresses Specialist,
General Purpose Detergent
Rented mattresses should be returned to
including Alpha x-cell;
(GPD)
the rental company after cleaning, with a
Nimbus Pumps & carry
decontamination certificate. Mattresses
bags, Pegasus
owned by the Community Trust should be
returned to the issuing Equipment Loan
Store for cleaning before being loaned
again.
Prior to removal from the client’s home
mattresses should be washed with GPD
and hot water. If visibly soiled treat as a
spillage (see Spillages page 7-C).
Cracked/damaged equipment should be removed from service. Report any malfunction immediately
to the Facilities Department.
I C Guidelines
19 - C
September 2000
Equipment
Agent/Method
Comments and Instruction for Use
Manufacturer’s guidelines must always be checked prior to carrying out the
decontamination process
Mouth pieces
General Purpose Detergent
Wash with GPD. Dry. Wipe over with
(GPD) then 70% alcohol wipe.
70% alcohol wipe. Store dry.
- for use with placebo
inhalers
- if not disposable
Manual handling
equipment
- Arm resters
General Purpose Detergent
(GPD)
Wipe with detergent and water and dry.
Use hard surface wipe if soiled or used
by infected patient.
Send to on site hospital laundry to
be washed between patients use
and when soiled or in local/ward
washing machine.
Allocated for individual patient use unless
patient is fully dressed and a low
infection risk.
-
Bath hoist
-
Banana board and
immoturn
-
Handling belts
(fabric)
-
Hoist sling
-
Sliding sheet and
easislide
-
Stand aid slings
Launder
Remove cover and send to on site
hospital laundry to be washed when
soiled.
-
Supine transfer
boards (Pat slide)
General Purpose Detergent
(GPD)
Wipe with detergent and water and dry if
in direct patient contact. Use alcohol
wipe if soiled or used by infected patient.
Ward dishwasher. Wash in detergent
and warm water. Do not wash at
handwash sink.
None.
Vacuum after each use. Do not use for
more than 2 days without washing or
reprocessing.
Launder after use.
Rinse after each use, wring and store
with mop head uppermost to allow head
to dry. Launder daily in high risk areas.
Disposable slings may be used and should
be allocated for use on one patient only.
Medicine cups
General Purpose Detergent
(GPD)
Mops (dish/dolly)
Mops (dry dust
attracting)
Do not use.
Mops (wet) flat
Mops wet
General Purpose Detergent
(GPD)
Mop (bucket)
General Purpose Detergent
(GPD)
Clean with detergent and warm water
inside and out, at the end of the day and
evening shift.
Cracked/damaged equipment should be removed from service. Report any malfunction immediately
to the Facilities Department.
I C Guidelines
20 - C
September 2000
Equipment
Agent/Method
Comments and Instruction for Use
Manufacturer’s guidelines must always be checked prior to carrying out the
decontamination process
Nail brushes (surgeons’ Single use disposable
Use only if essential. A sterile nail brush
hands)
should be used.
Nail brushes (ward
Single use disposable
Avoid use if possible.
areas)
Nasal atomizer
Single use disposable
None.
Nebulisers
General Purpose Detergent
Nebuliser masks and tubing can be re(GPD)
used for the same patient. Wash mask
with hot water and GPD. Store mask
and tubing dry in a designated container
(NB container should be clearly marked
with the patient’s name if not for use in
his/her home).
Neurological testing
Single use disposable
Never improvise, eg name badges etc
due to the risk of blood borne infection.
Pillows
General Purpose Detergent
Must be completely covered with water
(GPD)
impermeable cover. Wash cover with
detergent and warm water and dry
between patient use.
Proctoscopes
Disposable.
Autoclave for non disposables.
Raised toilet seat
General Purpose Detergent
Wash with GPD. Excessive scratching,
cracks etc will make adequate cleaning
difficult. In this instance seats should be
discarded.
Razors (safety and
Use disposables – single patient
None. Must be disposed of as a “sharp”
open)
use
immediately after use
Razors (electric)
Use disposable heads – single
None
patient use
Receivers
General Purpose Detergent
Wash with GPD. Dry. Wipe over with
- if not disposable
(GPD) then 70% alcohol wipe.
70% alcohol wipe.
Resuscitation Equipment For silicone or black bags, ensure
- Ambubag
they are physically clean then
- Face mask
wipe with 70% isopropyl alcohol.
Scissors
(General use nursing)
Sheepskins
Showers
Isopropyl Alcohol 70%
Disposable masks/ampubags are
available as an alternative and can be
used for infectious conditions but are a
single use item.
Use sterile scissors for aseptic
procedures.
Send to laundry
Cream Cleanser or General
Purpose Detergent (GPD)
To be cleaned and dried once daily by
domestic staff and by nursing staff
between patients.
Slings
Refer to Manual Handling Equipment
- for use with hoists
listed on page 20-C.
Cracked/damaged equipment should be removed from service. Report any malfunction immediately
to the Facilities Department.
I C Guidelines
21 - C
September 2000
Equipment
Agent/Method
Comments and Instruction for Use
Manufacturer’s guidelines must always be checked prior to carrying out the
decontamination process
Specula vaginal
Autoclave
Return to Sterile Services Department or
- if not disposable
use a bench-top autoclave (see Use of
Bench-to Autoclaves page 10-C).
Prior to autoclaving wash with general
purpose detergent to remove visible
organic matter. Avoid splashing during
this procedure.
(See Auriscopes)
Specula
- aural
Spillages
Spoons
Hypochlorite
- used for
administration of oral
poliomyelitis vaccine
– if not disposable
Sputum Pots
Disposable
Stethoscope
Isopropyl Alcohol Swab
(See Spillages page 7-C)
Wash with hot water and GPD. Place in
1000 ppm hypochlorite solution for 30
minutes. Rinse. Remove and store dry.
Stools
General Purpose Detergent
(GPD)
Suction machines
Hard surface wipes
Thermometers
- digital
Disposable sleeve
-
tympanic
Disposable cover
-
mercury
not recommended
None
Wipe head with 70% isopropyl alcohol
and leave to dry
Wash with GPD and hot water.
Damaged coverings should be replaced
immediately. Pay particular attention to
horizontal surfaces and/or grooves where
dust may collect.
All suction machines, where possible,
should be fitted with a closed disposable
liner system. Used suction liners and
tubing should be disposed of as clinical
waste. Machines should be wiped over
with hard surface wipes. Glass jars –
wear protective clothing (aprons,
visor/spectacles and gloves). Empty
contents down sluice, wash with
detergent and warm water. Dry
thoroughly. Catheters and tubing must be
changed between each patient/client daily
when in constant use (see page
2-E)
Wipe handle with 70% isopropyl
alcohol.
Single use.
Wipe with 70% isopropyl alcohol swab
and allow to dry
Cracked/damaged equipment should be removed from service. Report any malfunction immediately
to the Facilities Department.
I C Guidelines
22 - C
September 2000
Equipment
Agent/Method
Comments and Instruction for Use
Manufacturer’s guidelines must always be checked prior to carrying out the
decontamination process
Tourniquet
General Purpose Detergent
Wash with GPD and warm water if
(GPD)
soiled. Use disposables for patients with
Disposable single use
infectious disease.
Toys
- soft
Machine washable
Heavily contaminated toys may have to
be destroyed.
- hard
General Purpose Detergent
Wash with GPD and warm water. Rinse
(GPD)
and dry thoroughly. If contaminated with
blood treat as a spillage.
Trolleys
General Purpose Detergent
Prior to carrying out a procedure within
(GPD)
the clinic setting at the start/end of clinic
and when trolley visibly soiled, use of
hard surface wipes is satisfactory for use
if trolley visibly clean.
These should be used in accordance with
Ultrasonic baths
Detergent solution
the manufacturer’s instructions. A
detergent solution should be used in the
baths. The detergent solution should be
changed according to manufacturers
instruction. On removal from ultrasonic
baths instruments should be rinsed in
water and inspected for residual debris.
The baths should be emptied, cleaned and
left dry at the end of each day.
Uniforms
These should be laundered separately to
- staff
avoid contaminating non-work clothes.
Urine bag/bottle
General Purpose Detergent
Wash with GPD and warm water
holders/stands
(GPD)
between patients
Vaccine Spillage
(See Vaccines page 21-E).
Vacutainer barrels
Single use (Re use of barrels not
Discard as a single unit with needle
acceptable
attached immediately after use into a
sharps bin.
Vaginal Cones
Autoclave
Return to Sterile Services Department or
- if not for individual
use a bench-top autoclave (see section of
client use
the use of Bench-top Autoclaves page
10-C).
Prior to autoclaving wash with general
purpose detergent to remove visible
organic matter. Avoid splashing during
this procedure.
Vaginal Diaphragms
(See Diaphragms)
Vaginal Speculae
(See Speculae)
Walking aids
General Purpose Detergent
Wash with GPD and hot water. Store
(GPD)
dry.
Cracked/damaged equipment should be removed from service. Report any malfunction immediately
to the Facilities Department.
I C Guidelines
23 - C
September 2000
Equipment
Agent/Method
Comments and Instruction for Use
Manufacturer’s guidelines must always be checked prior to carrying out the
decontamination process
Wheelchairs
General Purpose Detergent
Wash with GPD and hot water. Pay
(GPD)
particular attention to grooves/crevices
where dust may collect. If visibly soiled
treat as a spillage (see Spillages of Blood
or Body Fluids page 7-C).
I C Guidelines
24 - C
September 2000
REFERENCES
AYLIFFE G.A.J, E.J.L. LOWBURY, J.D. WILLIAMS, A.M. GEDDES. 1992. Control of
Hospital Infection. A Practical Handbook. Third edition. Chapman and Hall. London.
AYLIFFE G.A.J, D. COATES, P.N. HOFFMAN. 1993. Chemical Disinfection in Hospitals.
PHLS. London.
COATES D, D.N. HUTCHINSON. 1993. How to produce a hospital disinfection policy. Journal
of Hospital Infection. 26. 57 - 68.
CONTROL OF SUBSTANCES HAZARDOUS TO HEALTH. 1988. Statutory Instrument No.
1657. HMSO. London.
DAMANI N. 1997. Manual of Infection Control Procedures. Oxford University Press. Oxford.
DEPARTMENT OF HEALTH. 1994. Health Technical Memorandum 2010. Sterilization. Parts 1
– 4. HMSO. London.
DEPARTMENT OF HEALTH. 1998. Health Technical Memorandum. 2031. Clean Steam.
HMSO. London.
HEALTH AND SAFETY AT WORK ACT. 1974.
HEALTH SERVICE CIRCULAR HSC 1999/123 - Controls Assurance Statements 1999/2000: Risk
Management and Organisational Controls
HEALTH SERVICE CIRCULAR HSC 1999/179.
Decontamination of medical devices.
Controls Assurance in infection control.
HEALTH SERVICE GUIDELINES. 1993. Decontamination of Equipment prior to Inspection,
Service or Repair. HSG (93) 26.
LEWIS J, D. MEESE. 1997. Promoting Public Health - Infection Control in the Community.
ICNA/RCN.
MEDICAL DEVICES AGENCY. 1995. MDA DB9501.
Supplied for Single use only. MDA. London.
The re-use of Medical Devices
MEDICAL DEVICES AGENCY. 1996. MDA DB9605. The purchase, operation and maintenance
of Bench top Steam Sterilisers. MDA. London.
MEDICAL DEVICES AGENCY. 1998. MDA DB9804. The validation and periodic testing of
Bench top Vacuum Steam Sterilisers. MDA. London.
MEDICAL DEVICES AGENCY. 1998a. Medical Device and Equipment Management for
Hospital and Community-based Organisations. Department of Health. London.
I C Guidelines
25 - C
September 2000
MEDICAL DEVICES AGENCY 2000. Equipped to Care – The safe use of medical devices in the
21st Century. MDA. London.
PERSONAL PROTECTIVE EQUIPMENT AT WORK REGULATIONS. 1992.
Health and Safety Regulations.
WILSON J. 1995. Infection Control in Clinical Practice. Baillierre Tindall. London.
WORCESTERSHIRE COMMUNITY AND MENTAL HEALTH NHS TRUST. 1997. Health and
Safety policies and procedures. Health and Safety: Glutaraldehyde.*
NB
* Until review is completed staff working in Wyre Forest and Tenbury should refer to the
equivalent policies approved by the former Kidderminster Health Care NHS Trust.
I C Guidelines
26 - C
September 2000