Module G APPLICATION OF CLEANING DISINFECTION AND STERILIZATION

Module G APPLICATION OF CLEANING, DISINFECTION AND STERILIZATION PRINCIPLES TO PATIENT CARE EQUIPMENT IN OUTPATIENT HEALTHCARE SETTINGS

GOAL Understand how to apply the principles of disinfection and sterilization of patient care equipment using the Spaulding Scheme.

PATIENT EQUIPMENT

INFECTION CONTROL IN PHYSICAL THERAPY • High risk patients (chronic debilitating conditions, trauma, burns, wounds) • Patients requiring Contact Precautions are ideally seen at the end of the day (provide education to patients on cross-transmission prevention)

Hydrotherapy Head rest, slings, etc. wiped with EPAregistered disinfectant detergent after each patient use

INFECTION CONTROL IN HYDROTHERAPY ROOM • Plastic disposable liner used for each patient • Hole punched in liner at drain site • Liner removed and placed in regular trash • Tubs cleaned between each patient if liner not used

INFECTION CONTROL IN GYM/ACTIVITIES ROOM • Splinting tanks emptied and cleaned weekly • The hot pack hydrocollator emptied, cleaned every 2 weeks. Assure water temp >160°F • Col. Pac is cleaned biannually, temperature monitored daily (10 -21° F)

INFECTION CONTROL IN GYM/ACTIVITIES ROOM • Frequently used items (hand weights, parallel bars, stair rails, and canes) cleaned after each use, and weekly. • Wheelchairs, cuff weights, and mats wiped down with a EPA-registered disinfectant weekly or when visibly soiled. • Paraffin bath used on intact skin only. Temperature 125 -130° F. The unit cleaned monthly with an EPAregistered disinfectant.

INFECTION CONTROL IN REHABILITATION AREAS • Shared equipment cleaned after each patient use with EPA-registered disinfectant. - Pulse oximeters, - Stethoscopes, - Blood pressure cuffs • Oxygen tubing if used without a humidifier can be reused by the same patient for up to 4 weeks. (Store tubing in plastic bag with patient name between uses. ) If used with a humidifier must be discarded after 72 hours.

CLEANING TOYS • Toys should be non-porous and able to withstand mechanical cleaning • Toys should be inspected for damage • Toys can be cleaned/disinfected : • Soap and water, rinsed and dried • Use of commercial dishwasher (must reach 82°C) • EPA-registered hospital disinfectant • 70% Alcohol solution • 1: 100 dilution of household bleach

CLEANING TOYS • Non-washable toys (puzzles, puppets) may be used by older children who do not put them in their mouths • Non-washable toys are gas sterilized or disposed of if soiled • Patient on Contact/Droplet Precautions, provide toys to keep, or clean well before use by another child.

PHARMACY - INFECTION CONTROL Perform hand hygiene with antimicrobial soap or alcohol-based hand rub at these times: • Upon arrival at work • After eating, drinking or handling food • After using the toilet • Prior to preparing IV medications • When repackaging and handling medications • When returning from outside pharmacy area

Stock-clip. com

MEDICATION STORAGE • Medication storage bins and shelves should be cleaned on a regular schedule, and when visibly soiled. • No food, drinks or specimens may be stored in refrigerators, freezers or other areas intended for storage of pharmaceuticals or supplies. • Medication refrigerators and freezers should be continuously monitored.

MEDICATION PREPARATION AREAS • Must be a clean, dedicated area • Countertops should be wiped down with an EPA- registered disinfectant at least once a shift. • Floors should be free of boxes or other items.

THERMOMETERS Electronic thermometers - rectal (red) or oral (blue) • New disposable hard plastic sheath for each patient • Cord, probe, and unit cleansed daily and when visibly soiled with alcohol single-use pledget • Do not place unit on surfaces in patient/exam room

EAR AND TEMPORAL SCAN THERMOMETERS Ear and Temporal Scan Thermometers • New plastic cover each use • Unit (especially end of probe membrane) wiped daily and when visibly soiled with 7090% alcohol, or per manufacturer’s recommendations

ELECTROCARDIOGRAM (ECG) CABLES AND LEADS • Cables and leads wiped with EPAregistered disinfectant • Clean machine at least weekly and when visibly soiled

BLOOD PRESSURE CUFFS • Cleaned with EPA- registered disinfectant or 70 -90% alcohol • Routinely (e. g. , between patients, daily), and when visibly soiled

VAGINAL SPECULA • Should be cleaned with detergent and water • Steam Sterilization or high-level disinfection • Each specula should be individually wrapped prior to sterilization • Stored in a manner that prevents contamination

DIAPHRAGM FITTING RINGS • Clean with enzymatic or non-enzymatic detergent and rinse • Immersed in high-level disinfectant or steam sterilization • Follow manufacturer's recommendations

CRYOSURGICAL PROBES • Cleaned with soap and water or enzymatic cleaner • Immersed in high-level disinfectant • Wrapped in high-level disinfectant soaked cloths • Follow manufacturer’s instructions

VAGINAL ULTRASOUND PROBES

PROSTATE BIOPSY PROBE Cleaning • Clean the external surface of the probe • Disassemble the transducer (remove needle guide from probe) • Brush clean or flush each lumen with enzymatic or non-enzymatic cleaner • Rinse and dry • Visually inspect

PROSTATE BIOPSY PROBE Disinfection and Sterilization • Steam sterilize needle guide • High-level disinfect heat sensitive components • Ensure that all lumens have contact with high-level disinfectant • Rinse with sterile, filtered or tap water. • Follow filtered or tap water with an alcohol rinse • Dry • Store to prevent recontamination

INFRARED COAGULATION UNIT

EAR, NOSE AND THROAT (ENT) EQUIPMENT Reusable ear specula and curettes • Should be washed with detergent and water and autoclaved. Reusable nasal specula • Should be cleaned and autoclaved after each patient use • Non disposable tips on audioscopes/tympanometers washed with detergent and water, soaked in alcohol 510 m

EYE EQUIPMENT • Applanation tonometer • Soaked in bleach (1: 10) dilution for a minimum of 5 minutes - then flushed with tap water for 15 -20 seconds and allowed to dry • Tonopens • Thoroughly disinfected with alcohol after each use • A new tip cover is placed for each patient use

GONIO LENSES • Disinfected between patient uses by immersion in a (1: 10) dilute bleach solution for 10 minutes, rinsed thoroughly through 3 cycles, and allowed to dry before storage

EYE EQUIPMENT Slit lamps • Head rests, chin rests, and handles wiped with a 1: 100 sodium hypochlorite solution or 70 -90% alcohol between patient uses. Eye Drops • Read label (single vs multi patient use) • If multi-patient, take steps to prevent contamination

REFERENCES • Rutala WA, Weber DJ. Disinfection and sterilization: What clinicians need to know. Clin Infect Dis 2004; 39: 702 • Rutala WA, Weber DJ. New developments in reprocessing semicritical items. Am J Infect Control 2013; 41; S 60 -66 • Rutala WA, Weber DJ, HICPAC. CDC guideline for disinfection and sterilization in healthcare facilities, 2008. MMWR. Available at CDC. gov. • Rutala WA, Weber DJ, APIC Text of Infection Control and Epidemiology, 3 rd Edition, Vol One, 2009. • FDA cleared sterilants and high level disinfectants with label claims for reprocessing reusable medical devices. Jan 2009. available at: http: //www. fda. gov/cdrh/ODE/germlab. html

Congratulations on completing the modules!