Copyright IAHCSMM 2007 Cleaning and Decontamination Chapter 9

Copyright IAHCSMM 2007Copyright IAHCSMM 2007

Cleaning and Cleaning and DecontaminationDecontamination

Chapter 9Chapter 9


ObjectivesObjectivesAs a result of successfully completing this chapter, As a result of successfully completing this chapter, students will be able to:students will be able to:

Discuss basic factors that impact cleaning and Discuss basic factors that impact cleaning and decontamination:decontamination:

Design and location of decontamination area.Design and location of decontamination area.Environmental design and controls.Environmental design and controls.Housekeeping concerns.Housekeeping concerns.Staff safety and personal attire.Staff safety and personal attire.Staff education and training.Staff education and training.

Describe important selection and usage concerns Describe important selection and usage concerns for cleaning agents (water, detergents, enzymes, and for cleaning agents (water, detergents, enzymes, and enzymatic detergents) and for lubricants.enzymatic detergents) and for lubricants.


ObjectivesObjectives Explain details about cleaning and decontamination, Explain details about cleaning and decontamination, and review manual procedures and mechanical methods and review manual procedures and mechanical methods to complete both processes.to complete both processes.

Discuss procedures to clean basic types of Discuss procedures to clean basic types of instruments:instruments:

General cleaning protocols.General cleaning protocols.Delicate and hard-to-clean instruments.Delicate and hard-to-clean instruments.Instrument containers and basins.Instrument containers and basins.Power equipment.Power equipment.Mobile patient care equipment.Mobile patient care equipment.Verification and quality control tactics.Verification and quality control tactics.

Review procedures to manage infectious waste. Review procedures to manage infectious waste.


Important FactsImportant FactsCleaning is the first step in device Cleaning is the first step in device reprocessing after use.reprocessing after use.

You can clean without sterilizing, but You can clean without sterilizing, but you can never sterilize without you can never sterilize without cleaning.cleaning.

Cleaning is the cornerstone of the Cleaning is the cornerstone of the sterilization process.sterilization process.


TerminologyTerminologyCleaningCleaning – The removal – The removal of all visible and non-of all visible and non-visible soil and any other visible soil and any other foreign material from the foreign material from the medical device being medical device being reprocessed.reprocessed.

DecontaminationDecontamination – – Removing or reducing Removing or reducing contamination by contamination by infectious organisms or infectious organisms or other harmful substances.other harmful substances.


Design of the Decontamination AreaDesign of the Decontamination Area

Floors and walls Floors and walls should be should be constructed of constructed of materials that can materials that can tolerate harsh tolerate harsh chemicals.chemicals.

Traffic should be Traffic should be restricted and PPE restricted and PPE is required.is required.


The Decontamination AreaThe Decontamination Area

Emergency Emergency Eyewash/shower Eyewash/shower equipment should equipment should be available within be available within 10 seconds or 30 10 seconds or 30 meters of a potential meters of a potential chemical exposure.chemical exposure.


HousekeepingHousekeepingHorizontal work surfaces should Horizontal work surfaces should be cleaned and disinfected at the be cleaned and disinfected at the beginning and end of each shift.beginning and end of each shift.

Spills should be cleaned Spills should be cleaned immediately.immediately.

Floors should be cleaned and Floors should be cleaned and disinfected daily.disinfected daily.

Biohazardous waste should be Biohazardous waste should be removed at frequent intervals.removed at frequent intervals.


Personal Protective EquipmentPersonal Protective Equipment

PPE is required at all PPE is required at all times.times.

Discard PPE that is Discard PPE that is soaked with blood or soaked with blood or infectious materials.infectious materials.

Discard torn, punctured Discard torn, punctured or nicked gloves.or nicked gloves.

Jewelry and acrylic Jewelry and acrylic fingernails are not fingernails are not permitted.permitted.


Food or Drink is not permitted in the Food or Drink is not permitted in the Decontamination area.Decontamination area.

No Food or Drink


TrainingTrainingNo employee should No employee should work in the work in the decontamination area decontamination area without training on:without training on:– Standard PrecautionsStandard Precautions– PPEPPE– SafetySafety– HandwashingHandwashing– Proper handling of Proper handling of

contaminated itemscontaminated items


WaterWaterThe primary vehicle in The primary vehicle in the cleaning process.the cleaning process.

Water quality can Water quality can impact cleaning impact cleaning outcomes.outcomes.

pH, hardness, and pH, hardness, and temperature must be temperature must be monitoredmonitored


pH Scale

14131211109876543210

• pH is used to measure acidity or alkalinity.

• Acids turn litmus paper RED.

• Alkalies (sometimes called bases) turn litmus paper BLUE.


Chelating Agents Chelating Agents – Chemicals that hold Chemicals that hold

hard water minerals in hard water minerals in solution, and prevent solution, and prevent soaps or detergents soaps or detergents from reacting with from reacting with minerals.minerals.

Sequestering AgentsSequestering Agents– Chemicals that remove Chemicals that remove

or inactivate hard water or inactivate hard water minerals.minerals.


An Overview of Effective An Overview of Effective Cleaning AgentsCleaning Agents

Are non-abrasiveAre non-abrasiveAre low-foamingAre low-foamingAre free-rinsingAre free-rinsingAllow for rapid soil dispersionAllow for rapid soil dispersionAre non-toxicAre non-toxicAre effective on all types of soilAre effective on all types of soilHave a long shelf lifeHave a long shelf lifeAre cost-effectiveAre cost-effectiveCan be monitored for effective concentration Can be monitored for effective concentration and useful life.and useful life.


DetergentsDetergents

Substances that Substances that dislodge, remove, dislodge, remove, and disperse solid and disperse solid and liquid soils from and liquid soils from the surface being the surface being cleaned.cleaned.


DetergentsDetergentsDetergents are Detergents are specially formulated specially formulated for the specific uses. for the specific uses. For example, manual For example, manual cleaning or cleaning or mechanical cleaning.mechanical cleaning.


EnzymesEnzymes

Breakdown or “digest” large organic Breakdown or “digest” large organic molecules to facilitate their removal.molecules to facilitate their removal.

Are very specific in their actions. Are very specific in their actions. Different enzymes work on different Different enzymes work on different soils.soils.


EnzymesEnzymesProteaseProtease – Breaks down blood, mucous, – Breaks down blood, mucous, feces, and albumin.feces, and albumin.

LipaseLipase – Breaks down fatty deposits such – Breaks down fatty deposits such as bone marrow and adipose tissue.as bone marrow and adipose tissue.

AmylaseAmylase – Catalyzes (changes) starch. – Catalyzes (changes) starch.


Enzymes and TemperatureEnzymes and Temperature

Temperatures above Temperatures above 404000C (140C (14000F) can affect F) can affect chemical reactions.chemical reactions.

Cool temperatures may Cool temperatures may not activate the enzyme.not activate the enzyme.

Monitor water Monitor water temperature and check temperature and check manufacturer instructions manufacturer instructions for specific temperature for specific temperature requirements.requirements.


Selecting an Enzymatic DetergentSelecting an Enzymatic Detergent

Consider the following factors:Consider the following factors:– Water temperatures in the decontamination areaWater temperatures in the decontamination area

– Room temperature in the decontamination areaRoom temperature in the decontamination area

– Useful life and stability of the productUseful life and stability of the product

– Expiration date of the productExpiration date of the product

– The material used to construct the device to be cleanedThe material used to construct the device to be cleaned

– Whether it is approved and registered by the EPAWhether it is approved and registered by the EPA


Detergents for Ultrasonic CleanersDetergents for Ultrasonic Cleaners

Must be Must be low-foaminglow-foaming to prevent to prevent interference with the interference with the cleaning process.cleaning process.

Are usually Are usually formulated with formulated with SurfactantsSurfactants and and ChelatingChelating agents. agents.


SurfactantSurfactant – A surface-acting agent that lowers – A surface-acting agent that lowers the surface tension of a liquid so it can penetrate the surface tension of a liquid so it can penetrate deeper. Surfactants also prevent debris from deeper. Surfactants also prevent debris from being re-deposited on items.being re-deposited on items.

Chelating AgentChelating Agent – A chemical that holds hard – A chemical that holds hard water minerals in solution and prevents soaps or water minerals in solution and prevents soaps or detergents from reacting with minerals.detergents from reacting with minerals.


Instrument LubricantsInstrument Lubricants

Prolong the life and function of instruments.Prolong the life and function of instruments.

Instrument lubricants must be water-soluble.Instrument lubricants must be water-soluble.

Should be applied after cleaning.Should be applied after cleaning.

Instrument lubricants cay be applied Instrument lubricants cay be applied manually in the clean assembly area or manually in the clean assembly area or mechanically as one of the final steps in a mechanically as one of the final steps in a mechanical wash cycle.mechanical wash cycle.


CleaningCleaningThe removal; (usually with detergent and The removal; (usually with detergent and

water) of both visible and invisible soil water) of both visible and invisible soil from the surfaces, crevices, serrations, from the surfaces, crevices, serrations,

joints and lumens of instruments, devices joints and lumens of instruments, devices and equipment.and equipment.


Remove Gross Soil As Soon As Remove Gross Soil As Soon As Possible to:Possible to:

Reduce the number of Reduce the number of microorganisms on the item.microorganisms on the item.

Reduce the nutrient material Reduce the nutrient material that can support microbial that can support microbial growth.growth.

Reduce the potential for Reduce the potential for environmental contamination, environmental contamination, aerosolization, or spillage.aerosolization, or spillage.

Minimize damage to devices Minimize damage to devices from blood and other from blood and other substances.substances.


The Importance of CleaningThe Importance of Cleaning

Cleaning is the Cleaning is the foundation of foundation of disinfection disinfection and and sterilization.sterilization.


DecontaminationDecontamination

The use of physical or chemical The use of physical or chemical procedures to remove, inactivate, procedures to remove, inactivate, or destroy bloodborne pathogens.or destroy bloodborne pathogens.


DecontaminationDecontamination

How an item was, How an item was, or will be used or will be used determines the determines the level of level of decontamination decontamination required.required.


Technology Creates Technology Creates Cleaning ChallengesCleaning Challenges


Manual CleaningManual CleaningMay be doneMay be done::– Prior to mechanical cleaningPrior to mechanical cleaning– When the decontamination area When the decontamination area

does not have mechanical does not have mechanical cleanerscleaners

– For delicate or complex For delicate or complex instrumentsinstruments

– For powered-surgical For powered-surgical instrumentsinstruments

– For instruments with lumensFor instruments with lumens


Facilitate Cleaning By:Facilitate Cleaning By:

Monitoring water Monitoring water temperature and temperature and hardness.hardness.

Measuring detergents Measuring detergents accurately.accurately.


Facilitate Cleaning By:Facilitate Cleaning By:

Opening hinged Opening hinged instruments to instruments to expose hinges, expose hinges, jaws, and jaws, and box-locks.box-locks.


CleaningCleaningUse a 3-Sink Set-upUse a 3-Sink Set-up– Wash sinkWash sink– Intermediate Rinse Intermediate Rinse

sink sink – Final Rinse sinkFinal Rinse sink

*Brush instruments *Brush instruments under the surface of under the surface of the water to prevent the water to prevent aerosols.aerosols.


Cleaning BrushesCleaning Brushes

Use the correct size brush for the item being Use the correct size brush for the item being cleaned.cleaned.

Clean and disinfect/sterilize routinely or discard Clean and disinfect/sterilize routinely or discard and replace.and replace.


Mechanical CleaningMechanical Cleaning

Washers Washers – Automated equipment Automated equipment

used to clean, used to clean, decontaminate, or decontaminate, or disinfect and dry disinfect and dry medical devices.medical devices.


Ultrasonic CleanersUltrasonic CleanersUse Cavitation Use Cavitation ProcessProcess

Superior to manual Superior to manual scrubbing/cleaningscrubbing/cleaning

Require non-foaming Require non-foaming detergentsdetergents


Cavitation:Ultrasonic vibrations create tiny air bubbles that grow larger until they implode (collapse). That implosion dislodges soil from theinstrument’s surface, as well as crevices, hinges, and other hard

to reach areas within the instrument.

ImplosionImplosion


Ultrasonic Cleaner TipsUltrasonic Cleaner Tips

Rinsing is necessary to remove residue Rinsing is necessary to remove residue that remains on instruments.that remains on instruments.

The tank must be routinely cleaned.The tank must be routinely cleaned.

Instruments must be precleaned to Instruments must be precleaned to remove gross soil.remove gross soil.


Ultrasonic Cleaner TipsUltrasonic Cleaner Tips

Must be degassed each time they are filled.Must be degassed each time they are filled.

The cleaner’s lid should remain closed during The cleaner’s lid should remain closed during operation.operation.

All lumens should be completely filled with All lumens should be completely filled with cleaning solution.cleaning solution.

All instruments should be completely open and All instruments should be completely open and submerged.submerged.


Ultrasonic CleanersUltrasonic Cleaners

Do not place these items in the ultrasonic Do not place these items in the ultrasonic cleaner:cleaner:– Chrome-plated instrumentsChrome-plated instruments– Ebonized InstrumentsEbonized Instruments– PlasticPlastic– CorkCork– GlassGlass– WoodWood– ChromeChrome– RubberRubber


Automated Mechanical WashingAutomated Mechanical Washing

ImpingementImpingement– The spray-force The spray-force

action of action of pressurized water pressurized water against against instruments being instruments being processed to processed to physically remove physically remove bioburden.bioburden.


Mechanical WashersMechanical Washers

Use several Use several successive steps successive steps in their cycles to in their cycles to clean medical clean medical devices.devices.


Mechanical Washer TipsMechanical Washer Tips

Expose all surfaces.Expose all surfaces.

Do not stack trays on top of one another.Do not stack trays on top of one another.

Remove lids or covers from trays.Remove lids or covers from trays.

Check detergent levels frequently.Check detergent levels frequently.


Washers Need Direct ContactWashers Need Direct Contact

Multi-level Multi-level organizing trays organizing trays may impede may impede mechanical cleaning mechanical cleaning processes by processes by shielding the shielding the instruments from instruments from the wash spray.the wash spray.


Protect Instruments from Damage Protect Instruments from Damage during Mechanical Cleaningduring Mechanical Cleaning


Mechanical WashersMechanical Washers

Choose the correct Choose the correct cycle for the items cycle for the items being processed.being processed.


Automated Cart WashersAutomated Cart Washers

Automated Cart Automated Cart Washers use Washers use detergent and hot detergent and hot water to clean large water to clean large carts.carts.

With special racks, With special racks, they may also be they may also be used to clean basins, used to clean basins, pans, etc.pans, etc.


Basic Instrument Basic Instrument Cleaning ProceduresCleaning Procedures


Instrument DecontaminationInstrument Decontamination

The most important The most important step in the step in the sterilization sterilization process.process.

Instruments that Instruments that have not been have not been properly cleaned properly cleaned cannot be sterilized.cannot be sterilized.


Instrument CleaningInstrument Cleaning

Every instrument or Every instrument or device that enters the device that enters the decontamination area decontamination area must be treated as if it must be treated as if it is potentially is potentially hazardous.hazardous.


Instrument CleaningInstrument CleaningShould begin within Should begin within 15 minutes to 1 hour 15 minutes to 1 hour after use.after use.

Prolonged delays in Prolonged delays in instrument cleaning instrument cleaning can have negative can have negative impacts on impacts on instruments.instruments.


Blood should Blood should never never be allowed be allowed to dry on instruments.to dry on instruments.

Process instruments Process instruments immediately, or:immediately, or:– Cover with a moist Cover with a moist

toweltowel– If they can be If they can be

immersed, place in a immersed, place in a soak basin with the soak basin with the appropriate solution.appropriate solution.


Instrument CleaningInstrument Cleaning

Disassemble multi-Disassemble multi-part instrumentspart instruments

Open boxlocks and Open boxlocks and hinges for cleaninghinges for cleaning


Instruments with LumensInstruments with Lumens

Place under water to Place under water to prevent aerosols when prevent aerosols when brushingbrushing

Brush lumens using an Brush lumens using an appropriate size brushappropriate size brush

Force water and Force water and detergent through them detergent through them using a syringe or using a syringe or cleaning nozzlecleaning nozzle


Defective InstrumentsDefective Instruments

When Instruments When Instruments come back from come back from Surgery tagged for Surgery tagged for repair they must be repair they must be decontaminated decontaminated before they are sent before they are sent for repair.for repair.


Clean All Items in Accordance with Clean All Items in Accordance with Manufacturers’ Instructions.Manufacturers’ Instructions.


Power EquipmentPower EquipmentMust be manually Must be manually cleaned.cleaned.

Do Not Immerse.Do Not Immerse.

Clean cannulations Clean cannulations (lumens) thoroughly.(lumens) thoroughly.

Follow Manufacturer’s Follow Manufacturer’s instructionsinstructions


Mobile Patient Care EquipmentMobile Patient Care Equipment

Follow OEM (Original Follow OEM (Original Equipment Equipment Manufacturer’s) Manufacturer’s) instructions.instructions.

Pay attention to Pay attention to details such as details such as access doors, access doors, latches, etc.latches, etc.


Cleaning Quality ControlCleaning Quality Control

Instruments are Instruments are visually inspected for visually inspected for cleanliness in the cleanliness in the clean assembly area.clean assembly area.

There are some There are some commercial commercial monitoring products monitoring products available to test the available to test the effectiveness of effectiveness of mechanical washers.mechanical washers.


Infectious WasteInfectious Waste

Not all healthcare facility trash is “Medical Not all healthcare facility trash is “Medical Waste”. Waste”.

Healthcare facilities separate their waste.Healthcare facilities separate their waste.


Waste CategoriesWaste CategoriesGeneral TrashGeneral Trash – garbage disposed of as municipal solid – garbage disposed of as municipal solid waste.waste.

Regulated Medical Waste or Infectious WasteRegulated Medical Waste or Infectious Waste – – waste capable of transmitting infectious disease.waste capable of transmitting infectious disease.

Hazardous WasteHazardous Waste – May cause serious illness or death. – May cause serious illness or death. Must be red-bagged.Must be red-bagged.

Low-level Radioactive WasteLow-level Radioactive Waste – exhibits radioactive – exhibits radioactive characteristics such as radioactive decay.characteristics such as radioactive decay.


Cleaning SummaryCleaning SummaryFollow established Follow established standards and standards and manufacturers’ manufacturers’ instructions.instructions.

Pay attention to detail.Pay attention to detail.

Cleaning is the most Cleaning is the most important step in important step in medical device medical device processing.processing.


Questions?Questions?

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Copyright IAHCSMM 2007 Cleaning and Decontamination Chapter 9