IDEAS CONFERENCE 2012 Sanitization for AT Loan Closets Carolyn Phillips Liz Persaud
Learning Objectives Understand the need for sanitization Become acquainted with the Indicators of Quality for AT Reuse related to sanitization Learn to use simple techniques and checklists for sanitizing common AT devices Learn about appropriate storage and handling for safe AT reuse
AT Reuse Changes Lives! AT Reuse is a concept that was born out of need. It increases access to and acquisition of AT and Durable Medical Equipment in underserved regions and promotes increased independence and more participation in education environments, the workplace and the community.
AT Reuse Federally-funded AT Act Programs In every state and territory Reutilization is a mandated activity Nonprofit organizations Many that offer services to people with disabilities also reutilize AT Sometimes partner with AT Act Programs Informal community groups
AT Reuse Closes The Gap By: Allowing trials on possible solutions Providing interim equipment while waiting for the permanent solution Providing permanent solutions where no funding is available for new devices Providing duplicate devices in warranted situations Replacing equipment lost in disasters
LEARN ABOUT REUSE. Pass It On Center offers resources to promote new programs and to help existing ones improve. PIOC web site Indicators of Quality with Online Program Assessment Tool Online Knowledge Base Free webinars with ondemand archive Reuse Locations database Find AT NEED AT*
AT Reuse activities include: Device exchange Device loan Reassignment Refurbishment Remanufacturing Recycling
Device exchange: Matching donors to users without intervention (e.g., classifieds and on-line auctions) Device loan: Providing a device on loan for some period of time or indefinitely, usually to help user make informed choice or to provide interim solution www.passitoncenter.org
Reassignment: Making donated devices available to new users Refurbishment: Repairing/restoring donated devices to working order www.passitoncenter.org
Remanufacturing making changes to donated items that alter original manufacturer s specifications or function NOT RECOMMENDED! Recycling breaking down unusable devices into spare parts or disposing of in an environmentally appropriate manner www.passitoncenter.org
Take Advantage of Our Free Resources To Support AT Reuse
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Optimizing AT Resources in Schools 17
THE NEED FOR SANITIZATION
Why sanitize previously used AT?* Sanitizing lowers the number of microorganisms on surfaces or objects to a safe level as judged by public health standards or requirements. This process works by either cleaning or disinfecting surfaces or objects to lower the risk of spreading infection. *Centers for Disease Control and Prevention, October 2010
Why sanitize stored devices? To protect all who come into contact with the devices To provide some immediate protection to those handling the devices To maintain in a clean state while in inventory or storage
What types of devices will be sanitized? Durable medical equipment Manual devices such as walkers, wheelchairs, transfer benches, potty chairs, and perhaps other devices Digital devices Computers, keyboards, tablets, AAC devices, and others Suggestion: Collect manufacturer recommendations to begin building a procedures manual for sanitization by device type. You can find these on the manufacturer s web site.
Sanitizing the Devices Who will do this? It would be great to have a technician for the task, but we know the most likely answer: teachers and paraprofessionals. Where will this be done? The school probably won t have a place designed and equipped for the task, so the best available choices are: A classroom or office for desktop sanitizing of small electronic devices A large accessible bathroom with a bathtub to sanitize durable medical equipment
Microorganisms That Cause Disease can survive for long periods on solid surfaces VIRUSES BACTERIA FUNGI BACTERIA WITH SPORES Colds Influenza Hepatitis HIV RSV Polio Measles Mumps Rubella Chicken pox Staph Strep Tuberculosis Anthrax Molds Mildew Tetanus Botulism
Language of Sanitization Cleaning physical removal of visible soil and some microorganisms from objects or surfaces using water and soap (or detergent); may not kill germs but lowers the number and the risk Disinfection lowers risk of infection by using chemicals to kill some harmful microorganisms Sterilization total destruction of microorganisms using heat or chemical action* *Essential for some medical environments in which devices contact internal membranes of the patient or facilitate the transmission of gases or fluids into the body. This assumes no such devices are stored in a loan closet.
INDICATORS OF QUALITY FOR AT REUSE (IQ-ATR)
Indicator of Quality for AT Reuse 3.10 Sanitization of Devices The program has written sanitization procedures based on sound medical or scientific practice and that are consistent with the manufacturer s recommendations for the sanitization of equipment.
Related Indicators of Quality 3.2 Facilities: Safety and Security The facility is safe and secure for employees, contractors, volunteers and customers.
PLANNING A SANITIZATION PROGRAM
Planning a Sanitization Program Policies and procedures: Identify devices frequently stored Collect manufacturer s recommendations for cleaning the device and develop procedures Tools: Identify appropriate devices to aid cleaning Identify worker safety devices Supplies: Select products to clean devices Select products to protect workers Training How to sanitize safely
Policies and Procedures Sanitization Policy Which devices will be sanitized? When? Reason, basis (manufacturer recommendation) Sanitization Procedures: General Procedures Worker Training, Required Worker Personal Protective Equipment Use and Storage of Tools Use, Storage and Disposal of Chemicals Storage of Sanitized Equipment
Sanitizing: A Three-Step Process Clean: Use physical (friction) cleaning to remove as much of the dirt, debris and germs as possible. This may involve soap (or a detergent) and water. Dry: Use air or a clean cloth to dry the device thoroughly. The device may be cleaned adequately at this point. If not, it must be dry to avoid diluting the disinfectant. Disinfect: Use a recommended chemical in the prescribed solution and manner to remove germs to an appropriate degree.
CDC Guidelines for Disinfection Most AT devices fall into the noncritical category because they contact intact skin but do not contact mucous membranes. Most AT devices can be sanitized without use of high-level disinfecting chemicals
Choosing Products Follow manufacturer recommendations Choose cleaners for the specific surfaces that will be cleaned manually: glass, chrome, plastic, upholstery, etc. Disinfectants sold in the U.S. are considered pesticides and must be EPAregistered. Only EPA-registered sanitizers and disinfectants can be used by schools. NOTE: Not all EPA-registered products are appropriate choices for schools.
Selecting Cleaners and Disinfectants: Factors Factors to consider: Legal: Laws, regulations, school policies Effectiveness Convenience Residual effects on surface materials Human and environmental considerations Cost Tip: Commercial cleaners designed for healthcare settings are better and more cost effective than home formulations. Not all are suitable for schools.
Chemical Sensitivities Alert Try to avoid cleaners and disinfectants with residual fumes or odors that can cause irritation to the device user. A study conducted in Atlanta found 12.6% of the population had multiple chemical sensitivities, a hypersensitivity to common chemicals such as cleaners, perfume, pesticides, paint and building materials.* *Environmental Health Perspectives, September 2003
Choosing Cleaners: Children are at greater risk than adults! Inhalation: Children breathe more air per pound of body weight than adults. Toxic vapors or fumes that persist can cause breathing problems or absorb into the bloodstream. Skin contact: Immature systems may not detoxify poisons; residues may damage skin or eyes, or absorb. Ingestion: Children play on floors and touch everything available. They may drink, eat or lick chemicals from surfaces.
Common Disinfectant Types CATEGORY/ Examples ADVANTAGES DISADVANTAGES HALOGENS - Hypochlorites - Bleach ALCOHOLS - Ethanol - Isopropanol QUATERNARY AMINES ( QUAT ) - Alky dimethyl benzyl ammonium chloride Cheap Effective Active against viruses (HIV, hepatitis) Good for surfaces that contact user and for skin Available in wipe form Effective surface disinfectant at low concentrations Inexpensive Rapidly inactivated by organic material Corrosive to metals Respiratory hazard Disposal Requires water to kill bacteria Disposal Disposal of concentrations >1% regulated by EPA
More selection Tips Most schools do not permit the use of some of the products in the table (e.g., bleach) Low-level disinfection can be accomplished with distilled vinegar (5% concentration of acetic acid), but it s not on an official list because the manufacturers don t want to register it as a pesticide with the EPA! This is used in some medical facilities to disinfect items that don t require sterilization. Again, read the product manual for manufacturer recommendations.
Reminders: Do: Emphasize friction (contact) cleaning, minimize use of chemicals when possible Use chemicals in ventilated area Use gloves and protect skin and eyes Use mildest effective product Don t: Overuse antibacterial products when soap and water will do Mix commercial cleaners with each other Use pine and citrus cleaners (they can react with ozone to create formaldehyde)
Environment: Work Area SAFETY EQUIPMENT STORAGE: Tools Supplies Chemicals SPACE NEEDS WORK AREA CLEANING EQUIPMENT
Work Area Considerations Devices to be sanitized: Computers and small digital devices are more easily sanitized on tables or workbenches (consider computer labs or science labs.) Sanitizing durable medical equipment (DME) is greatly facilitated by tile rooms with floor drains and easy access to water. In the absence of this, a bathtub with a spray hose would be helpful.
Training Before Sanitizing Know School or School System Policies and Procedures Teach workplace safety (including OSHA regulations, if any apply; e.g., use of Material Safety Data Sheets) Learn to use appropriate personal protective equipment for the task Learn proper use, storage and disposal of chemicals to avoid adding risk in the sanitization process
Laws and regulations affecting workplace safety OSHA (federal) regulations EPA regulations State and local building codes State and local health dept. regulations State and local laws that apply to schools School system policies
Personal Protective Equipment
Tools for Manual Cleaning Durable Medical Equipment: Utility buckets Industrial tweezers Brushes Microfiber cloths Hospital-grade antibacterial wipes Computers and Electronic Components: Cans of compressed air for keyboards Soft artist paintbrushes Microfiber cloths Alcohol wipes
Supplies for Sanitizing Durable Medical Equipment (DME) Cleaners and disinfectants: manual cleaning Hard surface cleaners Hard surface stain removers Leather, vinyl, plastic and glass cleaners Intermediate-level chemical disinfectant Car wax (for protective coating after cleaning) Plus washable or disposable cloths
General Steps for Cleaning Durable Medical Equipment Clean: Remove major dirt and debris using physical means brush, vacuum cleaner, cloth or sponge and water with soap or detergent Dry completely. Disinfect using recommended chemical. Apply with clean sponge, cloth or brush. Leave on surface for recommended time and wipe as indicated.
Resources For more detailed information about sanitizing AT, visit the Pass It On Center s Knowledge Base at www.passitoncenter.org/content and look for Sanitization in the Program Operations module. Instructions and workflow diagrams for sanitizing: Wheelchairs Canes, crutches, walkers Bathroom AT Hospital beds Computers, keyboards, mice Oxygen concentrators Nebulizers
Workflow Example: Cleaning Bathroom AT From Pass It On Center Knowledge Base BEFORE YOU START WASH HANDS Follow the directions for handwashing hygiene. Wear disposable gloves. GATHER SUPPLIES AND TOOLS Bucket Warm water Bristle brush Mild detergent Non-caustic stain remover Mildew remover or bleach Cotton-tipped swabs Detailed text instructions are also available. 1. Mix cleaning solution. Add mild detergent to warm water. Do not use caustic cleaners on surfaces that may come into contact with the user's skin. 2. Scrub all surfaces with brush and detergent solution. Clean all surfaces thoroughly. If stains persist, use a non-caustic stain remover. 3. Remove and clean rubber tips from legs. The moist conditions in which these objects are used make the rubber feet prone to mildew. They may require stain remover or soaking in water/bleach solution to clean. Rinse and dry before replacing. 4. Clean extensible legs. Remove extensible legs and clean all surfaces and buttons with detergent solution. Rinse well. Dry thoroughly before re-assembling. 5. Clean drain holes and crevices. Use cotton-tipped swabs and detergent solution to reach drain holes and crevices. Rinse with clean water. 6. Check for damage. Ensure that metal has no nicks or dents, rubber feet are not split, and "buttons" for extensible legs are working properly. 7. Store object in clean area. 8. Clean work area. Discard disposable towels or place re-usable towels in laundry. Return supplies to storage. 9. Update records. Log cleaning. Update inventory status.
Warning: Unsafe keyboards! A 2004 study conducted by the University of Arizona found that keyboards and mice harbor 400 times as many microbes as toilet seats. In early 2008, the Centers for Disease Control reported that a 2007 flu outbreak in a U.S. elementary school was the result of shared keyboards.
Cleaning Electronic Equipment Clean the surfaces of the device casing with a cloth sprayed with an appropriate cleaner or an anti-bacterial wipe. This requires consideration of material (whether metal, plastic, etc.) Extreme care must be taken to avoid liquids on unprotected surfaces inside computers and electronic devices. Workers need special training and equipment for safe sanitization.
Supplies for Sanitizing Computers Compressed air cans Alcohol wipes Anti-bacterial wipes Anti-static cloths Worker protection: anti-static wristband
Example: Cleaning a keyboard Dust between keys with soft brush or use compressed air to remove dust. Clean keys with anti-bacterial wipe or use a clean, dampened (not dripping) cloth sprayed with an anti-bacterial disinfectant.
STORAGE AND HANDLING FOR AT REUSE
Storing the Sanitized Device If possible, place the sanitized device in a sealed bag or container before storing. Avoids contact with dust and other pollutants Avoids human contact and re-contamination Protects from odors Keeps all components and accessories in one place Store in a manner that will not be adversely affected by temperature extremes Organize storage in some logical manner for easy location and identification of devices
References Pass It On Center Knowledge Base http://www.passitoncenter.org/content/ See Program Operations/Sanitization. Mini-Guide to Sanitization Guidelines for Disinfection and Sterilization in Healthcare Facilities, 2008 (CDC) 10 Ways to Find Safer and Greener Cleaners, Toxic Use Reduction Institute Understanding Sanitizers and Disinfectants, Multi-Clean Technical Bulletin, 2007
Questions?
Contact Us www.passitoncenter.org Carolyn Phillips Program Director Pass It On Center Carolyn@passitoncenter.org Liz Persaud Training & Development Coordinator Pass It On Center Liz@passitoncenter.org Trish Redmon Consultant Pass It On Center Trish@passitoncenter.org DISCLAIMER This work is supported under a five-year cooperative agreement # H235V060016 awarded by the U.S. Department of Education, Office of Special Education and Rehabilitative Services, and is administered by the Pass It On Center, Tools for Life Program of the Alternative Media Access Center at Georgia Institute of Technology. However, the contents of this publication do not necessarily represent the policy or opinions of the Department of Education or Georgia Tech, and you should not assume endorsements of this document by the Federal government.