Module 8: Decontamination Point Zone PDF

DECONTAMINATION POINT ZONE Introduction This module covers methods of receiving, cleaning and disinfecting contaminated reusable medical devices. We discuss equipment used for automated processes such as washer disinfectors, ultrasonic washers, and cart washers as well as manual cleaning and disin...

DECONTAMINATION POINT ZONE Introduction This module covers methods of receiving, cleaning and disinfecting contaminated reusable medical devices. We discuss equipment used for automated processes such as washer disinfectors, ultrasonic washers, and cart washers as well as manual cleaning and disinfection processes. We’ll also cover procedures for testing equipment, water quality, and chemistries. Pre-Module Quiz Keep these questions in mind as you go through the content and don’t worry if you don’t know the answers yet – that’s what you’re here to learn. Q: Can you name the three Spaulding classifications? Q: What are two of the most common types of disinfection processes used by CSSDs? Q: What are three types of soil removal tests most commonly found in CSSDs? Q: What are the five recommended actions when sorting and disassembling reusable medical devices prior to automated cleaning? Q: What are three common user errors when loading a washer-disinfector? Q: What does an ultrasonic cleaner do? Q: What is the meaning of the term IFU? Choice of Decontamination Process Surgical Instrument Processing Steps In/Near 1. Pre-Preparation (wiping & keeping moist) OR 2. Manual Cleaning Dirty side 3. Ultrasonic Cleaning Clean side 6. Figure M5–1 Surgical device processing steps To prevent infection, all RMDs that come into contact with the patient or surgical field should be systematically decontaminated after each surgical procedure, giving attention to all potential sources of contamination. All decontamination processes must be validated and the reusable medical devices reprocessed to a level appropriate for their intended use. The appropriate level depends on the body sites where the device will be used and the risk associated with a particular procedure. The minimum levels of processing, based on three risk categories of use, are shown in a classification system called the Spaulding classifications (Figure M5–2). For example, non-critical would be a stethoscope, semi-critical would be a Parkes retractor and critical would be a Travers retractor. Device Minimum Inactivation Patient Contact Examples Classification Level Cleaning and/or Low/ Skin surface Non-Critical Intermediate Level non-invasive Disinfection Mucous membranes Semi-Critical High Level Disinfection or non-intact skin Sterile areas of the body, including blood Critical Sterilization contact Figure M5–2  The minimum levels of reprocessing for different types of sites are: Critical site – devices must be sterile at the time of use. This means devices are either single use, steam sterilized (for devices that are capable of withstanding heat) or have undergone low temperature sterilization (for “thermo-labile” devices that are not capable of withstanding heat). Semi-critical site – devices are either single use or sterilized after each use. If this is not possible, high- level disinfection is the minimum acceptable level of reprocessing. Non-critical site – cleaning alone is generally sufficient for all noncritical items after every individual use, although either intermediate or low-level disinfection may be appropriate in specific circumstances. Later in the module, when we learn about procurement or acquisition of new devices, we will discuss choosing decontamination processes based on compatibility with the reusable medical device. Reprocessing methods must provide minimum decontamination and safety standards, while keeping up with the demands of clinical services. decontamination for the devices I’m dealing with? Khaled: Always remember—the appropriate level of decontamination will depend on the body sites where the device will be used and the risk associated with the procedure. So for a device that enters the body, like surgical scissors, it is considered a critical risk and must be sterilized. An endoscope, that comes in contact with intact skin or mucous membranes, is considered a semi-critical risk, and a high level of disinfection is needed. A Sorting and Disassembly of Contaminated RMD As mentioned in module 4, to be effective, reusable medical device decontamination must be carried out in a timely manner. Sorting, disassembly and cleaning facilitates timely cleaning and in a way that minimizes risk to you, the decontamination specialist. Once the containers are received and unloaded from the transport carts you learned about in module 4, the reusable medical devices are sorted—usually according to whether they need a manual or an automated cleaning process. Policies and/ or procedures should be developed for the handling, sorting and disassembly of all devices used within the facility, and for handling specialized items if required. The manufacturer’s instructions for cleaning are followed in order to ensure the device is not damaged and is cleaned adequately. Disassembly of RMD Complete the following activities to facilitate Arrange medical devices in an effective cleaning: orderly fashion in mesh trays so that all surfaces are exposed to Open all reusable medical device the cleaning action when using an box locks, hinges etc. automated cleaner (Figure M5–3c). Place the medical devices in a Place each jointed medical device mesh basket in a way that ensures in the open position in the mesh effective cleaning of the device. Do basket. If extra mesh baskets are not place reusable medical devices required for cleaning a device set, a on top of one another. Overloaded marker is placed in the extra baskets baskets will result in ineffective to identify the set name and number. cleaning Place heavy retractors and other heavy medical devices on the bottom or in a separate tray. Secure small and light items with a hold down screen or by other means, to ensure they are not free to move around during the cleaning Figure M5–3a Overloaded baskets result in ineffective cleaning process. Place scissors, light-weight medical devices, and microsurgical devices next (Figure M5–4). Receivers and gallipots (bowl- shaped items) must not be placed New-M5-3b Poor Arrangement WD New-M5-3c Better Arrangement WD  over any other reusable medical Open ratcheted devices for cleaning devices, as they may cause to ensure the box joints and jaws are shadowing and interfere with the being cleaned thoroughly and all cleaning process. debris removed. Separate all sharp devices from Dismantle any devices with valves, general devices. This is to ensure ports or multiple parts as far as ease of identification for personnel possible for cleaning, following assembling the devices after manufacturer’s instructions (Figure cleaning, in order to prevent sharps M5–6). injury. Open, flush and brush taps that do For medical devices with one or not come apart, before mechanically more lumens (tubes), connect each cleaning. lumen to the appropriate flushing Stylets are used to unblock devices system provided for that purpose during use. Remove them, and (Figure M5–5). flush and brush the devices prior to Ensure the tips of devices align mechanical cleaning (Figure M5–7). and meet at the tip, and are not Stylets need to be checked for hooked or snagged—items that are correct fit and function. misaligned, damaged or worn need to be sent for repair. Figure M5–4 Hold-down screen for small or light items Figure M5–6 Flush tubes for Lumens Figure M5–7 Cleaninglumens Automated Cleaning (including pre-cleaning) As we have learned, cleaning is an essential prerequisite for all effective disinfection and sterilization processes, as organic residue may prevent the disinfectant or sterilants from contacting the surfaces of the item being processed and may also bind and inactivate chemical disinfectants. In other words—if the item can’t be cleaned, it can’t be disinfected or sterilized. Twenty years ago, decontamination experts focused on the sterilizer, while today it is globally accepted that cleaning is the initial and most crucial step in breaking the chain of disease transmission. The use of mechanical cleaners such as washer-disinfectors (Figure M5–8) and ultrasonic cleaners (Figure M5–16 to 12) is preferred to the manual cleaning of items. The advantage of using automated cleaning equipment is that it provides an efficient, validated, reproducible process which is more easily controlled than manual methods. A simple example of this is the temperature of the water at