Infection Control in Healthcare and Acupuncture Settings

Cleaning and Pathogen Reduction Techniques in Healthcare and AOM Practice Locations

• The WHO, CDC, and OSHA standards for cleaning and disinfection apply to all types of healthcare practices, including acupuncture practices.
• Acupuncture schools and clinics offer training in the practical applications of these regulations for the acupuncture practitioner.

Maintaining a Clean and Sanitary Environment

• The treatment location should be kept clean and sanitary.
• OSHA requires a written schedule for cleaning and decontamination, and a clean and sanitary workplace.
• The cleanliness of the general environment affects the practitioner's ability to create a clean field.

Hand Hygiene and Cleaning

• A sink with hot and cold running water must be located in or near the treatment rooms.
• Liquid hand soap and paper towels must be available at handwashing stations.
• Single-use, disposable towels should be used to dry hands.
• Clean paper towels are appropriate for use.

Treatment Room and Equipment Disinfection

• The treatment room table tops, shelves, and other working surfaces should have a smooth, impervious surface, be in good repair, and be cleaned with a suitable disinfectant at least once a day and whenever visibly contaminated.
• Hepatitis B virus can survive on surfaces for at least one week at room temperature.
• Treatment tables and chairs used for treatments need to be disinfected between each patient visit.

Disinfectants

• Disinfectants are recommended for office surfaces and equipment.
• Disinfectants do not kill all germs or spores, but they will reduce the danger of infection.
• EPA-registered disinfectants for clinical settings neutralize most viruses, including hepatitis B.
• Disinfectants must be mixed according to the manufacturer's instructions and labeled if not in the original bottle.

Classification of Disinfectants

• The Environmental Protection Agency (EPA) classifies disinfectants according to claims by the manufacturer.
• The CDC classification system establishes three categories of items requiring sterilization and disinfection: critical, semi-critical, and non-critical.
• Disinfectants may be classified as high-level disinfectants, intermediate-level disinfectants, and low-level disinfectants.

Types of Disinfectants

• Chlorine and chlorine compounds: have a broad spectrum of antimicrobial activity, are inexpensive, and fast-acting, but can be corrosive and toxic.
• Glutaraldehyde: is a high-level disinfectant, but has limitations in its mycobacteriocidal activity and can coagulate blood and tissue to surfaces.
• Hydrogen peroxide: is capable of high-level disinfection, non-toxic, and does not require hood ventilation.
• Iodophors: are used as antiseptics on skin or tissue, but not as high-level disinfectants.
• Phenol: has occupied a prominent place in the field of hospital disinfection, but is not FDA-cleared as a high-level disinfectant.

EPA and FDA Approval of Disinfectants

• The EPA regulates chemical germicides under the Federal Insecticide, Fungicide, and Rodenticide Act (FIFRA) of 1947.
• A list of products registered with the EPA and labeled for use as sterilants or tuberculocides or against HIV and/or HBV is available on the EPA's website.
• A list of FDA-approved high-level disinfectants is available on the FDA's website.

Monitoring and Labeling of Disinfectants

• All disinfectants should be handled according to the manufacturer's instructions.
• Hypochlorite solutions should be made fresh daily according to the intended use.
• OSHA regulations require that containers of disinfectant must be labeled if not in their original bottle.
• An MSDS (Manufacturer Safety Data Sheet) should always be available in case of accidents.

Indications for Sterilization, High-Level Disinfection, and Low-Level Disinfection

• Sterilization is required for instruments that enter normally sterile tissue or the vascular system.
• High-level disinfection is required for equipment that touches either mucous membranes or non-intact skin.
• Low-level disinfection is required for noncritical patient-care surfaces and equipment that touch intact skin.

Cleaning and Disinfecting Reusable Medical Equipment

• Reusable medical equipment must be disinfected between use on patients.
• Cleaning is the removal of foreign material from objects and is normally accomplished using water with detergents or enzymatic products.
• Thorough cleaning is required before low-, intermediate-, or high-level disinfection and sterilization.

Safety Guidelines for Disinfecting Reusable Medical Equipment

• Sterility requirements vary depending on the type of equipment and its intended use.
• Examples of non-critical, semi-critical, and critical equipment are provided.

Preventing Cross-Contamination

• Reuse of single-use medical devices is not acceptable in AOM practices.
• Pre-cleaning of reusable medical equipment is required before low-, intermediate-, or high-level disinfection and sterilization.
• Equipment and devices that do not touch the patient or that only touch intact skin of the patient need only be cleaned with a low-level disinfectant or detergent.

Clean Use of Lubricants

• Lubricants in open-mouth jars can become contaminated by the practitioner's hands.
• Pump or squeeze bottles of lubricants should be used, or decant a treatment-sized portion of lubricant into a small disposable cup or other clean disposable container.

Cleaning and Disinfecting Environmental Surfaces in Healthcare Facilities

• Clean housekeeping surfaces regularly, when spills occur, and when these surfaces are visibly soiled.

• Follow manufacturers' instructions for proper use of disinfecting products.

• Clean walls, blinds, and window curtains in patient-care areas when these surfaces are visibly contaminated or soiled.### Disinfectants for Surface Cleaning

• Noncritical surfaces (e.g., floors, door handles) have a minor risk of causing infection, primarily HAI such as influenza.

• Noncritical medical equipment surfaces (e.g., blood pressure cuffs, stethoscopes) should be disinfected with an EPA-registered low- or intermediate-level disinfectant between each patient use.

Blood or Body Fluid Spills

• Decontamination of spills involves a three-step procedure: (1) removing visible matter with disposable absorbent material, (2) cleaning with detergent soap and water, and (3) disinfecting with an EPA-registered commercial hypochlorite solution.
• Protective gloves and PPE should be worn, and a gown or impervious apron should be worn if there is a risk of contaminating clothing.
• Safety glasses and a disposable or sterilizable clothing protector should be worn if there is a risk of splashing or a large spill.

Laundering Sheets, Towels or Other Linens

• All linens, gowns, etc. must be changed between patient treatments/visits.
• Cloth gowns, sheets, etc. are safe for reuse after laundering with hot water and soap or detergent.
• Adding hypochlorite (bleach) solution to the wash provides an extra margin of safety.

Sharps and Non-Sharps Biohazard Equipment and Disposal

• Sharps containers must be labeled with the universal biohazard symbol and the word "biohazard" or be color-coded red.
• Sharps containers must be maintained upright, replaced routinely, and not be allowed to overfill.
• Reusable containers must not be opened, emptied, cleaned manually, or used in any other manner that would expose employees to the risk of percutaneous injury.

Regulated Waste

• Regulated waste includes liquid or semi-liquid blood or OPIM, items contaminated with blood or OPIM, and contaminated sharps.
• Disposal of regulated waste must be in accordance with applicable state regulations.
• OSHA rules require regulated waste to be placed in containers that are closable, constructed to contain all contents, and labeled or color-coded in accordance with the standard.

Contaminated Laundry

• Contaminated laundry must be handled as little as possible with a minimum of agitation.
• Contaminated laundry must be bagged or containerized at the location where it was used and must not be sorted or rinsed in the location of use.
• Employees who have contact with contaminated laundry must wear protective gloves and other appropriate PPE.

Summary of Recommendations

• Critical: All instruments that break the skin should be single-use pre-sterilized equipment.
• Critical: Never reuse single-use medical devices.
• Critical: Clean and disinfect surfaces only with products registered with EPA and labeled for use in the healthcare office.
• Critical: Promptly clean and decontaminate spills of blood and other potentially infectious materials (OPIM).
• Strongly Recommended: The clinical workplace must be maintained in a clean and sanitary condition, and there must be an appropriate written schedule for cleaning and decontamination.
• Strongly Recommended: All linens, gowns, etc. must be changed between patient treatments/visits.

This quiz covers the importance of cleaning and disinfection in healthcare and acupuncture practices, adhering to WHO, CDC, and OSHA standards. It also explores the role of acupuncture schools and clinics in training practitioners in these regulations.