Christina Bradley Laboratory Manager Hospital Infection Research Laboratory Queen Elizabeth Hospital Birmingham, UK

Transcription

1 Christina Bradley Laboratory Manager Hospital Infection Research Laboratory Queen Elizabeth Hospital Birmingham, UK

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4 Irrespective of where the decontamination is performed or who it is performed by the aim should be the same, patient safety, so the standards framework should be the same

5 Standardisation of the process Facilities for manual cleaning Disinfection or sterilization Validation of decontamination equipment Separation of clean and dirty Standard operating procedures Traceability Training

6 Decontamination A combination of processes including cleaning, disinfection and sterilization are used to render a reusable item safe for use. Factors Input Output Item that needs cleaning Soil that needs removing Water Detergent Process Equipment Clean/disinfected item safe to handle

7 Essential requirements Dedicated area Manual cleaning workstation Sufficient sinks Cleaning equipment Detergent solution (Washer disinfector) Separation of clean and dirty items Separate hand wash area Documentation/record keeping

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9 It protects:- the equipment soil can damage equipment the staff inspection before sterilization is required 9

10 It removes :- Potentially infectious micro-organisms The organic material on which microorganisms thrive Soil which protects micro-organisms during sterilization and disinfection Soil which may inactivate disinfectant 10

11 Segregation & Separation Segregation & Separation Review manufacturer's processing instructions, work instructions and comments on checksheets to decide the correct pre-wash and main wash for the instrumentation. Pre Wash Options Main Wash Options Manual Pre-Wash Automated Washer-Disinfector Ultra Sonic Pre-Wash Manual Clean Immersion No Pre-Wash Manual Clean Non-Immersion

12 Manual At sink Automated Washer disinfector Ultrasonics

13 Water essential Mechanical action wiping, flushing, brushing, spraying Chemical action Detergent at correct concentration Heat improves the detergent performance Time Access to all surfaces

14 Cloths Brushes Spray guns Flushing devices

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16 Gloves Apron Visor Avoid production of aerosols Immunisation

17 Put on protective clothing Prepare fresh cleaning solution Change solutions frequently Dispose of cleaning solutions and wipes Leave surfaces dry Clean (disinfect) dry and store equipment Remove gloves, wash hands

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19 Fill sink with sufficient water so that the device is completely immersed Add appropriate detergent following the manufacturer s instructions for use Clean the device under the surface of the water so that aerosols are not produced Use appropriate brushes to clean box-locks, lumens, etc Use soft (nylon) bristle brushes of the correct length and diameter so that the surface of the instrument is not damaged Remove all visible soil from the device In another sink completely immerse the device in clean water and rinse device thoroughly Air dry or hand dry using a clean, non-linting cloth Cloths, detergent solution and water should be changed after each use

20 Clean device by wiping surfaces thoroughly with a clean, soft cloth and detergent ensuring that moisture does not enter critical areas of the device (i.e. power connections) until all visible soil is removed Rinse device by wiping surfaces thoroughly with a damp, clean, soft cloth until all detergent residue is removed Air dry or hand dry using a clean, non-linting cloth Cloths, detergent solution and water should be changed when visibly soiled

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22 Combination of physical cleaning and thermal microbicidal disinfection Will inactivate all micro-organisms except bacterial spores Items must be able to withstand temperatures in excess of 80 o C Items must be robust to withstand powerful jets and be compatible with detergents

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24 Delays before processing Initial wash temperature too high Blocked or misdirected jets Failure to irrigate lumened devices Badly placed instruments Shading effects Overloading

25 Essential requirements Dedicated area Good light (plus magnification) for inspection of instruments Work stations for inspection, assembly and packing Packing materials Sterilizer Cooling area Documentation/record keeping

26 Good light plus magnification Dryness Presence of residual soil especially in joints and ridges

27 Standard operating procedures with regular review Document control Records of staff training equipment testing and maintenance system failures and remedial action

28 Purpose of SOP s SOP s are required for all tasks which could have an effect on the quality of the decontamination process SOP s Must clearly describe specific tasks Must be easy to understand Must change if the task changes Are an essential tool in training

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30 Process Minimal Resources Intermediate Resources High Resources Manual cleaning Clean water Brushes/cleaning materials Sink Purified water Brushes/cleaning materials Sink Purified water Brushes Three-sink set up Cleaning chemistries PPE Impervious gown Hair cover Gloves Impervious Gown Hair cover Gloves Other items as available All appropriate PPE: Impervious Gown Gloves Hair cover Face Mask Face Shield Shoe covers Point of Use Preparation Remove sharps and disposables Remove gross soil from instruments Contain instruments in leak-proof container Keep instruments moist Remove sharps and disposables Remove gross soil from instruments Contain instruments in leak-proof container Keep instruments moist Remove sharps and disposables Remove gross soil from instruments Contain instruments in leak-proof container Keep instruments moist with enzymatic spray Mechanical Cleaning N/A Ultrasonic Cleaner Ultrasonic cleaner Automated Instrument Washer Disinfector Cart Washer Verification of processes according to ISO standards

31 Basic Reprocessing in a dedicated unit outside the operating department recommended. At least one room with separation for dirty and clean work. Steam sterilizer. Standard: Reprocessing in a dedicated unit outside the operating department recommended with physical separation between dirty and clean work Ideal: Reprocessing in a dedicated unit outside of the operating department mandatory. Equipped with fully validated and verified decontamination equipment i.e. washer disinfectors and sterilizers.

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