Decontamination Point of Use Preparation and Transport PDF

Module 8 DECONTAMINATION POINT OF USE PRAPARATION AND TRANSPORT Introduction THIS ZONE PROVIDES AN OVERVIEW OF THE DECONTAMINATION ZONE AND THE EQUIPMENT AND PROCESSES NEEDED TO ACCOMPLISH THOROUGH CLEANING Choice of Decontamination Process To prevent infection, all RMDs that come into contact with...

Module 8 DECONTAMINATION POINT OF USE PRAPARATION AND TRANSPORT Introduction THIS ZONE PROVIDES AN OVERVIEW OF THE DECONTAMINATION ZONE AND THE EQUIPMENT AND PROCESSES NEEDED TO ACCOMPLISH THOROUGH CLEANING Choice of Decontamination Process 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. Patient Contact Examples Device Classification Minimum Inactivation Level Skin surface non-invasive Non-Critical Cleaning and/or Low/ Intermediate Level Disinfection Mucous membranes or non-intact skin Semi-Critical High Level Disinfection Sterile areas of the body, including blood contact Critical Sterilisation Figure M5–1 Surgical device processing steps Figure M5–2 Surgical Instrument Processing Steps Must follow established department protocol In/Near 1. Pre-Preparation (wiping & keeping moist) OR SPD Dirty side SPD Clean side 2. Manual Cleaning 3. Ultrasonic Cleaning (if necessary) 5. Instrument Care 6. Sterilization 4. Automated Washer Decontamination Book.indb 112 27/02/2018 16:33 Medical Device Reprocessing (Decontamination Specialist) 113 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 215 for all noncritical items after every individual use, although either intermediate or lowlevel 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. 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 effective cleaning: Open all reusable medical device box locks, hi nges etc. Place the medical devices in a mesh basket in a way that ensures effective cleaning of the device. Do not place reusable medical devices on top of one another. Overloaded baskets will result in ineffective cleaning Arrange medical devices in an orderly fashion in mesh trays so that all surfaces are exposed to the cleaning action when using an automated cleaner (Figure M5–3c). Place each jointed medical device in the open position in the mesh basket. If extra mesh baskets are required for cleaning a device set, a marker is placed in the extra baskets to identify the set name and number. 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 process. Place scissors, light-weight medical devices, and microsurgical devices next (Figure M5–4). Receivers and gallipots (bowlshaped items) must not be placed Figure M5—3a Overloaded baskets result in ineffective cleaning Figure M5—3b Poor Arrangement Figure M5—3c Better Arrangement Decontamination Book.indb 114 27/02/2018 16:33 Medical Device Reprocessing (Decontamination Specialist) 115 over any other reusable medical devices, as they may cause shadowing and interfere with the cleaning process. Separate all sharp devices from general devices. This is to ensure ease of identification for personnel assembling the devices after cleaning, in order to prevent sharps injury. For medical devices with one or more lumens (tubes), connect each lumen to the appropriate flushing system provided for that purpose (Figure M5–5). Ensure the tips of devices align and meet at the tip, and are not hooked or snagged— items that are misaligned, damaged or worn need to be sent for repair. Open ratcheted devices for cleaning to ensure the box joints and jaws are being cleaned thoroughly and all debris removed. Dismantle any devices with valves, ports or multiple parts as far as possible for cleaning, following manufacturer’s instructions (Figure M5–6). Open, flush and brush taps that do not come apart, before mechanically cleaning. Stylets are used to unblock devices during use. Remove them, and flush and brush the devices prior to mechanical cleaning (Figure M5–7). Stylets need to be checked for correct fit and function. Figure M5–4 Hold-down screen for small or light items Figure M5–6 Flush tubes for Lumens Figure M5–5 RMD with Lumens attached to flushing system Figure M5–7 Cleaning Manual Cleaning The use of automated cleaning methods may be contra-indicated for washing certain delicate or complex devices, for example when: Medical devices cannot be immersed in water e.g, certain power tools (Figure M5–13) Medical devices have an operating temperature lower than is achieved in automated washing Mechanical damage may result from the impact of the water jets or other 218 items in the load Carefully wash and rinse these devices according to the manufacturer’s instructions. Non-immersion manual cleaning methods are appropriate for certain devices like electrical tools that may be compromised by soaking in wet solutions. Immersion Method Essential Requirements Sink—(not a hand hygiene sink), or a receptacle which will hold enough water and detergent to fully immerse the item to be cleaned Detergent—and a validated method of dispensing a measured quantity, following manufacturers’ instructions for dilution and temperature of warm detergent solution Temperature control—in the wash and rinse sinks (usually < 40C), thermostatic mixer taps are preferred Brushes—a selection of nondamaging brushes in a range of diameters and lengths for cleaning both the external surfaces and the internal surfaces of devices (Figure M5–14). Single-use is desirable. If not using single-use, there must be a protocol in place to decontaminate Figure M5–13 Figure M5–14 Decontamination Book.indb 121 27/02/2018 16:33 122 Cleaning and disinfection the brushes at least daily. The manufacturer should provide information regarding the appropriate brush size. Always use brushes under water to avoid splashing and aerosols. After cleaning, dry the manually washed devices that are not to be further processed through the washer-disinfector. Place devices in a drying cabinet (Figure M5–17). Where a drying cabinet is not available use a clean, disposable lint-free, absorbent wipe to dry the devices. To ensure effective manual cleaning, follow written procedures (including wearing PPE (module 2) at all times while handling contaminated devices). Fill the sink with water to a predetermined level, at the specified temperature and with the appropriate amount of detergent (as per manufacturers’ instructions). Use the sink solely for the cleaning of devices and not for any other purpose. It is recommended to use three sinks—washing, potable or tap water rinse, and purified water rinse (Figure M5–15). Use detergents specifically designed to clean RMD. Household soap must never be used! A mild detergent is preferred for manual cleaning (pH range 8.0–11.5). Follow the manufacturer’s instructions and local policies and procedures for detergent dilution and water temperature. Consider the use of an enzymatic detergent to facilitate the cleaning of devices with channels or complex parts. Immerse the item, carefully, in the solution in order to displace trapped air—it is important to ensure that the cleaning solution reaches all surfaces including those of lumened (tubed) devices. Remove all visible soiling, including lumens and valves. Remove stubborn staining by using inside non-abrasive scouring pad or soaking in an approved stain-removing solution. Flush all lumened devices with a jet-gun (discharge under water to avoid splashing and aerosols) (Figure M5–16). Rinse the item finally in warm-to-hot water (unless contra-indicated). Figure M5–15 Three cleaning sinks washing, potable or tap water rinse, and