Disinfection Policy - Chitra

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Decontamination & Disinfection Policy

Mid-Cheshire Hospitals NHS Trust

Contents Policy Statement…………………………………………………………………………Page 2 Definition of Terms………………………………………………………………………Page 2 Single Use Items and Instruments………………………………………………………Page 2 Risk Assessment for Decontamination Methods………………………………………………………………..…………………Page 4 Procedures Required for Achieving Decontamination………………………………..Page 5 Table 1…Properties and Uses of Chemical Disinfectants……….……………………Page 7 Table 2 Recommended Disinfectants/Antiseptics…………………………………….0 Table 3 Methods for Decontamination………………………………………………..Page 11 Considering Decontamination prior to Purchase………………………….………….Page 19 Decontamination of Healthcare Equipment prior to Inspection, Service or Repair…………………………………………………..……….Page 20 Handling and Transportation of Equipment to the Sterile Supplies Department………………………………………………….…Page 21 Roles and Responsibilities…………………………………………………………...…Page 21 Legislation, Guidance and References……………………………………………...…Page 21 Policy Management……………………………………………………………………..Page 22

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Decontamination and Disinfection Policy

Policy Statement The role of decontamination procedures as part of effective measures for the prevention and control of infection is essential for both patients/clients and healthcare workers. COSHH regulations (amended 2003) advise the need for employers and employees to be aware of their responsibilities in relation to evaluating and controlling the risks posed by hazardous substances, including both chemicals and pathogenic micro-organisms. These include risk assessment of any process involving pathogenic micro-organisms and taking action to reduce the risk to a minimum. The following guidance relating to decontamination and disinfection outlines the processes and methods designed to reduce the risk of cross-contamination via commonly used items of equipment within the clinical area. Whilst the policy aims to cover most situations and eventualities, many factors which include the following, may influence risk assessment and subsequent solutions for decontamination. • the nature of the contamination • time required for processing • heat, pressure of moisture and chemical tolerance of the object • quality and risks associated with decontamination method Therefore, the following guidance is intended to provide a basic guide to decontamination only. Staff within MCHT are encouraged to discuss local decontamination and disinfection requirements with the Infection Prevention and Control Team (IPCT) to ensure appropriate methods and processes are in place for decontamination within each ward/department. Definition of Terms Contamination – the soiling or pollution of inanimate or living material with harmful, potentially infectious or other unwanted substances, eg, organic matter (blood and body substances), micro-organisms, dust, chemical residues, etc.

Such contamination may have an adverse effect on the function of the inanimate object or may be transferred to a susceptible host (patient/staff) during use, subsequent processing or storage. Decontamination – a combination of processes which removes or destroys contamination, preventing micro-organisms or other contaminants reaching a susceptible site in sufficient quantities to cause infection or other harmful response.

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The processes include effective cleaning, disinfection and/or sterilization, used to render reusable medical devices safe for further use. NB. The life-cycle of reusable medical devices includes the acquisition, cleaning, disinfection, inspection, packaging, sterilization, transport and storage. Cleaning – this is the first level of decontamination and may be all that is required for certain items. Cleaning is an essential pre-requisite for disinfection or sterilization as the presence of any organic matter may render higher levels of decontamination ineffective. Disinfection – a process which reduces the number of viable micro-organisms but is not necessarily effective against bacterial spores or some viruses. Disinfection can be achieved through the use of heat or chemicals. The aim is to reduce the contamination to safe levels. Chemicals that achieve this result are known as disinfectants. Such procedures are used when sterilisation is impractical. For example; • Rapid processing of endoscopes • Treatment of non-autoclavable equipment in contact with infectious cases. Disinfectants that may be applied to skin or mucous membranes are called antiseptics. Sterilisation – means that the complete destruction of all micro-organisms, including spores. Equipment and materials which come into contact with broken skin or mucous membranes should be sterile, eg, instruments, dressings and injection/irrigation fluids. Sterilisation is best effected by moist heat, usually by autoclaving under pressure. Single Use Items and Instruments These are medical devices manufactured with the intention to be used once only and then discarded. It is to be noted that current advice from the Department of Health on equipment marked as single use is that no item of equipment is ever re-used. Items designated as single use carry the following symbol:-

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Re-use of these items means that the Trust becomes a producer of a product and not simply a user. Attempts to decontaminate and re-sterilise such items are likely to be unsuccessful and would render the Trust liable in the event of an adverse outcome. Staff attempting to decontaminate and re-use items marked as ‘single-use only’ are in breach of Trust policy and guidance issued by the Medicines and Healthcare Products Regulations Agency.

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Single Patient Use – this means that the medical device is intended for more than one episode of use on one patient only. The device may undergo some form of re-processing between each use and then be discarded, eg, some types of tracheostomy tubes. Manufacturer’s instructions should be followed carefully when using any medical device. Advice from the IPCT should always be sought prior to purchasing any medical advice. Risk Assessment for Decontamination Methods In order to maximise the protection of patients/clients and staff from exposure to infection from medical devices and other equipment, a safe system of work requires implementation. This includes risk assessment and the implementation of appropriate decontamination methods to render the item(s) safe for subsequent handling or use. All medical and other equipment can be categorized according to its potential infection risk. The following method of risk assessment and selection of appropriate decontamination methods can be applied across all healthcare settings and situations. High-risk items – these can be classified as those items that come into contact with a break in the skin or mucous membranes, or enter a body cavity or organ. High-risk items must be sterile Examples: Surgical instruments, urinary catheters, cardiac catheters, wound dressings, arthroscopes, cystoscopes, intravenous/intra-arterial devices, some respiratory equipment. Medium-risk items – these are items that come into contact with intact mucous membranes. Medium –risk items must be cleaned then disinfected – preferably by heat Examples: Re-usable bedpans/urinals, re-usable face masks, cutlery/crockery, bed linen; oral thermometers and other items placed in the mouth, auroscope ear pieces and nasal scopes. Low-risk items – these are those items that do not come into direct contact with the patient, or only come into contact with healthy, intact skin. Low-risk items must be physically cleaned and dried Examples: Equipment – Drip stands, dressing trolleys, monitors, blood pressure cuffs, mattresses, examination couches, bath hoists, bed cradles, washbowls, suction machines, commodes. Environment – Furniture, floors, soft furnishings, fixtures and fittings. NB: Low-risk does not mean there is no risk, as any low-risk item may become a source of infection if it becomes contaminated with pathogenic micro-organisms. Subsequently, an item of equipment or the environment may require the application of a disinfectant agent if contaminated.

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Procedures required for achieving decontamination The choice of decontamination method centres around the infection risk associated with the intended use of the equipment. Other factors that must be considered include:

1. The nature of the contamination. 2. The time required for processing. 3. The heat, pressure, moisture and chemical tolerance of the object. 4. The availability of the processing equipment. 5. The quality and risk associated with the decontamination method. 6. The manufacturer’s guidance.

All items requiring decontamination must first be adequately cleaned to remove organic matter. For low-risk items, manual cleaning is generally acceptable. Medium-risk items where possible should be cleaned/disinfected in a thermal automated washer. High-risk items requiring re-processing ideally should not be cleaned manually due to the infection risk associated with such invasive items. There may be certain pieces of equipment used with scopes, however, which require manual cleaning initially due to their design. Cleaning Procedures; Low Risk Items Only • Protective gloves and apron should be worn. Facial protection may be necessary if splash or

spray is likely. • If appropriate, the item should be dismantled prior to cleaning. • The item should be submerged in a deep sink (NOT A HANDWASH BASIN), or a suitably

sized receptacle, containing a solution of warm water and general-purpose detergent. The item should be washed carefully with a disposable cloth.

• Where immersion is impracticable or inappropriate, the item should be washed with a disposable cloth wrung out in a solution of warm water and detergent.

• The item should be rinsed with warm water and dried thoroughly. Drying is an important part of the cleaning process as some organisms are able to flourish in wet residues. Dry with paper towels where possible, if not, allow to drain and dry by natural means.

• Cleaning equipment must also be stored clean and dry. Disposable items must be discarded after use.

• Protective clothing (aprons and gloves) must be discarded as clinical waste and hands thoroughly washed after any cleaning procedure.

Disinfection Procedures Disinfection can be achieved through the use of heat or chemicals.

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High-level disinfectants - eg, Paracetic acid and Chlorine dioxide are highly effective in destroying micro-organisms and recommended for the disinfection of endoscopes where heat disinfection is not possible. Chemical disinfection is not, however, a substitute for sterilization and is not as effective as disinfection by heat. It must not be used where the use of single-use items would be more appropriate. As with any form of disinfection, effective cleaning must be performed initially to remove organic matter. Disinfection by heat is the preferred method for those items that must be rendered safe to use, but do not need to be sterile. The process generally involves the use of a washer-disinfector, which will inactivate all micro-organisms except bacterial spores and some heat-resistant viruses. Sterilisation Procedures The most commonly achieved method of sterilisation is by the use of steam under pressure. The process should be carried out centrally within the Sterile Services Department, Leighton Hospital. Benchtop steam sterilisers are not recommended for use within departments. Central sterilisation is recommended by the Department of Health and consequently MCHT should endeavour to minimise local sterilisation. If the use of Benchtop steam sterilisers is unavoidable, refer to the Infection Prevention and Control Team within MCHT. The following tables are designed to provide a basic reference guide for chemical disinfection, antiseptic solutions and cleaning methods for equipment; Table 1- Properties and uses of Chemical Disinfectants Table 2-Recommended Disinfectants/Skin Antiseptics for MCHT Table 3-Methods for Decontamination-Commonly Used Equipment/Items

Table 1. Properties and Uses of Chemical Disinfectants

Disinfectants

TYPE EXAMPLE COMMENTS Chlorine Dioxide Tristel Rapidly bacterical, virucidal and sporicidal. Achieves high level

disinfection within 5 minutes. NB: Tristel currently used for Endoscopy disinfection within MCHT. Available in wipes and solution.

Quaternary Ammonium Compounds Roccal, Zephiran Cetrimide, Cetavlon

Antibacterial – inhibits the growth of bacteria. Not bactericidal, which would kill bacteria. Ineffective against viruses and spores. Not recommended for use in the clinical area.

Phenolics Stericol, Hycolin, Clearsol Active against a wide range of bacteria. Fungicidal, but limited virucidal and sporicidal activity. Corrosive to instruments, too toxic for skin. Not widely used for disinfection.

Alcohol 70% Alcohol solutions - Cliniwipes - Azowipes - Mediswabs - Hand gel preparations

Effective, rapid acting disinfectants and antiseptics. Poor penetrative powers – should only be used on clean surfaces. Active against bacteria and not spores. Virucidal activity variable. Commonly used for skin disinfection and as agent for rapid disinfection of physically clean hands.

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Disinfectants TYPE EXAMPLE COMMENTS

Chlorine-releasing agents Strong Sodium Hypochlorite solutions Hypochlorite powders Sodium dichloroisocyanurate (NaDCC) Weaker Sodium Hypochlorite solutions

- Chloros, Domestos,

Sterite - Titan, Enbac - Sanichlor, Haztab, Presept (Tablets or powders) - Milton (limited use in

clinical areas due to weak concentration)

Chlorine-releasing agents are rapidly effective against viruses, fungi bacteria and spores. Recommended for hazards of viral infection, eg Hepatitis B, C, HIV READILY INACTIVATED BY ORGANIC MATTER – MAY DAMAGE CERTAIN MATERIALS; SOME PLASTICS, RUBBER, METALS & FABRICS. MUST NOT BE MIXED WITH ACIDS INCLUDING ACIDIC BODY FLUIDS SUCH AS URINE.

REQUIRED CONCENTRATIONS OF CHLORINE-RELEASING AGENTS:- USES AVAILABLE CHLORINE(ppm) Blood or Body Substances 10,000 (Not urine) Infant feeding bottles 125 Food preparation areas and catering equipment 125 Hydrotherapy pools - Routine 1.5-3 - Contaminated 6-10 Routine water treatment 0.5-1 NB: Product used within MCHT is Titan Sanitiser. See Spillage policy for management of spillages.

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Disinfectants

TYPE EXAMPLE COMMENTS

Triclosan Sterzac, Manusept, Cidal, Aquasept, Irgasan

Antiseptic agents used in hand rubs, soaps, bath concentrates and powders. Active against gram-positive organisms, eg, Staphylococcus aureus, Streptococcus. Less effective against gram-negative organisms, eg Pseudomonas and some Gastro-intestinal bacteria. Generally less effective than chlorhexidine preparations.

Chlorhexidine Hibitaine Skin antiseptic – Effective for surgical disinfection of hands with residual antimicrobial effect. Useful for pre-operative disinfection, not suitable for the soaking of equipment/instruments.

Iodine and Iodophors Iodine Iodophors – Betadine, Disadine, Videne

Skin preparation. Skin reaction may occur in some individuals, 0.5% alcoholic chlorhexidine or an alcoholic iodophor solution is preferable. - Mainly used for hand disinfection.

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Table 2: Recommended Disinfectants/Antiseptics

Disinfectants TYPE EXAMPLE COMMENTS

Chlorine Dioxide

Tristel

Endoscope disinfection

Sodium Hypochlorite

Titan Sanitiser Spillages of blood/body substances – wards/departments

Hand gel For use on physically clean hands – refer to hand hygiene guidelines

Alcohol solution

Skin preparation – not to be used for soaking items of equipment.

Alcohol 70%

Cliniwipes/mediwipes Mediswabs

Skin preparation wipes may be used for smooth, clean surfaces or equipment that cannot be immersed in solutions ALWAYS ALLOW ALCOHOL TO EVAPORATE TO ENSURE EFFECTIVENESS

Chlorhexidine Hibitaine Skin preparation/surgical scrub Not necessary for routine handwashing – liquid soap adequate

Iodine

Betadine Disadine Videne

Skin preparation Hand disinfection (Theatres)

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Table 3: Methods for Decontamination

COMMONLY USED EQUIPMENT/ITEMS – METHODS FOR CLEANING OR DISINFECTION ITEM

FREQUENCY

ROUTINE

ALTERNATIVE PROCEDURES OR OTHER RECOMMENDATIONS

Airways After each patient Disposable Ambu bags After each use Wash with detergent, dry thoroughly Ambulift Detergent and hot water, dry thoroughly Hypochlorite if soiled with blood/body

substances. Ampoules and vials Multi bottle/vial

Prior to use

No preparation needed Swab entry port with 70% alcohol swab Allow to dry

Do not immerse ampoules in disinfectant solutions May not be reused unless new needle and syringe used

Auroscopes After each use Wash with detergent, dry thoroughly Alcohol wipe

Baby feeding bottles After each use Wash with detergent. Soak in chlorine solution; 125 ppm e.g. Milton

Single use preferable Send to SSD

Baby security tag After each use Wash with detergent or detergent based wipe Single use preferable

Baby scales Daily and when visibly contaminated

Wash with detergent or detergent based wipe Hypochlorite if soiled with blood/body substances

Baths and wash basins (see sinks)

Each time used Clean daily and in between patients with detergent

Infected patients or patients with open wounds use Hypochlorite sanitizer

Bath mats Each time used Wash with detergent, rinse and hang over side of bath or rail. Allow to dry

Infected patients or contaminated with blood/body substances – use Hypochlorite sanitizer

Bath water Antiseptics should not be added as a routine Bed frames

Between patients when visibly contaminated

Wash with detergent or detergent wipes Infected patients or contaminated with blood/body substances use Hypochlorite sanitizer

Bed pan holders (plastic)

Between patients after each use

Wash with detergent and store dry. Slipper pans should be a disposable pulp material – not plastic

Infected patients or contaminated with blood/body substances use Hypochlorite sanitizer

Bed pan disposal units (macerators)

Daily and when contaminated Wash exterior with detergent

Breast Pumps and attachments

After each use Send to Sterile Services for reprocessing after each use – detergent & cold water sterilant

Disposable breast pumps as an alternative

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COMMONLY USED EQUIPMENT/ITEMS – METHODS FOR DISINFECTION

ITEM FREQUENCY ROUTINE ALTERNATIVE PROCEDURES OR OTHER RECOMMENDATIONS

Bowls (Surgical) After each use Send to Sterile Serivces for re-processing Bowls (Washing) Between each use and after

patient discharge Individual bowls should be used Wash with detergent, rinse and store dry Avoid stacking inside each other

Infected patients or contaminated with blood/body substances – use Hypochlorite sanitizer

Carpets

Daily Carpets not suitable for clinical areas

Vacuum clean daily Contaminated spillage – remove organic matter. Use Hypochlorite solution and rinse well to avoid discolouration

Cleaning equipment

After use or when visibly dirty MOPS – rinse after use, wring and store inverted. Launder mop head daily. BUCKETS – Change hot water and detergent frequently. CLOTHS – Disposable FLOOR SCRUBBERS – Detergent and hot water (including scouring pads) Store all equipment dry

Use different cloths/mops in different areas e.g. Green – Kitchens Red – Toilets and Bathrooms Blue – General areas Yellow – Isolation/cohort areas NB – white mop for spillages - launder mop head after each episode

Cots

After each patient Wash with detergent, dry Use detergent wipe

Cot sides

After each patient when visibly contaminated

Wash with detergent, dry Use detergent wipe

Commodes

After each patient use Frame – wash with detergent/detergent wipe Seat- detergent unless soiled Remove faecal matter prior to using Hypochlorite sanitizer

Infectious patients must have individual commodes Use Hypochlorite sanitizer for spillages if enteric pathogens are isolated.

Crockery and Cutlery

After use Ward dishwasher. Rinse cycle must exceed 80 C

Hand wash with detergent and hot water if machine wash not available

Drains

As required Chemical disinfectants are of no value. Flush with hot water and soda crystals when necessary

Drip stands

Daily, in between patients and if contaminated

Wash with detergent Additional wipe with 70% alcohol if contaminated

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ITEM

FREQUENCY

ROUTINE


Dressing Trolleys Thoroughly clean with detergent and hot water or detergent wipe before commencing dressings

Alcohol impregnated wipe or detergent wipe in between patients

Clean thoroughly if used for infected patients or contaminated with blood/body substances Ensure thoroughly cleaned at least daily

SCOPES;

Disposable scopes and accessories should be considered where possible

Endoscopes

At the beginning of each list and in between each patient Must be used within two hours of processing

Clean with detergent prior to processing in automated washer/disinfector with Tristel (chlorine dioxide)

Bronchoscope

At the beginning of each list and in between each patient Must be used within two hours of processing


Nasopharyngoscope

At the beginning of each list and in between each patient

Clean with detergent prior to wiping with chlorine dioxide (Tristel wipe) Ensure contact time of 30 secs Rinse and dry thoroughly

Use of alcohol wipe or solution NOT adequate

Fibre optic Laryngoscope


Clean with detergent and hot water prior to sending to SSD.

Use of alcohol wipe or solution NOT adequate

Hysteroscope


Central re-processing in SSD required

Local re-processing not to be performed

Cystoscope


Rigid- Central re-processing in SSD required. Flexible- Clean with detergent prior to processing in automated washer/disinfector with Tristel (chlorine dioxide)

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COMMONLY USED EQUIPMENT/ITEMS – METHODS OF DISINFECTION

ITEM

FREQUENCY

ROUTINE


Proctoscope


Central re-processing in SSD required


Colonoscope



ERCP scope



Enteral feeding pumps

Wash pump daily with detergent Syringes- DISPOSABLE Giving sets- DISPOSABLE

Fans

Discouraged from clinical areas due to volume of dust/pathogenic matter dispersed. If essential, must be cleaned in between each patient.

Wipe exterior with detergent wipe. Estates to dismantle and clean interior thoroughly when build up of dust noted, or used for patient with MRSA

Risk of dispersal to other patients if not cleaned after each use

Floors

Daily or when contaminated/visibly dirty

Detergent only unless spillage of blood/body substance present – refer to spillage policy

Detergent only in isolation rooms/bays unless blood/body substances present

Flower vases

After each use Detergent, hot water, rinse and dry. Do not leave to soak. Do not use sterilising solution or tablets, e.g. Hypochlorite/Milton

Do not wash in the kitchen, bay area or side rooms Do not use the hopper for this purpose Use the stainless steel equipment sink in the sluice, or a designated flower sink.

Food/drinks trolleys

After each drinks round, more frequently if self-serve system is operated

Detergent and hot water Ensure all surfaces are dried thoroughly

Ensure water tank is drained, sluiced through and re-filled daily.

Furniture

See local cleaning schedules Wash with detergent and water Contact the Infection Control Team for specific decontamination requirements

Hands

Before and after each patient contact

Soap and water, rinse and dry well Alcohol gel on physically clean hands

See hand hygiene guidelines

Humidifiers

Daily where practical Before and after each patient use

Short term humidifier – disposable Long term humidifier -wash equipment with soap and water

Disposable attachments

Incubators

After each use Detergent and hot water Rinse and dry thoroughly

Clean exterior daily whilst in use

COMMONLY USED EQUIPMENT/ITEMS – METHODS OF DISINFECTION ITEM

FREQUENCY

ROUTINE


Instruments

Immediately after use Return to SSD for reprocessing in accordance with SSD policy. For instruments with narrow lumen, parts that are difficult to clean – use disposable if available

Contact the Infection Control Team for specific decontamination requirements or heat sensitive instruments/equipment

Intravenous equipment e.g. pumps, syringe devices.

To be wiped daily and in between each patient

Follow manufacturer’s instructions for cleaning regime and method Ideally equipment to be wiped between patients with an alcohol impregnated swab or wipe

For giving sets; cut off sharp end and dispose in sharps bin, remainder in clinical waste

Jugs - measuirng urine and

body fluids - hairwashing/ bathing - for use with suction

Disposable only Use for 24hrs only

Single use, then dispose of in ward macerator 24 hour use, then return to SSD

Laryngoscope blades

After each use Disposable blades or send to SSD after single use

Lockers (Bedside) Surfaces daily and following spillage

Detergent and water, Ensure dried thoroughly

Clean inside and out after each patient

Mattresses: Refer to manufacturer’s instructions for specialist mattresses or covers

Following spillage, after each patient use or prior to leaving ward area

Detergent and hot water or detergent wipe Dry thoroughly See Spillage Policy for procedure for checking mattress integrity

Examine mattress in between patient for staining, cover integrity and moisture collection. Renew mattress if cover is no longer impervious to body substances

Medicine pots After each use Disposable or detergent and hot water Rise and store dry DO NOT LEAVE TO DRAIN

Medicine pots to be washed in the kitchen May be suitable for ward dishwasher if racking system available

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COMMONLY USED EQUIPMENT/ITEMS – METHODS FOR DISINFECTION ITEM

FREQUENCY

ROUTINE


Manual handling aids- Machinery

Following spillage and as part of ward schedule for equipment. Twice weekly clean preferable

Detergent and hot water, dry thoroughly Disinfect with Hypochlorite if blood/body substances present

Manual handling aids- Slings

Single patient sling if available

Launder centrally, label appropriately to ensure return to ward

Do not use a visibly contaminated sling on any patient. Where possible do not use a sling used for isolated patients on other patients unless it has been laundered

Nail Brushes

Disposable only Disposable only Not recommended for use except in Theatres

Nebuliser chamber and mask

After each use Wash with detergent and hot water Rinse and store dry For single patient use only. Can be used as a disposable item if decontamination not achievable

Do not leave to drain – ensure dried thoroughly.

Notices

Following contamination. After each use for isolation.Weekly as part of ward schedule

Wipe with detergent and dry

Opthalmoscope After each use Wash with detergent or wipe with alcohol impregnated wipe

Razors – Electric Wet

After each use Disposable

Not for communal use Disposable type only – if patients own; rinse and store dry

Clean patients razor with brush after each use Ensure disposal of wet razors into Sharpsbin

Resuscitation mask

After each use Wash with detergent Store dry

Rooms

Daily according to ward cleaning schedule Isolation cleans in between as requested

Detergent and hot water Hypochlorite for blood or body substances

For isolation rooms or bays detergent and hot water Hypochlorite for blood or body substances Ensure disposable cloths are used.

Scissors

According to task and at the end of each shift if own scissors are used Disposable scissors or return to SSD if able to be processed

When sterility not required, wash with detergent and water and clean with 70% alcohol (Mediswab)

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ITEM

FREQUENCY

ROUTINE


Sharps containers *Sharps trays

When visibly contaminated, or if in use for longer than a week eg; used in an isolation room

Wipe any blood contamination with alcohol impregnated wipe *Sharps trays to be cleaned twice weekly with detergent, alcohol wipe when visibly contaminated

Dispose of Sharps bins used in isolation rooms following patient discharge

Shaving brushes After each use if patient’s own Communal use not recommended, use aerosol foam unless patient’s own

Shower cubicle/curtain or chair

Shower cubicle and chair after each patient use. Shower curtain weekly as part of routine cleaning schedule

Detergent and water unless blood or body substances present

Shower screens preferable to curtains due to cleaning difficulties

Sinks – Handwash basins Equipment sinks (sluice area) and Bucket sluice (Domestic’s room) Hopper/body substances disposal unit (sluice area)

Daily, unless greater frequency required Daily, unless greater frequency required Daily, unless greater frequency required

Detergent, hot water clean inside and outside. Dry thoroughly Detergent, hot water and dry. Hypochlorite sanitiser, rinse and wipe surfaces dry where possible

Hypochlorite sanitiser for stains and build up Scouring pad and detergent for build up of lime scale and soap Hypochlorite for blood or body substances Scourer for build up of deposits/lime scale

Sphygmomanometer cuffs

Dependent on material Alcohol wipe if material allows Avoid material cuffs on non-intact skin

Stethoscopes

At least daily if used communally between staff. Encourage single staff use

Wipe head with alcohol wipe between patients. Ear pieces to be cleaned daily with Steret or hot soapy water

Stands/holders for urine bags etc

In between patient use or when visibly soiled. Twice weekly for longer stay patients

Detergent and water, dry thoroughly

Hypochlorite for blood or body substances.

Suction Units

After each use and in between patient use

Detergent and water, dry thoroughly

Use disposable liners for fluid collection

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COMMONLY USED EQUIPMENT/ITEMS – METHODS FOR DISINFECTION ITEM

FREQUENCY

ROUTINE


Theatre footwear

Automated wash daily or following theatre session Must be cleaned when visibly contaminated .

Automated wash preferable. Adequate PPE required for manual cleaning

Specialist areas to develop local protocols for the cleaning of theatre footwear

Thermometers; tympanic

Disposable cover must be disposed of after each patient use and not re-used

Wipe handpiece with detergent wipe when visibly contaminated, after use in each bay and after use in an isolation area

Tonometer heads

Single use for each patient Disposable products only advocated by the Infection Control team

Toys

When visibly contaminated, or after use by each patient

Vinyl/plastic – wash with detergent weekly or when visibly soiled Fabric toys not suitable for communal play areas

Fabric toys not suitable for use in isolation rooms

Vaginal specula

After each use Disposable preferred. If not, return to SSD for processing

Vaginal ultra sound probe

After each use Wash thoroughly with detergent. Wipe with Tristel wipe(chlorine dioxide) allowing contact time of 30 secs Rinse and dry thoroughly prior to use

Disposable sheath to be used additionally

Wash bowls

Each patient to have an individual wash bowl for the duration of their stay. Ensure thoroughly cleaned on discharge and after each use.

Detergent and hot water Dry thoroughly inside and store dry after each use. Do not stack whilst wet

W.C.

Twice daily unless greater frequency required

Inside of bowl and rim with Hypochlorite sanitiser and toilet brush. Rinse brush in clean flush water Disposable cloth for cistern, handle,seat and bowl

X-Ray equipment

Twice weekly. After patient use if visibly contaminated

Damp dust with detergent and water according to frequency of use, or use detergent wipes

If disinfection or a less moist wipe is required, use a wipe impregnated with 70% alcohol

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Considering Decontamination prior to Purchase It is vital that decontamination methods are considered before any piece of equipment is purchased. The following points should be considered and if necessary discussed with the Infection Prevention and Control Team; • What is the equipment going to be used for? For example;

Single patient use Same patient, multiple use Multiple patient use

• How invasive is the piece of equipment?

If skin, orifices or mucous membranes are breached, what level of disinfection or sterilisation is needed?

• Is there a single use alternative that may ultimately prove cost effective in terms of cleaning time and other resources?

• How can the equipment be safely decontaminated? Is detergent satisfactory or are other specific agents required? (Consider COSHH requirements)

• Is the equipment easy to clean? For example; smooth surfaces and edges, constructed of a non-porous material. Additionally, consider crevices, ridges present, or hollow parts that are inaccessible

• If a Hypochlorite or alcohol solution is required, will the integrity of the equipment be affected. Additionally, will the device or piece of equipment withstand regular cleaning?

If adequate methods of decontamination cannot be identified due to the structure or material of an item, the Infection Prevention and Control Team (IPCT) will recommend that it is taken out of service if already in use, or not purchased in the first instance. Whilst considering items for purchase, ensure that the manufacturer or representative provide as much information as possible with regard to cleaning requirements or restrictions. A Pre-Purchase Questionnaire/Requisition form (PPQ form) requires completion prior to ordering some items of equipment. This form will be reviewed by EBME prior to the item of equipment being ordered and the section detailing decontamination methods considered in conjunction with the IPCT. Not every piece of equipment requires a PPQ form, therefore it is advisable that decontamination methods are discussed with the IPCT to ensure that appropriate decisions are made, risks can be minimised and that resources are not wasted.

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Decontamination of Healthcare Equipment Prior to Inspection, Service or Repair The following procedures outline safe systems of work in relation to health care equipment which has been in contact with blood or body substances or other undesirable substances, eg, dust, soil, chemical residues, etc. Procedures outlined are applicable to all staff likely to be involved both directly and indirectly in patient care and the use of equipment. • All equipment must be decontaminated by the user prior to being presented to or sent to

third parties for maintenance, service, inspection or repair. If contamination is not apparent, the item must be physically cleaned before being presented for service or repair. Usually general-purpose detergent and water is adequate for this task.

• Visible soiling MUST BE REMOVED by the user before being presented to a third party. • Manufacturer’s instructions must be adhered to at all times. The decontamination

procedure must be detailed on the contamination status label. The label is to be used when a request is made for inspection, service or repair of an item of healthcare equipment. Completion of the contamination status label will confirm to the inspecting/servicing department that the required decontamination/cleaning procedure has been completed.

• Some items of equipment cannot be decontaminated without being dismantled by an

engineer. In such instances, the relevant section of the contamination status label must be completed and discussion with the receiving department or firm must take place before the item is left with them. A suitable method of bagging or covering must be decided upon before transportation can occur. Appropriate personal protective equipment must be worn during handling, service or repair of the item.

• Any items of equipment dispatched from Trust premises or returned to the manufacturer

must be packaged carefully and according to Post Office regulations. The contamination status label must be accurately completed and enclosed in the packaging. If a full decontamination procedure has not been carried out, it is the responsibility of the ward/department to advise the recipient accordingly.

EQUIPMENT FOR REPAIR OR SERVICING WITHOUT THE COMPLETED CONTAMINATION STATUS LABEL WILL NOT BE ACCEPTED. ITEMS THAT ARE VISIBLY SOILED OR CONTAMINATED WILL NOT BE ACCEPTED. WARDS/DEPARTMENTS WILL BE ASKED TO CLEAN THE ITEM THOROUGHLY PRIOR TO THE COMPLETION OF SERVICE OR REPAIR.

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• Prior to purchasing any new equipment for clinical purposes, staff must ensure that

effective cleaning and decontamination can be performed. Advice must be sought from the manufacturer and the Infection Prevention and Control Team prior to purchase.

If equipment is purchased that cannot be safely decontaminated, in the interest of patient and staff safety, the IPCT may recommend its withdrawal from service.

Handling and Transportation of Equipment to the Sterile Services Department For items of equipment/instruments requiring re-processing within the Sterile Services Department, care must be taken to ensure safe methods of handling and transportation are employed. Please refer to the SSD Policy (return of used medical devices) the procedures required to facilitate safe and legal re-processing of medical devices. Roles and Responsibilities It is the responsibility of every member of staff within MCHT to ensure that procedures within the Decontamination and Disinfection policy are carried out. Infection Prevention and Control Team: • To provide advice and support to any department/member of staff in relation to decontamination and disinfection. • To liaise with manufacturer’s company representatives and experts in the field of

decontamination to ensure that advice given is accurate, appropriate and evidence based. • To ensure national initiatives or guidance is incorporated into policies and practice within

MCHT. Legislation, Guidance & References Ayliffe G, Coates, D & Hoffman P (1986) Chemical Disinfection in Hospitals Ayliffe, Fraise, Geddes and Mitchell (2000) Control of Hospital Infection – A Practical Handbook (4th edition). Arnold: London

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British Medical Association (1989) A Code of Practice for the Sterilisation of Instruments and control of Cross Infection BMA: London Control of Substances Hazardous to Health Amendment Regulations (2003) HMSO: London Department of Health and Public Health Laboratory Service (1995) Hospital Infection Control – Guidance on the Control of Infection in Hospital Department of Health: London Health & Safety At Work Act (1974) HMSO: London HSG (93) 26 – Decontamination of Equipment prior to inspection, service or repair NHS Management Executive Medical Devices Agency (2000) Single-use Medical Devices: Implications and Consequences of re-use. MDA DB2000 (04) August 2000 NHS Estates CD-Rom Decontamination Guidance on NHS website www.doh.nhsweb.nhs.uk/health/decontamination-guidance.htm Pratt et al (2001). The epic Project: Developing National Evidence-based Guidelines for Preventing Healthcare Associated Infections. The Journal of Hospital Infection, Vol. 47. Supplement January 2001 Sterilisation, Disinfection and Cleaning of Medical Services and Equipment: guidance on decontamination. Microbiology Advisory Committee to Department of Health Medical Devices Agency 1996. Medical Devices Agency Policy Management The Decontamination and Disinfection policy has been issued in Dec 2004 and has been ratified by the Infection Control Committee and Health and Safety Committee. Compliance with the policy is required by all members of staff within MCHT. NB. A policy audit is available for this particular policy. Refer to the appendix of the policy entitled Guidelines for the Review of Infection Control Practice.

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The policy is due for revision on or before Dec 2006 and will be updated by the Infection Prevention and Control Team. Policies to be read in conjunction with the decontamination and disinfection policy; • Good Practice guidelines • Hand Hygiene guidelines • Blood and Body Substances Policy • Universal Precautions Policy

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Disinfection Policy - Chitra

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