Infection Control Guidelines for office pr ctices nd other ... · IntRoDUCtIon ACT He lth Infection Control Guidelines for office practices and other community based services (the

Infection Control Guidelines 2006 �

Infection Control

officepr�ctices�ndothercommunityb�sedservices

2006

forGuidelines

ii Infection Control Guidelines 2006

Contents

IntRoDUCtIon . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1

Important note . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

Guideline objectives . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

Administration of the Guidelines. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

EmployeeknowledgeoftheGuidelines..................................................................3 Discl�imerofli�bility....................................................................................................3 Acknowledgments......................................................................................................3

PARt one: InFeCtIon ContRoL PRACtICes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5

1.1 standard Precautions ................................................................................................ 5

1.1.1H�ndw�shing.....................................................................................................5 1.1.2Person�lProtectiveEquipment(PPE)forpr�ctitioners..................................7 1.1.3H�ndling�nddispos�lofsh�rps......................................................................9 1.1.4M�n�gementofw�ste(otherth�nsh�rps).................................................10 1.1.5Aseptictechnique...........................................................................................10 1.1.6Oper�tingfield.................................................................................................11 1.1.7Skindisinfect�nts(�ntiseptics)........................................................................11

1.2 Additional Precautions............................................................................................ 12

1.3 other Infection Control Practices .......................................................................... 12

1.3.1Pr�ctitionerhe�lth...........................................................................................12 1.3.2Environment�lcle�ning..................................................................................13 1.3.3Linen�ndl�undering......................................................................................13 1.3.4Single-usemedic�tions,inject�bles�ndinstruments..................................14 1.3.5Blood�ndbodysubst�ncespills....................................................................15 1.3.6Sh�rpsinjuries�ndblood�ndbodysubst�nceexposures........................15 1.3.7Workpl�ces�fety............................................................................................16 1.3.8Policies�ndproceduresm�nu�l...................................................................16 1.3.9Anim�ls..............................................................................................................17

PARt tWo - RePRoCessInG oF APPLIAnCes ............................................19

2.1 Management of appliances .................................................................................. 19 2.1.1Cle�ning�ppli�nces.......................................................................................19

2.1.2Cle�ning�gents..............................................................................................20

2.1.3Therm�lw�shers/disinfectors..........................................................................21

2.1.4Ultr�sonicCle�ners(UC).................................................................................21

ACt Health Infection Control Guidelines for office practices and

other community based services

2006

Infection Control Guidelines 2006 iii

2.1.5Dryingof�ppli�nces.......................................................................................22

2.1.6P�ck�gingofitemsforsterilis�tion.................................................................23

2.1.7Non-conformingstock.....................................................................................23

2.2 Disinfection of appliances ...................................................................................... 24

2.2.1Therm�ldisinfection.........................................................................................24 2.2.2Chemic�ldisinfection......................................................................................24

2.3 sterilisation of appliances....................................................................................... 25 2.3.1Ste�m-under-pressure(ste�msterilis�tionusing�n�utocl�ve)................26 2.3.2Sterilisermonitoring..........................................................................................27 2.3.3Steriliserv�lid�tion/rev�lid�tion.....................................................................28 2.3.4Steriliserf�ilures.................................................................................................29 2.3.5Document�tionofsterilisercycles.................................................................30 2.3.6Dryhe�tsterilis�tion.........................................................................................30

2.4 Critical incidents ...................................................................................................... 31

PARt tHRee - BUsIness sPeCIFIC ReQUIReMents ......................................33

3.1 Acupuncturist ........................................................................................................... 33

3.2 Beauty therapist ...................................................................................................... 34 3.2.1Gener�l.............................................................................................................34 3.2.2Procedureform�n�gementofbleedingduringtre�tment......................35

3.3 Body Piercer ............................................................................................................. 35

3.4 Dentists ..................................................................................................................... 36

3.5 Dental Laboratory (both on and off site) ............................................................... 38

3.6 Mobile Practitioners................................................................................................. 38

3.7 tattooist .................................................................................................................... 39

PARt FoUR - ConstRUCtIon oF PReMIses In oFFICe PRACtICe ............41

4.1 Introduction .............................................................................................................. 41

4.2 Additional resources ............................................................................................... 41

4.3 treatment areas....................................................................................................... 41

4.4 Cleaning areas ........................................................................................................ 42

4.5 storage areas .......................................................................................................... 43

4.6 Lighting and ventilation .......................................................................................... 43

4.7 Hand basins and sinks ............................................................................................ 44

GLossARY ....................................................................................................45

ReFeRenCe LIst .............................................................................................51

iv Infection Control Guidelines 2006

APPenDICes .................................................................................................53

Appendix one: C�tegoriesofw�ste�ndrecommendedcont�inment�nddispos�l.........................53

Appendix two: Minimumlevelsofreprocessingrequiredforspecificitemsinuse................................54

Appendix three: H�ndw�shingtechniques..................................................................................................56

LIst oF DIAGRAMs

Diagram one: Correcth�ndw�shingtechnique.......................................................................................7

Diagram two: Ultr�sonicCle�nerfoiltest.................................................................................................22

Diagram three: Ex�mpleof designof�cle�ningroomshowingdirtytocle�nflowof�ppli�nces�ndsegreg�tionof�re�s.............................................................................44

LIst oF tABLes

table one: Surf�cetemper�turetimerel�tionshipsfortherm�ldisinfection.................................24

table two: Temper�turepressure-timerel�tionshipforste�munder-pressuresterilis�tion..........26

ABBRevIAtIonsACHs Austr�li�nCouncilonHe�lthc�reSt�nd�rds

AnCA Austr�li�nN�tion�lCouncilonAIDS

As Austr�li�nSt�nd�rd

As/nZs Austr�li�nNewZe�l�ndSt�nd�rd

BePCon Building,Electric�l�ndPlumbingControl

eQuIP Ev�lu�tion�ndQu�lityImprovementProgr�m

nAtA N�tion�lAssoci�tionofTestingAuthorities

nH&MRC N�tion�lHe�lth�ndMedic�lRese�rchCouncil

PALM Pl�nning�ndL�ndM�n�gement

tGA Ther�peuticGoodsAdministr�tion

DoHA Dep�rtmentofHe�lth�ndAgeing

Infection Control Guidelines 2006 v

vi Infection Control Guidelines 2006

IntRoDUCtIon

ACTHe�lthInfection Control Guidelines for office practices and other community based services(theGuidelines)�re�pplic�bleto�nybusinessth�tperformsskinpenetr�tionorinfectionriskprocedures.TheGuidelinesshouldbere�dinconjunctionwiththeACTHe�lth Infection Control for office practices and other community based servicesCodeofPr�ctice(theCode).

TheGuidelinesprovideinform�tiononminimumst�nd�rdsofinfectioncontrolforbusinesses�ndoper�torswhoperformprocedureswhichm�yresultinthetr�nsmissionofdise�se.TheGuidelines�reb�sedonthekeyprinciplesofinfectioncontrol,thosebeinghygiene,cle�nliness�ndsterility.Theyincludeinform�tionontheimplement�tionofst�nd�rd�nd�ddition�lprec�utions,thereprocessingof�ppli�nces,occup�tion�lhe�lth�nds�fetyconsider�tions,s�fedispos�lofclinic�lw�ste,environment�lm�inten�nce�ndpremiseconstructionrequirements.

Businesses covered by the Code may include but not be limited to:

Health and allied health care services (including government owned):

• Dent�lpr�ctices;

• Di�gnosticclinics;

• Ph�rm�cies;

• Podi�tryclinics;

• Acupunctureclinics;�nd

• P�thologycollectioncentres.

Personal service industries:

• Be�utyther�pists;

• T�ttoostudios;

• Bodypiercingstudios;

• Mobilepr�ctitioners;�nd

• E�rpiercingbusinesses.

Otherbusinesses/individu�lsth�tperformproceduresth�tm�yresultinthetr�nsmissionofdise�sem�y�lsoutilisetheGuidelinestoimplement�ppropri�teInfectionControlpr�ctices.

Infection Control Guidelines 2006 1

Important note

the Guidelines should be read in conjunction with the Code. the Code details a set of standard outcomes, which are required to be adhered to, or achieved by, the business, premises or practitioner.

All businesses and practitioners are bound by the requirements of the Code. the Code is enforceable under section 20 of the Public Health Act 1997 and is based upon recognised national infection control guidelines and Australian standards.

Proprietors are required to take reasonable measures to ensure that all staff are aware of and comply with the contents of the Code.

Breaches of the Code

Theproprietorof�nybusinessboundbytheCodemustinformHe�lthProtectionService(HPS)of�nyincidentth�toccurs�tthepremises,whichresultsin�m�jorbre�chofthisCode.

Anincidentnotifiedundersection20ofthePublic Health Act 1997mustbereportedbytelephoneon62051700,withinonebusinessd�yoftheincidentt�kingpl�ce.

F�iluretocomplywiththissectionm�yresultinconditionsbeingpl�cedon�businesslicence,th�tlicencebeingrevokedorrelev�nt�ctiont�kenunderthePublic Health Act 1997.

For further information about how businesses, proprietors or practitioners can meet the requirements of the Code, contact the Infection Control Unit, Health Protection service, ACt Health during business hours on (02) 6205 1700.

Guideline objectivesTheobjectivesoftheGuidelines�retoensureth�toper�torsh�veinform�tiononhowto�chievethest�nd�rdscont�inedintheCode.

TheGuidelinesprovideinform�tiononpr�cticesto:

• minimisetheriskoftr�nsmissionofbloodborne�ndotherinfectionsby the�doptionofSt�nd�rdPrec�utionsduringskinpenetr�tion�ndinfection riskprocedures;

• ensure�ppli�nces�recle�n�ndsterilebeforebeingintroducedintohum�n tissue;

• minimisetheriskoftr�nsmissionofmicroorg�nismsbetweenthepr�ctitioner, the�ppli�ncesused�ndotherclients/p�tients;

• promote�s�feworkingenvironmentforst�ffperformingskinpenetr�tion�nd infectionriskprocedures;�ndto

• promotepublic�w�renessofs�feworkingpr�ctices�ndproceduresin businesses�ffectedbytheCode.

2 Infection Control Guidelines 2006

TheGuidelines�resetoutintofourp�rts:

• P�rtOnedet�ilsinfectioncontrolpr�ctices;

• P�rtTwodet�ilstherequirementsforthem�n�gementof�ppli�nceswithin� businessorf�cility;

• P�rtThreedet�ilsextr�industryspecificrequirementsfor�cupuncturists, be�utyther�pists,bodypiercers,dentists,mobileoper�tors�ndt�ttooists;�nd

• P�rtFourdet�ilsrecommend�tionsfornewofficeb�sedpremises�nd premisesundergoingrefurbishment.

Administration of the Guidelines

employee knowledge of the Guidelines

Theproprietororm�n�gerof�businessisrequiredtocomplywiththeCode�ndensureth�t�llproceduresperformedbypr�ctitionersorpersonseng�gedbythebusiness�recompletedinsuch�w�y,�stoprotectthepublicfromthetr�nsmissionofbloodborne�ndotherinfections.Employersshouldensureth�t�llst�ff�re�w�reofthecontentsoftheCode�ndtheseGuidelines.

Disclaimer of liability

• Thisdocumenth�sbeenprep�redinconsult�tionwith�wider�ngeof expertswithinrelev�ntfields,infectioncontrolpr�ctitioners,profession�l org�nis�tions,licensedbusinessproprietors�ndthegener�lcommunity.

• TheGuidelinesreflectthecurrentst�teofinfectioncontrolknowledge, �ndwhileeveryefforth�sbeenm�detoensureits�ccur�cy,pr�ctitioners shouldbe�w�reth�titcouldbe�lteredinthefuturetoreflectch�ngesin knowledgeconcerningtr�nsmissionofbloodborne�ndotherinfections.

• NeitherACTHe�lthnor�nypersoninvolvedintheprep�r�tionofthe Guidelines�ccepts�nycontr�ctu�l,tortiousorotherli�bilitywh�tsoeverin respecttothecontentsoftheGuidelinesor�nyconsequence�risingfromits useorrepresent�tionsm�deinrel�tiontotheGuidelines.

Acknowledgements

TheGuidelines�reb�sedupon�numberofn�tion�linfectioncontroldocumentsincluding:

• Austr�li�nGovernmentDep�rtmentofHe�lth�ndAgeing(DoHA),2004 “Infection control guidelines for the prevention of transmission of infectious diseases in the health care setting”.

• Austr�li�n/NewZe�l�ndSt�nd�rd(AS/NZS)4815:2006“Office-based health care facilities – Reprocessing of reusable medical and surgical instruments and equipment, and maintenance of the associated environment”.

• Austr�li�n/NewZe�l�ndSt�nd�rd(AS/NZS)4187:2003 “Cleaning, disinfecting and sterilising reusable medical and surgical instruments and equipment, and maintenance of associated environments in health care facilities”.



PARt one: InFeCtIon ContRoL PRACtICes

Theprim�rypurposeofinfectioncontrol,inthecontextoftheGuidelines,istominimisetheriskofinfectionduringtheprovisionofservices.Thefollowingsectionsprovideinform�tionontheprinciplesofinfectioncontrolpr�ctice,�swell�spr�ctic�lmethodsforimplementingtheseprinciples.

1.1 standard PrecautionsSt�nd�rdPrec�utions�reworkpr�ctices,whichrequireeveryoneto�ssumeth�t�llblood�ndbodysubst�nces�repotenti�lsourcesofinfection,independentofperceivedrisk.Suchprec�utionsinvolvetheuseofs�feworkpr�ctices,protectiveb�rriers�ndthes�fedispos�lofbodysubst�nces�ndsoiledm�teri�l.

St�nd�rdPrec�utions�pplyto�llbodyfluids,reg�rdlessofwhethertheycont�invisibleblood(includingdriedbodysubst�ncessuch�sdriedbloodors�liv�),secretions�ndexcretions(excludingswe�t),non-int�ctskin�ndmucousmembr�nes.

the principle underlying standard Precautions is the assumption that all clients/patients and practitioners are potentially infected with blood borne or other communicable diseases, irrespective of the perceived risk.

St�nd�rdPrec�utionsinclude:

• goodhygienepr�ctices,p�rticul�rlyw�shing�nddryingh�ndsbefore�nd�fter client/p�tientcont�ct;

• useofprotectiveb�rrierswhere�ppropri�te,includinggloves,gowns,pl�stic �prons,m�sks,eyeshieldsorgoggles;

• �ppropri�teh�ndling,stor�ge�nddispos�lofsh�rps,�ndothercont�min�ted orinfectiousw�ste�ndlinen;�nd

• useof�septictechniquestominimisetheriskofintroductionortr�nsmissionof infection.

1.1.1 Handwashing

Handwashing is an important factor in controlling and managing infection risks.

(�) Itisimport�ntth�th�ndsbew�shedbeforesignific�ntcont�ctwith�nyclient/ p�tient�nd�fter�ctivitieslikelytoc�usecont�min�tion.

(b) H�nds�ndotherskinsurf�cesth�t�resoiledwithbloodorbodysubst�nces �rerequiredtobew�shedwithliquidso�p�ndw�terimmedi�tely,or�ssoon �spossible,�ftersoiling.

(c) H�ndsshouldbew�shedbefore�nd�fterusinggloves.

(d) N�ilbrushes�renotrecommendedforscrubbingh�nds,unlessused�sp�rtof �surgic�lscrub,�stheym�yc�used�m�getoskin.Abre�kintheskin’s integrityincre�sestheriskoftheindividu�lcontr�cting�ninfection.


(e) Followingeffectiveh�ndw�shing�ndrinsing,h�nds�rerequiredtobe driedthoroughlyusingdispos�blep�pertowelsorsingleusecle�nclothtowels. Apumpp�ckdispensedmoisturisingcre�mc�n�lsobeusedtoprevent ch�ffing�ndimproveskinintegrity.

(f) Ifclothtowels�reused�singleusetowelshouldbeusede�chtime.

(g) Ifh�nds-freet�ps�renot�v�il�ble,�techniqueshouldbedevelopedto ensureth�tcle�nh�nds�renotre-cont�min�tedbycont�ctwitht�ps.

(h) Aliquidskincle�nsershouldbeusedforregul�rh�ndw�shing,whichshouldbe pHneutr�l�ndshouldnotcont�in�ny�ddedsubst�ncesth�tm�yirrit�te ordrytheskin.An�nti-microbi�lh�ndw�shshouldbeusedbeforec�rrying outproceduresinvolvingentryintonorm�llysteriletissue.

(i) Duetothedifficultyincle�ning,itisprefer�bletorepl�ceplungerswhenskin cle�nser�ndmoisturisingcre�mcont�inersbecomeempty.Ifre-use�ble liquidskincle�nser/moisturisingcre�mcont�inersorplungers�reused,they shouldbecle�ned�nddriedpriortorefilling.F�iluretodothiscouldresult inthecont�min�tionoftheliquidskincle�nserfromthepreviously cont�min�tedcont�inerorplunger.

(j) Infieldsitu�tions,whereh�ndw�shingf�cilities�relimitedornot�v�il�ble,itis recommendedtouse�detergent-cont�iningtowelettetocle�nsetheh�nds beforeusing�n�lcoholb�sechlorhexidineortriclos�nh�ndrub/h�ndw�shgel.

(k) Cuts�nd�br�sionsonh�ndsshouldbecoveredwith�nocclusivedressing whichshouldbech�ngedwhenitlosesitsintegrity(such�swhenthedressing becomessoiledorwet).

Routine handwashingshouldbeusedbefore�nd�ftersignific�ntcont�ctwithclients/p�tient�nd�fterh�ndling�ppli�ncesorequipmentcont�min�tedwithbloodorbodysubst�nces(see Appendix Three).

Aroutineh�ndw�shinvolves:

• wettingh�ndsthoroughly�ndl�theringwith�pHneutr�lliquidso�p;

• vigorouslyrubbingh�ndstogetherfor�tle�st10to15seconds (see Diagram One);

• rinsingh�ndsunderw�rmrunningw�ter;�nd

• dryingh�ndswith�dispos�blep�pertowelorsingleuseclothtowel.

For non-surgical procedureswhichrequire�septictechniques(see Appendix Three),h�nds�rerequiredtobe:

• w�shedthoroughlyfor�tle�stoneminuteusing�liquid�nti-microbi�lso�p orskincle�nser,p�yingp�rticul�r�ttentiontothesp�cebetweenthefingers �nd�roundthen�ils(see Diagram One);

• c�refullyrinsed,keepingh�nds�bovetheelbows;�nd

• driedwithp�pertowelorsingleuseclothtowel.


A surgical handwashisrequiredbefore�nyprocedureth�tinvolvesthesurgic�lpenetr�tionofnorm�llysteriletissues**(see Appendix Three).Thisincludessurgic�lentryintotissues,c�vitiesororg�nsfordi�gnosticorther�peuticpurposes.Asurgic�lh�ndw�shisrequiredpriortowe�ringsterilegloves.

Asurgic�lh�ndw�shinvolves:

• h�nds,n�ils�ndfore�rmsbeingw�shedthoroughlytoremovedirt�nd tr�nsientb�cteri�with�suit�bleliquid�nti-microbi�lso�porskincle�nser;

• thefirstsurgic�lh�ndw�shforthed�ybeingfor�minimumoffiveminutes withsubsequentw�shesbeingforthreeminutes;�nd

• h�ndsbeingdriedc�refullyusingsteriletowels.

Diagram One: Handwashing technique

(Source:Ansell Medical)

1.1.2 Personal Protective equipment (PPe) for practitioners

In determining the type of protective barriers to employ for a particular procedure, the operator should consider:

• the probability of exposure to blood and body fluids;

• the amount of blood and body substance likely to be encountered;

• the type of body substance involved; and

• the possible transmission route of pathogens.

Itisimport�ntth�tprotectiveclothing�ndequipmentbe�v�il�ble�nd�ccessibleine�chest�blishment�ndm�yinclude:

• gloves;

• eye�nd/orf�ci�lprotection;

• m�sks;

• gowns�nd�prons;

• �ppropri�tefootwe�r;�nd

• provisionofs�feneedleh�ndlingsystems.


**Or�lsurgic�lproceduresm�yinvolve�nincisionintothemusos��ndr�isingofthemuco-perioste�lflap. This includes, but is not limited to, Exodontia, Periodontal surgery, Endodontic root surgery, implants �ndbiopsy.

(�) Gloves:

• shouldbewornwhencont�ctwithblood�nd/orbodysubst�ncesis �nticip�ted;

• shouldbe�ppropri�tetothet�sk:

• sterileglovesforproceduresrequiring�ninv�sivesurgic�loror�l surgic�lprocedure;

• non-sterileglovesforproceduresotherth�nthe�bove;�nd

• gener�lpurposeutilityglovesforhousekeepingchoresincluding cle�ning.

• �rerequiredtoberemoved�nd/orch�ngedbetweenclients/p�tientsto �voidcrosscont�min�tion,including:

• whenperformingsep�r�te�nddistinctproceduresonthes�me client/p�tient;

• beforecont�ctwithdoors;

• before�nsweringthephoneorrecordingintheclient/p�tientnotes;

• ifthereis�nyevidenceoff�ults,holes,te�ringordeterior�tion;�nd

• whentheybecomegrosslycont�min�tedwithbodyfluids.

• shouldbewornwhenh�ndlingp�thologyspecimens,evenwhenthe specimenisenclosedwithin�le�k-proofcont�iner;

• �re�v�il�bleforst�ffwithl�texsensitivities(powderfree�ndnonl�tex glovesc�nbeused);

• such�s‘utilitygloves’m�ybereusedunlessthereisevidenceof deterior�tion;

• such�s‘reus�bleutilitygloves’shouldbew�shedinw�rmso�pyw�ter �ndstoreddry�ftere�chuse;�nd

• �renot�substituteforh�ndw�shing.H�ndsshouldbew�shedboth before�nd�fterwe�ringgloves.

(b) Eye/F�ci�lprotection:

• �rerequiredtobewornwhenperformingproceduresth�t�re re�son�blylikelytobe�ssoci�tedwithspl�shorspr�yofbloodorbody subst�nces.

Eyeprotection:

• shouldbedistortionfree,optic�llycle�r�nd�nti-fogging (prescriptiongl�sses�renotsufficient);

• shouldfitclosetothehe�d�ndbeshielded�te�chside�ndcomply withAS/NZ1337:1997Eye protectors for industrial applications; �nd

• m�ybereused�ftercle�ningwithdetergent�ndw�ter.

(c) M�sks:

• �n�ppropri�tem�skisrequiredtobewornbythepr�ctitionerwhen thereis�likelihoodofspl�shingorspl�tteringofbodysubst�ncesor where�irbornetr�nsmissionm�yoccur;

• �fluid-repellentm�skisrequiredtobeusedwhen�erosol�tionor spl�tteringofbloodispossible;


• shouldbeworn�ndfitted�ccordingtom�nuf�cturer’sinstructions;

• shouldbech�nged�fter20minutesofcontinuousexposureto �erosolsorsooneriftheybecomemoistorvisiblysoiled;

• shouldnotbewornloosely�roundtheneck,butberemoved�nd disc�rded�ssoon�spr�ctic�ble�fteruse;

• shouldberemovedbytouchingthestrings�ndloopsonly;�nd

• shouldnotbetouchedbyh�ndwhilebeingworn�sthisc�ncont�min�te h�nds�swell�sm�kethem�skperme�bletofluids.

(d) Gowns�nd/ordispos�blepl�stic�prons:

• shouldbewornwhenthereis�nypossibilityofcont�min�tionofclothing orskinbyspl�shing/spr�yingofbloodorbodyfluids.

(e) Footwe�r:

• shouldbeenclosed�ndc�p�bleofprotectingfeetfrominjuryorcont�ct withsh�rpobjects�ndcont�min�tionfromspilledsubst�nces.

Suppliesofperson�lprotectiveequipment(gowns,gloves,m�sks�ndprotectiveeyewe�r)�rerequiredtobe�v�il�bleforst�ff�ndloc�tedincloseproximitytotre�tment�ndcle�ning�re�s.

1.1.3 Handling and disposal of sharps

sharps represent a major cause of incidents involving potential exposure to blood borne diseases. Resheathing of single use needles should be avoided.

(�) Them�n�gement�nds�fedispos�l�retheresponsibilityofthepr�ctitioner th�tgener�testhesh�rps.

(b) Sh�rpsshouldnotbereshe�thed�ndshouldbedisc�rded�ssoon�s pr�ctic�ble,�ftertheriskproneprocedureiscompleted.Ingener�l,thiswillbe �tpointofuse�ndinto�n�pprovedsh�rpscont�iner.

(c) Needlesshouldnotberemovedfromsyringesfordispos�l,purposelybroken,or otherwisem�nipul�tedbyh�nd.

(d) Reshe�thingofusedneedlesisnotrecommendedduetothehighriskof needlestickinjuries.However,incert�incircumst�ncessuch�sdentistry, reshe�thingm�yberequired.Wherereshe�thingofneedlesc�nnotbe �voided:

• thepr�ctitionerisresponsibleforensuringtheneedleisproperly rec�pped;

• theshe�thshouldnotbeheldinthefingers;�nd

• either�singleh�ndedtechniqueusingforcepsor�speci�llydesigned protectivegu�rdor�pprovedrec�ppingdeviceshouldbeused.

(e) Dispos�blesh�rps�rerequiredtobepl�cedin�design�tedpuncture-resist�nt cont�inerth�tmeetsAS4031:1992Non-reusable containers for the collection of sharp medical items used in health care areas,orAS/NZS4261:1994Reusable containers for the collection of sharp items used in human and animal medical applications.


(f) Sh�rpscont�inersshould:

• notbefilled�bovethelineindic�tedonthecont�iner;

• notbedoubleh�ndledfromonecont�inerto�nother;

• bepositionedfore�sy�ccess;

• beoutofre�chofchildren(openingshouldbe�pproxim�tely1.2mfrom floorlevel);

• beclosedbeforedispos�l;�nd

• bedisposedofby�licencedclinic�lw�stecontr�ctor.

1.1.4 Management of waste (other than sharps)

Management of waste must comply with the ACT Clinical Waste Act 1990, the Clinical Waste Manual 1991, the ACT Public Health Act 1997, As/nZs 3816 and the ACT Waste Minimisation Act 2001.

(�) Clinic�lw�steshouldbesegreg�ted�ndcont�ined�tthesourceof gener�tionusing�ppropri�telycolourcoded�ndl�belledcont�iners(see Appendix One).

(b) Recept�clesforclinic�lw�ste�rerequiredto:

• complywithAS4031:1992,AS/NZS4261:1994�ndAS/NZS3816:1998 Management of clinical and related waste;

• becle�rlyidentifi�ble�ndbe�v�il�ble�tpointofuse;

• besecurelyclosedbeforetr�nsportingto�notherloc�tion;�nd

• beremoved�nddisposedofby�licencedclinic�lw�stecontr�ctor.

(c) Adesign�tedsecure�re�orcont�inerisrequiredtobeset�sidefortheshort termstor�geofclinic�lw�stepriortocollectionby�n�uthorisedw�ste remov�lcontr�ctor.This�re�isrequiredtobeprotectedfromwe�ther�nd un�uthorised�ccess.

1.1.5 Aseptic technique

All procedures are required to be performed so as to reduce the risk of infection or cross contamination.

(�) Aseptictechniquereferstothepr�cticesusedbypr�ctitionersto:

• reducethenumberofinfectious�gents;

• preventorreducethelikelihoodoftr�nsmissionofinfectious�gentsfrom onepersonorpl�ceto�nother;

• minimisetheriskoftheintroductionofinfectious�gentsintothesterilefield ofoper�tion;�nd

• m�int�inobjects�ndwork�re�s,�sfree�spossible,frominfectious �gents.


(b) Aseptictechniqueincludes:

• h�ndw�shingorcle�ningtoreducethenumberofinfectious�gentson theskin;

• useofb�rrierstoreducetr�nsmissionofinfectious�gents;

• useofenvironment�lcontrols;�nd

• reprocessingof�ppli�nces�ndequipmentbetweenp�tient/clientuse.

1.1.6 operating field

All practitioners undertaking invasive procedures should adopt the concept of the ‘operating field’ and thus minimise the risk of cross contamination.

(�) Anythingwithin�definedr�diusoftheinv�siveprocedureisrequiredto becle�ned�nddecont�min�tedbetweene�ch�ndeveryp�tient/client. Theoper�tingfieldincludes�nywhereth�tthep�tient’s/client’sblood(�nd otherbodyfluids,includings�liv�)m�yconceiv�blytr�nsferduringprocedures.

(b) Indentistrytheuseofb�rrierswill�ssistinreducingcont�min�tionofdifficultto cle�nsurf�ceswithintheoper�tingfield.

1.1.7 skin disinfectants (antiseptics)

skin disinfectants are formulated to reduce transient bacteria on the client/ patient and thus prevent cross contamination.

(�) Where�ppropri�te1,beforecommencing�skinpenetr�tionprocedurethe �re�tobepenetr�tedshouldbewipedwith�suit�bleskindisinfect�nt.

(b)Suit�bleskindisinfect�ntsolutionsincludethefollowingprep�r�tions:

• 70-80%w/wethyl�lcohol(eth�nol);

• 60-70%v/visopropyl�lcohol(isoprop�nol);

• chlorhexidinein�queousformul�tions(0.5-4%w/v)orin�lcoholic formul�tionswithchlorhexidine(0.5-1%w/v)in60-70%isoprop�nolor eth�nol;

• 10%w/v�queousor�lcoholicpovidine-iodine(1%w/v�v�il�bleiodine); �nd

• solutionscont�ining1%w/vdiphenylether(triclos�n).

(c)Thedisinfect�ntshould:

• bedrybeforecommencementoftheprocedure;

• notberemovedfromtheskinpriortothecommencementofthe procedure;

• notbeused�ftertherecommendedexpiryd�te;�nd

• beusedin�ccord�ncewiththem�nuf�cturer’sinstructions.


1Itisrecognisedth�tinsomesitu�tionssuch�sin�nemergencyorduringimmunis�tion,theuseof�skinprep�r�tionwillnotbe�ppropri�teduring�skinpenetr�tionprocedure.

1.2 Additional Precautions

Additional Precautions are designed to interrupt transmission of infection by the routes listed below and are required to be used in addition to standard Precautions.

(�) Addition�lPrec�utions�reusedforp�tients/clientsknownorsuspectedtobe infectedorcolonisedwithclinic�llyimport�ntorhighlytr�nsmissiblep�thogens th�tc�nc�useinfectionby:

• �irbornetr�nsmission(e.g.Mycobacterium tuberculosis(TB),me�slesvirus, v�ricell�(chickenpox)virus);

• droplettr�nsmission(e.g.mumpsvirus,Bordetell�pertussis(whooping cough),influenz�virus);

• directorindirectcont�ctwithdryskin(e.g.colonis�tionwithmultiresist�nt Staphylococcus aureus)orwithcont�min�tedsurf�ces;or

• �nycombin�tionoftheseroutes.

(b) Addition�lPrec�utions�rerequiredtobeusedin additiontoSt�nd�rd Prec�utionswhentr�nsmissionofinfectionmightnotbecont�inedbySt�nd�rd Prec�utions�lone.Addition�lPrec�utionsm�ybespecifictothesitu�tion required,orm�ybecombinedwheremicroorg�nismsh�vemultipleroutesof tr�nsmission.

(c) Appropri�teAddition�lPrec�utions�reprim�rilyrequiredforusein�cute�nd semi�cutehe�lthc�ref�cilities,wheretheinfectiousst�tusofclients/p�tientsis morelikelytobeknown.Addition�lPrec�utionsm�yinclude�nycombin�tion of:

• �lloc�tionof�singleroomwithdedic�tedtoiletf�cilities;

• �ddition�luseofprotectiveb�rriers(egm�sksforst�fftominimisetherisks ofrespir�toryinfection);�nd/or

• dedic�tedp�tient/clientequipment.

Inofficepr�cticew�itingrooms,tri�gingsuspectedinfectiousrespir�tory dise�sec�rriers�he�dofothersisrecommendedtodecre�sepotenti�l exposuretimetoclients/p�tients.

1.3 other Infection Control Practices

1.3.1 Practitioner health

A practitioner who has a condition that may be transmitted to a client/patient is required to take preventative measures to minimise the risk of transmission of the condition.

(see Section 99 Principles - Notifiable conditions Public Health Act 1997).

(�) Prevent�tiveme�suresm�yinclude:

• prec�utionst�kenonthe�dviceof�medic�lpr�ctitioneror�n �uthorisedofficer;


• useofocclusivedressingswherebrokenskinorinfectionsoccuron exposedp�rtsof�pr�ctitioner’sbodyth�tm�ycomeintocont�ctwith thep�tient.

(b) Pr�ctitionersshouldm�int�in�n�ppropri�televelofhygiene�ndcle�nliness when�ttendingtoclients/p�tients.

1.3.2 environmental cleaning

Although environmental surfaces play a relatively minor role in the transmission of infections, regular cleaning and maintenance schedule is necessary to maintain a safe environment.

(�) Aroutine�ndregul�rcle�ningscheduleofthepremiseisrequiredtobe employedtoreducethelevelofenvironment�lcont�min�tion.Routine cle�ninginvolves:

• cle�ning�nddryingofworksurf�ces�ftere�chsessionorwhenvisibly soiled;

• useofdetergent�ndw�rmw�ter;

• useofdisinfect�nts(ifrequired);

• emptying�ndcle�ningbuckets�ndstoringdry;�nd

• cle�ningmopsindetergent�ndw�ter�ndstoringdry�fteruse.

(b) Chemic�ldisinfect�nts�renotrecommendedforroutineenvironment�l cle�ning.Ifthey�retobeused,thesurf�ceisrequiredtobecle�nedwith detergent�ndw�terfirst,thenthedisinfect�ntused�sperm�nuf�cture instructions.

(c) Cle�ningproceduresshouldminimisethedispers�lofmicro-org�nismsintothe �ir.

(d) Followingthetre�tmentof�client/p�tient,�llcont�min�ted�ppli�nces �rerequiredtoberemovedfromthetre�tment�re��ndeitherdisposedof orreprocessedin�ccord�ncewithP�rtTwooftheseguidelines.

(e) Appli�ncesth�t�renolongerusedbythebusinessshouldberemovedfrom thepremises.

(f) Aregul�rpestcontrolprogr�mshouldbeemployedtoensurethecontrolof vermin.

1.3.3 Linen and laundering

Linen such as pillowcases and sheets used on examination tables are required to be changed between clients/patients.

(�) Protectivep�percoversm�ybeusedoverorinste�doflinenbut�rerequired tobech�ngedbetweenclients/p�tients.Ifusedoverlinen,thelinenisrequired tobech�nged�ttheendofe�chsession�ndwhenvisiblysoiled.

(b) Linen�ndprotectivep�percoversshouldbestoredin�m�nnertoprevent cont�min�tion.


(c) Routinel�undrypr�ctices,�sperAS4146:2000Laundry practice,�re�dequ�te forprocessing�lllinen.

(d) Allusedlinen�ndprotectivep�percovers�rerequiredtobeh�ndledin �ccord�ncewiththerelev�ntlinen�ndw�stem�n�gementst�nd�rds�nd guidelines.

1.3.4 single-use medications, injectables and instruments

to avoid cross contamination, single-use equipment should be used.

(�) Single-dosevi�ls

• medic�tionsorsolutionsth�tcomeintocont�ctwithnorm�llysteriletissue shouldbesterile;

• themosteffectivew�yto�voidcross-infection,vi�injectionof medic�tion,isthroughtheuseofsingle-dosevi�lsor�mpoules�nd single-usesterileinjectingequipment.

ReferDoHA,2004Infection control guidelines for the prevention of transmission of infectious diseases in the health care setting, Section 6.3.1.

(b) Multidosevi�ls

• Inject�bleproductsp�ck�gedinmultidosevi�lsshouldnotbeused exceptwhereproductssuch�sinsulin�reintendedsolelyfortheexclusive useof�nindividu�lp�tient.Inthesep�rticul�rc�ses,specificprotocols shouldbeinpl�cetoensureth�ttheproducts�reusedforthose individu�lsonly.Everyprec�utionshouldbet�kentoensureth�tthe unusedportionofthevi�lisnotcont�min�ted,includingusing�cle�n needle�ndsyringetodr�wuptherem�iningcontentsofthevi�lonevery occ�sion.

• Pr�ctitionersshouldbe�w�reofsitu�tionswherecross-cont�min�tion mightoccurduringroutinemedic�lordent�lprocedures.Whensingle dosevi�lsor�mpoules�renot�v�il�ble,theriskofcross-cont�min�tionis highifinject�bleproducts�reusedonmultiplep�tients.Theriskm�ybe controlledby:

• dr�wingup�llthecontentsofthecont�inerintoindividu�lsyringes before�dministeringtop�tients;

• est�blishing�sep�r�te�re�design�tedforthepl�cementofthese medic�tions�w�yfromthe�nywork�re�;

• coveringthemedic�tionstopreventenvironment�lcont�min�tion;

• h�vingonlythecurrentp�tient’smedic�tionintheimmedi�te workingenvironment;

• using�cle�nneedle�ndsyringetodr�wuptherem�iningcontents ofthevi�l/�mpouleoneveryocc�sion;�nd

• disc�rding�nyopen�mpoule(s)�ttheendofe�chprocedure.

(c) Single-useinstruments�ndequipment

• Instrumentsorequipmentl�belled�ssingleuse,orsingleusedispos�ble bythem�nuf�cturershouldbedisposed�fteruse.Ifitisuncle�rwhether �nitemissingle-useorreus�ble,cont�ctthem�nuf�cturer/supplierfor �dvice.


1.3.5 Blood and body substance spills

Blood and body substance spills pose a health risk.

(�) If�visiblespill�geofbloodorbodysubst�nceoccurs:

• we�rdispos�blegloves�ndprotectiveclothing(see Section 1.1.2);

• pickupbrokengl�ssor�nyothersh�rpincludedinthespillwithforceps �nddisposeofinto�n�pprovedsh�rpscont�iner;

• wipeupblood�nd/orbodysubst�ncesusingdispos�blewipesorp�per towels;

• cle�nsurf�cewithdetergent�ndw�rmw�terusingdispos�blewipesor p�pertowels;

• rinse�nddrysurf�ce(c�rpeted�re�sshouldbesh�mpooed);

• pl�ce�llsoiledm�teri�lsin�n�pprovedyellowclinic�lw�steb�g;�nd

• w�shh�nds�fterremov�lofgloves.

(b) Allst�ffmemberswithinthebusinessshouldh�veknowledgeof�nd�ccessto �current�ndrecogniseddocumentedprocedureforspillm�n�gement.

1.3.6 sharps injuries and blood and body substance exposures

exposures can occur from injuries inflicted by sharps or by splashes into the eyes, nose, mouth or on to non-intact skin.

(�) Them�n�ger,orthelicenseeof�business,should�ppoint�design�tedofficer, �sthepointofcont�ct,toberesponsibleform�n�gementofexposuresto blood�ndbodyfluids�te�chf�cility.Solepr�ctitionersshouldensurethey�re �w�reof�ppropri�teproceduresforde�lingwithoccup�tion�lexposures.

(b) Allst�ffmemberswithinthebusinessshouldh�veknowledgeof�nd�ccessto �current�ndrecogniseddocumentedprocedureform�n�ging�n occup�tion�lexposuretobloodorotherbodysubst�nce.Theseprocedures shouldbereviewedregul�rly�ndthisreviewdocumented.Anynecess�ry ch�ngesidentifiedshouldbecle�rlydefined�ndresponsibilitiesdevelopedfor theirimplement�tion�ndcompletion.

(c) Afterexposuretobloodorotherbodysubst�ncesthefollowing�ctionshould bet�ken�ssoon�siss�fetodoso:

• wheretheexposureinvolves�cutorpuncture,w�shthe�re�thoroughly withliquidso�p�ndw�terfor�periodof�tle�st30seconds;

• ifeyes�recont�min�ted,whileopen,rinsethemgently�ndthoroughly withw�terornorm�ls�line;

• ifbloodorotherbodysubst�ncesgetinthemouth,spititout,thenrinse themouthwithw�tersever�ltimes;

• disposeofneedles�nd/orsyringesinthe�ppropri�tem�nner.These items�regener�llynotrequiredtobeforw�rdedtothel�bor�toryfor testing;�nd

• ifclothingiscont�min�ted,removeclothing�ndshowerifnecess�ry.


Wherew�terisnot�v�il�ble,useof�non-w�tercle�nseror�ntisepticshould repl�cetheuseofso�p�ndw�terforw�shingcutsorpuncturesoftheskinor int�ctskin.

(d) Theinjuredpersonshouldreporttheincidentimmedi�telytotheirsupervisor �ndthengototheirmedic�lpr�ctitioner,hospit�lorhe�lthcentre�ssoon�s possiblefor�ssessmentoftheexposure,bloodtests�ndpostexposure counselling.

(e) Fortheperson�ssessingtheexposure,inform�tionreg�rdingthetype�nd �mountofbodyfluidinvolved,thetypeofequipment/needlebeingused�nd theprocedurebeingperformed�tthetimeoftheexposureisusefulin consideringtheinjuredpersonslevelofrisk.

(f) Theinjuryshouldbedocumented�ndincidentrecordsm�int�inedtomonitor workpr�ctises.

1.3.7 Work place safety

employers have a responsibility to provide a safe work environment.

(�) As�feworkenvironmentinvolvestheprovisionof�dequ�test�fftr�ining, �ppropri�tef�cilities�ndequipment.Workpl�ceconditions,structures,policies �ndprocedures�rerequiredtobedevelopedtominimisepotenti�lh�z�rds.

(b) Bothemployers�ndemployees�rerequiredtobe�w�reof�ndcomplywith Workcoverrequirements�ndtheACT Occupational Health and Safety Act 1989.

(c) St�ffshouldbeencour�gedtobeimmunisedin�ccord�ncewith recommend�tionsdet�iledinthecurrenteditionofThe Australian Immunisation Handbook.Refertohttp://immunise.he�lth.gov.�u/h�ndbook.htm.Hep�titisB v�ccin�tionshouldbeofferedtost�ffinsettingswherethereis�nypossibility ofoccup�tion�lexposuretobloodorbodyfluids.

(d) Employersh�vetheresponsibilitytoensureth�ttheirst�ff�re�w�reof guidelines�ndth�ttheGuidelines�re�v�il�bleforreferencewhenneeded.

1.3.8 Policies and procedures manual

Policies and procedures should be consistent with national standards and infection control principles outlined in national guidelines.

(�) Policy�ndprocedurem�nu�lsb�sedontheproceduresperformedbythe business,shouldbem�int�inedonthepremises�ndshouldbeconsistentwith theCode�ndtheGuidelines.

(b) Policies�ndproceduresshouldbepr�ctic�l,work�ble,relev�nt�ndre�dily �ccessibleto�llpr�ctitionerseng�gedbythebusiness.

(c) Apolicym�nu�lshouldbedevelopedforthefollowingprocedures(where �pplic�ble):

• methodsofh�ndw�shing-routine�ndsurgic�l;

• person�lprotectiveequipmentrequirements;


• cle�ningproceduresbetweenclients/p�tients,includingthecle�ningof benchtops�ndothersurf�ces;

• h�ndling�nddispos�lofsh�rps�ndotherw�ste;

• h�ndling�nddispos�lofused�ndcont�min�tedlinen;

• m�n�gementofblood�ndbodysubst�nceexposures;

• m�n�gementofbloodorbodyfluidspills;

• processingofre-use�bleitemsincludingcle�ning,p�ck�ging, sterilis�tionordisinfection�ndstor�ge;

• v�lid�tionofcle�ning,disinfection�ndsterilis�tionprocesses;

• st�fftr�ining;�nd

• st�ffimmunis�tionrequirements.

(d) Itisrecommendedth�t�systembedevelopedtoensureproofofsighting�nd re�dingofpolicies�ndproceduresby�llst�ff.

1.3.9 Animals

Animals, except for guide dogs, hearing dogs or assistance animals, should not enter an area where skin penetration or infection risk procedures are undertaken.

No�nim�ls�re�llowedtoenter�n�re�wheresterileprocedures�reundert�ken(seeSection9oftheACT Discrimination Act 1991).



PARt tWo: RePRoCessInG oF APPLIAnCes

2.1 Management of appliancesThisis�guideto�ssistst�ffonhowthest�nd�rdscont�inedintheCodem�ybe�chieved.M�n�gementof�ppli�ncesmustbecompli�ntwiththeCode,whichisb�sedonAustr�li�n/NewZe�l�ndSt�nd�rd(AS/NZS)4815:2006“Office-based health care facilities – Reprocessing of reusable medical and surgical instruments and equipment, and maintenance of the associated environment”.

Thelevelofdisinfectionorsterilis�tionsubjectedto�n�ppli�nceisb�sedonthedegreeofriskoftr�nsmissionofinfectioninvolvedintheuseofth�t�ppli�nce.Thec�tegorydependsontheintendeduseofth�t�ppli�nce.(Please note:�ppli�ncec�tegoriesm�ych�ngefromnon-critic�ltosemi-critic�lifcont�ctwithmucousmembr�nesornon-int�ctskinoccurs).

A. Critical: Appliances that enter sterile human tissue, body cavity or blood stream must be sterile at point of use.**

B. semi-critical: Appliances that come into contact with intact mucous membrane or non-intact skin should be single use or sterilised after each use. If this is not possible, high-level disinfection is the minimum level of reprocessing that is acceptable.

C. non-critical: Appliances that come into contact with intact skin are required to be cleaned after every individual use.

(See Appendix Two)

2.1.1 Cleaning appliances

Cleaning is an important prerequisite for disinfection and sterilisation. effective cleaning ensures that appliances and equipment are clean to the naked eye and free from any protein residues and other stains.

(�) Re-us�ble�ppli�ncesshouldbecle�ned�ssoon�spossible�fteruseto preventco�gul�tion�nddryingofblood�ndproteins.If�ppli�ncesc�nnot becle�nedimmedi�tely�fteruse,theyshouldbeimmersedinw�rmw�ter �nddetergentpriortoroutinecle�ning�ndprocessing.

(b) Themethodform�nu�lcle�ningshouldbe�sfollows:

• rinseundertepidrunningw�tertoremovegrosssoiling;

• fill�sinkorbowlwithw�rmw�ter�nddetergenttotheconcentr�tion recommendedbythem�nuf�cturer;

• dism�ntleoropen�ppli�ncespriortopl�cementinthecle�ningsolution;

• w�shbyscrubbingthoroughly�ndensureth�t�ppli�nces�rescrubbed belowthesurf�ceofthew�tertominimise�erosolproduction;

**Itisrecognisedth�tforsomedent�lproceduresequipmentth�tentershum�ntissue,bodyc�vityorbloodstre�mc�nnotbesterile�tpointofuse.Inthesesitu�tions,equipmentmustbesinglep�tientuseonly.


• rinseinw�rmtohotw�tertoremove�nyresidu�ldetergentorother debris;

• dry�ppli�ncespriortofurtherprocessing(see Section 2.1.5);�nd

• visu�llyinspectthecle�nlinessof�llitems.

(c) Duringthisprocess�ll�ppli�ncesshouldbec�refullyinspectedford�m�ge, rust�ndf�ultsinfunction.If�nyd�m�ge,rustorf�ults�refound,the �ppli�nceshouldberemovedfromserviceuntilrep�iredorrepl�ced.

(d) Scrubbingbrushes�ndburrbrushesshouldbecle�ned�nd�utocl�vedon� d�ilyb�sis�ndstoreddry.

2.1.2 Cleaning agents

Cleaning agents are required to be used to remove residual soil and organic matter from appliances and equipment.

(�) Cle�ning�gentsform�nu�lcle�ningshouldbe:

• biodegr�d�ble;

• non-corrosive;

• non-toxic;

• non-�br�sive;

• lowfo�ming;

• freerinsing;

• prefer�blyliquid;�nd

• ofmild�lk�liformul�tions.

(b) Cle�ning�gentsformech�nic�lcle�nersshouldbe:

• biodegr�d�ble;

• non-�br�sive;

• lowfo�ming;

• freerinsing;�nd

• prefer�blyliquid.

(c) Mild�lk�linedetergentsinthepHr�nge8.0-10.8�repreferredoverneutr�l pHdetergentsinmostinstrumentprocessing�pplic�tions.Alk�linedetergents h�veprovenmoreefficientth�nneutr�ldetergentsineffectivecle�ning involvedwithgrosslycont�min�teditems.However,someinstruments�nd equipmentm�ybem�deofm�teri�lswheretheuseofneutr�ldetergentsm�y bemore�ppropri�te.

(d) Proteolyticenzym�ticcle�nersshouldnotberoutinelyused,otherth�nfor fiberopticinstruments�nd�ccessories,�ndforotherinstrumentswheredesign ch�r�cteristicsm�keroutinecle�ningdifficult.Ifproteolyticenzym�ticcle�ners �reused,personnelusingthemshouldbe�w�reoftheir�ssoci�tedh�z�rds, �ndprotectiveclothingisrequiredtobem�de�v�il�ble.

(e) Commonhouseholddetergentsshouldnotbeusedduetotheirhighfo�ming properties�ndthedifficultiesinvolvedinrinsingitemsfreeofresidue.


(f) M�teri�lS�fetyD�t�Sheetsfor�llcle�ning�gentsshouldbere�dily�v�il�ble.

2.1.3 thermal washers/disinfectors

If a large number of appliances need to be cleaned at any one time, the installation of a thermal washer/disinfector could be considered.

(�) If�l�rgenumberof�ppli�ncesneedtobecle�ned�t�nyonetime,the inst�ll�tionof�therm�lw�sher/disinfectorm�ybeconsidered�costeffective option.Therm�lw�sher/disinfectors�respeci�llymodifieddishw�shersth�t�re �bletorinse,cle�n�ndtherm�llydisinfect�ppli�nces.

(b) Wheninuse,therm�lw�sher/disinfectorsshouldbeoper�ted�ndm�int�ined in�ccord�ncewithm�nuf�cturer’sinstructions�ndAS2945:1998Batch-type washer/disinfectors for health care facilities.

2.1.4 Ultrasonic Cleaners (UC)

UCs used to assist with the cleaning of jointed and serrated stainless steel and other appliances are required to comply with As 2773 – 1999 Ultrasonic cleaners for health care facilities.

(�) UCs�rerequiredtocomplywithAS2773:1999 Ultrasonic cleaners for health care facilities.

(b) UCs�rerequiredtobeoper�ted�ndm�int�ined�ccordingtothe m�nuf�cturer’srecommend�tions.

(c) UCsm�ybeusedtoeffectivelycle�njointed�ndserr�tedst�inlesssteel instruments.C�nnul�tedinstrumentsm�ybecle�nedintheUCprovided th�tthem�nuf�cturer’sinstructions�refollowed.Pl�stics�ndothersimil�r m�teri�lsm�ynotbesuccessfullyprocessedbythismethod.Appli�ncesof differentmet�lsshouldnotbecle�nedtogether.Cementedgl�sssyringes, mirrors�ndlenseswillbed�m�gedifrepe�tedlysubjectedtothisprocess.

(d) Met�lvesselswithperfor�tionsofnomoreth�nsixmillimetresm�ybeusedto cont�insm�ll�ppli�nceswithintheUC.Pl�sticcupsorothervesselsshouldnot beusedtoholditemsinsidetheUC�sthesevesselspreventeffectivecle�ning.

(e) Theoper�tionprocessfortheUCis�sfollows:

• fillthew�tert�nkwithcoldortepidw�ter�nd�ddtherecommended �mountofdetergentforUCuse;

• oper�tetheemptyUCforthreeminutestodeg�sthesolution;

• rinseoff�nybloodorothervisiblesoilbeforeimmersingintheUC;

• pl�cejointed�ppli�ncesopened�ndunlockedintheUC;

• oper�teUCforrequiredtime-lidclosed;

• rinsecle�ned�ppli�nces�nddry;�nd

• visu�llyinspectthecle�nlinessof�llitems.


(f) UCoper�tionshouldbemonitoredd�ilyusingthe�luminiumfoiltest(see Diagram Two-Ultrasonic Cleaner foil test).Thistestinvolvesthepl�cementof vertic�lsheetsof�luminiumfoilintotheUCfilledwith�n�pprovedUC detergent.

• Thefoilshouldbeheldinpl�ce(notwithfingers)soth�titissuspendedin thefluid.

• TheUCshouldbeturnedonfortenseconds.DuringthistimetheUCwill putholesinthefoil.

• Iftheholes�reuniformlyspre�d�crossthesheetoffoiltheUCisoper�ting correctly.Ifholes�reonlyconfinedtocert�in�re�s�ndnotothers,orthe foiliswithoutholes,theUCisconsideredtoh�vef�iledthetest�ndis requiredtobeservicedpriortoitsnextuse.

• ResultsoftheUCfoiltestshouldberecorded�ndkeptwithother monitoringrecords.

• OncompletionoftheUCfoiltestthet�nkshouldbedr�ined�nd thoroughlycle�nedtoremove�nyfoilresidue.

(g) Thew�ter�ndcle�ning�gentusedintheUCisrequiredtoberepl�cedd�ily ormorefrequentlyifvisiblecont�min�tionoccurs.UCs�rerequiredtobe cle�ned�ndstoreddryovernight.

Diagram Two: Ultrasonic Cleaner foil test

(Source:Australian Standard 2773.2:1999,p16)

2.1.5 Drying of appliances

Drying reduces the risk of recontamination during inspection and assembly of appliances. Residue and moisture interfere with the sterilisation process and can damage appliances.

(�) All�ppli�nces�rerequiredtobethoroughlydried�fterthecle�ningprocess.

(b) Dryingshouldbecompletedimmedi�tely�fter�ppli�nces�recle�ned throughuseof�lintfreeclothor�dryingc�binet.

(c) Duringthisprocess�ll�ppli�ncesshouldbec�refullyinspectedford�m�ge, rust�ndf�ultsinfunction.If�nyd�m�ge,rustorf�ults�refound,the �ppli�nceshouldberemovedfromserviceuntilrep�iredorrepl�ced.


2.1.6 Packaging of items for sterilisation

Packing items for sterilisation provides an effective barrier against sources of potential contamination, maintains sterility of the appliances and permits aseptic removal of the contents of the pack.

(�) Alljointed�ppli�ncesshouldbep�ck�gedopen�ndunlockedor dis�ssembled,topermitthesterilising�genttocomeintocont�ctwith�ll surf�cesofthe�ppli�nces.

(b) Instrumentsetsshouldbep�ck�gedin�m�nnerth�tpreventsd�m�geto delic�teitems.P�cksshouldnotbeoverfilled.

(c) Sh�rp�ppli�ncesshouldbep�ckedinsuch�w�yth�tthetipsofthese �ppli�nces�reexposedtothesterilising�gentbutwillnotperfor�tethe p�ck�gingm�teri�l.

(d) Allp�ckspl�cedinthesterilisershouldbel�belledwith:

• steriliseridentific�tionnumberorcode(ifthereismoreth�nonesteriliser withinthef�cility);

• d�teofsterilis�tion;

• cyclelo�dornumber;�nd

• contentsofthep�ckifnotvisiblethroughthep�ck.

(e) Prep�redl�bellingsystems,nontoxicfelttippedm�rkingpensorrubberst�mps shouldbeusedforl�bellingp�ckspriortosterilis�tion.Sh�rptipped,w�ter b�sedorb�lltypepensmustnotbeused,�sthesepensm�ycompromisethe integrityofthep�ck.

(f) Allp�cksth�t�renotselfse�ling�rerequiredtobese�ledwith�he�tse�ler orsterilisingindic�tort�pe.Anymethodofclosureth�twillcompromisethe integrityofthep�ckisnottobeused.

2.1.7 non-conforming stock

non-conforming stock is required to be reprocessed prior to reuse.

(�) Ap�ck�gesh�llbeconsiderednon-conforming,ie.non-sterile�ndnotsuit�ble foruse,whenit:

• isincorrectlywr�pped;

• isd�m�gedoropened;

• iswet�fterremov�lfromthesterilisingcycle;

• comesintocont�ctwith�wetsurf�ce;

• ispl�cedordroppedon�dirtysurf�ce,e.g.floororsink�re�;�nd

• h�snoindic�tionofh�vingbeenthrough�sterilisingprocess.

(b) Allnon-conformingp�cks�rerequiredtoberep�ck�ged�ndreprocessed beforereuse.


2.2 Disinfection of appliances

Disinfection by thermal or chemical means does not render appliances sterile and must not be used as a substitute for sterilisation.

Disinfectionisthedestruction,remov�lorreductioninnumbersofmicro-org�nisms�ndissuit�blefor�ppli�nceswhichcomeintocont�ctwith,butdonotpenetr�te,int�ctskinormucousmembr�nes.

(�) Methodsofhighleveldisinfectioninclude:

(i) Therm�ldisinfection

(ii) Chemic�ldisinfection

(b) Priortodisinfection,�ppli�nces�rerequiredtobecle�ned�nddried.

(c) Appli�ncesmustnotbestoredindisinfect�ntbeforeor�fter�nyformof processing.

2.2.1 thermal disinfection

(�) Beforetherm�ldisinfectionisc�rriedout,theitemmustbethoroughlycle�ned.

(b) Foritemsth�t�reunlikelytocont�inhighnumbersofhe�t-resist�ntorg�nisms, thefollowingminimumsurf�cetemper�turetimerel�tionshipsfortherm�l disinfection�rerecommended(see Table One).

Table One: Surface temperature time relationships for thermal disinfection

Surface Temperature (oC) Minimum Disinfection Time (minutes)

90 1

80 10

75 30

70 100

(Source:Standards Australia - AS4815:2006)

(c) Allp�rtsoftheitemneedtobesubjectedtomoisthe�t�tor�bovethe recommendedtemper�turefortherecommendeddur�tion.

2.2.2 Chemical disinfection

A material safety data sheet should be available and the recommended personal protective equipment should be worn when using any chemical disinfectant.

(�) Chemic�ldisinfect�ntsshouldonlybeusedonsemicritic�l�ppli�ncesornon- critic�l�ppli�ncescont�min�tedwithblood�ndbodyfluids.Thorough w�shing�nddryingof�ppli�nces,�sperSection2.1.1�nd2.1.5,isrequired priortotheuseofchemic�ldisinfect�nts.


(b) W�shingwithdetergent�ndw�rmw�teristhepreferredmethodof decont�min�tingnon-critic�l�ppli�nces�ndsurf�ces.

(c) Onlydisinfect�ntsl�belled‘instrumentgr�dedisinfect�nts’whichisin �ccord�ncewiththeTher�peuticGoodsAdministr�tion(TGA),�resuit�blefor reprocessingreus�bleinstruments.

(d) High-levelinstrumentgr�dedisinfect�nts�resuit�bleforuseonsemi-critic�l �ppli�ncese.g.fibreopticscopes,whichcont�ctunbrokenmucous membr�nesth�t�renotnorm�llysterile.

(e) Anintermedi�te-levelorlow-levelinstrumentgr�dedisinfect�ntm�ybeused fordisinfectionofnon-critic�linstruments,which�renorm�llyrestrictedto cont�ctwithunbrokenskin.

(f) Priortouseofdisinfect�nts,referencesh�llbem�detotherelev�nt Occup�tion�lHe�lth�ndS�fetyregul�tions�ndM�teri�lS�fetyD�t�Sheets.

(g) Whenusingchemic�ldisinfect�nts,them�nuf�cturer’sinstructions�re requiredtobefollowedinrel�tiontothedilutionofthedisinfect�nt�ndthe cont�ctorimmersiontime.

(h) The�ppropri�tenessofthedisinfect�ntisdeterminedbythecompositionof thesurf�ceofthe�ppli�nce.Forex�mple,ble�chisnotrecommendedfor useonmet�ls,�sittendstocorrode�ndpitmet�lsurf�ces.Thispittingis difficulttocle�n�ndc�nh�rbourb�cteri�.

(i) Theexpiryd�teshouldbecheckedwithe�chuse.Disc�rdexpiredstock.

2.3 sterilisation of appliances

All appliances used in procedures involving contact with normally sterile areas of the body must be sterile.

(�) Sterilis�tionisthev�lid�tedprocessusedtorender�productfreeof�llforms ofvi�blemicro-org�nisms.Thetwomethodsofsterilis�tion�v�il�bletooffice- b�sedpr�ctice�re:

• ste�m-under-pressure(ste�msterilis�tionusing�n�utocl�ve);�nd

• dryhe�t.

(b) Ultr�violetc�binets,ultr�soniccle�ners,he�tbe�ddevices,pressurecookers, electric,g�sormicrow�veovens�ndboilingdonotresultinsterilis�tion�nd mustnotbeused�s�n�ltern�tivemethodforthesterilis�tionof�ppli�nces.

(c) St�ffinvolvedinreprocessingof�ppli�nces�rerequiredtoh�veknowledgeof correcttechniquestoensuresterilis�tionof�ppli�nces.


2Thisistheminimumtemper�ture�ndpressurerecommendedforsterilising�ppli�ncesusedforclients/p�tientssus-pected�sh�vingCreutzfeldt-J�kobDise�se(CJD)orSub�cutespongiformenceph�lop�thy.Cycletimes�reb�sedon recognised national CJD guidelines at time of publishing. NB. If you are required to use this cycle in office based pr�ctice,notifytheInfectionControlUnit,He�lthProtectionService,ACTHe�lthon62051700.


2.3.1 steam under pressure (steam sterilisation using an autoclave)

the manufacturer’s recommendations and As/nZs 4815:2006 are required to be followed on the use of steam sterilisers.

(�) Appli�ncesmustbethoroughlycle�ned�nddried�soutlinedinSection2.1.1 �nd2.1.5priortoste�msterilis�tion.

(b) Critic�l�ppli�nces,which�renotforimmedi�teste�msterilis�tionoruse �rerequiredtobecle�ned,dried�ndwr�pped/p�ck�gedpriortosterilis�tion orstor�ge.M�teri�lsusedforthep�ck�gingorwr�ppingof�ppli�nces�re requiredtobesuit�bleforthesterilisingmethod.

(c) Steriliserswithout�dryingcyclemustnotbeusedtosterilisewr�ppeditems.

(d) Lo�dingofthesterilisermustbecompletedinsuch�m�nnertoensureth�t ste�mcomesincont�ctwith�llsurf�cesofthe�ppli�nce.

(e) Therecommendedtemper�ture,pressure�ndholdingtime,�sindic�tedin T�bleTwo,mustbere�chedwhenprocessing�ppli�nces.

Table Two: Temperature pressure-time relationship for steam under-pressure sterilisation

Temperature Pressure Pressure Holding Time (minutes) oC kPa psi plus safety factor

121 103 15 15

126 138 20 10

132 186 27 4

134 203 30 3 *CJD2134 206 30 18minutesor6sep�r�te 3minutecycles

(Ad�ptedfromAustralian Standard AS 4815:2006)

(f) Followingthesterilisingcycle,�ppli�nces�rerequiredtoberemovedfromthe steriliserin�drycondition.P�ck�gesremovedwetmustbe�ssumednonsterile �ndrequirereprocessing.

(g) Sterile�ppli�ncesmustbestored�ndh�ndledin�m�nnerth�tm�int�insthe integrityofp�cks�ndpreventscont�min�tionfrom�nysource(see Section 2.1.7).

2.3.2 steriliser monitoring

It is essential that staff understand the steps that should be taken to monitor every sterilisation cycle.

(�) E�chsterilis�tioncyclemustbemonitored�ndtheresultsrecorded.These results�rerequiredtobecheckedbytheoper�tortoverifyth�tthecorrect cyclep�r�meters�remetbeforethelo�disrele�sedforuse.

(b) Forsteriliserswith�ninbuiltmonitoringf�cilityth�tproduce�perm�nent record,e�chcycleisrequiredtobemonitoredwith:

• �printoutofp�r�meters�tregul�rinterv�lsthroughoutthecycle;or

• downlo�ding�ndreviewinginform�tionstoredon�d�t�logger�fter e�chcycle�ndpriortorele�seofthelo�d;�nd

• �cl�ssonechemic�lindic�tortodistinguishifthelo�dh�sbeen processedorunprocessed.(Cl�ssoneindic�torsinclude�utocl�vet�pe, sterilizingp�ck�ging,chemic�lindic�tors�ndb�tchl�bels)(see Glossary).

(c) Forsteriliserswithout�ninbuiltmonitoringf�cility,e�chcycleisrequiredtobe monitoredwith:

• theuseof�cl�ssfour,fiveorsixchemic�lindic�tor(see Glossary);or

• directobserv�tion�ndrecordingofcyclep�r�meters,foreveryindividu�l cycle�tinterv�lsof10seconds.

(d) Biologic�lorenzym�ticmonitoring�rerequiredtobeconductedweekly.

(e) Iftheentiresterilis�tionprocessh�sbeenv�lid�ted,biologic�lorenzym�tic monitoringdoesnoth�vetobeperformedweekly.Biologic�lorenzym�tic monitoringisrequiredtobecompleted�sp�rtofthe�nnu�lv�lid�tion process(see Section 2.3.3).

(f) Biologic�lorenzym�ticindic�tors�rerequiredtobeusedduringinst�ll�tion �ndtestingofsterilisers,�nd�fterrep�irs�sp�rtofthev�lid�tionprocess.

(g) Acontrolisrequiredtobeusedwhenundert�kingbiologic�lmonitoring.

(h) Routinec�libr�tionchecks�ndm�inten�nceof�llme�suringdevices,timers, g�uges�nddispl�ysmustbec�rriedoutby�skilledperson,certifiedby� recognisedcertific�tionbodysuch�stheN�tion�lAssoci�tionofTesting Authorities(NATA).Thesteriliserisrequiredtobec�libr�ted:

• oninst�ll�tion;

• eithereverysixmonths(ifnoc�libr�tionhistoryexists)or12months(where �n�ccept�blec�libr�tionhistoryexists);

• �fterrep�ir;�nd

• �sp�rtofthev�lid�tionprocess(see Section 2.3.3).


2.3.3 steriliser validation/revalidation

(�) ‘V�lid�tion’is�documentedprocedureforobt�ining,recording�nd interpretingresultsrequiredtoest�blishth�t�processwillconsistentlyyield �productcomplyingwithpre-determinedspecific�tions.

(b) Rev�lid�tionmustbeperformed�nnu�lly�nd�fter�nyofthefollowingevents:

• inst�ll�tion�ndcommissioningofnewequipment;

• servicingofthesteriliser;

• modific�tionsortechnic�lch�ngestothesteriliser;

• ch�ngestothep�ck�ging/wr�ppingm�teri�ls;

• ch�ngestothecontentoftr�ys�ndp�cksth�texceedpreviously v�lid�tedp�r�meters;�nd

• ch�ngestothelo�dsizesth�texceedpreviouslyv�lid�tedp�r�meters.

(c) V�lid�tion/rev�lid�tionismostefficientlyc�rriedoutbypr�cticest�ffin conjunctionwithroutine,�nnu�lc�libr�tion�ndservicingofthesteriliser.

(d) Tov�lid�te/rev�lid�te�sterilisingprocess,threeidentic�l,consecutive ‘ch�llenge’lo�dsmustbeperformed,monitored�nddocumented(seebelow).

A‘ch�llenge’lo�dconsistsof:

• �‘ch�llengep�ck’–themostdifficult�ndl�rgestpiece/setof equipmentsterilised�tthepr�ctice,p�ckedwith�biologic�l/enzym�tic indic�torpl�cedinthecentre;

• �ddition�lp�ckscont�ining�ppli�ncesusedinthepr�ctice(fillthe rem�ining�v�il�blesp�ceinthesteriliser);�nd

• �n�ddition�lbiologic�l/enzym�ticindic�tor,pl�cedinthe‘coldspot’ ofthesteriliser.(Usu�llythereis�coldspotin�steriliserth�th�sbeen determinedbythesterilisertechnici�n.Thisspotwillnotch�ngeunless rep�irsh�vebeenperformedorthesteriliserh�sbeenmoved).

(e) The�n�lysisofthed�t�obt�inedfromthethree‘ch�llenge’lo�dswill demonstr�teth�t�cycleforth�tsteriliser,willorwillnotconsistentlyrender �specifiedlo�dsterilewhen�llp�rtsoftheprocess�refollowed.V�lid�tion is,therefore,notjustrel�tedtothesteriliser,but�lsotosuchf�ctors�sthelo�d, itsprep�r�tion�nditspl�cementinthesteriliser.

(f) Procedure for validation/revalidation is as follows:

1. L�belbiologic�l/enzym�ticindic�tors�ccordingtothecyclenumber�nd pl�cementpositioninthesteriliser. note:Indic�torsmust�llbeofthes�metype�ndb�tchnumber�ndthe usebyd�temustbereviewed.

2. Pl�ce�l�belledindic�torinthecentreofthe‘ch�llengep�ck’.

3. Pl�ce�l�belledindic�torinthe‘coldspot’ofthesteriliser(commonly �tthere�rne�rthedr�in).

4. Pl�cethech�llengep�ck�ndotherp�cks,which�renot�sdenseor bulky�sthe‘ch�llengep�ck’,intothesteriliser.

5. Runthesteriliseron�regul�rcycle.


6. Repe�tthisprocesstwomoretimes,using�nidentic�l‘ch�llenge p�ck’with�newindic�tor,�nd�newindic�torinthecoldspot.When repe�tinge�chcycle,p�cksmustberewr�ppedwithinstrumentscooled toroomtemper�ture.

7. Atcompletionofthethreecycles,thesevenindic�tors(6tests�nd1 control)mustbeincub�ted(ifbiologic�l)ortre�ted�ppropri�tely(if enzym�tic)�ccordingtothem�nuf�cturer’sinstructions.Pr�cticesm�y opttopurch�setheirownincub�tor(c�libr�ted�nnu�llybeforeuse),or utilise�loc�lp�thologyservice(Tr�nsportthebiologic�lindic�torsto� p�thologyl�bin�coolerbox). note:Acontrolindic�tor(onewhichh�snotbeenthroughthesterilis�tion process)isutilisedtocheckthevi�bilityofthespores.

8. Allindic�torsth�th�vebeenthroughthesterilis�tionprocessshouldshow nogrowth.Ifnot,itindic�tes�processf�ilure.Thismustbeinvestig�ted. Documentthec�use�ndcorrectiveme�surest�ken.Thewhole procedureisrequiredtoberepe�ted.the control indicator should show growth.

9. Theentirev�lid�tionprocessisrequiredtobedocumented. Document�tionshouldinclude:

• descriptionofthe‘ch�llengep�ck’contents�ndp�ck�ging;

• descriptionoftheothercontentsinthe‘ch�llenge’lo�d;

• di�gr�mshowingthepl�cementof�llp�cksinthe‘ch�llenge’ lo�d;

• position/loc�tionoftheindic�tors;

• time/d�teofe�ch‘ch�llenge’lo�dcycle;

• indic�torb�tchnumber�ndexpiryd�te;�nd

• resultsofindic�tors.

2.3.4 steriliser failures

In the event that one or more of the monitoring processes fails, the event is required to be investigated and action taken.

(�) Allmonitoringf�ilures,togetherwith�nycorrective�ction,mustbe documented.

(b) Thefollowingisrequiredtobecompletedintheeventof�f�ult:

• thesteriliserisrequiredtobere-tested�ndthecycleobservedto determineifthef�ultc�nbeidentified;

• �llcritic�lp�r�meters�rerequiredtobecheckedtoensurethereh�s beenno�lter�tionofthecyclesetpoints;�nd

• iftheoper�torisun�bletoobt�in�successfulresult�fterrunning� testcycle,thesterilisermustbet�kenoutofuse�nd�servicec�llpl�ced with�serviceprovider.Followingrep�ir,re-v�lid�tionisrequiredtobe c�rriedoutbytheuser�ttheusersitepriortothesteriliserbeing reintroducedforuse(Refer to AS/NZ 4815:2006).


2.3.5 Documentation of steriliser cycles

Documentation of steriliser cycles assures monitoring of the steriliser cycle and establishes accountability. It also enables identification of items should evidence indicate sterility problems or failure.

(�) Fore�chsterilisingcycle,records�rerequiredtobem�int�ined.Thecycle recordsmustinclude:

• thed�teofthecycle;

• thesterilisernumberorcode(ifthereismoreth�nonesteriliser);

• thecycleorlo�dnumber(ifmorethenonelo�dperd�y);

• theexposuretime�ndtemper�ture;

• then�meoftheperson�uthorisingrele�seoflo�dcontents;

• �summ�ryofthelo�dcontents;�nd

• there�doutorresultofchemic�l,physic�lorbiologic�l/enzym�tic indic�tors.

note: Existingsteriliserswithoutprocessrecordersneedtobeupgr�dedor repl�cedtoensure�utom�ticp�r�meterrecording.

(b) Documentedevidenceofsteriliserc�libr�tion�ndservice�rerequiredtobe keptfore�chsteriliserinuse.Theserecordsmustinclude:

• c�libr�tionofthesteriliser;

• mech�nic�ltesting;

• �nysteriliserf�ilures;�nd

• rep�irs�ndprevent�tivem�inten�nce.

(c) Steriliserrecordsshouldbe�rchivedfor�periodoffiveye�rswiththe requirementth�ttherecordsforthetwomostrecentye�rsbeon-siteinthe workpl�ce.

2.3.6 Dry heat sterilisation

the manufacturer’s recommendations are required to be followed on the use of dry heat sterilisers. .

(�) Appli�ncesmustbethoroughlycle�ned�nddried�soutlinedinSection2.1.1 �nd2.1.5priortodryhe�tsterilis�tion.

(b) To�chievesterilis�tionthe�ppli�nces�rerequiredtobem�int�inedin�dry �iroven(dryhe�tsteriliser–hot�irtype)�t160degreesCelsiusfor�minimum holdingtimeof120minutespluspenetr�tiontime.

(c) M�teri�lsusedforthep�ck�gingorwr�ppingof�ppli�ncesmustbesuit�ble forthesteriliser.

(d) Allp�ck�ged�ndwr�pped�ppli�nces�rerequiredtobestored�ppropri�tely tom�int�insterility.


(e) Monitoringofthesterilisermustinclude:

• weeklybiologic�ltesting;

• �chemic�lindic�torineverylo�d;�nd

• physic�lrecordingofthetime,pressure�ndtemper�tureeverylo�d. Wherethesep�r�meters�redispl�yedong�uges�nddeviceswith noperm�nentrecord,there�dingshouldbedocumentedforevery individu�lcycle�tinterv�lsof10minutesor�Cl�ss4,5or6(see Glossary) chemic�lindic�torspecificfordryhe�tisrequired�ndsh�llbeusedfor e�chlo�d.

note:Existingsteriliserswithoutprocessrecordersneedtobeupgr�dedor repl�cedtoensure�utom�ticp�r�meterrecording.

2.4 Critical incidents

Theproprietorof�nybusinessboundbytheCodemustinformtheHe�lthProtectionService(HPS)of�nyincidentth�toccurs�tthepremises,whichresultsin�m�jorbre�choftheCode.

Theincidentmustbereportedbytelephoneon62051700,withinonebusinessd�yoftheincidentt�kingpl�ce.

F�iluretocomplywiththissectionm�yresultinconditionsbeingpl�cedon�businesslicence,th�tlicencebeingrevokedorrelev�nt�ctiont�kenunderthePublic Health Act 1997.

Anex�mpleof�m�jorbre�choftheCodewouldincludethereuseof�ppli�ncesth�th�venotbeeneffectivelycle�ned,disinfected�nd/orsterilised.

For further information relating to this section refer to

As/nZs 4815:2006 Office-based health care facilities – Reprocessing of reusable medical and surgical instruments and equipment, and maintenance of the associated environment.

to purchase a copy of As/nZs 4815:2006 phone standards Australia on 1300 65 46 46 or access the website at www.standards.org.au



PARt tHRee: BUsIness sPeCIFIC ReQUIReMents

P�rtThreeoftheGuidelinesisdirected�tbusinessesth�th�vespecificinfectioncontrolrequirements.

Itisrecognisedth�tthisp�rtm�ynotcover�ll�spectsin�llbusinesses,�nd�ssuch,specificquestionsm�ybedirectedtotheInfectionControlUnit,He�lthProtectionService,ACTHe�lthon(02)62051700.

3.1 Acupuncturist

All appliances used in the penetration of skin in acupuncture procedures are required to be sterile and single use only.

(�) Skinisrequiredtobedisinfectedpriortoneedleinsertion(see Section 1.1.7).

(b) Anewsw�bisrequiredbeusedfore�chsep�r�te�re�ofthebody.For ex�mple,ifneedles�retobeinsertedintotheb�ck�ndthelegs,�sep�r�te sw�bisrequiredfortheb�ck�nde�chleg.

(c) All�ppli�ncesusedinthepenetr�tionofskinin�cupunctureprocedures�re requiredtobesterile�ndsingleuseonly.Thisincludes:

• �cupunctureneedles;

• e�rpressneedles;

• derm�lh�mmer;�nd

• guidetubes.

(d) Sh�rps�rerequiredtobeh�ndled�nddisposedofin�ccord�ncewithSection 1.1.3.

(e) Whereitisnecess�rytogr�sptheneedlesh�fttof�cilit�teinsertion,the followingmethodsmustbeused:

• use�sterileinsertiontube;

• use�freshpre-p�ck�gedsterile�lcoholsw�borfreshsteriledrysw�b;or

• use�sterileglove.

(f) Suctioncups�ndothernon-sh�rpdevices�ppliedto�skin�re�directly�fter theuseof�derm�lh�mmer,l�ncetorprism�ticneedle,�rerequiredto becle�ned�nddisinfectedorsterilisedpriortobeingreused(See Part Two).

(g) B�mboosuctioncups�resingleuse�ppli�nces�ndmustnotbereused,�s b�mbooisporous�nddifficulttocle�n�fteruse.


3.2 Beauty therapist

Wax must not be reused.

3.2.1 General

(�) We�rsingleusegloveswhenperformingskinpenetr�tionprocedures(e.g. w�xing,electrolysis).

(b) Topreventcont�min�tionofthestockw�x,either:

• �newsingleusesp�tul�isrequiredtobeusede�chtimew�xist�kenout ofthepot;or

• thepotisrequiredtobeemptied�ndcle�nedbetweenclients�ndthe rem�iningw�xdisposedofin�n�ppropri�tem�nner.

(c) Onlysingleusedispos�blel�ncets�ndelectrolysisneedles�rerequiredtobe used.Thesesh�rps�rerequiredtobeh�ndled�nddisposedofin�ccord�nce withSection1.1.3.

(d) Allnon-inv�sive�ppli�ncessuch�stweezers,brushes,�nd�pplic�torsusedfor be�utytre�tments,shouldbecle�nedthoroughlypriortoreuse.

(e) Equipment,otherth�nscissors�ndclippers,usedinm�nicures�ndpedicures �rerequiredtobesingleuse�nddisposedofimmedi�tely�fteruse.

(f) Reus�blem�keup�pplic�tionequipmentisrequiredtobecle�nedthoroughly priortoreuse.

(g) Reus�ble�ppli�ncesshouldnotbestoredin�disinfect�nt.Theyshouldbe �ppropri�telyreprocessed�ndstoreddry.

(h) Noncritic�l�ppli�ncescont�min�tedwithbloodorbodyfluids�rerequiredto becle�ned,dried�nddisinfectedpriortoreuse.(see Sections 2.1.1 ,2.1.5, 2.2, 2.2.1, 2.2.2 and Appendix Two).

(i) Any�ppli�nceswhichc�nnotbeproperlycle�ned,such�sloof�hsponges, �rerequiredtobesingleuse.

(j) Whereperm�nentm�keupis�ppliedthroughtheprocessoft�ttooing,the specificrequirementsfort�ttooingshouldbefollowed(see Section 3.7).

(k) Oil,dye,pigmentorlotionm�ybep�ck�ged�ssingleuseorcont�inedin pump�ctioncont�iners.However,ifitistobeusedfrom�multi-usesupply,it shouldbedec�ntedfromitscont�ineron�singleuseb�sis.Fluidrem�ining�t theendofe�chprocedureshouldbedisc�rded�ndtheusedcont�iner cle�ned�nddriedbeforereuse.

(l) Cre�mm�ybep�ck�ged�ssingleuseorcont�inedin�pump�ction cont�iner.Ifmorecre�mfrom�multiusej�risrequiredduring�procedure,it shouldbe�ppliedwith�newsp�tul�.


(m) Ifreus�blepumpcont�inersorplungers�reusedtheyshouldbecle�ned�nd driedpriortorefillingwithfreshfluidsorcre�ms.F�iluretodothiscouldresultin thecont�min�tionofthefluidorcre�mfromthepreviouslycont�min�ted cont�inerorplunger.Duetothedifficultyincle�ning,itisprefer�bletorepl�ce plungerswhenpumpcont�inersbecomeempty.

(n) Footb�thcle�ningprocedureincludes:

• we�ringgloves;

• w�shinginw�rmw�ter�nddetergent;

• rinsinginhotrunningw�ter;�nd

• dryingwithlintfreecloth.

note:Cle�ningm�ynotbesufficienttoremovesomefung�lmicro-org�nisms thereforedisinfection�ftere�chclientisrecommendedp�rticul�rlyifthefoot b�this�‘sp�’type.

3.2.2 Procedure for management of bleeding during nail treatments

Assoon�sbleedingoccursst�ffshould:

• stoptheprocedure�ndputon�p�irofdispos�blegloves;

• pl�ce�cle�ndressingonthewound�nd�pplypressuretostop bleeding;

• if�pplyingstyptic,�pplyitdirectlyonto�cottonbud,ensurethebottleof stypticdoesnotcomeintocont�ctwiththeclient’sskin;

• keepequipmentth�th�sbeenincont�ctwithbloodsep�r�tefromother cle�ndryequipment;

• pl�cesoiledreus�bleequipmentinto�smoothw�sh�blecont�inerto �w�itcle�ning;

• disc�rdfilehe�dsintorubbishbin�nddisc�rdbloodst�ineddressing�s soon�stre�tmentiscomplete;

• wipetheelectricfileh�ndlewithdetergent�ndw�ter�nd�dispos�ble clothtoremove�nyblood;

• cle�nwork�re�surf�ces(eg.benches,ch�irsorfloors)th�th�vebeen soiledwithblood,�ssoon�spossible,usingw�ter,detergent�nd� dispos�blecloth;

• disposeofclothsusedforwipingupblood;�nd

• w�shh�ndsthoroughly�fterremovinggloves.

3.3 Body Piercer

Jewellery used in a piercing is required to be sterile.

(�) Skinisrequiredtobedisinfectedpriorto�bodypiercingprocedure.

(b) Sterilejewelleryisrequiredtobeusedin�piercing.


(c) Closede�rpiercinggunsshouldbeusedtopiercelowere�rlobesonly�nd m�ynotbeusedtopiercethenoseoruppere�r.Closedpiercingguns�re requiredtobethoroughlycle�nedwithdetergent�ndw�ter�nddisinfected priortoreuse.

(d) C�nnul�susedtopiercetheskin�rerequiredtobesterile�ndsingleuseonly.

(e) Sh�rps�rerequiredtobeh�ndled�nddisposedofin�ccord�ncewithSection 1.1.3.

(f) Loopedforceps�ndpliersusedduringthepiercingprocedure�rerequiredto besterile.Ifreused,these�ppli�nces�rerequiredtobecle�ned�ndsterilised priortoreuse,in�ccord�ncewithP�rtTwooftheseguidelines.

(g) Iffingers�reusedinste�dofplierstoclosethejewellery,sterileglovesmust beworn.Itisimport�nttopreventcont�min�tionoftheseglovespriortothe procedure.

(h) Allclientsth�treceive�piercingshouldbesuppliedwithwritten�fterc�re inform�tionincluding:

• gener�lc�reinstructionsofthepiercing;

• cle�ningofthepiercingsite�ndjewellery;

• piercinghe�lingtimes;�nd

• signs�ndsymptomsofinfection�ndwhotocont�ctifinfectionis suspected.

(i)Biopsyorderm�lpunchesshouldnotbeused.

3.4 Dentists

Unused appliances remaining on the bracket tray after treatment of a client/ patient should be considered contaminated and are required to be reprocessed.

(�) Slowspeedst�inlesssteelburrs�reconsideredsingleuseitems�ndc�nnotbe s�felyreprocessed.

(b) Slowspeedtungstenc�rbide�ndhighspeeddi�mondtipburrs,th�t�renot deemedsingleusebythem�nuf�cture,shouldbereprocessedbyrinsingin tepidw�ter�ndthencle�nedin�nultr�soniccle�nerorbyh�ndwith�burr brush.

(c) Burrsc�nnotbes�felyprocessedbyso�kingin�chemic�ldisinfect�nt. Oncecle�nofdebris,tungstenc�rbide�nddi�mondtippedburrsshouldthen be�utocl�ved�ndstoredprotectedfromenvironment�lcont�min�tionprior toreuse.

(d) Tungstenc�rbideburrswillcorrodewithrepe�ted�utocl�ving�ndshouldbe disc�rdedwhenobviouslydiscoloured.

(e) Singleuseproductsshouldnotbereused.Thisincludesdispos�blesuctiontips.


(f) Whenretrieving�ddition�l�ppli�nces�ndm�teri�lsoutsidetheoper�tingfield (work�re�)�cle�nh�nd,b�rrierortr�nsferforcepsshouldbeused.Itis import�ntth�t�llcupbo�rds�nddr�wers�ndthe�ppli�ncestherein�renot cont�min�tedwithdirtygloves.

(g) Dis�ssembledent�lh�ndpiecesbeforecle�ning.H�ndpiecesmustbe cle�ned�ndsterilisedbetweenp�tients.Cle�ning,lubric�tion�ndsterilising shouldbec�rriedout�ccordingtom�nuf�cturer’sinstructions�ndP�rt Twoofthisdocument.Wipingorso�kingin�chemic�ldisinfect�ntisnot�n �ccept�blemethodforreprocessingh�ndpieces.

(h) Dent�lunitssupplyingw�tertointr�-or�ldent�lh�ndpiecesmusth�venon- returnv�lves.

(i) H�ndpieces,triplexsyringes,ultr�sonicsc�ler�ndsuctionlinesshouldbe flushedfor�minimumoftwominutes�tthest�rtofe�chd�y�ndfor30 secondsbetweenp�tients.

(j) Files,re�mers�nd�llotherdispos�bleequipmentusedforpulpectomies�re requiredtobesinglep�tientuse.

(k) Triplexsyringetipsmustberemoved,cle�ned�ndsterilized�ftere�chp�tient use.Ifsterilis�tionisnotpossiblethensingleusepl�stictipsmustbeused.

(l) Ultr�sonicsc�lertipsmustberemoved,cle�ned�ndsterilised�ndtheh�ndle cle�nedwithdetergent�ndw�rmw�ter�ftere�chp�tientuse.

(m) P�tientsshouldbesuppliedwithprotectivegl�ssesduringtre�tmentstoprotect theeyesfrompotenti�llyh�rmful�erosolsgener�tedduringtre�tments. Protectiveeyewe�rm�ybereused�ftercle�ningwithdetergent�ndw�ter.

(n) Reshe�thingofneedlesisnotrecommended,however,whererec�ppingof �needlec�nnotbe�voidedtheperson�dministeringtheinjectionshould dotherec�ppingoftheneedle.Rec�ppingshouldbedoneusing�one h�ndedscooptechnique,withforceps,orother�pprovedrec�ppingsystem.

(o) Sh�rps�rerequiredtobeh�ndled�nddisposedofin�ccord�ncewithSection 1.1.3.

(p) WhenusingX-r�yfilm,st�ffshouldemploythefollowingtechnique:

• pl�cepl�sticsleevesovertheX-r�yfilmbeforeuse;

• remove�nddisc�rdthesleevefollowingexposure,withoutcont�min�ting thefilm;

• remove�nddisc�rdgloves;�nd

• processthenon-cont�min�tedfilm.

(q) M�sksusedforthedeliveryofnitrousoxidefor�n�estheticpurposesshouldbe eitherdisposedof�fteruseorcle�ned,disinfected�ndstoreddry.

(r) Personstr�nsportingdent�lprostheticitemstol�bor�toriesoffsitemustnotbe pl�ced�triskfromh�ndlingcont�min�tedorunse�leditems.


3.5 Dental Laboratory (both on and off site)

Prosthetic items received from off site dental laboratories are required to be rinsed and washed in detergent and water on receipt.

(�) Impressions,w�xrims,�ndj�wregistr�tionstry-ins�rerequiredtoberinsed�nd w�shedindetergent�ndw�rmw�teronreceiptinthel�bor�tory.

(b) Prostheticdent�ldevices(such�sdentures�ndp�rti�lpl�tes)�rerequiredto becle�nedwithdetergent�ndw�rmw�teronreceiptinthel�bor�tory.

(c) Freshpumiceistobeusedfore�chprosthetic.

(d) Freshl�themops/brushes�retobeusedfore�chimpression/prosthetic.The mops/brushes�retobew�shedindetergent�ndw�rmw�ter�ndthenleftto dryfollowinguse.

(e) Ifpossible,�ftercle�ningwithdetergent�ndw�rmw�ter,l�themops/brushes shouldbepl�cedthrough�sterilis�tioncycle.

(f) Personstr�nsportingdent�lprostheticitemsfroml�bor�toriesoffsiteshouldnot bepl�ced�triskfromh�ndlingcont�min�tedorunse�leditems.

3.6 Mobile Practitioners

Anyone who carries out skin penetration or infection risk procedures away from fixed premises for fee, reward or public service, is considered to be a mobile practitioner and should comply with the Code.

(�) Pr�ctitionerswhoperforminfectionriskprocedures�w�yfrom�pproved premises�rerequiredtobelicensed�s�mobilepr�ctitioner(refertheCode Section 5, Licensing requirements and exemptions 5.1).

(b) Themobileest�blishmentisrequiredtobem�int�inedin�cle�ncondition�t �lltimes�ndmustnotbeusedforfoodprep�r�tionor�ccommod�tion.

(c) Pr�ctitioners�rerequiredtoensureth�tf�cilities�re�v�il�bleto�dequ�tely store�llequipment,linen�ndw�stes�felybefore�nd�fteruse�ndwhilein tr�nsit.

(d) Tr�nsportingsh�rps�ndcont�min�tedw�ste�rerequiredtocomplywith Sections1.1.3�nd1.1.4.

(e) Pr�ctitioners�rerequiredtoensureth�ttheirh�nds�re�dequ�telyw�shed priorto�nd�fterskinpenetr�tionorinfectionriskproceduresbeingperformed (see Section 1.1.1).

(f) Allpr�ctitionerstr�nsportingcont�min�ted�ppli�ncesfromonepremiseto �nother�rerequiredtoensureth�tthe�ppli�nces�resecurelystoredin�rigid �irtightcont�iner.

(g) Sterileitemsintendedforuseoutsidetheofficepr�cticesh�llbesecurely p�cked�ndprotected�g�instd�m�ge�ndcont�min�tionduring tr�nsport�tion.


(h) Skinpenetr�tionorinfectionriskproceduresc�rriedon�tshows,outdoor events,nightclubs,conventionsorotherpubliceventsforfee,rew�rdorpublic service,mustbecompli�ntwiththeCode.

(i) Anypersonperformingskinpenetr�tionorinfectionriskprocedures�tshows, outdoorevents,nightclubs,conventionsorotherpubliceventsisconsideredto be�mobilepr�ctitionerforthepurposeoftheCode.

3.7 tattooist

tattoo needles and needle bars, tubes or barrels must be cleaned and sterilised before reuse.

(�) Ifsh�vingisrequired,�newdispos�bles�fetyr�zorisrequiredtobeusedfor e�chclient�nddisc�rdedinto�n�pprovedsh�rpscont�iner.

(b) Skinisrequiredtobedisinfected�tthesitewherethet�ttoowillbec�rriedout.

(c) Sh�rps�rerequiredtobeh�ndled�nddisposedofin�ccord�ncewithSection 1.1.3.

(d) Steriledispos�blesingleuseneedles�rerequiredtobeused.

(e) Needleb�rs�ndtubesorb�rrelsusedon�clientshouldbecle�n�ndsterile.

(f) Ifpetroleumorlubric�tingjellyistobeusedtocovertheclient’sskin,thejelly shouldberemovedfromthecont�inerusing�newwoodenorpl�sticsp�tul�. Anewsp�tul�shouldbeusedeverytimemorejellyisrequiredfromthe cont�iner.

(g) If�cre�m,oil,dye,pigmentorlotionisbeinguseditshouldbedec�ntedfrom itscont�ineron�singleuseb�sisusing�cle�nsp�tul�.Fluidrem�ining�tthe endofe�chprocedureshouldbedisc�rded�ndthecont�inercle�ned beforereuse.



PARt FoUR: ConstRUCtIon oF PReMIses In oFFICe PRACtICe

4.1 Introduction

Thecorrectdesignof�premiseorf�cility�ssistsinminimisingtheriskoftr�nsmissionofinfectionduringtheprovisionofservices.Premiseswithoutsep�r�te�ndcle�rlydefinedtre�tment,h�ndw�shing�ndcle�ning�re�sm�yposeperm�nentproblemsforst�ff,clients/p�tients.Itisrecognisedth�tnot�llcurrentpremiseswillmeetthesest�nd�rds,howeverifbusinessesrenov�te,reloc�teornewbusinessesopen,itis�requirementtocomplywithcurrentst�nd�rds.

Pl�nningfornewconstructionorm�jorrenov�tionrequirese�rly�ndcontinuousconsult�tionbetween�rchitects,engineers,st�ffoper�tinginthenewf�cility�ndgovernment�uthorities,includingtheInfectionControlUnit,He�lthProtectionService,ACTHe�lth.Thisconsult�tionprocessisrequired,to�ssistthepremisesorf�cilitytocomplywithinfectioncontrolguidelines,ACTGovernmentlegisl�tion�ndtomeettheneedsofthef�cilityst�ff.

Occup�tion�lhe�lth�nds�fety�ndcle�ningissues�rerequiredtobeconsidered�t�llst�gesofthedesign�ndconstructionof�premiseorf�cility.Thetextureofflooring,height�ndpositioningofsinks/b�sins,benches�ndswitches�rerequiredto�llbet�keninto�ccountduringthedesignph�se,�stheym�ybedifficult�ndorexpensivetorectify�ftercompletionoftheworks.

4.2 Additional resources

Thissectionshouldbere�dinconjunctionwiththeBuilding Code of Australia�ndotherdocuments�sspecifiedbyACTPl�nning�ndL�ndAuthority(ACTPLA)�ndACTBuilding,Electric�l�ndPlumbingControl(BEPCON).

Priortothedesign�ndconstructionofhe�lthc�re�ndotherl�rgef�cilities,otherdocumentsbeconsultedinclude:

• theAustr�li�nCouncilonHe�lthc�reSt�nd�rds(ACHS)EQuIPGuide;�nd

• Austr�li�nSt�nd�rdAS/NZS4187:2003Cleaning, disinfecting and sterilizing reusable medical and surgical appliances and equipment, and maintenance of associated environments in health care facilities.

4.3 treatment areas

A hand basin should be installed in close proximity to the treatment area. Where non-invasive procedures are performed the hand basin may be installed adjacent to the treatment room.

(�) Thetre�tmentroomor�re�shouldbeofsufficientsizeto�llowproceduresto bes�fely�ndeffectivelyperformed.Indeterminingthesize,consider�tion shouldbegivento�ny�ppli�nceswhichm�yberequiredinthe�re��tthe timeof�procedure.


(b) Allfloors,floorcoverings,w�lls,ceilings,shelves,fittings�ndotherfurniture shouldbeconstructedfromm�teri�lssuit�blefortheproceduresbeing undert�keninthetre�tment�re�.

(c) In�re�swherebloodorbodyfluidspills�repossible,orinv�siveprocedures �reperformed,smoothimpervious�ndse�mlesssurf�ces,includingw�lls,floors �ndbenchsurf�ces,shouldbeused.Floorcoveringsshouldbenon-slip.

(d) Allfixtures�ndfittingsloc�tedinthetre�tment�re�shouldbedesignedto �llowe�sycle�ning�ndtolimitthe�ccumul�tionofdust.M�teri�lsusedin thesefixtures�ndfittings�rerequiredtobe�bletowithst�ndcle�ning�gents.

(e) Ah�ndb�sinisrequiredtobeinst�lledincloseproximitytothetre�tment�re�. Wherenon-inv�siveprocedures�reperformedtheh�ndb�sinm�ybeinst�lled �dj�centtothetre�tmentroomfollowing�pprov�lfrom�n�uthorisedpublic he�lthofficer.

4.4 Cleaning areas

the cleaning area is required to be physically separate from the treatment area by design and function to prevent cross contamination.

(�) Provided�dequ�tefunction�lsep�r�tionc�nbe�chieved,these�re�sm�y existinthes�meroom,following�pprov�lfrom�n�uthorisedpubliche�lth officer.

(b) Withinthecle�ning�re�,sep�r�te�re�s�rerequiredtobeprovidedfor cont�min�ted,cle�ned�ndsterile�ppli�ncestof�cilit�tethedirtytocle�n flow.Anex�mpleofthisisshowninDi�gr�mThree(seep�ge45).

(c) Adoublebowlsinkshouldbeprovidedifcritic�lorsemi-critic�l�ppli�nces �retobecle�nedonthepremises.Whereonlynon-critic�l�ppli�nces�reto becle�nedonthepremises,�singlebowlsinkm�ybeinst�lled.

(d) Sinksizesshouldbe�sfollows:

• cle�nupsink:�minimumof350mmwideby200mmdeep;

• rinsingsink:�minimumof200mmwideby150mmdeep.

Bothsinksshouldbel�rgeenoughto�llowsubmersionofthel�rgest�ppli�nce tobecle�ned.

(e) Asinglebowlsinkm�ybeinst�lled�tthepremisesif�ppli�nces�retobere- processed�t�premisesotherth�nwheretheprocedurew�sperformed.In suchsitu�tions,�singlebowlsinkshouldbeinst�lled�tthepremisesforthepre cle�ningofcont�min�ted�ppli�nces.Thissinkshouldnottobeusedfor�ny otherpurpose.

(f) Sufficientbenchsp�ceshouldbeprovidedto�llow�ppli�ncestobes�fely �ndeffectivelyreprocessed�ndto�ccommod�te�ppli�ncessuch�s ultr�soniccle�ners,bench-topste�msterilisers�ndifrequired,fumecupbo�rds. Ensurethereissufficientdepthinthebenchto�ccommod�tethese �ppli�nces.


Itisrecommendedth�tthereshouldbe�tle�st400mmofcle�rbenchsp�ce �v�il�ble:

• beforethecle�nupsinkfordirty�ppli�nces;

• forthedryingof�ppli�nces;�nd

• forthep�ckingof�ppli�nces.

(g) Allfixtures�ndfittingsloc�tedinthecle�ning�re�shouldbedesignedto�llow e�sycle�ning�ndtolimitthe�ccumul�tionofdust.M�teri�lsusedinthese fixtures�ndfittingsshouldbe�bletowithst�ndcle�ning�gents.

(h) Smoothimperviousse�mlesssurf�cesincludingw�ll,floor�ndbenchsurf�ces shouldbeusedwherethereislikelihoodoffluidspills�ndspl�shestof�cilit�te cle�ning.Floorsurf�ceshouldbenon-slip.

(i) Ah�ndb�sinshouldbeprovidedforst�ffworkinginthecle�ningroom.The h�ndb�sinm�ybeinst�lled�dj�centtothecle�ningroom�ndshouldbeof thes�mesize�nddimension�sth�tdescribedinSection4.7(b).

(j) Ap�pertoweldispensershouldbeinst�lled�dj�centtotheh�ndb�sin.

4.5 storage areas

Design and function should physically separate clean and dirty storage areas although they may be in the same room.

(�) Sufficientstor�gesp�ceshouldbeprovidedfor�ppli�nces,procedur�l�nd �dministr�tivesupplies,linen�ndw�ste,includinggener�l�ndclinic�lw�ste.

(b) Clinic�lw�stestor�geconstructionisrequiredtocomplywithAS/NZS3816:1998 Management of Clinical and Related Wastes.Adesign�tedsecure�re�or cont�inershouldbeset�sidefortheshort-termstor�geofclinic�lw�steprior tocollectionby�n�uthorisedw�steremov�lcontr�ctor.This�re�orcont�iner sh�llbeprotectedfromwe�ther�ndun�uthorised�ccess.

4.6 Lighting and ventilation

Where gluteraldehyde is used the recommendations expressed in Worksafe Hazard Alert no.1, 1991 and As/nZs 4187:2003 are required to be followed.

(�) Sufficientlightingshouldbeprovidedsoth�tprocedures,including�ppli�nce cle�ning,c�nbes�fely�ndeffectivelyperformed.Alllightingshouldcomply withAS1680.2.5:1997 Interior lighting – Hospital and medical tasks.

(b) Allventil�tionsystems�rerequiredtocomplywithAS1668.2:2002Mechanical ventilation for acceptable indoor air quality. Aregul�rm�inten�nce�nd cle�ningprogr�mfor�irconditioningvents,ducts�ndfiltersisrequiredtobe undert�ken.


4.7 Hand basins and sinks

It is important that hand basins be used for hand washing only and not for purposes such as cleaning appliances, washing eating and drinking utensils or disposing of liquids.

(�) H�ndb�sinsshouldbe:

• inst�lled�ndm�int�inedinsuch�w�yth�tthey�rere�dily�ccessibleto thepr�ctitioner�t�lltimes;

• be�tle�st300mmx350mm�tthemouth(top)oftheb�sin;

• h�ve�minimumc�p�cityofsevenlitres;

• besuppliedwithhot�ndcoldw�terthrough�singleoutlet;�nd

• fittedwithh�nds-freet�ps(h�nds-freet�psincludeelbowoper�ted,foot oper�ted,kneeoper�tedorelectronic�llycontrolledt�ps).

(b) Sinksusedforcle�ningcont�min�ted�ppli�ncesshouldnotbeusedforh�nd w�shingorw�shinge�ting�nddrinkingutensils.

(c) Ap�pertoweldispensershouldbeinst�lled�dj�centtotheh�ndb�sin.

Diagram Three: Example of design of a cleaning room showing dirty to clean flow of appliances and segregation of areas (adaptation may be required for different specialties)

(SourceLin Lochead 1995)


GLossARY

Additional Precautions:prec�utionsrequiredwhenst�nd�rdprec�utionsmightnotbesufficienttopreventtr�nsmissionofinfection.These�reusedforp�tientsknownorsuspectedtobeinfectedorcolonisedbyp�thogensth�tc�nbetr�nsmittedby�irborne,dropletorcont�cttr�nsmission.Addition�lprec�utions�redesignedtopreventtr�nsmissionofinfectionbythese�gents�ndshouldbeusedin�dditiontost�nd�rdprec�utionswhentr�nsmissionofinfectionmightnotbecont�inedbyusingst�nd�rdprec�utions�lone.

Antiseptic:�subst�nceth�t,duetoitsbiost�ticn�ture,istopic�lly�ppliedtotissuetominimiseinfection.

Appliance: thewholeorp�rtof�nyutensil,m�chinery,instrument,device,�pp�r�tusor�rticleusedorintendedtobeusedinconnectionwiththeperform�nceofskinpenetr�tionorinfectionriskprocedure,orthecle�ningorsterilis�tionof�nother�ppli�nce.

As:referstodocumentspublishedbySt�nd�rdsAustr�li�th�tformAustr�li�nSt�nd�rds.

As/nZs:referstodocumentspublishedbySt�nd�rdsAustr�li��ndSt�nd�rdsNewZe�l�ndth�tformAustr�li�n�ndNewZe�l�ndSt�nd�rds.

Aseptic technique: proceduresusedtominimisetheriskoftr�nsferofmicro-org�nisms

Authorised officer:theChiefHe�lthOfficer,�PublicHe�lthOfficer,or�nAuthorisedMedic�lOfficer�ppointedunderthePublic Health Act 1997.

Autoclave:colloqui�ltermfor�ste�m-under-pressuresteriliser.

Batch principle:m�deinonedesign�tedcycleofm�nuf�cture.

Beauty treatment:includesf�ci�ls,�pplic�tionofm�keup,skinpeels,m�nicures�ndpedicures,electrolysis,w�xing�ndcosmetict�ttooing.

Benchtop steriliser:�self-cont�ined,port�ble,benchtopelectric�lly-he�tedm�chineth�tgener�tess�tur�tedste�mwithintheunit�tselectedtemper�turesupto,�ndincluding,136oC.

Bioburden:thenumber�ndtypesofmicro-org�nismspresenton�n�ppli�ncepriortosterilis�tion.

Biofilm:�l�yerofm�teri�lonthesurf�ceof�ninstrumentordevicewhichcont�insbiologic�lm�teri�ls�ndm�ybeembeddedwithmicro-org�nisms.

Biological indicator:�popul�tionofc�libr�tedb�cteri�lsporesonorin�c�rrier,cont�inedwithinitsprim�ryp�ck,re�dyforuse,th�tprovides�definedresist�ncetothespecifiedsterilis�tionprocess.

Body fluids: includes�nyhum�nbodilysecretion,excludingswe�t,orsubst�nceotherth�nblood.


Calibration: comp�risonof�me�surementsystemordeviceofunknown�ccur�cyto�me�surementsystemordeviceofknown�ccur�cytodetect,correl�te,report,orelimin�teby�djustment,�nyv�ri�tionfromtherequiredperform�ncelimitsoftheunverifiedme�surementsystemordevice.

Chemical indicator: �dye,whichc�nbeimpregn�tedintom�teri�lsorcont�inedwithin�device,whichch�ngescolourwhensubjectedto�sterilisingprocess.

Class one Indicator: �processindic�tore.g.steriliserindic�tort�pe,sterilisingp�ck�ging.These�reintendedforusewithindividu�lunits,e.g.p�cks,cont�iners,todemonstr�teth�ttheunith�sbeenexposedtothesterilis�tionprocess�ndtodistinguishbetweenprocessed�ndunprocessedunits.

Class four Indicator: �multi-p�r�meterindic�tore.g.time�ndtemper�ture.These�redesignedfortwoormorecritic�lp�r�meters�ndindic�teexposureto�sterilis�tioncycle�tst�tedv�luesofthechosenp�r�meters.

Class five Indicator:�nintegr�tingindic�tore.g.time,temper�ture�ndmoisture.These�redesignedtore�ctto�llcritic�lp�r�metersover�specifiedr�ngeofsterilis�tioncycles.

Class six Indicator:�nemul�tingindic�tor(cycleverific�tionindic�tor)e.g.134oCfor3.5mininste�m.These�redesignedtore�ctto�llcritic�lp�r�metersover�specifiedr�ngeofsterilis�tioncyclesforwhichthest�tedv�lues�reb�sedonthesettingsoftheselectedsterilis�tioncycles.

Cleaning: thephysic�lremov�lofforeignm�teri�l,forex�mple,dust,soil,org�nicm�teri�lsuch�sblood,secretions,excretions�ndmicroorg�nisms.Cle�ningphysic�llyremovesr�therth�nin�ctiv�tesmicroorg�nisms.Cle�ningis�ccomplishedwithw�ter,detergents�ndmech�nic�l�ction,�ndmustprecededisinfection�ndsterilis�tion.

Clinical waste:seeACT Clinical Waste Act 1990 and Clinical Waste Manual 1991 (See�lsoCont�min�tedw�ste).

Code:theACTHe�lthInfection Control for office practices and other community based services Code of Practice 2005(unlessotherwiseidentified).

Commissioning:theobt�ining�nddocumentingofevidenceth�tequipmenth�sbeenprovided�ndinst�lledin�ccord�ncewithitsspecific�tion�ndth�titfunctionswithinpredeterminedlimitswhenoper�tedin�ccord�ncewiththem�nuf�cturer’sinstructions.

Contaminated waste:w�stes�risingfrommedic�l,nursing,dent�l,veterin�ry,ph�rm�ceutic�lorsimil�rpr�ctices,�ndw�stesgener�tedincommerci�lenterpriseswhichcont�inorinvolve�nybloodorbodyfluids.Cont�min�tedw�steisrequiredtobesegreg�tedfromgener�lw�ste(See�lsoClinic�lw�ste).

Contamination: theintroductionofmicroorg�nismsorforeignm�tter(orboth)tosterileornon-sterilem�teri�lsorlivingtissue.

Critical medical device:�devicewhichenters,orisc�p�bleofentering,tissueth�twouldbesterileundernorm�lcircumst�nces,orthev�scul�rsystem.

Cytotoxic waste: w�ste-cont�iningsubst�ncesth�t�rec�rcinogenic,cytost�tic,mut�genicorter�togenic.


Defined radius: �nywhereth�tthep�tient’sbloodorotherbodyfluid,includings�liv�,m�yconceiv�blybetr�nsferredduring�procedure.(Alsoknown�soper�tingfield).

Detergent:�cle�ning�gentcomposedof�‘surf�cewetting�gent’whichreducessurf�cetension,�‘builder’whichistheprinciplecle�ning�gent,�nd�‘sequestering’or‘chel�ting’�genttosuspendthesoil.

Dirty to clean flow: denotesthep�ss�geofcont�min�ted�ppli�ncesthroughthecle�ningroomin�nordered,sequenti�lme�ns.Thephysic�lsegreg�tionofitems�sthey�reprocessedine�chst�gefromcont�min�tedtosterilecombinedwith�unidirection�lflowpreventsthere-cont�min�tionofitems�te�chst�ge.

Disinfectant:�n�gentusedfordisinfection.

Disinfection: thein�ctiv�tionofnon-sporeformingmicro-org�nismsusingeithertherm�l(he�t�lone,orhe�t�ndw�ter)orchemic�lme�ns.Thisprocessdoesnotkillb�cteri�lspores.

Drying stage (drying cycle): thest�geinthesequenceofthefunctionof�ste�msteriliserduringwhichtheitemsinthech�mber�redried.Thisst�geoccursimmedi�telyfollowingthesterilis�tionst�gewhilstthesteriliserch�mberrem�insse�led.

emergency: denotes�neventwherebyurgent�ndimmedi�te�ctionisrequiredtopreventdeterior�tioninthep�tient/clientscurrentcondition.

enzymatic indicator:�nindic�torth�tutilizesdetectionofspore-derivedenzyme,r�therth�ntheconvention�lobserv�tionofvisibleorg�nismgrowthinculturemedi�.

General Waste:includesotherw�stesth�tdonof�llintothec�tegoryofclinic�lw�ste.

Guidelines: ACTHe�lth, Infection control guidelines for office practices and other community based services 2006.

Hands-free: impliesthefunction�lconstructionoft�psth�trequirenoh�ndcont�ctbytheuser�ftertheprocessofh�ndw�shingiscomplete.Ex�mplesofthiswouldincludemotionsensing,surgic�llevers,footoper�ted�ndsinglelevermixingt�ps.

Health care facilities:f�cilitieswhereprescribedmedic�lprocedures�rec�rriedon,�nd/orpremiseswhereovernightp�tientst�ys�reprovidedpriorto,or�fterreceivingmedic�ltre�tment.

Holding time: thetime�t�giventemper�tureth�th�sbeenest�blishedtodestroy�llmicroorg�nisms.

Immediate area:withinthebound�riesoftheroomwhereinv�siveprocedures�reperformed.

Industry: referstooccup�tion�lgroupsnotregistered�she�lthprofession�ls.

Infection: inv�sionofthebodywithorg�nismsth�th�vethepotenti�ltoc�usedise�se.


Infection Control:str�tegiesth�tminimisetheriskofinfectiontopr�ctitioners,p�tients�ndclients.

Infection control guidelines: theACT Infection Control Guidelines for office practices and other community based services(unlessotherwiseidentified).

Infection risk procedure: me�ns�nyprocessth�tinvolvestheinsertionofinstruments,equipment,foreignobjects,subst�ncesorotherm�tterinside�hum�nbodyforcosmeticorther�peuticpurposes;or�nyprocessth�tinvolvesthe�dministr�tionofm�ke-uporotherlikesubst�nceonhum�nskinormucusmembr�ne.

Invasive procedure: �nyprocedureth�tpiercesorbre�ksskinormucousmembr�nesorenters�bodyc�vityororg�n.Thisincludesentryintotissues,c�vitiesororg�nsorrep�iroftr�um�ticinjuries.

May:indic�testheexistenceof�noption.

Micro-organism:�b�cteri�,virus,fungus,mouldorye�st.

Mobile practitioner:�personwhoperformsskinpenetr�tionorinfectionriskprocedures�w�yfromfixedpremisesforfee,rew�rdorpublicservice.

Monitoring: �progr�mmedseriesofch�llenges�ndchecks,repe�tedperiodic�lly�ndc�rriedout�ccordingto�documentedprotocolwhichrecordswhethertheprocessbeingstudiedisreli�ble�ndrepe�t�ble.

Must: �m�nd�toryrequirement.

non-conforming: sterile�ppli�ncesth�tm�yh�vebeenrenderednonsterilebyincorrectcle�ning,moisture,condens�tion,excessiveexposuretosunlight�ndothersourcesofultr�violetlight,vermin�ndinsects,in�ppropri�tep�ck�gingm�teri�ls,incompletese�lingofp�cks,sh�rpobjects,expiredstock,roughh�ndlingwhichm�yc�used�m�getop�ck�gingm�teri�ls�ndincorrecth�ndlingduringtr�nsport.

non-critical medical device: �deviceth�tcomesintocont�ctwithint�ctskin.

occlusive dressing:�w�terproofwoundcovering.

occupational exposure:workpr�ctices�ssoci�tedwiththepotenti�lforpercut�neousinjury,bodysubst�ncespill,spl�shorspr�yth�th�vethepotenti�ltoexposethepr�ctitionerto�ninfectious�gent.

operating field: refertodefinedr�dius.

oral surgical Procedure: includes,butisnotlimitedto,exodonti�,periodont�lsurgery,endodonticrootsurgery,impl�nts�ndbiopsy.Or�lsurgic�lproceduresm�yinvolve�nincisionintothemusos��ndr�isingofthemuco-perioste�lfl�p.

Pathogenic organism:�nyorg�nismc�p�bleofiniti�tinginfectionin�susceptiblehost.

Penetration time:thetimerequiredforeveryp�rtof�lo�dtore�chtheselectedsterilisingtemper�ture�fterth�ttemper�tureh�sbeenre�chedinthesterilisingch�mber.


Practitioner: �nypersonwhoperformsskinpenetr�tionorinfectionriskproceduresorwhoreprocessesreus�ble�ppli�ncesusedinskinpenetr�tion�ndinfectionriskproceduresforfee,rew�rdorpublicservice.

Premises:�perm�nentortempor�rystructureorbuildingwhereskinpenetr�tionorinfectionriskprocedures�rec�rriedout.Thisdoesnotinclude�clientorp�tient’spremiseswhen�ttendedby�mobilepr�ctitioner.

Procedures: �n�ctionorprocess.

Public Health:Thehe�lthofindividu�lsinthecontextofthewiderhe�lthofthecommunityortheorg�nisedresponsebysocietytoprotect�ndpromotehe�lth�ndpreventillness,injury�nddis�bility.

Public Health officer:�nOfficer�uthorisedunderSection12ofthePublic Health Act 1997.

Reprocessing:�llstepsnecess�rytom�ke�cont�min�tedreus�blemedic�ldevicere�dyforitsintendeduse.Thesestepsm�yincludecle�ning,function�ltesting,p�ck�ging,l�belling,disinfection�ndsterilis�tion.

Reusable item:�nitemdesign�tedorintendedbythem�nuf�cturer�ssuit�bleforreprocessing�ndreuse.Itisnot�deviceth�tisdesign�tedorintendedbythem�nuf�cturerforsingleuseonly.

Revalidation: Therepetitionofp�rtor�llofthev�lid�tiontestrequirementsforthepurposeofreconfirmingprocessreli�bility.

Risk prone procedure: �nyprocedureth�tm�yresultin�nindividu�l�cquiring�ninfection.

safe work practices:pr�ctices,whichminimisetheriskofinjuryorinfectiontopr�ctitioners�ndclients/p�tients.

semi critical medical device:�deviceth�tcomesintocont�ctwithint�ctmucousmembr�nes�nddoesnotnorm�llyentersterile�re�softhebody.

sharps: �nyobjectsc�p�bleofinflictingpenetr�tinginjury,includingneedles,sc�lpelbl�des,wires,troc�rs,�utol�ncets,stitchcutters�ndbrokengl�ssw�re.

should: indic�tes�recommend�tionth�tistobefollowedwherepossible.

single patient use item: �nitemdesignedforreuseonthes�meindividu�l.Theseitemsm�yrequirecle�ningifongoingmultipleuses�reneeded.Onceuseisnolongerrequiredforth�tindividu�l,thedevicemustthenbedisc�rded�ppropri�tely.

single use item:�nitemdesignedforsingleuseonly�ndnotdesign�tedorintendedbythem�nuf�cturer�ssuit�bleforreprocessing�ndreuse.

skin penetration procedure: �nyprocessinvolvingthepiercing,cutting,puncturingorte�ringof�livinghum�nbodybutdoesnotincludethecutting,sh�ving,ordyeingof�personsh�ir,orclosede�rpiercingortheuseoftestequipment.

soil: dirtordebristh�tm�yprotect,h�rbouror�ssistthegrowthofmicro-org�nisms.Includesinorg�nicm�tter�ndorg�nicm�tter,such�sblood�ndbodysubst�nces.


standard Precautions: workpr�cticeswhichrequireeveryoneto�ssumeth�t�llblood�ndbodysubst�nces�repotenti�lsourcesofinfection,independentofperceivedrisk.Suchprec�utionsinvolvetheuseofs�feworkpr�ctices�ndprotectiveb�rriers�ndthes�fedispos�lofbodysubst�nces�ndsoiledm�teri�l.

sterile: st�teofbeingfreefromvi�blemicro-org�nisms.

sterilisation:v�lid�tedprocessusedtorender�productfreeof�llformsofvi�blemicro-org�nisms.

steriliser failure:thef�ilureof�sterilis�tion�ppli�ncetoproduceorre�chtherequiredp�r�metersoftime�ttemper�ture�ndste�mqu�lityrequiredtorender�nitemsterile.

thermal disinfector: �devicedesignedbythem�nuf�cturerth�t�chievesdisinfectionvi�theuseofhe�t�ndw�ter,toen�blein�ctiv�tionofnon-sporeformingorg�nisms.

validation:Documentedprocedureforobt�ining,recording�ndinterpretingtheresultsrequiredtoest�blishth�t�processwillconsistentlyyield�productcomplyingwithpre-determinedspecific�tions.

Definitions used in this glossary have been aligned with definitions used in national and international documentsincludingAustr�li�nGovernmentDep�rtmentofHe�lth�ndAging,2004Infection control guidelines for the prevention of transmission of infectious diseases in the health care setting,AS/NZS4187:2003 Cleaning, disinfecting and sterilizing reusable medical and surgical appliances and equipment, and maintenance of associated environments in health care facilities�ndAS/NZ4815:2006Office based health care facilities-Reprocessing of reusable medical and surgical instruments and equipment, and maintenance of the associated environment.



ReFeRenCe LIst

ACHSEQuIP GuideJune1996.

ACTClinical Waste Act 1990.

ACTClinical Waste Manual,1991.

ACTDiscrimination Act 1991.

ACTHealth Infection control for office practices and other community based services Code of Practice 2005.

ACTOccupational Health and Safety Act 1989.

ACTPublic Health Act 1997.

ACTWaste Minimisation Act 2001.

Austr�li�nSt�nd�rd,AS1668.2:2002Mechanical ventilation for acceptable indoor air quality.

Austr�li�nSt�nd�rd,AS1680.2.5:1997Interior lighting – Hospital and medical tasks.

Austr�li�nSt�nd�rd,AS2182:1998Sterilisers - Steam - Portable.

Austr�li�nSt�nd�rd,AS2487:1981Dry Heat Sterilisers (Hot Air Type).

Austr�li�nSt�nd�rd,AS2773.1:1999Ultrasonic cleaners for healthcare facilities.

Austr�li�nSt�nd�rd,AS2945:1998Batch type washer/disinfectors for health care facilities.

Austr�li�nSt�nd�rd,AS4031:1992Non re-useable containers for the collection of sharp medical items used in health care areas.

Austr�li�n/NewZe�l�ndSt�nd�rd,AS/NZS1337:1997Eye protectors for industrial applications.

Austr�li�n/NewZe�l�ndSt�nd�rd,AS/NZS3816:1998Management of clinical and related waste.

Austr�li�n/NewZe�l�ndSt�nd�rd,AS/NZS4146:2000Laundry practice.

Austr�li�n/NewZe�l�ndSt�nd�rd,AS4187:2003Cleaning, disinfecting and sterilising reusable medical and surgical appliances and equipment, and maintenance of associated environments in health care facilities.

Austr�li�n/NewZe�l�ndSt�nd�rds,AS/NZS4261:1994Re-useable containers for the collection of sharp medical items used in human and animal medical applications.

Austr�li�n/NewZe�l�ndSt�nd�rd,AS/NZS4815:2006 Office-based health care facilities-Reprocessing of reusable medical and surgical instruments and equipment, and maintenance of associated environments.

Austr�li�nGovernmentDep�rtmentofHe�lth�ndAgeing(DoHA);2004. Infection Control Guidelines for the prevention of transmission of infectious diseases in the health care setting.

BuildingCodeofAustr�li�,M�y2006.Class 2 to Class 9 buildings.

N�tion�lHe�lth�ndMedic�lRese�rchCouncil/Austr�li�nN�tion�lCouncilonAIDS,Infection control in health care setting: Guidelines for the prevention of transmission of infectious diseases,AGPS,C�nberr�,1996.

N�tion�lHe�lth�ndMedic�lRese�rchCouncil,The Australian Immunisation Handbook,8thEdition,AGPS,C�nberr�,2003.

Ther�peuticGoodsAdministr�tion, Therapeutic Goods Order Nos. 54, 54A & Guidelines - Standards for composition, packaging, labelling and performance of disinfectants and sterilants,Commonwe�lthDep�rtmentofHe�lth�ndF�milyServices,1997.

Works�feH�z�rdAlertNo1-1991Gluteraldehyde – Use in the health and associated industries.



APPenDICes

APPenDIX one

Categories of waste and recommended containment and disposal

Symbol Waste Container Colour Disposal

Nosymbol Gener�l Bl�ck,buff,green, L�ndfill white Considerrecycling (Confidenti�lw�ste tobeshreddedor inciner�ted)

Clinic�lw�ste Licensedcontr�ctor

-sh�rps Yellow,rigid Inciner�tion cont�iner

-nonsh�rps Yellowb�g Inciner�tionor v�lid�tedste�m sterilis�tion,then supervisedl�ndfill

-liquid Sewer:loc�l regul�tionsmustbe followed

R�dio�ctive Red Licensedcontr�ctor

Monitorbefore dispos�lby inciner�tionor supervisedl�ndfill

Diluteisotopesm�ybe disposedofvi� sewer�gesystemin �ccord�ncewith relev�ntguidelines

Cytotoxic Purple Licensedcontr�ctor Inciner�tion:1100oC

note:Anyw�ste,cont�min�tedwithorstoredwith�notherw�sterequiring�higherlevelofdestructionMUSTbecl�ssified�tthehigherlevel.

Source:DoHA(2004) Infection control guidelines


APPenDIX tWo

Minimum level of reprocessing required for specific items in use

Level of Risk Application Process Storage Example

Critic�l Entryor Sterilis�tionby Sterilitymustbe Appli�ncesused penetr�tion ste�munder m�int�ined: in�inv�sive intosterile pressure,or� •p�ck�ged surgic�l�nd tissue,c�vity minimumof�n itemsshould dent�l orblood �utom�ted bedrywhen procedures stre�m lowtemper�ture removedfrom eg.or�lsurgic�l chemic�lsteril�nt thesteriliser; instruments, system,otherliquid •theintegrity podi�try chemic�lsteril�nt ofthewr�p instruments orethyleneoxide mustbe c�p�bleof sterilis�tion m�int�ined �br�dingthe skin

bSemi-critic�l Cont�ctwith He�ttoler�nt Storeto V�gin�l int�ctnonsterile items:Ste�m protectfrom specul�e,for sterilis�tionis environment�l �ppli�nces routinedent�l mucos�(or preferredwhere cont�min�tion procedures nonint�ctskin) possible

He�tsensitive Storeto cFlexible items:Usehigh protectform endoscopes, levelchemic�l environment�l inv�sive disinfectionor cont�min�tion utr�sound lowtemper�ture probes �utom�ted chemic�lsteril�nt systems

Noncritic�l Cont�ctwith Cle�n�snecess�ry Storein� Noninv�sive int�ctskin withdeterget�nd cle�ndry �cupuncture w�ter pl�ce devices, Sphygmo- Ifdecont�min�tion m�nometers, isrequired,cle�n, mercury thendisinfectwith thermometers 70percent�lcohol noninv�sive orothersuit�ble ultr�sound disinfect�nt�s probes required �Aninv�siveprocedureisdefined�ssurgic�lentryintotissues,c�vities,ororg�ns,orrep�iroftr�um�ticinjuries.Inv�sivedent�lproceduresincludesubgingiv�lcurett�ge�ndmostrootc�n�lprocedures.

bTheseitemsentersterilesites�ndshouldthereforebesterile.However,inpr�cticethey�rem�defromm�teri�lsth�tdonotwithst�ndste�msterilis�tion.If�low-temper�turechemic�lsterilis�tionsystemis�v�il�bleitshouldbeusedfortheseitems;otherwisetheyshouldbehigh-levelchemic�llydisinfected.

cThesec�tegoriesreflectcurrentpr�ctice–sterilis�tionispreferredwherepossible.Processingst�nd�rdsshouldevolveto�ccommod�tech�ngesinequipmentdesign�ndemergingsterilis�tiontechnologies

note:Topreservethesurf�ces�ndcompositionofthe�ppli�nces,sep�r�tedissimil�rmet�lsbeforecle�ning.Avoiduseof�br�sivem�teri�ls.Donotstore�ppli�ncesindisinfect�ntbeforeor�fter�nyformofprocessing.

Ad�ptedfrom:DoHA(2004)Infection control guidelines


APPenDIX tHRee

Handwashing techniques

Type Technique Duration Drying Example (When)

Routine Weth�ndsthoroughly 10-15 P�tdry •Beforee�ting h�nd �ndl�thervigorously seconds using •Afterusingtheb�throom w�sh usingneutr�lpHliquid p�per •Beforesignific�ntcont�ct so�p towel,or withp�tientse.g.physic�l Rinseunderrunning �fresh ex�min�tion,emptying� w�ter cle�n dr�in�gereservoir cloth •Beforeinjectionor towel venipuncture •Before�nd�fterroutine useofgloves •Afterh�ndling�ny instrumentsorequipment soiledwithbloodorbody subst�nces •Routinedent�l ex�min�tions

H�nd W�shh�nds 1minute P�tdry •Before�nynonsurgic�l w�sh thoroughlyusing�n using procedureswhichrequire priorto �nti-microbi�lskin p�per �septictechnique �septic cle�ner towel •Before�nyinv�sive proced- Rinsec�refully dent�lprocedure ures(non- Donottoucht�ps (Inv�sivedent�l surgic�l) withcle�nh�nds–if proceduresinclude elboworfootcontrols subgingiv�lcurett�ge �renot�v�il�ble,use �ndmostrootc�n�l p�pertoweltoturn procedures) t�psoff

Surgic�l W�shh�nds,n�ils Firstw�sh Drywith •Before�nyinv�sive w�sh �ndfore�rms forthed�y sterile surgic�lprocedure thoroughly�nd�pply 5minutes; towels (oper�tingroom �n�nti-microbi�lskin subsequent procedures) cle�ner(cont�ining w�shes •Beforeor�lsurgic�l 4%w/vchlorhexidine) 3minutes procedures(involves�n ordetergentb�sed incisionintothemusos� povidoneiodine �ndr�isingofthemuco- cont�ining0.75% perioste�lfl�p) �v�il�bleiodineor�n �queouspovidone- iodinesolution cont�ining1% �v�il�bleiodine. Rinsec�refully, keepingh�nds�bove theelbows Notouchtechniques �pply

Source:DoHA(2004) Infection control guidelines

Documents

Infection Control Guidelines for office pr ctices nd other ... · IntRoDUCtIon ACT He lth Infection Control Guidelines for office practices and other community based services (the