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Element V-Cleaning, Disinfection, & Sterilization. Problem: Choosing reprocessing methods for safety and integrity of patient care equipment Controlling the Problem: Professional responsibility for maintenance of safety environment. Universal Principles .

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Element v cleaning disinfection sterilization

Element V-Cleaning, Disinfection, & Sterilization

Problem: Choosing reprocessing methods for safety and integrity of patient care equipment

Controlling the Problem: Professional responsibility for maintenance of safety environment


Universal principles
Universal Principles

  • Instruments, medical devices and equipment should be managed and reprocessed according to recommended/appropriate methods regardless of a patient’s diagnosis except for cases of suspected prion disease.

  • Industry guidelines as well as equipment and chemical manufacturer recommendations should be used to develop and update reprocessing policies and procedures.

  • Written instructions should be available for each instrument, medical device, and equipment reprocessed.

Element 5 - Infection Control


Potential for contamination
Potential for contamination

  • Type of medical device, equipment or environmental surface.

  • Frequency of hand contact with instrument medical device, equipment, or environmental surface.

  • Potential for contamination with body surfaces or environmental sources of microorganisms.

  • Level of contamination.

Element 5 - Infection Control


Steps of reprocessing
Steps of Reprocessing

  • Pre-Cleaning

  • Cleaning

  • Disinfection

  • Sterilization

Element 5 - Infection Control


Choice of reprocessing methods
Choice of Reprocessing Methods

  • Intended use:

    • Critical instruments and medical devices

    • Semi-critical instruments and medical devices

    • Non-critical instruments and medical devices

  • Manufacturer’s recommendations

    • Compatibility among equipment, materials and chemicals

    • Equipment heat and pressure tolerance

    • Time and temperature requirements for reprocessing

Element 5 - Infection Control


Critical instruments and devices
Critical instruments and devices

  • Enter a sterile body site or bloodstream

  • Must be sterile

    • surgical instruments

    • Implants

    • Plasma

  • Must be cleaned prior to processing

  • Steam, heat, ethylene oxide gas

  • Monitor time, temperature, pressure, concentration

  • Maintain an autoclave log

Element 5 - Infection Control


Semi critical instruments devices
Semi-Critical Instruments & Devices

  • Have contact with mucous membrane or non-intact skin

  • Need sterilization or high-level disinfection

    • scopes

    • tonometer

    • speculum

  • Chemical sterilization techniques. Use full time mandated for agent selected

Element 5 - Infection Control


Non critical instruments devices
Non-Critical Instruments & Devices

  • Have contact with intact skin

    • blood pressure cuff, tub, electrode

  • Have low risk of transmitting infection

    • may cause colonization

  • Use detergent or low-level germicide

Element 5 - Infection Control


Cleaning environmental surfaces
Cleaning Environmental Surfaces

  • Use EPA registered disinfectants in accordance with manufacturers instructions.

  • Follow manufacturers’ instructions for cleaning and maintaining noncritical medical equipment.

  • Keep housekeeping surfaces (e.g., floors, walls, and tabletops) visibly clean on a regular basis and clean spills promptly.

    *CDC Guidelines for Environmental Infection Control in Health-Care Facilities

Element 5 - Infection Control


BC Centre for Disease Control

Element 5 - Infection Control


Effectiveness of reprocessing instruments medical devices and equipment
Effectiveness of reprocessing instruments, medical, devices and equipment

  • Cleaning prior to disinfection

  • Disinfection

    • Selection and use of disinfectants

    • Presence of organic matter

    • Presence of biofilms

    • Monitoring

    • Post-disinfection handling and storage

Element 5 - Infection Control


Effectiveness of sterilization process
Effectiveness of sterilization and equipmentprocess

Effectiveness of the sterilization process is dependent on:

  • Selection and use of sterilization methods

  • Monitoring the sterilization process

  • Post sterilization handling and storage

Element 5 - Infection Control


How equipment gets contaminated
How Equipment Gets Contaminated and equipment

Contamination can occur at any point in handling or reprocessing:

  • Failure to reprocess or dispose of items between patients

  • Inadequate cleaning

  • Inadequate disinfection or sterilization

  • Contamination of disinfectant or rinse solutions

  • Improper packaging, storage and handling

  • Inadequate/inaccurate record keeping of reprocessing requirements

Element 5 - Infection Control


Preventing cross contamination
Preventing Cross-Contamination and equipment

  • Identify surfaces or equipment which require between patient cleaning.

  • Identify practices which contribute to hand contamination and the potential for cross-contamination.

  • Implications of reuse of disposable equipment or devices.

Element 5 - Infection Control


Disinfection and sterilization methods and agents based on practice setting and responsibilities
Disinfection and sterilization methods and agents based on practice setting and responsibilities

All health professionals must:

  • Understand core concepts and principles

    • Standard and Universal Precautions

    • Cleaning, disinfection, and sterilization

    • Appropriate application of safe practices in handing instruments, medical devices and equipment

    • Designation and physical separation of patient care areas from cleaning and reprocessing areas is strongly recommended by NYSDOH

Element 5 - Infection Control


Disinfection and sterilization methods and agents based on practice setting and responsibilities1
Disinfection and sterilization methods practice setting and responsibilitiesand agents based on practice setting and responsibilities

Health professionals in settings where handling, cleaning and reprocessing is performed elsewhere:

  • Verify with those responsible for reprocessing what steps are necessary prior to submission

    • Pre-cleaning

    • Soaking

Element 5 - Infection Control


Disinfection and sterilization methods and agents based on practice setting and responsibilities2
Disinfection and sterilization methods practice setting and responsibilitiesand agents based on practice setting and responsibilities

Health professionals with primary or supervisory responsibilities for equipment or device reprocessing:

  • Must also know the consequences of reuse of single-use/disposable instruments, medical devices or equipment

  • Determine Appropriate reprocessing practices

Element 5 - Infection Control


Selection criteria
Selection Criteria practice setting and responsibilities

  • Antimicrobial efficacy

  • Time constraints

  • Compatibility among equipment/material

  • Toxicity

  • Residual effect

  • Ease of use

  • Stability

  • Odor

  • cost

  • Monitoring

Element 5 - Infection Control


Fda regulations for reuse of medical devices
FDA regulations for reuse of medical devices practice setting and responsibilities

  • Medical devices rented/leased from third parties may not be adequately disinfected

  • Follow manufacturer’s specifications

  • Follow FDA/ANSI/AAMI sterilization standards

  • Do initial cleaning in procedure room

  • Devices should not be placed in disinfectant prior to cleaning

  • Devices should be dry before gas sterilizing

  • Report adverse events

Element 5 - Infection Control


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