Basics Of Cleaning, Disinfection & Sterilization Teleclass .
Basics of Cleaning, Disinfection & Sterilization for Health CareDr. Lynne Sehulster, CDCA Webber Training TeleclassDisclaimerBasic Principles ofCleaning, Disinfection, and Sterilizationin Health CareThe findings and conclusions in this presentation are those of the author and herinformation resources and do not necessarily represent any determination orpolicy of the Centers for Disease Control and Prevention (CDC).Lynne Sehulster, PhD, M(ASCP)Division of Healthcare Quality PromotionCenters for Disease Control and PreventionHosted by Paul mBluebonnets in Central TexasChain of InfectionTopics for Today Basic infection control considerationsLevels of disinfectionIntroduction to the SpauldingClassificationSterilizationCleaning and disinfection ofenvironmental surfacesVirulent pathogenSufficient number of the pathogen(infectious dose)Susceptible hostMode of transmissionCorrect portal of entrySo Why All the Fuss AboutHand Hygiene?From Point A to Point BMedical/Dental Instrumentsand Accessories Patient APhysicians,Nurses, andAssistantsPatient B Medical Equipment,Environmental Surfaces,Frequently TouchedSurfaces Most common modeof transferral ofpathogens is via thehands!Infections acquired inhealthcareSpread of resistantmicroorganismsHosted by Paul Webber paul@webertraining.comwww.webbertraining.com1
Basics of Cleaning, Disinfection & Sterilization for Health CareDr. Lynne Sehulster, CDCA Webber Training TeleclassEvidence of RelationshipBetween Hand Hygiene andHealthcare-Associated Infections Substantial evidence that hand hygienereduces the incidence of infections Historical study: Semmelweis More recent studies: rates lower whenantiseptic handwashing was performedCleaningA process that: Renders a surface or device safe to handle Reduces the natural bioburden on devicesand environmental surfaces Removes organic / inorganic contaminants Reduces the challenge load posed to asterilizing or disinfecting processGuideline for Hand Hygiene in Health-care Settings. MMWR 2002;vol. 51, no. RR-16.Disinfection Low-Level DisinfectionBy definition, disinfection differs fromsterilization by its lack of sporicidal powerLevels of disinfection:– High– Intermediate– LowEnvironmental surfaces need only low- tointermediate level disinfection – Hospital-type germicides usedprimarily for housekeeping quaternary ammonium compounds(“quats”) some phenolics some iodophorsIntermediate-LevelHigh-Level DisinfectionDisinfection Kills resistant mycobacteria (MTB var.bovis or M. terrae) and all other vegetativebacteria, fungi, and most viruses– “Tuberculocidal” chemicals phenolicsiodophorschlorine compoundsalcoholsKills most vegetative bacteria, someviruses, and some fungi, but NOTmycobacteria Kills all microorganisms except HIGHnumbers of bacterial spores– Liquid chemical sterilizing agents(sporicides), minimum 10-20 minutesexposure time aldehydes hydrogen peroxide peracetic acidHosted by Paul Webber paul@webertraining.comwww.webbertraining.com2
Basics of Cleaning, Disinfection & Sterilization for Health CareDr. Lynne Sehulster, CDCA Webber Training TeleclassSterilizationWhat is Sterility? Sterile – free from living microorganismsIn practical terms, this is expressed as aprobability function, such as the probabilityof a surviving microorganism on an item asbeing 1 in 1 millionSterility Assurance Level (SAL) – thepredictor of the efficacy of the sterilizationprocess Kills all microorganisms, including HIGHnumbers of bacterial spores––––Heat (moist or dry)Chemical gas or vaporRadiationLiquid chemical sterilizing agents(sporicides); 6-10 hours exposure time aldehydes hydrogen peroxide peracetic acidRelative Microbial Resistance and Germicide Levels*Sterilization*Bacterial SporesB. subtilisHLD*Cl. sporogenesMycobacteriaMTB var. bovisILD*Nonlipid Virusespolio rhino FungiLLD*Cryptococcus sp.Candida sp.Spaulding ClassificationandInstrument ReprocessingVegetative BacteriaPseudomonas sp.Salmonella sp.Staphylococcus sp.Lipid VirusesHSVCMVHBVHIVCritical InstrumentsSpaulding Classification ofInstruments and Devices Medical instruments and devices:– Critical– Semicritical– Noncritical CDC modification; Environmental– Housekeeping– Frequently touched, clinical touch Critical – penetrates mucousmembranes; makes contact with bone,the bloodstream, or other normallysterile tissues Examples:– Surgical instruments, scalpel blades– Surgical dental burs– Orthopedic drill bits, sawsHosted by Paul Webber paul@webertraining.comwww.webbertraining.com3
Basics of Cleaning, Disinfection & Sterilization for Health CareDr. Lynne Sehulster, CDCA Webber Training TeleclassSemicritical Instruments Semicritical – contacts mucousmembranes, but does not not make contactwith the bloodstream, bone, normallysterile tissues, or penetrate soft tissueExamples:– Dental mouth mirror– Speculum– Ultrasonic probe tipsLevels of Reprocessing Critical – sterilizationSemicritical – sterilization, high-leveldisinfectionNoncritical – low- to intermediate-leveldisinfection (depending on the type anddegree of contamination)Environmental – low- to intermediate-leveldisinfection (depending on the type anddegree of contamination)Decontamination andCleaning Decontamination or cleaning helps toensure the success of the terminalreprocessing step (e.g., sterilization)Manual scrubbing or automated processKeep instrument surfaces moist to preventorganic matter from dryingDO NOT USE HIGH-LEVELDISINFECTANTS AS HOLDINGSOLUTIONS!!Noncritical Instrumentsand Devices Noncritical – contacts intact skin Examples:– Blood pressure cuff– Stethoscope– Pulse oximeterThe most important step ininstrument reprocessing orsurface management is .Reusable Medical Devices:Effect of Cleaning on Bioburden(1) Nyström - instrument washer– 78% of the instruments had 101 CFU/device– 96% had 102; 100% had 103(2) Rutala - standard cleaning procedure– 72% of the instruments had 101 CFU/device– 86% had 102; 94% had 3 x 102(3) McAllister, et al. - standard cleaning procedure– 88% of the instruments had 102 CFU/device– 100% had 103(1) J. Hosp. Infect. 1981, 2: 363-368(2) Amer. J. Infect. Cont. 1997. 25: 185.(3) Amer. J. Infect. Cont. 1997. 25: 156.Hosted by Paul Webber paul@webertraining.comwww.webbertraining.com4
Basics of Cleaning, Disinfection & Sterilization for Health CareDr. Lynne Sehulster, CDCA Webber Training TeleclassFlexible Fiberoptic Endoscopes:Effect Cleaning on BioburdenFactors AffectingSterilization or Disinfection(1) Colonoscope insertion tube: – After clinical use - 1.3 x 107 - 2.0 x 1010cfu/device– After manual cleaning - 1.3 x 105 - 4.5 x105 cfu/device (2) Five studies showed that cleaning aloneprovided a mean 4.0 log10 reduction in microbialcontamination (1) Chu, NS er al. 1997. Am. J. Infect. Cont. 25: 186.(2) Rutala, WA & DJ Weber. 1995. Infect. Cont. Hosp. Epidemiol. 16: 231-235. AMOUNT OF ORGANIC MATERIALNumber of microorganismsType of microorganisms (resistance levels)Type of germicidal agentConcentration of germicidal agentExposure time to germicidal agentTemperature of exposurepH of solutionPresence or absence of moistureInstrument Factors Sterilization Attributes of the IdealSterilant* Strong permeability– Penetrates packaging materials and devicelumens Non-toxic Organic material resistance AdaptabilityMonitoring capability Cost effective– Poses no health hazards to the operator, patient, orthe environment– Withstands reasonable organic challenge withoutloss of efficacyRapid activity– Achieves sterilization quickly Attributes of the IdealSterilant*Highly efficacious– Bacteriocidal, sporicidal, tuberculocidal,fungicidal, virucidalMaterials compatibility– Negligible changes in either appearance orfunction of processed itemsLumensMated surfacesAcute anglesAbsorbent surfacesSprings / valvesRough / pitted surfacesInaccessible areasHeat-sensitive materialsFaulty “cleaning” devices– Physical, chemical, or biological indicators* Source: Schneider, PM. Low-temperature sterilization in the 1990’s.1994. Tappi Journal 77: 115-121.Hosted by Paul Webber paul@webertraining.comwww.webbertraining.com5
Basics of Cleaning, Disinfection & Sterilization for Health CareDr. Lynne Sehulster, CDCA Webber Training TeleclassEffective Sterilization:Controlled Conditions For all physical processes:Moist Heat Sterilization – Time, temperature, relative humidity All moist heat sterilization processesconsist of four phases in their cycles:– Heating phase– Sterilization phase– Evacuation and cooling phase– Drying phaseFor liquid chemical processes:– Time, temperature, pH, concentration For gas or plasma processes:– Time, temperature, gas concentration,relative humidity, wrappingSterilization via Saturated Steam:Air Removal Mechanisms Air interferes with the ability of steam to makecontact with items to be sterilized. Air isremoved by:Gravity displacement: incoming steam forcesair to the bottom of the chamber for removalPre-vacuum (porous load): air is pumped outof the chamber mechanically in one ormultiple cycles before steam entersFlash Sterilization None of the new processes are approved forflash sterilizationItems must be thoroughly cleanedAAMI, AORN recommendations:– Non-porous loads, unwrapped: 3 minutes 132ºC in either gravity-displacement orprevacuum units– Porous loads: at 132ºC , 10 minutes in gravitydisplacement units, or 4 minutes in prevacuumunits“Flash” Sterilization In hospitals, unwrapped item(s) are runthrough a sterilization cycle using a highertemperature and a shorter exposure timeItems used immediately after cool-downDo not use flash sterilization for implanteddevicesAvoid using flash sterilization if possibleHave adequate instrument inventoryLiquid Chemical Sterilantsand Low-TemperatureProcesses Use of liquid chemical sterilants or lowtemperature sterilization processes isintended for the reprocessing of heatsensitive instruments and devicesNOTE: The vast majority of instrumentsin medicine and dentistry are heatstableHosted by Paul Webber paul@webertraining.comwww.webbertraining.com6
Basics of Cleaning, Disinfection & Sterilization for Health CareDr. Lynne Sehulster, CDCA Webber Training TeleclassLiquid Chemical Sterilants andLow-Temperature Processes Liquid chemical sterilants– Powerful, toxic chemical used for immersion– Safety concerns; follow instructions carefully– Use of these chemicals is discouraged Low-temperature sterilization processes– Ethylene oxide (EO)– Gas-plasma (e.g., hydrogen peroxideplasma)– Chemical systemsBiological Indicators Advice From an IndoorEnvironmental Microbiologist“The proper method of reprocessing aheat-stable device is toAUTOCLAVE it! You COOK it!You don’t gas it, you don’t dunk it,YOU COOK IT!!!”W.W. Bond, MSCDC Microbiologist (Retired)Types of Biological IndicatorsA standardized preparation of bacterialspores on or in a carrierServes to demonstrate whether sterilizingconditions have been metBI must be placed in the most difficult sitefor sterilant penetrationA positive BI indicates a process failure Bacillus stearothermophilis– Moist-heat systems– Geobacillus stearothermophilis Bacillus subtilis– EO, dry heat systems– Bacillus atropheus Bacillus pumilus– Radiation-based systemsChemical Indicators Measure key parameters of the sterilizationprocessVisual change when the desired parameterhas been achieved (e.g., color change withtemperature)Single parameter indicators, multiparameter indicatorsPhysical Indicators Equipment monitors that are engineeredto detect any of these parameters:–––––Temperature, timePressure, gas concentrationRelative humiditySteam purityDelivered dose of sterilantHosted by Paul Webber paul@webertraining.comwww.webbertraining.com7
Basics of Cleaning, Disinfection & Sterilization for Health CareDr. Lynne Sehulster, CDCA Webber Training TeleclassGeneral Points to Consider Cleaning:– Was this done, automated or manual, what cleaningchemical, use conditionsRinsing:– Use of tap water, removal of residuals, water qualitySterilization/disinfection:– Label instructions, contact time, factors affecting theoperation of equipment, water quality, inappropriateuse/misuse of disinfectants, drying of the instrumentEquipment use during medical procedures:– Use of tap water, reuse of single-use devices, multidose vials, examine all instruments/devices available foruseDocumentation:– Instrument identification noted in charts, processesused, instrument trace backThe Inanimate Environment CanFacilitate TransmissionXrepresents VRE culture positive sitesDisinfectionEnvironmentallyTransmitted Infections Healthcare workers and patients can beinfected directly or indirectly fromenvironmental sources– Sources can be air, fomites, instruments, oraerosols Contaminated surfaces increase cross-transmission Abstract: The Risk of Hand and Glove Contamination after Contact with aVRE ( ) Patient Environment. Hayden M, ICAAC, 2001, Chicago, IL.Environmental surfaces (e.g., walls, floors) arenot directly involved in infectious diseasetransmissionFomite: An inanimate object or substance capable of carryinginfectious organisms and hence transferring them from oneindividual to anotherChoosing a DisinfectantProcedureChoosing a Disinfectant Clean first!Nature and use of the item to be disinfected Sufficient potency for disinfection Intrinsic resistance of microbes Chemical class of disinfectant, use conditions Disinfection levelMaterials compatibilitySafety concerns: hazards with use? Aerosols, residuals, chemical sensitivities Nature of the item to be disinfectedConcentration of microorganisms presentInnate resistance of those microorganismsAmount of organic soilType and concentration of germicide usedDuration and temperature of germicidecontactOther factors if using a proprietary productHosted by Paul Webber paul@webertraining.comwww.webbertraining.com8
Basics of Cleaning, Disinfection & Sterilization for Health CareDr. Lynne Sehulster, CDCA Webber Training TeleclassEPA Lists of RegisteredGermicides List A – sterilantsList B – tuberculocidesList C – HIV-1List D – HIV-1, hepatitis B virus (HBV)List E – HIV-1, HBV, and MycobacteriumtuberculosisList F – hepatitis C virus (HCV)List G – norovirusList H – MRSA, VRE (E. faecalis or E. faecium)List J – medical waste treatment“Tuberculocidal” Germicides Use of these products will NOT prevent thespread of TB because TB is not acquiredfrom environmental surfacesMeasure of potencyMycobacteria have the highest intrinsiclevel of resistance among the vegetativebacteria, viruses, and fungiBroad spectrum antimicrobial capabilityCleaning and Disinfecting ofMedical Equipment What is a “HospitalDisinfectant?”FOLLOW THE MANUFACTURER’SINSTRUCTIONS!!!In the absence of instructions, clean andfollow with low- to intermediate-leveldisinfection depending on the degree ofcontaminationConsider covering those surfaces that arefrequently touched during delivery of care An EPA category for disinfectantsDemonstrated potency against:– Pseudomonas aeruginosa– Staphylococcus aureus– Salmonella choleraesuis Low-level disinfectantIntermediate-level disinfectant if thechemical is tuberculocidalDo NOT use high-leveldisinfectants/chemical sterilants(e.g., glutaraldehyde,formaldehyde) to disinfectmedical equipment surfaces orhousekeeping surfaces!!Cleaning and Disinfecting ofthe Housekeeping Surfaces Clean on a regular basis to remove soil anddustPhysical removal of microorganisms andorganic soil is as important as theantimicrobial effect of the disinfecting agentSurfaces not touched frequently by hand (i.e.,floors) in general care areas are cleaned anddisinfectedThis is controversial – routine disinfection offloors is not supported by epidemiology; lackof consensus among infection control staffand hospital epidemiologistsHosted by Paul Webber paul@webertraining.comwww.webbertraining.com9
Basics of Cleaning, Disinfection & Sterilization for Health CareDr. Lynne Sehulster, CDCA Webber Training TeleclassMicroorganism Removal with MicrofiberCleaning Solution Cleaning SystemDry Time(mins)Mean % Reduction CFU SDQUATCotton string mop/standardbucket with wringer2:4894.84 4.8QUATMicrofiber mop/standardbucket with wringer2:1387.94 17.2QUATMicrofiber mop/microfiberbucket7:0495.31 5.7DetergentCotton string mop/standardbucket with wringer2:4867.75 31.6DetergentMicrofiber mop/standardbucket with wringer2:2379.74 24.8DetergentMicrofiber mop/microfiberbucket8:0394.50 4.6Cleaning and Disinfecting ofthe Housekeeping Surfaces Follow manufacturer’sinstructions if usingproprietary cleaners ordisinfectants Use conditions (e.g.,concentration, contact time) Clean and disinfect surfacesthat are touched by hand ona frequent and regular basis Door knobs, light switches,bed rails Surfaces around the toiletQUAT 1:128 dilution of product containing 5.15% didecyl dimethyl ammonium chloride, 3.43%dimethyl benzyl ammonium chloride. Detergent was a neutral cleaner with no germicidal propertiesRODAC plates with D/E Neutralizing agar; CFU compared before and after cleaningSource: Rutala WA, Gergen MF, Weber DJ. Microbiologic evaluation of microfiber mops for surface disinfection. Am J InfectControl 2007; 35: 569-73.Minimize Glove “Misuse”Environmental Cleaning Study:VRE in RUMC MICUFailure to remove or change contaminated gloves18.3% (4/22) samples showed potential transferral ofmicroorganisms [a from patient, b from gloves] 4 periods of time over 9 months: Period 1: baseline, current procedures Period 2: enhanced environmental cleaning Virex (cleaner / quat disinfectant) 20 – 25 mins/room, 2X per day “Bucket method for the floors, 8 – 12 cloths for touched surfacesSource: Girou E, Chai SHT, Oppein F, et al. J Hosp Infect 2004; 57: 162-9Glove CulturesNo. of ContactsBeforeSamplingPathogenicBacteria64,500P. aeruginosa (a),Serratiamarcescens (a)Bed barrier (rail)10 30,000P. aeruginosaBedside table2P. aeruginosa10 30,000P. aeruginosaBedside table 300P. Aeruginosa (a)17 30,000P. aeruginosaWeighingmachine169P. aeruginosa cteria85P. aeruginosa,Serratiamarcescens (a, b) EPA-registered products labeled as“cleaner/disinfectants:”– Label clearly distinguishes between use ofthe product as a cleaner OR as adisinfectant– Level of soil, precleaned surface– Contact time– Surface is to remain WET for the fullcontact timeRectal swabs for patients; environmental swabs; hand cultures for HCWsVRE acquisition rates: Period 1: 33.47 cases per 1000 patient-days at riskPeriod 2: 16.84Period 3: 12.09Period 4: 10.40Limitations to the study and unanswered questions: No reported use of neutralizer for the disinfectant Little or no details on the housekeeping procedures An Example on WhyInstructions are so Important Period 3: “washout” (no continued emphasis) Period 4: hand hygiene campaignEnvironmental CulturesBacterialCounts(CFU)Hayden MK, Bonten MJM, Blom DW, Lyle EA, van de Vijver DAMC, Weinstein RA. Reduction in acquisition of vancomycin-resistantEnterococcus after enforcement of routine environmental cleaning measures Clin Infect Dis 2006; 42: 1552-60Should EnvironmentalSampling Be Done? NO, not routinely Environmental sampling may be useful: To verify the effectiveness of a new cleaningand disinfecting process To identify environmental reservoirs duringoutbreak situations Coordinate sampling with the laboratoryHosted by Paul Webber paul@webertraining.comwww.webbertraining.com10
Basics of Cleaning, Disinfection & Sterilization for Health CareDr. Lynne Sehulster, CDCA Webber Training TeleclassCleaning in the ICU:The Most and the LeastEnvironmental InfectionControl: Bacterial Spores Anthrax spore abatement; management ofClostridium difficile outbreaksThe Big Dilemma!– HLDs are not routinely recommended for useon environmental surfaces– ILDs are not EPA-registered as sporicides– Safe, yet effective decontamination ofaffected areasA SinkB Tray Table C Toilet Seat D Bedside TableE Room Door Knobs F Bathroom Door Knobs G Bedpan CleanerH Bathroom Light SwitchAdapted From: Carling PC, et al. J Hosp Infect 2008; 68: 39-44Hydrogen Peroxide VaporVapor-phase hydrogen peroxide VHP has been shown tobe sporicidal at concentrations ranging from 0.5 10mg/L; optimal range of 2.4 mg/L with a contact time of1 hrBreak down products are non toxic (water and oxygen)Can adsorb to some plasticsRequires low RH 30%Two commercial companies slightly different technologiesHas been used for laboratories, BuildingDecontamination following Anthrax releases fromintentionally contaminated mail, glove boxes, aerosolchambers, patient wards and rooms in healthcarefacilities How to Determine if Cleaning Products AreHazardous or Contain HazardousSubstancesImpact on Staff and Patients Review ingredients on material safety data sheet (MSDS). You can checkproducts or ingredients against the following databases or lists.Staff:– Irritant and allergiccontact dermatitis onhands and forearms– Muscular/skeletalinjuries (ergonomics) TURI – Toxic Use Reduction Institute: www.cleanersolutions.org – Occupational asthmaon the increase– 20% are eye and skinburns (chemicalexposures)IARC – International Agency for Research on Cancer: www.iarc.frNTP – National Toxicology Program; http://ntp-server.niehs.nih.govOSHA – Occupational Safety and Health Administration: www.osha.govIRIS – EPA Integrated Risk Information System: www.epa.gov/irisNIOSH – National Institute of Occupational Health and Safety: www.cdc.gov/nioshACGIH – American Conference of Governmental Industrial Hygienists: www.acgih.orgCleanGredients Database – Green Blue Institute: www.greenblue.orgGreen Seal: www.greenseal.orgEPA DfE - EPA Design for the Environment: CHS - Indiana Relative Chemical Hazard Score: www.ecn.purdue.edu/CMTI/IRCHS/ Patients:- Many exposedto chemicals 24/7- Chemicalsensitivities Hosted by Paul Webber paul@webertraining.comwww.webbertraining.com11
Basics of Cleaning, Disinfection & Sterilization for Health CareDr. Lynne Sehulster, CDCA Webber Training TeleclassSafety Assessment of Cleaning andDisinfectant ProductsStrategies to Enhance the Safety andEfficacy of Cleaning and DisinfectingBe familiar with the product’s MSDS andinstructions for proper and safeapplicationLook for opportunities to prevent surfacecontamination from occurringLook for opportunities to reduce theamounts of chemicals used How is the product diluted and how frequently is it being used? What is the product’s intended use? What is the likelihood it will be misused? What is the experience level of users? What are the hazard ratings for the product? What does the MSDS say about the product safety? Does the product present an acceptable level of risk? What do others report about the product safety?EPA and FDA InformationEPA information about hemregindex.htm FDA information about LCS/HLD:http://www.fda.gov/cdrh/ode/germlab.html FDA MAUDE /cfMAUDE/search.CFM Source: U.S. Dept. of the Interior, National Park Service: Grand Teton National ParkThank You!Division of Healthcare Quality PromotionCenters for Disease Control and Prevention“Protect patients, protect health-carepersonnel, and promote safety, quality, andvalue in the health-care delivery system”Bonus MaterialUse and Interpretation ofSterilizer BI IndicatorsBiological Spill ManagementEmerging Pathogens,Antimicrobial ResistanceHosted by Paul Webber paul@webertraining.comwww.webbertraining.com12
Basics of Cleaning, Disinfection & Sterilization for Health CareDr. Lynne Sehulster, CDCA Webber Training TeleclassUse and Interpretation ofIndicators Use and Interpretation ofIndicatorsUse on each sterilizer periodically (e.g., atleast weekly)Use on each load of implantable devicesUse control BI’s (not processed) forcomparison purposesIn-office culture services vs. mail-in services: – No significant influence on results if delayedduring mailing Use and Interpretation ofIndicators Repeat BI testing with controls on threeconsecutive sterilization cycles, empty chamberIf all processed BI’s are negative, return the unitto serviceIf any of the processed BI’s are positive:– Recall the processed items from that unit,rewrap, and re-sterilize these items– Have the equipment repaired and repeat the BIchallenge seriesBasic Principles of BiologicalSpill Management Know and understand the Chain of InfectionAerosol production and control– Is the agent an airborne organism?– Does the spill management activity produceaerosols?Low- to intermediate-level disinfectionDo not let the pathogenicity of the agentoverride the science of its inactivation!Sodium HypochloriteSolutionsBiological Spill Management Contain the spill’s organic material withdisinfectant-soaked absorbent towelingIntermediate-level disinfectant– Hospital disinfectant with tuberculocidalproperty– Sodium hypochlorite solutionsRemove organic material, cleanApply fresh disinfectant at proper useconditionsCheck the mechanical parametric readings(e.g., time, pressure) and internal/externalchemical indicators (e.g., temperature) firstWhen these suggest that the sterilizer isfunctioning properly, a single positive BI maynot indicate process failureTake sterilizer out of service, review processof operation to determine possible error Intermediate-level germicide, tuberculocidalpropertiesWhen using generic or reagent gradeformulations: 5000-6000 ppm or 500-600ppm working solutionsManufacturer’s instructions for proprietary,EPA-registered formulationsHosted by Paul Webber paul@webertraining.comwww.webbertraining.com13
Basics of Cleaning, Disinfection & Sterilization for Health CareDr. Lynne Sehulster, CDCA Webber Training TeleclassAntimicrobial ResistanceAnd Emerging PathogensMore About Spill Management DO NOT use liquid sterilants to disinfectenvironmental surfaces!– Not cleared for this purpose; respiratoryhazardDO NOT use environmental surfacedisinfectants to wash exposed skin!– Use antiseptic solutions for this purposeDO NOT use alcohol to “neutralize” chlorineresiduals on surfaces! Antimicrobial Resistance Drug Resistant Pathogens In general, antibiotic resistance is a traitindependent of an organism’s innatesusceptibility or resistance to adisinfectant’s properties.Environmental infection control of majorantibiotic-resistant bacteria (e.g., MRSA,VRSA, VRE) is similar to that for antibioticsensitive organisms Resistance may be apparently“increased” because of physicalfactors– Thicker cell walls– Biofilms– Release into the environment as acell-associated agent– Other organic matterNo correlation to drug resistance andresistance to disinfectionSome organisms may develop tolerance atconcentrations hundreds to thousand foldsbelow use dilutionCurrent protocols do not have to be altered;use products per manufacturer’s label or perlaboratory protocolsAntibiotic-Resistant GramPositive Cocci: MRSA, VREAntimicrobial Resistance Newly discovered pathogens or organismsthat acquire antimicrobial resistance areusually erroneously assigned extraordinaryresistance to commonly used disinfection andsterilization proceduresExamples: SARsCo-V, HIV, HBV, Ebolavirus, Hantavirus, MDR-Tb, VRE, MRSA,VRSA Antibiotic resistance does not confer increased resistance tochemical germicidesHand transferral is considered to be the primary means of spreadingthese bacteria to patients, workers, and other surfacesControl measures: HANDWASHING! Follow the hands – what is touched with gloved hands duringcare? Appropriate barrier precautions Patient isolation measures Standard cleaning and disinfection of surfaces Terminal cleaning and disinfection of the patient’s room may beintensified if environmental reservoirs of the MDRO persistHosted by Paul Webber paul@webertraining.comwww.webbertraining.com14
Basics of Cleaning, Disinfection & Sterilization for Health CareDr. Lynne Sehulster, CDCA Webber Training TeleclassMDROs and Environmental InfectionControlStaphylococcus aureus andMRSA: Infection Control Issues People are the source: a. Clean and disinfect surfaces and equipment that maybe contaminated, including those in close proximity to thepatient and frequently touched surfaces in the patientcare environment on a more frequent schedule comparedto that for minimal touch surfaces. Category IB b. Dedicate noncritical medical items when patients areknown to be infected or colonized with MDROs.Category IB c. Prioritize room cleaning of patients on ContactPrecautions. Focus on cleaning and disinfectingfrequently touched surfaces and equipment in theimmediate vicinity of the patient. Category IB– Carriage, infection– Shed into the general environment– Transmit to other peopleSmall numbers of staph can initiate infectionStaph contaminates the environment – Person to environment to person– Staph can survive for long periods of timeCleaning can reduce staph and MRSA in theenvironmentCleaning can reduce staph / MRSA infection rates V.A.6. Environmental MeasuresManagement of Multi-Drug Resistant Organisms in Healthcare Settings, 2006. HICPACguideline available at: dfAdapted from: Dancer SJ. The Lancet Infectious Disease; epub 10/31/07Environmental Sites Positive forMRSA in Endemic and OutbreakSituationsItem or SurfaceMean %Range %Floor34.59.0 – 60.0Patient Gown40.534.0 – 53.0Bed Rails27.01.0 – 60.0Bed Linens41.034.0 – 54.0Overbed Table40.018.0 – 67.0Bathroom Door Knob14.08.0 – 24.0Room Door Knob21.54.0 – 59.0Furniture27.011.0 – 59.0Flat Surfaces21.57.0 – 38.0Sink Taps23.514.0 – 33.0Infusion Pump Button19.07.0 – 30.0MDROs: When All Else Fails V.B.8 Enhanced Environmental Measures a. Use patient-dedicated or single-use noncriticalequipment and devices. Category IB b. Intensify training of environmental staff to achieveconsistency of proper environm
Basics of Cleaning, Disinfection & Sterilization for Health Care Dr. Lynne Sehulster, CDC A Webber Training Teleclass Hosted by Paul Webber paul@webertraining.com www.webbertraining.com 1 Basic Principles of Cleaning, Disinfection, and Sterilization in Health Care Lynne Sehulst
WFHSS-ÖGSV Basic Script Fundamentals of Cleaning, Disinfection, Sterilization Page2/30 TABLE OF CONTENTS . 1 TERMS 3 1.1 Cleaning 3 1.2 Disinfection 3 1.3 Sterilization 3 2 CLEANING 4 2.1 Detergents and methods of cleaning (summary) 5 3 DISINFECTION 7 3.1 Chemical disinfection 8 3.2 Thermal disinfection 17
Slide 1 Welcome to Cleaning, Disinfection & Sterilization, Part 2 of 2. Slide 2 One way to achieve sterilization is with steam. Steam sterilization uses 4 parameters to achieve sterilization. These include the
Best Practice Guidelines for Cleaning, Disinfection and Sterilization in Health Authorities - December 2011 Page 1 of 136 pages Semi Best Practice Guidelines For Cleaning, Disinfection . D. Reprocessing Products.40 8. DISINFECTION OF REUSABLE MEDICAL DEVICES .
Because sterilization of all patient-care items is not necessary, health-care policies must identify, primarily on the basis of the items' intended use, whether cleaning, disinfection, or sterilization is indicated. Multiple studies in many countries have documented lack of compliance with established guidelines for disinfection and sterilization.
Sterilization Trays for Steam Sterilization (18099-07, 18099-08, 18099-08A).162 TABLE OF CONTENTS Cleaning, Disinfection & Sterilization Guide Rev. 5.2 5. INTRAOPERATIVE IMAGING INSTRUMEN
Cleaning, Disinfection & Sterilization Guidelines for Ultrasound System 13 Strain relief Probe handle Liquid level Approx.10 mm - Wiping: Use a market disinfection wipe product or sterile disposable lint-free soft cloth wetted with disinfection spray and wipe all surfaces of the probe for a duration according to the manufacturer instructions. 4.
Disinfection . Failure to use disinfection products or processes appropriately . has repeatedly been associated with the transmission of . healthcare associated infections. Health Canada. Hand Washing, Cleaning, Disinfection and Sterilization. CCDR. 1998; 24S8
development of the International Standard and its recent publication, now, is a good opportunity to reflect on the body of information and guidance that is available a wide range of organisations. Whether you are trying to make sense of the variety of views on the revised International Standard, prepare for your transition or to keep up with the latest developments in Environmental Management .
