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CLEANING, DISINFECTION AND STERILIZATION GUIDELINES FORRE-USABLE MEDICAL DEVICES

STANDARD: There is a system in place that ensures as far as reasonably practicalthat all re-usable medical devices are properly decontaminated prior to use.

OVERVIEW: The decontamination of re-usable medical devices is the combinationof processes, which if not correctly undertaken, individually or collectively, mayincrease the likelihood of infectious agents being transferred to individuals, or theenvironment.

The re-usable medical device life cycle comprises all or some of the followingprocesses: acquisition, cleaning, disinfection, inspection, disposal, packaging,sterilization, transportation and storage before use.

These guidelines apply to all re-usable medical devices whether owned by the Trust,rented, on loan or acquired by any other means. On no account should single usemedical devices be re-used again after decontamination.

The decontamination process is required to make medical devices: Safe for users to handle Safe for use on the patient

CLASSIFICATION OF INFECTION RISK ASSOCIATED WITH THE DECONTAMINATIONOF MEDICAL DEVICES

RISK APPLICATION RECOMMENDATION

High Items in close contact with a break inthe skin or mucus membrane orintroduced into a sterile body area.

Sterilisation

Intermediate Items in contact with intact skin, mucusmembranes or body fluids, particularlyafter use on infected patients or prior touse on immunocompromised patients.

Sterilisation or disinfectionrequired. Cleaning may beacceptable in some agreedsituations.

Low Items in contact with healthy skin ormucus membranes or not in contactwith patient.

Cleaning

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Definitions of decontamination terms:

CONTAMINATION – the soiling or pollution of inanimate objects or living materialwith harmful, potentially infectious or other unwanted material. In the clinicalsituation, this is most likely to be organic matter and micro-organisms but may alsoinclude other undesirable inorganic substances eg dust, soil, chemical residues,radioactive material, degradation products, packaging materials etc. Suchcontamination may have an adverse effect on the function of the inanimate objectand may be transferred to a susceptible host during use or subsequent processingand storage.

The degree of risk to the host will depend on many factors, including the nature ofthe investigative or therapeutic procedure, the susceptibility of the host and thenature and extent of the contamination. The nature and extent of microbialcontamination is referred to as the BIOBURDEN.

DECONTAMINATION – a process which removes or destroys contamination andthereby prevents micro-organisms or other contaminants reaching a susceptible sitein sufficient quantities to initiate infection or any other harmful response.

CLEANING – a process which physically removes contamination but does notnecessarily destroy micro-organisms. The reduction of microbial contaminationcannot be defined and will depend on many factors including the efficiency of thecleaning process and the initial bioburden. Cleaning is an essential prerequisite ofequipment decontamination to ensure effective disinfection or sterilization.

STERILIZATION – a process used to render the object free from viable micro-organisms, including bacterial spores and viruses. This can only be performed in aSterile Services Department (SSD) as no bench top autoclaves are to be used in theTrust.

DISINFECTION – a process used to reduce the number of viable micro-organisms,which may not necessarily inactivate some viruses and bacterial spores.Disinfection may not necessarily achieve the same reduction in microbialcontamination levels as sterilization.

DISINFECTANT – a chemical agent which under defined conditions is capable ofdisinfection.

Some Guidelines for the Use of Disinfectants

This document gives guidance on the choice of the correct disinfectant to use inparticular situations and circumstances.

All the disinfectants in the policy are potentially hazardous to health and some haveoccupational exposure standards assigned to them.

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It is a statutory requirement under the Control of Substances Hazardous to Healthregulations (COSHH) that an assessment of the risks to health is made of allprocedures involving the use of these disinfectants, and also the micro-organismsthey are designed to eliminate.

Exposure

Prolonged contact with disinfectants can cause irritation. Wear rubber gloves,respiratory and eye protection and avoid inhalation of vapour, when exposure isnecessary.

When treating large areas, care should be taken to ensure adequate ventilation.

Do not mix disinfectants with each other or with other chemicals.

Accidental spillage on to clothes or skin should be removed with plenty of cold water.Safety data sheets are available on wards and departments and should be kept withother COSHH assessment data.

Deterioration

Many disinfectants deteriorate after dilution. Follow manufacturers instructions formixing. Do not store longer than advised. Organic material e.g. faeces, urine, pusand blood, inactivates all disinfectants. Clean before disinfecting in thesecircumstances.

Contact Period

All chemical disinfectants need time to work. This will vary considerably with theparticular organism and conditions involved.

Concentration

Too low – useless.

Too high – wasteful and risk of sore eyes and hands.

The use of chemical disinfectants is only recommended for:

Disinfection of heat sensitive instruments

Decontamination of surfaces

Making potentially infected items safe for subsequent handling.

All disinfectants work best in a clean environment and therefore liberal use ofdisinfectants is of no value as a substitute for a high level of general cleanliness.

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All requests for disinfectants will be approved by the Trust Pharmacist who willcheck that the request is in agreement with the infection control team and facilitiesstaff. In general, the Trust will only stock 1 neutral detergent, 1 hypochloritecontaining powder and 1 combined detergent and hypochlorite product.

All re-usable medical devices should be cleaned after each patient/procedure use.Most equipment also requires disinfection, some will require sterilization. All shouldbe stored clean and ready for use by the next patient preferably in an equipmentlibrary. Equipment sent to the Estates Department for servicing or repair must beaccompanied by the appropriate decontamination card, (these should be readilyavailable on the ward) and no equipment will be repaired unless this card isattached. (APPENDIX 1)

An alternative to re-usable medical devices are single use versions; purchase ofthese must be with the prior approval of the users.

All medical devices on loan to Trust staff, must be disinfected or sterilized before use[whichever is appropriate].

Prior to the acquisition of re-usable medical devices: the decontamination methodprovided by the manufacturer, which should be followed, must be considered prior tothe acquisition of re-usable medical devices by staff making the request forpurchase; if a new type of medical device is unable to be autoclaved, consultationwith the infection control team should take place. (APPENDIX 2) There should alsobe consideration of the handling, collection and delivery of the medical device toensure reduction of the risk of contamination to the device, patients, staff and theenvironment. A protocol for decontamination of equipment should be written by theusers based on the advice from the manufacturers and the infection control team.

Planned replacement programme of medical devices: All medical devices thatcannot be easily cleaned and for those in poor condition, should be identified andsubject to a planned replacement programme with equipment that is easier to clean,or replaced by a single use alternative.

Education and training: education and training should be provided to relevanthealthcare workers in appropriate aspects of the decontamination practice, includingthose working in a clinical environment.

Instructions for cleaning individual items that are the responsibility of thehousekeeping staff, are in the Trust’s Cleaning Manual. In addition to the day to daycleaning of these items, periodic deep cleaning is performed using steam cleaningfollowed by detergent and/or hypochlorite products as part of a routine programmewhich is also performed in situations where cross-infection of micro-organisms issuspected.

When cleaning spillages of blood and body fluids, refer to the “Universal InfectionControl Precautions” document in the Infection Control Manual. This documentcontains basic guidance. For further advice, telephone a member of the infectioncontrol team.

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DECONTAMINATION METHODS

Appropriate cleaning/decontamination/sterilisation is necessary after each patientuse; alternatively single use equipment is disposed of after each patient use. Somemedical devices e.g. tourniquet can be kept and re-used on the same patient if keptin a closed container. In general, nurses are responsible for cleaning medicalequipment and housekeepers are responsible for cleaning fixtures, fittings and theward environment; the nurse in charge of each ward/department should list themedical equipment in the cleaning book and ensure all other cleaning duties are partof the housekeepers’ schedule and ensure that the standard of “no dust, no dirt” isadhered to.

The decontamination method detailed by the manufacturer should be followed. Thefollowing is general advice when the former is not available. Each ward anddepartment should have written details on how to decontaminate the medicaldevices used.

Immediately after decontamination of a piece of equipment, a label should beattached to it, or equivalent record made, indicating that decontamination hasoccurred on that date by a specified member of staff. All equipment should bestored away from contaminated items following decontamination and labelling.

After the decontamination of each medical device, the device must be labelledstating who has carried out the decontamination and on which day. The medicaldevice should then be stored in a clean area.

All equipment that is unfit for purpose eg rusty, torn cover must be appropriatelydiscarded as soon as recognised.

SSD = Sterile Services Department

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Item Routine Method Additionalrecommendations/frequency of cleaning

Acupuncture needle Single use onlyAirway Single use onlyAnaesthetic machine andbreathing equipment

Adopt basic hygienicmeasures. Ensure filtersare in place anddecontaminate accordingto manufacturersinstructions.

Change airway filterbetween patients andchange anaestheticsystems & tubing weekly innormal circumstances.Change immediately ifused on a known infectedpatient. Always use anairway filter between thetubing & the patient.Anaesthetic machine fingerbuttons & control knobsshould be cleaned with adetergent wipe after eachpatient.

Apnoea alarm Use detergent wipe After each useArthroscope Return to SSD for

autoclaving.After each use

Aural speculum Use disposable whereavailable or return to SSD

After each use

Baby bath Wash with hot water anddetergent and drythoroughly. Storeinverted.

Dedicated bath for eachbaby.

Baby changing mat Wash with hot water &detergent or detergentwipe & dry

After each use

Baby feeding equipment Single use onlyBaby scale Wash with hot water and

detergent, rinse and storedry.

After each use.

Bag – valve mask Decontaminate accordingto manufacturersguidelines between eachpatient use

Single patient use maskpreferred

Bath Wash with hot water anddetergent

After each use

Bath hoist Clean with hot water anddetergent and dry

Clean after each use

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Bed frame Wash with detergent andhot water and dry

Clean after each use

Bedpan Single use only. Disposeof immediately inmacerator; if out of use,place in orange waste bagand seal

If macerator breaks downafter 7pm, estates staff willattend the following dayunless infected cases onthe ward.

Bedpan carriers Wash with detergent andhot water and store dry

After each use

Bedpan storage rack Wipe with hot water &detergent or detergentwipe & dry

Daily

Bidet Clean with hypochloritepowder after each use

See Cleaning Manual formethod

Blind (window) Damp dust as required toensure no dust ever visible

Window blinds are notrecommended in patientareas

Blood pressure cuff Single patient use if barriernursedMultiple -use cuffs shouldbe cleaned with detergentwipe after each patientuse

Keep covered in closedcontainer at bedside

Bottle warmer Wash with hot water anddetergent and store dry

Descale as necessary

Bowl (patient washing) Disposable Dispose of after each useBowl (surgical) If stainless steel, return to

SSDSingle use preferred

Breast pump – machine

- collection kit

Use filter to protectmachine. Wipe with hotwater and detergent, rinseand store dryUse sterile collecting kit Must be used each time

the pump is used.Carpet Vacuum daily For further details see

Cleaning ManualThese should not be inpatient care areas

Chair Damp dust with detergentand hot water

Only chairs with covers thatcan be wiped e.g. vinylshould be in patient areas.

Commode chair Wash with hot water anddetergent/ detergent wipesAFTER EACH PATIENTUSE

Use hypochlorite solution ifvisible contamination withblood/bodily fluids and/orenteric infection. Consideruse of cleaning labelsigned & dated by personwho cleaned commode.

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Computer keyboard Wipe with detergent wipeat least daily

Only purchase type withsmooth surface which is“water proof”

Contact lens Single patient use onlyCot and mattress Wash with hot water and

detergent and dryAfter each use

Crockery and cutlery Machine wash with rinsetemperature above 80°c

After each use

Curtain Should be changed aspart of a rollingprogramme every 3-6months

If visibly contaminatedchange when required.Change curtains onterminal cleaning ofroom/bedspace

Duvet Wash with detergent, rinseand store dry.

Discard if there is a breachin the cover

Electrocautery device Single patient use tipEndotracheal tube Single patient useEntonox equipment Wipe cylinder with

detergent. Single patientuse tubing.Single patient usemask/mouthpiece

After each use

Enuresis alarm and sensor Wipe daily with detergentwipe

New sensor for eachpatient

Fibreoptic endoscopes See Infection ControlManual 2.08

Fibreoptic light Wipe with detergent wipe

Flower Vase Wash with detergent & hotwater & dry

After each use

Furniture and fittings Damp dust with detergentand hot water

See Cleaning Manual forfurther details

Haemorrhoid ligatingdevice

Return to SSD After each use

Hair clipper Return to SSD or usesingle use only type

After each use

Headbox Wipe with hot water anddetergent, rinse and storedry

After each use

Headphone Disposable preferred. Ifmultiple use, wipe withdetergent wipe

After each useFOAM EARPIECES aresingle patient use only

Heat humidifier/heatmoisture exchanger

Follow manufacturer’sguidance

If evidence or suspicion ofcontamination, exchange

Hoist and sling Clean hoist with detergentwipe

After each use

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Slings should be singlepatient use

Send to laundry unlessdisposable type

Ice pack Single patient use; wipewith detergent wipe aftereach use.

When returned to freezer,ensure no contact withother packs occur

Incubator Wash with detergent andhot water, rinse and storedry

After each use

Inhaler Patient dedicated If use of placebo inhaler isnecessary, after each usedismantle and clean in hotwater and detergentfollowed by 1,000ppmchlorine solution and usepatient dedicated mouthpiece if possible.

Instruments (surgical)

SEE GUIDELINES ONMANAGEMENT OF PATIENTSWITH TRANSMISSIBLESPONGIFORMENCEPHALOPATHIES

Single use where availableReusable should bereturned to SSD

After each use

IV stand Wipe with detergent wipe After each useJug - measuring Use sterile or disposable After each use

Lanyard/identificationbadge

Identification badgesshould be clipped toclothing and cleaned witha detergent wipe

Lanyards should not beworn

Laryngeal mask airway Single patient usepreferred.Mulitple use type – returnto SSD up to 40 times

After each use

Laryngeal mirror Send to SSD

Laryngoscope blade Disposable use preferredor send to SSD

Risk assessment needs tobe made in respect ofusing disposable bladesfor tonsillectomy surgerywith regard to CJD/vCJD

Mammography plate Wipe with detergent wipe After each useMasks & oxygen tubing Anaesthetic masks

Oxygen masksOxygen tubing

Single patient useSingle patient useSingle patient use

Mattress, pillow, foamwedge

Use hot water anddetergent wipe

After each patient use.Discard if cover not intact.

Medicine cup Patient dedicated Keep at bedside in sealedcontainer

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Mobile communicationdevices eg mobiletelephones

Use detergent wipefrequently

Review appropriateness oftheir use in high risk areaseg ITU

Monitoring equipment -bedside and theatrePatient leads:

Sa02 probe:

Monitoring casing:

Finger buttons and controlknobs:

Clean with detergent wipeafter each patient use orearlier if contaminated.Clean with detergent wipeafter each patient use.Clean regularly withdetergent wipe.Clean with detergent wipeafter each patient use.

Mop Refer to cleaning manualfor appropriate colourcoding instructions.

Mop and bucket must bededicated for each patientin isolation. At thetermination of isolation,these must becleaned/handled as perisolation policy

Nasopharyngoscope Disinfect in washerdisinfector

After each patient use

Nebuliser Single patient use. Cleanand disinfect with sterilewater and dry after eachuse.

Keep on covered tray atside of patient

Oesophageal manometer Single use only

Orthopaedic saw Wipe with detergent wipeafter each use.

If contaminated with bodyfluids, return tomanufacturer.

PAT slide Wipe with detergent wipe After each use

Patient line equipment Wipe with detergent wipe After patient discharge asa minimum. Patient Linestaff are responsible atother times.

Peakflow meter Single patient use

Pillow See mattress

Pool – birthing

Pool - hydrotherapy

See Infection controlmanual part 3.14See Infection controlmanual part 3.06

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Pulmonary function testingequipment

Spirometry mouthpiecesshould be single use only

Take precautions toreduce risks for allrespiratory equipmentwhere contamination byrespiratory secretions ispossible

Razor Disposable After each useSigmoidoscope Disposable if used on ward After each useSink /wash basin Use detergent and hot

waterHand sinks must not beused for decontaminationof equipment

Slide sheet Launder as permanufacturers instructions,wipe with detergent andwater, rinse and dry

After each patient use

Sphygmomanometer cuff Wipe with detergent wipe After each patient use

Stethoscope, tendonhammer and similar

Wipe with detergent wipebetween each patient use.

Patients in isolation musthave a stethoscope etcdedicated for their use onlywhich is left in the roomand disposed of whenpatient is discharged.

Suction catheter Single use onlySuction equipment Use disposable liners Change after each use

Suction filter

tubing

Must be changed whenwet, refer to manufacturersinstructions

Change when visiblycontaminated and betweenpatients

New filters should be datedon insertion

Surgical marker pen Disposable After each patient useSyringe (glass/metal) Return to SSD After each patient useThermometer Disposable After each patient use

Toilet pan/seat Use hypochlorite powderand hot water

See Cleaning Manual formethod

Tongue depressor Single patient use(wooden)Metal - return to SSD

Tonometer prism & otherlenses that touch thesurface of the eye

Single patient use If re-usable must bespecified in DH CJDguidance

Tooth pot Single patient use Keep at bedside

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Tourniquet Use patient dedicateddisposable type and keepin sealed container bybedside.

Multiple-patient cloth typeshould not be used

Toy Only toys that can becleaned with water anddetergent should beavailable.

Clean regularly and whenobviously soiled.

Trolley (hotlocks/food/meal)

Other – eg dressing

Wash thoroughly withdetergent and hot water

Wipe with detergent wipe

Return to kitchen aftereach useAfter each use

Ultrasound probe Cover with condom forinvasive procedures.Adhere to manufacturers’instructions

For skin procedures, washwith detergent and hotwater, wipe with alcoholwipe. Where possibleautoclavable probesshould be used

Urinal Disposable After each patient use

Vaginal speculum Stainless steel return toSSD.Plastic

After each patient use

Single patient useVentilator Damp dust external

surface using detergentwipe

Daily

Ventilator circuits New ventilator circuittubing should be providedfor each patient and neednot be changed before 7days if bacterial filter used.Nebulizer should be singleuse.

Facial protective and otherpersonal protectiveequipment should be wornwhen closed breathingcircuits are disconnected.Follow national guidelinesre the use of expiratoryfilters for patients withhighly communicableinfections. Follow nationalguidelines for cleaning.

Vials Wipe with alcohol wipebefore each use and allowto dry before accessingwith needle

Volumetric infusiondevices & syringe drivers

Clean outer casing withdetergent wipe. Payparticular attention tocleaning finger buttons andcontrol knobs

After each patient use orearlier if contaminated

Walking Aids Detergent & hot water ordetergent wipe and dry

After each patient use

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Walls As per cleaning manual

Water dispensers Monitor in accordance withmanufacturers instructions

Ensure 0.5 litre is run offmachine at beginning ofeach day.

Weighing scales Detergent & hot water ordetergent wipe and dry

After each patient use

Wheelchairs Detergent & hot water ordetergent wipe and dry

After each patient use

Royal College of Nursing (2005) ‘wipe it out’ Good practice in infection preventionand control - Guidance for nursing staff. London, RCN publishing.

Department of Health (2004) The NHS Healthcare Cleaning Manual. London, DH

Department of Health (2005) Saving Lives: a delivery programme to reducehealthcare-associated infection including MRSA, Department of Health, London.

Online training in Infection Control (2006)http://www.corelearningunit.nhs.uk/

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