CLEANING AND DECONTAMINATION

Chapter 9

Objectives• As a result of successfully completing this chapter,

students will be able to:

• Discuss basic factors that impact cleaning and decontamination:

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

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

Objectives• Explain details about cleaning and

decontamination, and review manual procedures and mechanical methods to complete both processes.

• Discuss procedures to clean basic types of instruments:

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

• Review procedures to manage infectious waste.

Important Facts• Cleaning is the first step in device reprocessing after use

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

• Cleaning is the cornerstone of the sterilization process

Terminology• Cleaning – The removal of

all visible and non-visible soil and any other foreign material from the medical device being reprocessed

• Decontamination – Removing or reducing contamination by infectious organisms or other harmful substances

Design of the Decontamination Area

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

• Traffic should be restricted and PPE is required

The Decontamination Area

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

Housekeeping

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

• Spills should be cleaned immediately

• Floors should be cleaned and disinfected daily

• Biohazardous waste should be removed at frequent intervals

Personal Protective Equipment (PPE)

• PPE is required at all times

• Discard PPE that is soaked with blood or infectious materials

• Discard torn, punctured or nicked gloves

• Jewelry and acrylic fingernails are not permitted

Food or Drink is NOT Permitted in the Decontamination Area

No Food or Drink

Training• No employee should work in

the decontamination area without training on:• Standard Precautions• PPE• Safety• Hand washing• Proper handling of

contaminated items

Water• The primary vehicle in the

cleaning process

• Water quality can impact cleaning outcomes

• pH, hardness, and temperature must be monitored

pH Scale

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• pH is used to measure acidity or alkalinity.

• Acids turn litmus paper RED.

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

• Chelating Agents • Chemicals that hold

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

• Sequestering Agents• Chemicals that remove

or inactivate hard water minerals

An Overview of Effective Cleaning Agents

• Are non-abrasive• Are low-foaming• Are free-rinsing• Allow for rapid soil dispersion• Are non-toxic• Are effective on all types of soil• Have a long shelf life• Are cost-effective• Can be monitored for effective concentration and useful life

Detergents

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

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

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

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

• Protease – Breaks down blood, mucous, feces, and albumin

• Lipase – Breaks down fatty deposits such as bone marrow and adipose tissue

• Amylase – Catalyzes (changes) starch

Enzymes and Temperature

• Temperatures above 400C (1400F) can affect chemical reactions

• Cool temperatures may not activate the enzyme

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

Selecting an Enzymatic Detergent• Consider the following factors:

• Water temperatures in the decontamination area

• Room temperature in the decontamination area

• Useful life and stability of the product

• Expiration date of the product

• The material used to construct the device to be cleaned

• Whether it is approved and registered by the EPA

Detergents for Ultrasonic Cleaners

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

• Are usually formulated with Surfactants and Chelating agents

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

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

Instrument Lubricants• Prolong the life and function of instruments

• Instrument lubricants must be water-soluble

• Should be applied after cleaning

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

CLEANING

The removal (usually with detergent and water) of both visible and invisible

soil from the surfaces, crevices, serrations, joints and lumens of

instruments, devices and equipment

Remove Gross Soil As Soon As Possible to:

• Reduce the number of microorganisms on the item

• Reduce the nutrient material that can support microbial growth

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

• Minimize damage to devices from blood and other substances

The Importance of Cleaning

•Cleaning is the foundation of disinfection and sterilization

Decontamination

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

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

Technology Creates Cleaning Challenges

Manual Cleaning• May be done:

• Prior to mechanical cleaning• When the decontamination area

does not have mechanical cleaners• For delicate or complex instruments• For powered-surgical instruments• For instruments with lumens

Facilitate Cleaning By:• Monitoring water temperature and hardness

• Measuring detergents accurately

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

Cleaning• Use a 3-Sink Set-up

• Wash sink• Intermediate Rinse sink • Final Rinse sink

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

Cleaning Brushes

• Use the correct size brush for the item being cleaned

• Clean and disinfect/sterilize routinely or discard and replace

Mechanical Cleaning

•Washers • Automated equipment

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

Ultrasonic Cleaners• Use Cavitation Process

• Superior to manual scrubbing/cleaning

• Require non-foaming detergents

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

to reach areas within the instrument.

ImplosionImplosion

Ultrasonic Cleaner Tips

• Rinsing is necessary to remove residue that remains on instruments

• The tank must be routinely cleaned• Instruments must be pre-cleaned to remove gross soil.• Must be degassed each time they are filled• The cleaner’s lid should remain closed during operation

• All lumens should be completely filled with cleaning solution

• All instruments should be completely open and submerged

Ultrasonic Cleaners

• Do not place these items in the ultrasonic cleaner:• Chrome-plated instruments• Ebonized Instruments• Plastic• Cork• Glass• Wood• Chrome• Rubber

Automated Mechanical Washing

• Impingement• The spray-force action of

pressurized water against instruments being processed to physically remove bioburden

Mechanical Washers

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

• Choose the correct cycle for the items being processed

Mechanical Washer Tips

• Expose all surfaces• Do not stack trays on top of one another• Remove lids or covers from trays• Check detergent levels frequently

Washers Need Direct Contact

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

Protect Instruments from Damage during Mechanical Cleaning

Automated Cart Washers

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

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

Basic Instrument Cleaning Procedures

Instrument Decontamination

• The most important step in the sterilization process

• Instruments that have not been properly cleaned cannot be sterilized

Blood should never be allowed to dry on instruments

• Process instruments immediately, or:• Cover with a moist towel

• If they can be immersed, place in a soak basin with the appropriate solution

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

• Should begin within 15 minutes to 1 hour after use

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

• Open boxlocks and hinges for cleaning• Disassemble multi-part instruments

Instruments with Lumens• Place under water to prevent

aerosols when brushing

• Brush lumens using an appropriate size brush

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

Defective Instruments

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

Clean All Items in Accordance with Manufacturers’ Instructions.

Power Equipment

• Must be manually cleaned.

• Do Not Immerse

• Clean cannulations (lumens) thoroughly

• Follow Manufacturer’s instructions

Mobile Patient Care Equipment

• Follow OEM (Original Equipment Manufacturer’s) instructions

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

Cleaning Quality Control

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

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

Infectious Waste

• Not all healthcare facility trash is “Medical Waste”

• Healthcare facilities separate their waste

Waste Categories• General Trash – garbage disposed of as municipal solid

waste

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

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

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

Cleaning Summary

• Follow established standards and manufacturers’ instructions

• Pay attention to detail

• Cleaning is the most important step in medical device processing