Friday February 10, 2012
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 FAQ's - Frequently Asked Questions Cleaning/Disinfection/Sterilization
1. When would I use a high level disinfectant to clean environmental surfaces?
High level disinfectants would never be used to clean an environmental surface. In the PIDAC Best Practice Document For Cleaning Disinfection and Sterilization, high level disinfection (HLD) is defined as " the level of disinfection required when reprocessing semicritical medical equipment/devices. High level disinfection processes destroy vegetative bacteria, mycobacteria, fungi and enveloped (lipid) and non-enveloped viruses, but not necessarily bacterial spores. medical equipment/devices must be thoroughly cleaned prior to high level disinfection". Equipment being disinfected using the HLD method are immersed in the product for the period of time recommended by the manufacturer. 2. In our small hospital, there is only one room for clean and dirty equipment as well as our bedpan washer. Is this satisfactory? No, according to best practices this is not satisfactory. There must be clear separations between soiled and clean areas. The PIDAC Best Practices for Cleaning, Disinfection and Sterilization document recommends:
3. Can electric razors be used between patients/residents with cleaning? Sharing an electric razor between patients/residents is not considered an acceptable practice in a healthcare facility because it doesn’t respect basic personal hygiene care measures and can expose the patients/residents to the transmission of microorganisms and infection. (CCAR Infection Prevention and Control Best Practices, June 2007) 4. Is it really necessary to use alcohol as a final rinse for endoscope processing? Yes. The alcohol rinse is the final step in the drying process and has been shown to greatly reduce the possibility of recontamination of the endoscope by waterborne microorganisms. 5. Is it okay to use tap water for rinsing vaginal ultrasound probes after they are chemically disinfected? No, it is not acceptable to use tap water to rinse this equipment. Semi-critical items, devices that come into contact with non-intact skin or mucous membranes but do not penetrate them, minimally require high level disinfection (HDL). Vaginal ultrasound probes should be rinsed with sterile water after they have undergone HLD to prevent their contamination with organisms that may be present in tap water such as non-tuberculous Mycobacteria, Legionella or gram negative bacilli such as Pseudomonas spp.
6. Do vaginal ultrasound probes need to be high level disinfected if they are covered with a condom or probe cover? Yes. Probe covers can fail. Indeed, sterile transvaginal ultrasound probe covers have a very high rate of perforations even before use. Condoms have been found superior to commercially available probe covers for covering the ultrasound probe (1.7% leakage for condoms versus 8.3% for ultrasound probe covers), but this is not sufficient to suggest anything less than high level disinfection is appropriate. Other probes such as rectal, cryosurgical and transesophageal probes or devices should also be high level disinfected between patients. 7. It is my understanding that by 2011 anyone operating a sterilizer is required to have Training and Certification in this area with re-certification every 5 years. I would like the information on how to obtain this certification in order to ensure that we are compliant with CSA. The 2011 requirement for training and certification is correct. Refer to Appendix G of the PIDAC Best Practices for Cleaning, Disinfection and Sterilization to find contact information for organizations that provide certification courses for those involved in reprocessing medical equipment. The Central Service Association of Ontario also provides a course on reprocessing techniques.
8. I have received complaints from workers about bleach and am looking at purchasing a new product. How do I choose a product and assess what would be best for my setting? The PIDAC Best Practices for Cleaning, Disinfection and Sterilization compares various cleaning products appropriate to health care settings. Refer to Appendix A which also has a decision chart in which might help you in your assessment. Factors you need to consider include product efficacy, cost, contact time and staff acceptance. 9. I work in an acute care setting where we occasionally perform implant surgery that requires proper sizing and fit of an implant. During the surgery, multiple pieces of an implant set may become contaminated during the fitting process. Some implant sets can be extremely expensive and in effort to minimize cost, we would like to know how we can safely reprocess the pieces that are contaminated but not used. The manufacturer includes instructions on how to reprocess implants and at the same time, includes the following statement in their instructions: "Any implant contaminated with blood, tissue and bodily fluids/matters should be processed according to hospital protocol. The manufacturer does not recommend the reprocessing of contaminated implants. " While the directions from the manufacturer seem contradictory, it is important to realize that the statements are referring to different situations. The instructions provided by the manufacturer regarding processing of implants are indicated for use only on implants that have not been contaminated. The statement regarding implants contaminated with blood, tissue and bodily fluids/matters outlines that hospitals need to have policy/procedure regarding processing implants. Further in that statement, the manufacturer does not recommend reprocessing contaminated implants. Although this statement appears ambiguous, the manufacturer is pointing out that if hospital protocol is to reprocess contaminated implants, then the manufacturer is not liable for any problem that may arise from use of previously contaminated implants. As you point out, these implants are expensive to discard if contaminated but ultimately not used. The only recommendation that can be made in this situation is to follow the manufacturer’s instructions. In practical terms, try to minimize contamination during the procedure with the surgeon only handling those implants that he/she predicts will fit. The success of this will likely vary with the experience of the surgeon. Once the surgeon has handled the implant with gloves that have been in the operative site, it should be considered contaminated, regardless of whether contamination is visible. This equipment should not be reprocessed and must be discarded. 10. Can you transport a sterile medical device from an offsite storage facility or area to a receiving facility in a vehicle that has been used to transport contaminated items? Yes. The CSA document Z314.15-10 Warehousing, storage and transportation of clean and sterile medical devices states: "A compartment that has carried contaminated medical devices in a vehicle shall be cleaned and disinfected before being used to transport clean or sterile medical devices.” 11. What does the term "event-related sterility" mean? The shelf life of a sterile package is event related rather than time related. Event related shelf life is based on the concept that items that have been decontaminated, wrapped, sterilized, stored and handled in keeping with established procedures will remain sterile indefinitely unless the integrity of the packaging has been compromised. This means that the packaging must be carefully inspected prior to use of the item. The integrity of a package depends on, but is not limited to:
12. How frequently do bedpans have to be cleaned and disinfected when it is for repeated use by the same patient? There are no hard and fast rules for the frequency of cleaning of these items between uses by the same patient. Decisions about frequency of cleaning should be made with the following things in mind:
13. Is boiling equipment in a home care setting acceptable? The following references are taken directly from the PIDAC Best Practices for Cleaning, Disinfection and Sterilization: Page 31 ‘Non-critical/semi-critical devices do not require disinfection between uses (just cleaning).’ This applies to equipment and supplies that do not leave a client’s home and are used by only one client. Page 52 ‘The use of boiling water to clean instruments and utensils are not an effective means of sterilization. Boiling water is inadequate for the destruction of bacterial spores and some viruses. In the home care environment, boiling may be used for high-level disinfection for equipment/devices reused on the same client, following adequate cleaning.’ Page 55 ‘Equipment/devices owned by the client that are re-used in their home must be adequately cleaned prior to reuse. Home health care agencies may consider re-using single-use semicritical medical equipment/devices for a single client in their home when reuse is safe and the cost of replacing the equipment/device is prohibitive for the client.’ So, boiling equipment in the home care setting is acceptable, with consideration given to the use of the equipment. Ask the following questions and consider the risks and benefits associated with the responses:
14. Is it true that the efficacy of certain cleaning agents (specifically bleach) is affected by the hardness of the water. According to the CDC's Guideline for Disinfection and Sterilization in Healthcare Facilities, 2008, pp. 39-40, solutions of 5.25%–6.15% of sodium hypochlorite (usually called household bleach) have a broad spectrum of antimicrobial activity, do not leave toxic residues, and are unaffected by water hardness. Quaternary Ammonium Compounds (QUATs), however, are affected by water hardness. The CDC’s Guideline for Disinfection and Sterilization in Healthcare Facilities,2008, p. 52 indicates that:
"The quaternaries are good cleaning agents, but high water hardness and materials such as cotton and gauze pads can make them less microbicidal because of insoluble precipitates or cotton and gauze pads absorb the active ingredients, respectively.” 15. Are alcohol wipes sufficient to clean key boards? Our environmental manager stated that he was told that using alcohol wipes to clean key boards is enough. Is this so? Alcohol isn't a very good choice of cleaning products, as it has no detergent properties and is therefore not very effective. To clean, you want a product with a detergent that will help remove "soil" from the surface...and, if you've ever tried cleaning a keyboard, you are aware of how much "soil" there can be on them.
Alcohol can be used as a disinfectant but it isn't effective against bacterial spores such as C. difficile or non-enveloped viruses like Norovirus. Also, alcohol evaporates very quickly so it is very difficult to achieve the recommended contact time needed to inactivate microorganisms. While cleaning items such as computer key boards is important, emphasis and education about cleaning hands before and after touching keyboards may be another approach to take in addressing this issue. Consider placing alcohol based hand rub beside computers to reinforce the importance of cleaning hands. |
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