easi-sterilise standard operating procedures introduction & section 1 cleaning procedures

Easi-Sterilise Easi-Sterilise Standard Operating ProceduresStandard Operating Procedures

IntroductionIntroduction &&

Section 1Section 1Cleaning ProceduresCleaning Procedures

Housekeeping Fire exits Bathrooms Mobile phones Tea and coffee Respect

Topic Easi-Sterilise Standard Operating Procedure

TimeTopic:

8.30Sign in, Meet and Greet

0945Morning Tea

0945-1100 SOP 1

1100-1215

SOP 2

1215- 1245

Lunch

12451415

SOP 3

SOP 4

1415 - 1430 Afternoon Tea

1430- 1600 SOP 5 & Questions and Answers

Finish

Why are we here? Patient and staff safety Directives from QH EMT for rapid implementation of

education and training following incidents Implementing a continuous quality improvement

program Targeting training needs not targeting individuals Acknowledge an absence in effective communication

when changes are made To build on current level of knowledge in light of ever

changing technology, standards, guidelines, advisories and legislation

QH Commitment QH Commitment

Is to: Appropriately train and skill staff Provide information and resources so that

step-by-step quality processes are consistently followed

Assist in identifying gaps in knowledge and provide opportunities for improvement

Aim of this workshop

Provide participants with strategies to implement the SOPs and WSAs locally by improving and standardising knowledge on:

Pre-cleaning Cleaning Drying instruments Packaging Sterilising Storage Annual performance qualification/validation of the

sterilisation process

SOPs & WSAsSOPs & WSAs To assist Oral Health facilities operationalise QH policy

and guidelines A resource for staff Update and supersede the OH Critical Instrument Tracking

(2003) A framework to assist staff identify competence and areas

where education and improvement may be needed A resource to identify opportunities for improvement within

the department that will require further education and training

Section 1Section 1

Cleaning ProceduresCleaning Procedures

1.1 Standard Precautions1.1 Standard Precautions

Standard precautions are applied as a first-line approach to infection control. These form the basis for your decision-making and practice. Standard precautions are a set of guidelines based on the assumption that all blood and body fluids are potentially infectious.

1.1 Standard Precautions1.1 Standard PrecautionsIn the context of sterilising practice and ALL the Standard Operating Procedures, standard precautions include:

Hand HygieneHand cream – approved by infection control – not in packing areaPersonal Protective Equipment

• Gloves • Face shields, hair protection, safety glasses and masks• Fluid resistant gowns/aprons

OHS Requirements

1.2 Soiled Pickup Collection1.2 Soiled Pickup Collection Standard Precautions - PPE Contaminated items - dedicated collection trolley/cart Keep instrument sets together Follow the designated route with trolley (OHS)

Collection containers are: puncture-resistant leak-proof and made of either plastic or metal with a lid or liner that can be closed

1.2 Soiled Pickup Collection1.2 Soiled Pickup Collection Cleaned items must be dried prior to transport Reusable instruments cassettes and single items placed into

designated transport containers Secure single loose items Don’ts Place heavy instruments on light instruments Lift above shoulder height Containers should not exceed 10 kgs

Containers for Transport from SurgeryContainers for Transport from Surgery with a lid easily cleaned puncture and leak proof kept in a clean, dry condition not overloaded carefully packed

sharps recognised facing same direction

1.3 Sorting Prior To Cleaning1.3 Sorting Prior To CleaningInstruments and items sorted by;

• Type • Method of cleaning e.g. Manual , ultrasonic,

Instruments and items are checked for;• Completeness• Defects• Sharps or blades that have not been removed• Heavily soiled items• Single use only items are not to be returned for

reprocessingReport concerns to supervisor

CleaningCleaning Cleaning removes organic and inorganic soil, blood,

fats etc which contain pathogenic micro-organisms

Cleaning minimises contamination levels of bioburden (number of micro-organisms) prior to sterilisation

For sterilisation to occur the aim is to have a low number of micro-organisms present on instruments

CleaningCleaning

Steam will not penetrate contamination left on instruments

If the item is not clean it won’t be sterilised

1.4 Chemical & Detergent Mixtures1.4 Chemical & Detergent Mixtures

Breaking down and removal of Blood, proteins and debris (organic soils) Medicaments and chemicals (inorganic soils) Breaks water tension – surfactant Keeps the soils suspended in the water

Must be an “instrument” detergent. DO NOT use household type Compatible with instruments and equipment Material Safety Data Sheets (MSDS) – ChemAlert Appropriate storage requirements Chem Alert Intranet.url


Manual cleaning agents Mild alkaline instrument detergent - optimal pH: 8.0 -10.8 Low foaming properties Non-corrosive Non-toxic Non-abrasive Free rinsing Bio-degradable Preferably liquid Use and rate of concentration: as per manufactures

instructions


Mechanical cleaning agents Mechanical washer manufacturer’s requirements

e.g ultrasonic or washer/disinfector May be stronger alkaline pH range: 8.0-11.5 Biodegradable Nonabrasive Low foaming Free rinsing Preferably liquid Use and rate of concentration: as per manufactures

instructions


Enzymatic Cleaners Includes enzyme pre cleaners and enzymatic

detergents


Drying Agents/Rinse Aids – Washer disinfectors Surfactants that “wet” the final rinse water Automatically dosed into the final rinse water Spreads evenly over a surface instead of beading Beaded water leaves mineral salts Not as effective on plastics Load instruments and metals on the top racks with plastics on

the bottom Plastics on edge to allow drainage


Acid Base Agents Only on stainless steel surfaces Only intermittently descaling or destaining Dissimilar instruments should not processed at the same time Mix the agent as per manufacturers instructions Only mix when required and discard at end of the day OHS -Chemical manufactures instructions , including safety

precautions, dilution and instrument compatibility OHS - Rubber or nitrile gloves


Lubricants Water miscible – able to mix with water Compatible with the sterilizing agent As per manufacturers instructions Instrument stiffness needs to be investigated Lubrication used intermittently Routine use = heavy contamination

1.5 Pre Cleaning1.5 Pre Cleaning Pre cleaning (initial cleaning) allows for the removal

of visible blood, body fluids and debris from items prior to cleaning (definitive cleaning). Pre cleaning shall be undertaken as soon as possible (e.g. during and post procedure chairside).

If blood, proteins and other debris are allowed to dry or remain in crevices and joints, the instruments become very difficult to clean and are prone to stiffness and accelerated corrosion.

1.5 Pre Cleaning1.5 Pre Cleaning

Pre cleaning can be performed by methods such as dry wiping, damp wiping or use of a commercially available single use only instrument sponge

Place the dry wipe, damp wipe or sponge on the bracket table and carefully wipe the instrument across the material

1.5 Pre Cleaning1.5 Pre Cleaning

Rinsing removes excess blood and debris Prevents blood and debris drying on items As soon as possible - post procedure Reduces bioburden - micro-organisms will multiply rapidly Use warm water

hot water coagulates protein cold water - congeals fats

1.6 Hand Cleaning For Immersible Items1.6 Hand Cleaning For Immersible Items

Automated cleaning of instruments is the preferred practice, but not always feasible

Identify instruments that cannot be immersed under water for manual cleaning

Two dedicated sinks large, deep enough for practical use

Separate hand washing facility

1.6 Hand Cleaning For Immersible Items1.6 Hand Cleaning For Immersible Items Warm water – potable (drinkable) Instrument brushes various sizes Disposable low - lint cloth Suitable instrument detergent Ph: 8 Pressure equipment

High pressure water Air pressure Disposable Syringe

Non abrasive pad

DoubleDouble Sink OperationSink Operation

The first sink is to be always used for the initial rinse of instruments only and does not need to be cleaned between use.

The second sink is to be used for the cleaning and the final rinse of instruments and only needs to be cleaned between these two activities if the instrument cleaning water is discoloured or cloudy.

NB all sinks must be cleaned at the end of the day

Single Sink OperationSingle Sink Operation

The sink is to be cleaned with a detergent impregnated wipe between the first rinse of the instruments and the filling of the sink for cleaning the instruments.

Following cleaning of the instruments and before the final rinse the sink only needs to be cleaned with a detergent impregnated wipe if the cleaning water is discoloured or cloudy.

NB all sinks must be cleaned at the end of the day,


Standard Precautions Heavy duty gloves & PPE Initial Rinse - rinse instruments under warm running water Fill sink correct ratio of warm water and suitable detergent Identify instruments that require manual cleaning Disassemble and open items Inspect for damage or parts missing Immediately notify the supervisor and contact user area


Limit the generation of aerosols Holding item low in the sink under the water line Apply adequate friction Visualise item under the water line Prevent against sharps injury and damage to the instrument Final rinse – Rinse thoroughly under hot running water Check that the item is clean LOOK and CHECK Use a magnifying glass if necessary

1.6 Hand Cleaning - Final Rinsing1.6 Hand Cleaning - Final Rinsing

Final rinsing facilitates the drying of item Use warm water Mechanical washer disinfectors use hot water Removes chemical residues

Tissue irritation Instrument damage

If a demineralised/reverse osmosis water system is installed, rinse with demineralised/ reverse osmosis filtered water.


Cleaning brushes Check no broken bristles or requires replacing Kept free of visible debris during, after use and before reuse Single or limited use cleaning materials Single use, non-abrasive cleaning brushes are disposed of at

the end of the day. Reusable cleaning brushes are to be thermally disinfected at

the end of the day and stored dry.

Unsuitable Unsuitable Cleaning Agents or EquipmentCleaning Agents or Equipment

steel wool or other harsh abrasives

cleaning powders

excessive temperatures

dangerous chemicals

corrosive chemicals


Flush, Brush and Flush all lumen items Flush lumen with water Wet bristles of correct size instrument brush Pass instrument brush through the lumen and rinse debris off

brush tip in an appropriate cleaning solution Withdraw brush Flush through with running hot water Repeat until clean


Drying – As per manufacturer’s instructions Drying cabinet Disposable low-lint cloth for hose, battery and external parts Air pressure gun (for removal of excess moisture) Disposable syringe


Problems associated with incorrect drying

Items should NOT be air dried/ dripped dry Good conditions micro-organisms multiply in 20-30 minutes

Wet packaging result in unsterile item Can cause rusting, corrosion, pitting to the item

1.7 Hand Cleaning For Non-immersible Items1.7 Hand Cleaning For Non-immersible Items

For those items that are unable to be submerged under water

Some items e.g surgical handpieces and attachments, may need hoses or caps attached to prevent water entering delicate parts


Initial rinse - Some items may be gently rinsed with warm water to remove gross soil as per manufacturer’s instructions.

Initial rinse - Some items may be rinsed using a low lint cloth immersed in water if the item cannot be placed under gently running water

Fill sink correct ratio of warm water and suitable detergent Items are wiped using a clean cloth immersed in the clean,

warm water with detergent added The cloth is squeezed (wrung out) to prevent water entering

the instrument, it is damp only, and not dripping wet


The impregnated damp cloth is rubbed over the item

May need to be repeated depending extent of soiling

Handpieces that cannot be immersed in water follow the

manufacturer’s instructions

Non-immersible cannulated items - the manufacturer’s

instructions must be adhered to in relation to flushing and

brushing


Following washing the detergent must be removed

FINAL RINSE - Using a damp clean low lint cloth (that has not

been in contact with detergent), wipe over the item to

remove the detergent. Note if a demineralised/reverse

osmosis water system is installed, rinse with demineralised/

reverse osmosis filtered water

These steps may need to be repeated to remove all traces of

detergent (Dry as per instructions in SOP 1.6 immersible item)

HandpiecesHandpieces handpieces

outside surfaces cleaned using detergent wipe,

rinsed by wiping dried

slow speed motors outside surfaces cleaned using

detergent wipe, rinsed by wiping, dried

lubricated (manually or automatic) may need special adaptors Dried, wrapped & processed in a

wrapped cycle

Special adaptors may be neededSpecial adaptors may be needed


Ideally, handpieces and slow speed motors are cleaned and lubricated using mechanised cleaning equipment

1.8 Ultrasonic Cleaner1.8 Ultrasonic Cleaner

Purpose

Ultrasonic cleaning is a form of mechanical cleaning

that uses high frequency ultrasonic waves (cavitation)

that dislodges fine particles from the surfaces of

instruments.

Ultrasonic cleaning is an effective cleaning method for instruments prior to the reprocessing

1.8 Ultrasonic Cleaner1.8 Ultrasonic Cleaner Minimises manual cleaning Does not disinfect instruments Remove debris using cavitation (sound waves) Detergent as per manufacturer’s instructions Requires degassing before use Rinsing after use (if no further washer/disinfector processing) OHS – do not immerse hands when operating OHS – aerosols – use lid when operating OHS – noise – use lid & hearing protection OHS – dry hands – when handling electrical leads and turning

on or off at power point.


Follow manufacturer’s instructions Newer models may have different requirements Fill the tank with water (may be cold or warm follow manufacturer’s instructions) Then add the specified amount of detergent Degas the water – close the lid for recommended time Lumen instruments undergo manual cleaning first (FBF) Initial Rinse – Rinse all items with warm water to remove gross

soil before placing into designated baskets Disassemble and open items


Place instruments in basket as per manufacturer’s instructions. Do not overload basket as ultrasonic waves will be unable to penetrate the soil on the instruments

Never place items on the floor as transducers will be damaged.

Place delicate or small pieces of items into lock down baskets

Fully submerge the items below the waterline. Close lid and operate for recommended time


For bench top ultrasonic cleaning, use clean gloved hands

Final Rinse - Thoroughly rinse instruments with warm

running water

Lumened items to have excessive moisture removed by air

pressure gun or disposable syringe

Dry using a drying cabinet or with a disposable low lint

cloth


EMPTYING AND CLEANING THE MACHINE

Daily and if solution becomes murky or discoloured as cleaning cannot occur in dirty solution.

Routine cleaning of the ultrasonic machine is required see(SOP 5.9 Routine Cleaning Reprocessing Equipment)

1.9 Washer Disinfector Machines1.9 Washer Disinfector Machines

Batch and continuous type washer disinfectors clean and remove bio burden/micro-organisms (blood and debris)

Thermal (high level) disinfection using time at temperature – final rinse

Means the cleaning process is verifiable Lumened items still require Flush brush Flush Unlock and open items Use appropriate washer baskets/inserts Keep sets together


Loading Lumen instruments have been flushed, brushed and flushed Use specific washer insert that is required e.g. dental

handpieces Disassembled, unlocked, opened (e.g. forceps, needle holders,

scissors) Ensure parts of disassembled instruments are together Use disk or tags to identify instrument trays when using multiple

baskets Small/light items placed in lidded basket with hold down catch


Loading If using barcode baskets select correct basket Load the baskets/racks ensuring they are not

overcrowded or over opened Use a hold down screen Hollowware is loaded in a draining position Minimise lifting of racks Make sure equipment stays in the parameter of the

rack. Select the appropriate cycle for the load


REPORT IMMEDIATELY: Cycle parameters not meeting set requirements or

variations to cycle parameters – failed cycles Items that appear dirty or stained are returned to the

cleaning area for recleaning/destaining Excess water – check the following: the machine

temperature, amount of rinse aid going into the machine or the way in which the machine was loaded

Damaged instruments


Releasing the load and unloading the washer disinfector Authorising release of the load occurs on completion of

washer disinfector cycle and prior to opening the door. Check cycle parameters have been met and print out/log (or

equivalent) is signed

Care opening the doors due to heat and moisture

Inspect load not become dislodged or displaced

Avoid injury and damaging the equipment/instruments

Washer disinfector printout


UNLOADING continued

Check for cleanliness

If machine does not dry - place into drying cabinet

Industrial dry and oil free compressed air used to

remove excess moisture from lumen instruments.

Only when dry, place instruments onto designated

work benches to await packing/wrapping

1.10 De-staining1.10 De-staining

Stains = corrosion, pitting or other damage

Staining can occur

Chemical incompatibility

Water quality

Interaction of alloys in instruments

Investigate cause


Occupational Health & Safety

PPE

Acid based de-staining chemicals are a strong acid

and can cause burns to hands, eyes etc.

Read and follow the manufacturer’s instructions and

precautions.

Refer to MSDS for first aid instructions


Only use intermittently NOT ROUTINELY Check de-staining solution is compatible Usually only stainless steel instruments. Standard precautions Wear protective clothing + heavy duty gloves Use a container with a good fitting lid Strictly follow manufacturer’s instructions on water

temperature, chemical ratio and exposure time Dissimilar instruments not processed at the same time


Remove item using gloved hands After exposure item re-washed to remove chemical residue Only mix de-staining solution when required Change chemical daily or more often if solution discoloured. Remove gloves and wash hands. Identify and report any patterns of staining

1.11 Drying Cabinet1.11 Drying Cabinet

PurposeTo dry the cleaned item prior to wrapping and

packaging and prevent damage that occurs to the item if it is left wet.

Loading Unloading OH & S considerations

easi-sterilise standard operating procedures introduction & section 1 cleaning procedures

Documents

training slide

kgs slide

cleaning procedures

coffee respect slide

sterilisation process

answers finish slide

collection containers

single items