CLEANING & DISINFECTION OF EQUIPMENT'S RELATED TO PATIENT CARE

                                                                              

                  

CLEANING AND DISINFECTION OF EQUIPMENT'S RELATED TO PATIENT CARE

                                                  

                            

Introduction

The cleanliness of every health care environment is important for infection prevention-control & patient well-being environmental services staff along with other health care professionals, plays an important role in quality improvement in the confidence public has in hospitals and health care, and in reducing Infection related risks.

  Patient equipment’s and the healthcare environment must undergo routine cleaning and disinfection as required as part of the standard or transmission-based precautions. The choice of products for cleaning and disinfection is an important one; effectiveness of the product, suitability for the surface and practicality must all be considered.

patient care equipment that comes into contact only with intact skin such as IV pumps, blood pressure monitors and wheelchairs is classified as non-critical under the Spaulding classification. Non-critical equipment requires cleaning, at a minimum, between patients.
Disinfection of non-critical equipment is not routinely required unless the equipment has come into contact with blood or body fluids.  

Any equipment, instrument, device, apparatus, material or other article used for the diagnosis, prevention, monitoring, treatment or alleviation of disease (among other inclusions) is classified as a medical device. The regulation of medical devices is overseen by the Therapeutic Goods Administration (TGA).

There are three levels of decontamination: cleaning, disinfection and sterilization: -

                              

CLEANING

The selection and use of cleaning equipment, chemicals and exposure times suggested by the device manufacturer should generally be followed to prevent damage to the items as well to use the equipment’s for next use.

                                                                         

DISINFECTION

Disinfection is the process or act of destroying pathogenic microorganisms and removes most organisms present on surfaces. Disinfectants are antimicrobial agents that are applied to non-living objects to destroy microorganisms that are living on the objects.

                                                                             

STERILIZATION

Sterilization refers to any process that eliminates, removes, kills, or deactivates all forms of life (in particular referring to microorganisms such as fungi, bacteria, viruses, spores, unicellular eukaryotic organisms such as Plasmodium, etc.) and other biological agents like prions present in a specific surface, object or fluid, for example food or biological culture media. Sterilization can be achieved through various means, including heat, chemicals, irradiation, high pressure, and filtration. Sterilization is distinct from disinfection, sanitization, and pasteurization, in that those methods reduce rather than eliminate all forms of life and biological agents present. After sterilization, an object is referred to as being sterile or aseptic.

                                                       

PURPOSE

The overall goal of infection prevention practice is to eliminate the risk of transmission of pathogens between patients and health care workers. The purpose of sterilization and disinfection procedures is to prevent transmission of microbes to patients. In addition to sterilization and disinfection, other important measures to prevent transmission are included in the protocol of “standard precautions” 

                                                              

1.CLEANING AND DISINFECTION OF MECHANICAL 

VENTILATORS (CRITICAL CARE PATIENT EQUIPMENT'S)

1.To clean and disinfect a mechanical ventilator, wipe down the controls and entire outside of the equipment with a compatible disinfectant (e.g. sodium hypochloride solution of 0.05%

Disinfect tubing using sodium hypochlorite solution of 0.1% ensuring that the entire lumen of the tubing is flushed.

It is not necessary to routinely clean respiratory and pressure lines within a ventilator between patients, because the lines are not exposed to the patient or the patient's respiratory secretions.

                                                                                  

Usually, the entire expiratory side tubing is removable (the expiratory end has a valve to control the escape of gas from the circuit and may also have a flow measurement device or a water trap, or both). This tubing should be disassembled and cleaned first with a detergent, rinsed clean, and then subjected to either high-level disinfection or sterilization. High-level disinfection is the minimum required procedure for these items. But due to the practicability of some sterilization methods and health-care facility protocols (e.g. steam), these items can, if suitably designed, be submitted to sterilization.

When mechanical ventilators are used in the care of a patient with an ARI of potential concern, bacterial and viral filters are recommended on exhalation valves.

Indication- for surface cleaning can use MI GARD

Dilution- 3.9ml/litre in cold water for moping the critical and non-critical surfaces both.

 Composition -MI GARD Alkyl dimethyl benzyl ammonium chloride (QAC) 13.8% w/v didecyl dimethylammonium chloride (QAC) 9.2% w/v

 2.SEMI CRITICAL PATIENT CARE EQUIPMENT

1.CLEANING & DISINFECTION OF RESPIRATORY EQUIPMENT'S

Equipment used for respiratory therapy (e.g. items that come into contact with mucous membranes) is considered semi critical such items should be cleaned and then receive at least high-level disinfection between patients High-level disinfection of respiratory equipment takes place after cleaning, and is typically accomplished by chemical germicides or physical methods.

Chemical germicides used for high-level disinfection includes

• glutaraldehyde-based formulations (2%);
• stabilized hydrogen peroxide (6%);
• peracetic acid (variable concentrations, but ≤ 1% is sporicidal);
• sodium hypochlorite (5.25%, diluted to 1000 ppm available chlorine – 1:50 dilution).

The most appropriate chemical germicide for a particular situation should be selected on the basis of the object to be disinfected, its composition and intended use; the level of disinfection needed; and the scope of the services, physical facilities, resources and personnel available.

2.Products like Cidex and OPA can be used to disinfect the semi critical type patient care equipment’s like: - TEE SCOPE used in surgery & cardiology Endoscopes used in endoscopy, glideslopes and urology scopes which are used in urology procedures.

INDICATION: -Destroys 99.8% of Mycobacterium tuberculosis in 45 minutes at 25 degrees Celsius.Soke the equipment’s in Cidex or in OPA for 30mins for room temperature.

CIDEX AND OPA is a high-level disinfectant for reprocessing heat sensitive semi critical medical devices for which sterilization is not suitable.

COMPOSITION- 0.55% 1,2-benzenedicarboxaldehyde or OPA, and it has supplanted glutaraldehyde.  2.4% alkaline glutaraldehyde solution, destroys 99.8% of Mycobacterium tuberculosis in 45 minutes at 25 degrees Celsius.

Dilution -A 20-minute exposure time is required for HLD when using a 2.4% solution at room temperature. Concentrations range from 2.4% to 3.4% and the maximum use life can vary from 14 to 28 days.

                                                                    

3.NON-CRITICAL ITEMS WITH HIGH TOUCH COMPONENTS

S.NO.	HIGH TOUCH COMPONENTS	DISINFECTANT SOLUTION
1.	Carts- CPR trolly, Medication Trolly, dressing trolly, drawers & surface handles.	057%w/v, Benzalkonium Chloride I.P. 0.3%w/v, Isopropyl Alcohol I.P. 45%v/v, N Propanol 35%v/v, Sodium Benzoate 0.01% w/v, DeIonised water qs.(Rapid spray)
2.	B.P machine ECG machine, steam inhalation machine	057%w/v, Benzalkonium Chloride I.P. 0.3%w/v, Isopropyl Alcohol I.P. 45%v/v, N Propanol 35%v/v, Sodium Benzoate 0.01% w/v, DeIonised water qs.(Rapid spray)
3.	ICU equipment’s (Ventilators, NIV machine, Infusion pump)	Alkyl dimethyl benzyl ammonium chloride (QAC) 13.8% w/v didecyl dimethylammonium chloride(QAC) 9.2% w/v (MI GARD)
4.	X-ray and ultrasound machines with portable touchpads	057%w/v, Benzalkonium Chloride I.P. 0.3%w/v, Isopropyl Alcohol I.P. 45%v/v, N Propanol 35%v/v, Sodium Benzoate 0.01% w/v, DeIonised water qs.(Rapid Spray)
5.	Pulse oximeters and its probes	057%w/v, Benzalkonium Chloride I.P. 0.3%w/v, Isopropyl Alcohol I.P. 45%v/v, N Propanol 35%v/v, Sodium Benzoate 0.01% w/v, DeIonised water qs.(Rapid spray)
6.	Stethoscopes, B.P cuff and its probes and all monitor probes	057%w/v, Benzalkonium Chloride I.P. 0.3%w/v, Isopropyl Alcohol I.P. 45%v/v, N Propanol 35%v/v, Sodium Benzoate 0.01% w/v, DeIonised water qs.
7.	Glucometers, Thermometers	057%w/v, Benzalkonium Chloride I.P. 0.3%w/v, Isopropyl Alcohol I.P. 45%v/v, N Propanol 35%v/v, Sodium Benzoate 0.01% w/v, DeIonised water qs.
8.	Strachers, wheelchairs,walker,side bed rails	057%w/v, Benzalkonium Chloride I.P. 0.3%w/v, Isopropyl Alcohol I.P. 45%v/v, N Propanol 35%v/v, Sodium Benzoate 0.01% w/v, DeIonised water qs.(Rapid spray)
9.	Handle of doors, and all hand contact points.	Alkyl dimethyl benzyl ammonium chloride (QAC) 13.8% w/v didecyl dimethylammonium chloride (QAC) 9.2% w/v (MI GARD) 057%w/v, Benzalkonium Chloride I.P. 0.3%w/v, Isopropyl Alcohol I.P. 45%v/v, N Propanol 35%v/v, Sodium Benzoate 0.01% w/v, DeIonised water qs.(Rapid spray)

                              

Written By:

Priyanka Massey

Certified Infection Control Nurse & Professional Trainer.

Ingenious Health Care Consultants Pvt Ltd.