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Questions and Answers
When should new instruments typically be cleaned?
What is the primary function of manual cleaning in decontamination?
What should be done with delicate instruments during the cleaning process?
What is the recommended method for cleaning lumens or cannulated items?
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Why is manual preparation important before placing items in mechanical cleaning devices?
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How should power surgical instruments (PSI) that cannot be immersed be cleaned?
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What type of inspection should be conducted to ensure the cleanliness of instruments?
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What is a key consideration when cleaning instrument containers and basins?
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What is one of the key goals of point-of-use preparation?
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Which department is typically responsible for generating a high volume of contaminated items?
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What should be done to multi-part instruments before transport?
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What is a recommended safety guideline for transporting soiled items?
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Which of the following is NOT a guideline for point-of-use preparation?
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During the transport of soiled items, what should personnel do in hallways or elevators?
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What is a crucial step in avoiding soiled item contamination during transport?
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What precaution should be observed regarding cross-contamination during transport?
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Who must be involved in policy making regarding the transport of contaminated items?
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What should be considered about items used on a patient during transport?
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What is the definition of cleaning in the context of medical devices?
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Which factor is NOT recommended in the setup of a decontamination area?
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Why is personal protective equipment (PPE) important in the decontamination area?
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Which of the following describes the function of ultrasonic cleaners?
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Which cleaning tool is essential for scrubbing surgical instruments?
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What is the correct sequence in a three-sink cleaning system?
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Why is point-of-use cleaning crucial for medical instruments?
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Which of the following chemicals is specifically used to break down fatty deposits?
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What is a major disadvantage of alkaline detergents?
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What is the role of surfactants in cleaning agents?
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What does the term cavitation refer to in ultrasonic cleaning?
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How should instruments be arranged for optimal cleaning in a washer-disinfector?
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What temperature should not be exceeded during the use of cleaning chemicals?
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Which of the following is a NOT typical step in the decontamination process?
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Which of the following is a disadvantage of using certain disinfectants?
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What is necessary for a disinfectant to effectively meet its label claims for activity?
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What is a key requirement for high-level disinfectants used in practice?
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What is a primary function of an Automated Endoscope Reprocessor (AER)?
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During thermal disinfection, what substance is primarily utilized?
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What is a crucial process after applying a chemical disinfectant?
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What is the optimal temperature range for pasteurization during disinfection?
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What should be emphasized as part of quality assurance practices for disinfection?
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What is the primary difference between disinfection and sterilization?
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Which level of disinfection is effective against all forms of microbial life except spores?
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Which of the following disinfectants is a good option for environmental sanitation of non-critical surfaces?
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What is a significant disadvantage of using alcohol as a disinfectant?
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Phenolic disinfectants are typically used for which type of surfaces?
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Which disinfectant is effective against vegetative forms of bacteria but is not sporicidal?
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What is a key characteristic of high-level disinfectants?
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For what purpose is chlorine commonly used in healthcare facilities?
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Which type of disinfectant requires activation before use?
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What is a primary concern when using hydrogen peroxide as a disinfectant?
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In what situation would the Spaulding Classification System categorize a flexible scope?
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What is an important practice for manual disinfection processes?
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Which of the following substances is not classified as an intermediate-level disinfectant?
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What is a critical factor to ensure the effectiveness of disinfection?
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Which disinfectant is known for having a rapid action against vegetative bacteria?
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Study Notes
Decontamination: Point-of-Use
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Four Goals of Soiled Item Preparation and Transport:
- Removal of gross soil
- Prevention of damage
- Prevention of cross-contamination
- Keeping other safe
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Sources of Contaminated Items:
- High volumes generated in perioperative departments, ER, endoscopy, labor and delivery, cardiac
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Point-of-Use Preparation Procedures:
- Start the cleaning process at the point of use
- Wear PPE and remove gross soil
- Separate reusable sharps from other instruments
- Separate reusable linen from instruments
- Remove disposable components
- Open hinged instruments and disassemble multipart instruments
- Keep items together
- Keep instruments moist
- Empty fluid containers
- Notify CS department for repairs or expedited processing
- Report any rare infectious diseases
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Transporting Soiled Items:
- Transport personnel must wear gloves and masks
- Use closed case carts or closed bins with biohazard labels
- Avoid cross-contamination
- Do not mix opened and unopened packages
- Do not use a soiled case cart for sterile items
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Safety Guidelines for Soiled Item Transport:
- Assume all items used on a patient are contaminated
- Maintain control of transport carts at all times, move slowly and over short distances
- Never leave carts unattended
- Yield to patients and visitors in hallways and elevators
- Use dedicated elevators for soiled carts
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Off-Site Processing:
- Consult local health and transportation authorities for handling biohazard materials
- Arrange instruments properly to prevent damage during transport
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Education and Training:
- Infection control team should be involved in policy making
- AAMI, OSHA, and AORN provide transportation standards
Cleaning and Decontamination
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Cleaning:
- Removal of all visible and non-visible soil and foreign materials from medical devices
- Core of instrument reprocessing
- Improper cleaning can cause infections and death
- Challenges arise from the complexity of medical devices
- Requires the right tools, technique, and attention to detail
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Decontamination:
- Involves physical or chemical processes to remove, inactivate, or destroy bloodborne pathogens
- Makes instruments safe to handle
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Decontamination Work Area:
- Receives soiled instruments
- Centralized function for the entire hospital
- Location should be near the OR for ease of transport
- Floors must withstand chemical detergents
- Walls should be free of fiber-shredding materials
- Ventilation: 10 air exchanges per hour with negative pressure
- Temperature: 16-20°C, Humidity: 30-60%
- Adequate lighting and restricted access to decontamination personnel
- Emergency eyewash/shower equipment within 10 seconds/30 meters
- Regular cleaning and disinfection of all surfaces
- Removal of biohazardous waste at intervals
- Dedicated housekeeping materials for the decontamination area
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Work Area Setup:
- Sinks arranged from dirty to clean, with three bays: detergent wash, intermediate rinse, and final rinse
- Water quality must be consistently monitored
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Cleaning Tools:
- Water: the most important factor, should be RO filtered
- Brushes: come in various sizes, rigid or flexible, reusable or disposable
- Cleaning cloths: lint-free and disposable
- Sponges: impregnated with detergents and discarded after use
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Mechanical Cleaners:
- Reduce microbial contamination through multi-step approaches
- Ultrasonic Cleaners (Sonics):
- Remove soils from joints, crevices, and lumens
- Use cavitation (implosion of bubbles) to dislodge soil
- Instruments must be pre-cleaned
- Maintain bath temperature between 27-43°C
- Instruments must be immersed properly
- Regular rinsing and water changes are crucial
- Sonic detergents can dull anodized aluminum
- Quality assurance: soil test vs foil test
- Washer-Disinfector (WD):
- Automated cleaning and disinfection
- Uses impingement (spray-force action of pressurized water)
- Single or indexed models
- Multiple phases, including cold pre-rinse, detergent, rinse, thermal disinfection, and drying
- Daily maintenance includes checking spray arms, drain basket, detergent levels, and running a descaling cycle
- Quality assurance: soil test
- Cart Washers:
- Process carts, containers, and materials in large quantities
- Ensure carts are approved for reprocessing
- Do not process instruments
- Automated Endoscope Reprocessor (AER):
- Chemically disinfect approved flexible endoscopes
- Manual cleaning is required beforehand
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Cleaning Chemicals and Lubricants:
- Use proper chemicals in correct concentrations
- Detergents must be compatible with medical devices and equipment
- Enzyme Products:
- Biodegradable and non-toxic
- Break down soils, stains, and debris
- Detergents:
- Contain emulsifiers, surfactants, and chelating agents
- Neutral detergents are commonly used
- Alkaline detergents are highly effective
- Acid detergents remove mineral deposits
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Steps in the Process of Decontamination:
- Point of Use:
- Pre-clean instruments and keep them moist
- Dispose of consumables and arrange instruments in a closed cart or bin
- Soiled Receiving:
- Carefully open carts and inspect for completeness
- Separate rigid containers for cart washing
- Cleaning:
- Manual vs manual preparation
- Manual cleaning: done in three phases with detergents having disinfectant properties
- Manual preparation: for items going through mechanical cleaners
- Disassemble instruments when possible
- Immerse instruments in cleaning solution
- Flush lumens with solution
- Brush instruments under the water
- Clean delicate instruments separately
- Point of Use:
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Inspection of Cleanliness:
- Visual inspection for debris
- Quality testing: protein test for residual soil
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Cleaning Instruments That Cannot Be Immersed:
- Wipe power surgical instruments with cleaning solution and brush thoroughly
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Cleaning Instrument Containers and Basins:
- Manually or mechanically cleaned
- Position in racks for drainage and to prevent damage
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Mobile Patient Care Equipment:
- Use mild cleaning agents and disinfectants
- Inspect for areas requiring cleaning
Disinfection vs Sterilization
- Disinfection destroys nearly all pathogenic microorganisms on inanimate surfaces.
- Sterilization destroys all forms of microbial life, including bacteria, viruses, fungi and spores.
- No soils should be present during disinfection.
The Spaulding’s Classification
- Classifies items based on the risk of infection.
### Types of Disinfectants
- Low-level and Intermediate-level Disinfectants destroy vegetative forms of bacteria, some fungi and lipid viruses.
- High-Level Disinfectants destroy all forms from Low and Intermediate, fungal spores and some bacterial spores.
Quaternary Ammonium Compounds (QUATs)
- Advantages include: bactericidal, fungicidal and virucidal against lipophilic viruses, wetting agents with built-in detergent properties.
- Disadvantages: Not sporicidal, generally not tuberculocidal or virucidal against hydrophilic viruses, unless multiple compounds are included, may be inactivated by cotton and charcoal, incompatible with soap, not effective against some gram-negative organisms, deactivated by organic material.
- Uses: Environmental sanitation of non-critical surfaces, if multiple compounds in solution may be used on instruments if properly rinsed.
- Must remain wet on surface to be disinfected for 6-10 minutes.
Alcohol
- Advantages: Rapid bactericidal agent against vegetative microorganisms, tuberculocidal, fungicidal and virucidal, fast acting, no residue, non-staining.
- Disadvantages: Requires wet contact of at least 5 minutes, non-sporicidal, no residual activity, volatile, flammable, inactivated by organic material, can dissolve lens mountings, tends to harden and swell plastic tubing.
- Uses: Disinfecting fixed equipment and patient-use items.
- Can be used as a drying agent.
Phenolics
- Advantages: Broad spectrum of use, bactericidal, fungicidal and tuberculocidal, active against lipophilic viruses, residual activity.
- Disadvantages: Residual activity, not sporicidal, inactivated by organic material, corrosive to some plastics.
- Uses: Housekeeping usage for walls, floors, countertops and furniture, decontamination area for disinfection of hard surfaces.
- Copious rinsing is required to eliminate the potential for skin burns.
Chlorine
- Advantages: Effective against gram-positive and gram-negative (vegetative) microorganisms, tuberculocidal, fungicidal, virucidal, fast acting.
- Disadvantages: Inactivated by organic matter, corrosive to metals, stains fabrics, plastics and other synthetic materials, non-sporicidal, relatively unstable.
- Uses: Disinfection of dialysis machines, hydrotherapy baths, toilets, lavatories and bathtubs, bleach for laundry, sanitizer for dishwashing.
- A 1:10 dilution of 5.25% sodium hypochloride has been recommended for cleaning blood spills.
- Must remain wet on items to be disinfected for one to two-and-a-half minutes.
### Iodophors
- Advantages: Bactericidal, virucidal and tuberculocidal, rapid action against vegetative bacteria.
- Disadvantages: Corrosive to metals, detrimental to some plastics, stains fabrics and other materials, may require long contact time to kill some fungi.
- Uses: Skin preparations, disinfection of some equipment.
- Corrosive nature limits its use as a primary disinfectant.
- Must remain wet on items to be disinfected for at least 2 minutes.
Glutaraldehydes
- Advantages: Kills vegetative bacteria (2 minutes), bactericidal, tuberculocidal, fungicidal, virucidal and sporicidal (chemical sterilization = 6-10 hours).
- Disadvantages: Noxious odors, unstable (14-28 day product life), dilution of product reduces the activity.
- Uses: Semi-critical items – laryngoscope blades, flexible scopes, etc.
- Kills microorganisms by alkylation of protein.
- Needs activation.
Ortho-Phthalaldehydes (OPA)
- Advantages: Solution is compatible with a wide range of endoscopes, requires no activation or mixing, 14-day reuse life, can be discarded down facility drains.
- Disadvantages: Does not have a sterilant label claim.
- Uses: Semi-critical items – laryngoscope blades, flexible scopes, etc.
Hydrogen Peroxide (H2O2)
- Advantages: Broad spectrum HLD, kills bacteria and viruses, can be used as a sterilant at the right concentrations.
- Disadvantages: Corrosive to some materials, discoloration of anodized instruments.
- Uses: Disinfection of hard and soft surfaces.
Peracetic Acid (PAC)
- Advantages: Broad spectrum HLD, may be used as a sterilant in the appropriate AER, compatible with many materials.
- Disadvantages: Corrosive to some materials.
- Uses: HLD of laryngoscopes blades, endoscopes.
High-Level Disinfectants
- Needs to check daily of its efficacy with strips.
- Minimum Effective Concentration (MEC/MRC): Percentage concentration of the active ingredient in a disinfectant or chemical sterilant that is the minimum concentration at which the chemical meets all its label claims for activity against specific microorganisms.
- Disinfection process should be done in an enclosed, well-ventilated area.
- Preparation instructions must be followed cautiously.
- Labelling of solution must be kept clear for all staff to see.
- Contact and Exposure Time must be confirmed for the solution to be effective.
- Right Chemical, Right Contact Time and Coverage, Right Dilution.
- Thorough rinsing with RO water must be done.
Achieving Disinfection Using Mechanical Processes
- Thermal Disinfection: Uses heated RO water to disinfect instruments inside the WDs.
- Pasteurizers: Disinfection through pasteurization with temperatures at 65C-77C for 30 minutes.
-
AER (Automated Endoscope Reprocessor): Disinfection of endoscope simpler and safer.
- Advantages: Reduces personnel exposure to HLD, consistent contact of chemicals to instruments, timed contact with liquid chemical disinfectant, continuous movement of HLD, alcohol flush for drying, use of air flush cycle and consistent water, monitoring of channels during reprocessing, documentation of cycle parameters.
Quality Assurance Practices for Disinfection
- Education is a must.
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Description
Test your knowledge on the essential procedures and guidelines for cleaning surgical instruments. This quiz covers the steps involved in manual cleaning, handling delicate instruments, and the importance of point-of-use preparation. Understand the best practices for ensuring instrument cleanliness and safety in surgical environments.
