Decontamination & Disinfection Policy Mid-Cheshire Hospitals NHS Trust

Contents
Policy StatementPage 2 Definition of TermsPage 2

Single Use Items and InstrumentsPage 2

Risk Assessment for Decontamination Methods..Page 4

Procedures Required for Achieving Decontamination..Page 5 Table 1Properties and Uses of Chemical Disinfectants.Page 7 Table 2 Recommended Disinfectants/Antiseptics.Page 10 Table 3 Methods for Decontamination..Page 11

Considering Decontamination prior to Purchase..Page 19

Decontamination of Healthcare Equipment prior to Inspection, Service or Repair...Page 20

Handling and Transportation of Equipment to the Sterile Supplies Department.Page 21

Roles and Responsibilities...Page 21 Legislation, Guidance and References...Page 21 Policy Management..Page 22

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Decontamination and Disinfection Policy

Policy Statement
The role of decontamination procedures as part of effective measures for the prevention and control of infection is essential for both patients/clients and healthcare workers. COSHH regulations (amended 2003) advise the need for employers and employees to be aware of their responsibilities in relation to evaluating and controlling the risks posed by hazardous substances, including both chemicals and pathogenic micro-organisms. These include risk assessment of any process involving pathogenic micro-organisms and taking action to reduce the risk to a minimum. The following guidance relating to decontamination and disinfection outlines the processes and methods designed to reduce the risk of cross-contamination via commonly used items of equipment within the clinical area. Whilst the policy aims to cover most situations and eventualities, many factors which include the following, may influence risk assessment and subsequent solutions for decontamination. the nature of the contamination time required for processing heat, pressure of moisture and chemical tolerance of the object quality and risks associated with decontamination method

Therefore, the following guidance is intended to provide a basic guide to decontamination only. Staff within MCHT are encouraged to discuss local decontamination and disinfection requirements with the Infection Prevention and Control Team (IPCT) to ensure appropriate methods and processes are in place for decontamination within each ward/department.

Definition of Terms
Contamination the soiling or pollution of inanimate or living material with harmful, potentially infectious or other unwanted substances, eg, organic matter (blood and body substances), microorganisms, dust, chemical residues, etc. Such contamination may have an adverse effect on the function of the inanimate object or may be transferred to a susceptible host (patient/staff) during use, subsequent processing or storage. Decontamination a combination of processes which removes or destroys contamination, preventing micro-organisms or other contaminants reaching a susceptible site in sufficient quantities to cause infection or other harmful response.

The processes include effective cleaning, disinfection and/or sterilization, used to render reusable medical devices safe for further use. NB. The life-cycle of reusable medical devices includes the acquisition, cleaning, disinfection, inspection, packaging, sterilization, transport and storage. Cleaning this is the first level of decontamination and may be all that is required for certain items. Cleaning is an essential pre-requisite for disinfection or sterilization as the presence of any organic matter may render higher levels of decontamination ineffective. Disinfection a process which reduces the number of viable micro-organisms but is not necessarily effective against bacterial spores or some viruses. Disinfection can be achieved through the use of heat or chemicals. The aim is to reduce the contamination to safe levels. Chemicals that achieve this result are known as disinfectants. Such procedures are used when sterilisation is impractical. For example; Rapid processing of endoscopes Treatment of non-autoclavable equipment in contact with infectious cases.

Disinfectants that may be applied to skin or mucous membranes are called antiseptics. Sterilisation means that the complete destruction of all micro-organisms, including spores. Equipment and materials which come into contact with broken skin or mucous membranes should be sterile, eg, instruments, dressings and injection/irrigation fluids. Sterilisation is best effected by moist heat, usually by autoclaving under pressure.

Single Use Items and Instruments

These are medical devices manufactured with the intention to be used once only and then discarded. It is to be noted that current advice from the Department of Health on equipment marked as single use is that no item of equipment is ever re-used.

Items designated as single use carry the following symbol:-

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Re-use of these items means that the Trust becomes a producer of a product and not simply a user. Attempts to decontaminate and re-sterilise such items are likely to be unsuccessful and would render the Trust liable in the event of an adverse outcome. Staff attempting to decontaminate and re-use items marked as single-use only are in breach of Trust policy and guidance issued by the Medicines and Healthcare Products Regulations Agency.

Single Patient Use this means that the medical device is intended for more than one episode of use on one patient only. The device may undergo some form of re-processing between each use and then be discarded, eg, some types of tracheostomy tubes. Manufacturers instructions should be followed carefully when using any medical device. Advice from the IPCT should always be sought prior to purchasing any medical advice.

Risk Assessment for Decontamination Methods

In order to maximise the protection of patients/clients and staff from exposure to infection from medical devices and other equipment, a safe system of work requires implementation. This includes risk assessment and the implementation of appropriate decontamination methods to render the item(s) safe for subsequent handling or use. All medical and other equipment can be categorized according to its potential infection risk. The following method of risk assessment and selection of appropriate decontamination methods can be applied across all healthcare settings and situations. High-risk items these can be classified as those items that come into contact with a break in the skin or mucous membranes, or enter a body cavity or organ. High-risk items must be sterile Examples: Surgical instruments, urinary catheters, cardiac catheters, wound dressings, arthroscopes, cystoscopes, intravenous/intra-arterial devices, some respiratory equipment.

Medium-risk items these are items that come into contact with intact mucous membranes. Medium risk items must be cleaned then disinfected preferably by heat Examples: Re-usable bedpans/urinals, re-usable face masks, cutlery/crockery, bed linen; oral thermometers and other items placed in the mouth, auroscope ear pieces and nasal scopes.

Low-risk items these are those items that do not come into direct contact with the patient, or only come into contact with healthy, intact skin.

Low-risk items must be physically cleaned and dried Examples: Equipment Drip stands, dressing trolleys, monitors, blood pressure cuffs, mattresses, examination couches, bath hoists, bed cradles, washbowls, suction machines, commodes. Environment Furniture, floors, soft furnishings, fixtures and fittings. NB: Low-risk does not mean there is no risk, as any low-risk item may become a source of infection if it becomes contaminated with pathogenic micro-organisms. Subsequently, an item of equipment or the environment may require the application of a disinfectant agent if contaminated.

Procedures required for achieving decontamination

The choice of decontamination method centres around the infection risk associated with the intended use of the equipment. Other factors that must be considered include: 1. 2. 3. 4. 5. 6. The nature of the contamination. The time required for processing. The heat, pressure, moisture and chemical tolerance of the object. The availability of the processing equipment. The quality and risk associated with the decontamination method. The manufacturers guidance.

All items requiring decontamination must first be adequately cleaned to remove organic matter. For low-risk items, manual cleaning is generally acceptable. Medium-risk items where possible should be cleaned/disinfected in a thermal automated washer. High-risk items requiring re-processing ideally should not be cleaned manually due to the infection risk associated with such invasive items. There may be certain pieces of equipment used with scopes, however, which require manual cleaning initially due to their design. Cleaning Procedures; Low Risk Items Only Protective gloves and apron should be worn. Facial protection may be necessary if splash or spray is likely. If appropriate, the item should be dismantled prior to cleaning. The item should be submerged in a deep sink (NOT A HANDWASH BASIN), or a suitably sized receptacle, containing a solution of warm water and general-purpose detergent. The item should be washed carefully with a disposable cloth. Where immersion is impracticable or inappropriate, the item should be washed with a disposable cloth wrung out in a solution of warm water and detergent. The item should be rinsed with warm water and dried thoroughly. Drying is an important part of the cleaning process as some organisms are able to flourish in wet residues. Dry with paper towels where possible, if not, allow to drain and dry by natural means. Cleaning equipment must also be stored clean and dry. Disposable items must be discarded after use. Protective clothing (aprons and gloves) must be discarded as clinical waste and hands thoroughly washed after any cleaning procedure.

Disinfection Procedures Disinfection can be achieved through the use of heat or chemicals.

High-level disinfectants - eg, Paracetic acid and Chlorine dioxide are highly effective in destroying micro-organisms and recommended for the disinfection of endoscopes where heat disinfection is not possible. Chemical disinfection is not, however, a substitute for sterilization and is not as effective as disinfection by heat. It must not be used where the use of single-use items would be more appropriate. As with any form of disinfection, effective cleaning must be performed initially to remove organic matter. Disinfection by heat is the preferred method for those items that must be rendered safe to use, but do not need to be sterile. The process generally involves the use of a washer-disinfector, which will inactivate all micro-organisms except bacterial spores and some heat-resistant viruses.

Sterilisation Procedures The most commonly achieved method of sterilisation is by the use of steam under pressure. The process should be carried out centrally within the Sterile Services Department, Leighton Hospital. Benchtop steam sterilisers are not recommended for use within departments. Central sterilisation is recommended by the Department of Health and consequently MCHT should endeavour to minimise local sterilisation. If the use of Benchtop steam sterilisers is unavoidable, refer to the Infection Prevention and Control Team within MCHT. The following tables are designed to provide a basic reference guide for chemical disinfection, antiseptic solutions and cleaning methods for equipment; Table 1- Properties and uses of Chemical Disinfectants Table 2-Recommended Disinfectants/Skin Antiseptics for MCHT Table 3-Methods for Decontamination-Commonly Used Equipment/Items

Table 1. Properties and Uses of Chemical Disinfectants TYPE

Chlorine Dioxide Tristel

Disinfectants EXAMPLE

COMMENTS

Rapidly bacterical, virucidal and sporicidal. Achieves high level disinfection within 5 minutes. NB: Tristel currently used for Endoscopy disinfection within MCHT. Available in wipes and solution.

Quaternary Ammonium Compounds

Roccal, Zephiran Cetrimide, Antibacterial inhibits the growth of bacteria. Not bactericidal, which Cetavlon would kill bacteria. Ineffective against viruses and spores. Not recommended for use in the clinical area. Stericol, Hycolin, Clearsol Active against a wide range of bacteria. Fungicidal, but limited virucidal and sporicidal activity. Corrosive to instruments, too toxic for skin. Not widely used for disinfection.

Phenolics

Alcohol

70% Alcohol solutions - Cliniwipes - Azowipes - Mediswabs - Hand gel preparations

Effective, rapid acting disinfectants and antiseptics. Poor penetrative powers should only be used on clean surfaces. Active against bacteria and not spores. Virucidal activity variable. Commonly used for skin disinfection and as agent for rapid disinfection of physically clean hands.

Disinfectants
TYPE EXAMPLE COMMENTS

Chlorine-releasing agents Strong Sodium Hypochlorite solutions Hypochlorite powders Sodium dichloroisocyanurate (NaDCC)

Chloros, Domestos, Sterite Titan, Enbac Sanichlor, Haztab, Presept (Tablets or powders)

Chlorine-releasing agents are rapidly effective against viruses, fungi bacteria and spores. Recommended for hazards of viral infection, eg Hepatitis B, C, HIV

Weaker Sodium Hypochlorite solutions

- Milton (limited use in clinical areas due to weak concentration)

READILY INACTIVATED BY ORGANIC MATTER MAY DAMAGE CERTAIN MATERIALS; SOME PLASTICS, RUBBER, METALS & FABRICS. MUST NOT BE MIXED WITH ACIDS INCLUDING ACIDIC BODY FLUIDS SUCH AS URINE.

REQUIRED CONCENTRATIONS OF CHLORINE-RELEASING AGENTS:USES Blood or Body Substances (Not urine) Infant feeding bottles Food preparation areas and catering equipment Hydrotherapy pools - Routine - Contaminated Routine water treatment NB: Product used within MCHT is Titan Sanitiser. See Spillage policy for management of spillages.
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AVAILABLE CHLORINE(ppm) 10,000 125

125

1.5-3 6-10 0.5-1

Disinfectants
TYPE Triclosan EXAMPLE Sterzac, Manusept, Cidal, Aquasept, Irgasan COMMENTS Antiseptic agents used in hand rubs, soaps, bath concentrates and powders. Active against gram-positive organisms, eg, Staphylococcus aureus, Streptococcus. Less effective against gram-negative organisms, eg Pseudomonas and some Gastro-intestinal bacteria. Generally less effective than chlorhexidine preparations. Skin antiseptic Effective for surgical disinfection of hands with residual antimicrobial effect. Useful for pre-operative disinfection, not suitable for the soaking of equipment/instruments. Skin preparation. Skin reaction may occur in some individuals, 0.5% alcoholic chlorhexidine or an alcoholic iodophor solution is preferable. Mainly used for hand disinfection.

Chlorhexidine

Hibitaine

Iodine and Iodophors

Iodine Iodophors Betadine, Disadine, Videne

Table 2: Recommended Disinfectants/Antiseptics Disinfectants

TYPE Chlorine Dioxide Sodium Hypochlorite Alcohol 70% Tristel Titan Sanitiser Hand gel Alcohol solution Cliniwipes/mediwipes Mediswabs EXAMPLE Endoscope disinfection Spillages of blood/body substances wards/departments For use on physically clean hands refer to hand hygiene guidelines Skin preparation not to be used for soaking items of equipment. Skin preparation wipes may be used for smooth, clean surfaces or equipment that cannot be immersed in solutions ALWAYS ALLOW ALCOHOL TO EVAPORATE TO ENSURE EFFECTIVENESS COMMENTS

Chlorhexidine

Hibitaine

Skin preparation/surgical scrub Not necessary for routine handwashing liquid soap adequate Skin preparation Hand disinfection (Theatres)

Iodine

Betadine Disadine Videne

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Table 3: Methods for Decontamination

COMMONLY USED EQUIPMENT/ITEMS METHODS FOR CLEANING OR DISINFECTION ALTERNATIVE PROCEDURES OR FREQUENCY ROUTINE OTHER RECOMMENDATIONS After each patient Disposable After each use Wash with detergent, dry thoroughly Detergent and hot water, dry thoroughly No preparation needed Prior to use After each use After each use After each use Daily and when visibly contaminated Each time used Each time used Swab entry port with 70% alcohol swab Allow to dry Wash with detergent, dry thoroughly Wash with detergent. Soak in chlorine solution; 125 ppm e.g. Milton Wash with detergent or detergent based wipe Wash with detergent or detergent based wipe Hypochlorite if soiled with blood/body substances. Do not immerse ampoules in disinfectant solutions May not be reused unless new needle and syringe used Alcohol wipe Single use preferable Send to SSD Single use preferable Hypochlorite if soiled with blood/body substances Infected patients or patients with open wounds use Hypochlorite sanitizer Infected patients or contaminated with blood/body substances use Hypochlorite sanitizer Infected patients or contaminated with blood/body substances use Hypochlorite sanitizer Infected patients or contaminated with blood/body substances use Hypochlorite sanitizer

ITEM Airways Ambu bags Ambulift Ampoules and vials Multi bottle/vial Auroscopes Baby feeding bottles Baby security tag Baby scales

Baths and wash basins (see sinks) Bath mats

Clean daily and in between patients with detergent Wash with detergent, rinse and hang over side of bath or rail. Allow to dry Antiseptics should not be added as a routine Wash with detergent or detergent wipes

Bath water Bed frames

Between patients when visibly contaminated Between patients after each use Daily and when contaminated After each use

Bed pan holders (plastic)

Bed pan disposal units (macerators) Breast Pumps and attachments

Wash with detergent and store dry. Slipper pans should be a disposable pulp material not plastic Wash exterior with detergent Send to Sterile Services for reprocessing after each use detergent & cold water sterilant

Disposable breast pumps as an alternative

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ITEM Bowls (Surgical) Bowls (Washing)

COMMONLY USED EQUIPMENT/ITEMS METHODS FOR DISINFECTION FREQUENCY ROUTINE ALTERNATIVE PROCEDURES OR OTHER RECOMMENDATIONS After each use Send to Sterile Serivces for re-processing Between each use and after patient discharge Daily Carpets not suitable for clinical areas After use or when visibly dirty Individual bowls should be used Wash with detergent, rinse and store dry Avoid stacking inside each other Vacuum clean daily Infected patients or contaminated with blood/body substances use Hypochlorite sanitizer Contaminated spillage remove organic matter. Use Hypochlorite solution and rinse well to avoid discolouration Use different cloths/mops in different areas e.g. Green Kitchens Red Toilets and Bathrooms Blue General areas Yellow Isolation/cohort areas NB white mop for spillages - launder mop head after each episode

Carpets

Cleaning equipment

Cots Cot sides Commodes

After each patient After each patient when visibly contaminated After each patient use

Crockery and Cutlery Drains

After use As required

Drip stands

Daily, in between patients and if contaminated

MOPS rinse after use, wring and store inverted. Launder mop head daily. BUCKETS Change hot water and detergent frequently. CLOTHS Disposable FLOOR SCRUBBERS Detergent and hot water (including scouring pads) Store all equipment dry Wash with detergent, dry Use detergent wipe Wash with detergent, dry Use detergent wipe Frame wash with detergent/detergent wipe Seat- detergent unless soiled Remove faecal matter prior to using Hypochlorite sanitizer Ward dishwasher. Rinse cycle must exceed 80 C Chemical disinfectants are of no value. Flush with hot water and soda crystals when necessary Wash with detergent

Infectious patients must have individual commodes Use Hypochlorite sanitizer for spillages if enteric pathogens are isolated. Hand wash with detergent and hot water if machine wash not available

Additional wipe with 70% alcohol if contaminated

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ITEM Dressing Trolleys

SCOPES;

COMMONLY USED EQUIPMENT/ITEMS METHODS FOR DISINFECTION ALTERNATIVE PROCEDURES OR FREQUENCY ROUTINE OTHER RECOMMENDATIONS Thoroughly clean with Alcohol impregnated wipe or detergent wipe in Clean thoroughly if used for infected patients or detergent and hot water or between patients contaminated with blood/body substances detergent wipe before Ensure thoroughly cleaned at least daily commencing dressings Disposable scopes and accessories should be considered where possible At the beginning of each list and in between each patient Must be used within two hours of processing At the beginning of each list and in between each patient Must be used within two hours of processing At the beginning of each list and in between each patient Clean with detergent prior to processing in automated washer/disinfector with Tristel (chlorine dioxide)

Endoscopes

Bronchoscope

Clean with detergent prior to processing in automated washer/disinfector with Tristel (chlorine dioxide)

Nasopharyngoscope

Fibre optic Laryngoscope Hysteroscope Cystoscope

At the beginning of each list and in between each patient At the beginning of each list and in between each patient At the beginning of each list and in between each patient

Clean with detergent prior to wiping with chlorine dioxide (Tristel wipe) Ensure contact time of 30 secs Rinse and dry thoroughly Clean with detergent and hot water prior to sending to SSD. Central re-processing in SSD required Rigid- Central re-processing in SSD required. Flexible- Clean with detergent prior to processing in automated washer/disinfector with Tristel (chlorine dioxide)

Use of alcohol wipe or solution NOT adequate

Use of alcohol wipe or solution NOT adequate

Local re-processing not to be performed

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ITEM Proctoscope

Colonoscope

COMMONLY USED EQUIPMENT/ITEMS METHODS OF DISINFECTION ALTERNATIVE PROCEDURES OR FREQUENCY ROUTINE OTHER RECOMMENDATIONS At the beginning of each list Central re-processing in SSD required Clean with detergent prior to processing in and in between each patient automated washer/disinfector with Tristel (chlorine dioxide) At the beginning of each list Clean with detergent prior to processing in and in between each patient automated washer/disinfector with Tristel (chlorine dioxide) At the beginning of each list and in between each patient Clean with detergent prior to processing in automated washer/disinfector with Tristel (chlorine dioxide)

ERCP scope

Enteral feeding pumps

Fans

Floors Flower vases

Wash pump daily with detergent Syringes- DISPOSABLE Giving sets- DISPOSABLE Discouraged from clinical areas due to volume of dust/pathogenic matter dispersed. If essential, must be cleaned in between each patient. Daily or when contaminated/visibly dirty After each use

Wipe exterior with detergent wipe. Estates to dismantle and clean interior thoroughly when build up of dust noted, or used for patient with MRSA

Risk of dispersal to other patients if not cleaned after each use

Detergent only unless spillage of blood/body substance present refer to spillage policy Detergent, hot water, rinse and dry. Do not leave to soak. Do not use sterilising solution or tablets, e.g. Hypochlorite/Milton

Food/drinks trolleys

Furniture Hands Humidifiers

After each drinks round, more frequently if self-serve system is operated See local cleaning schedules Before and after each patient contact Daily where practical Before and after each patient use After each use

Detergent and hot water Ensure all surfaces are dried thoroughly Wash with detergent and water Soap and water, rinse and dry well Alcohol gel on physically clean hands Short term humidifier disposable Long term humidifier -wash equipment with soap and water Detergent and hot water Rinse and dry thoroughly

Detergent only in isolation rooms/bays unless blood/body substances present Do not wash in the kitchen, bay area or side rooms Do not use the hopper for this purpose Use the stainless steel equipment sink in the sluice, or a designated flower sink. Ensure water tank is drained, sluiced through and re-filled daily. Contact the Infection Control Team for specific decontamination requirements See hand hygiene guidelines

Disposable attachments Clean exterior daily whilst in use

Incubators

ITEM Instruments

Intravenous equipment e.g. pumps, syringe devices. Jugs - measuirng urine and body fluids hairwashing/ bathing for use with suction

COMMONLY USED EQUIPMENT/ITEMS METHODS OF DISINFECTION ALTERNATIVE PROCEDURES OR FREQUENCY ROUTINE OTHER RECOMMENDATIONS Immediately after use Return to SSD for reprocessing in accordance Contact the Infection Control Team for specific with SSD policy. decontamination requirements or heat sensitive For instruments with narrow lumen, parts that instruments/equipment are difficult to clean use disposable if available To be wiped daily and in Follow manufacturers instructions for cleaning For giving sets; cut off sharp end and dispose in between each patient regime and method sharps bin, remainder in clinical waste Ideally equipment to be wiped between patients with an alcohol impregnated swab or wipe Disposable only Single use, then dispose of in ward macerator

Use for 24hrs only

24 hour use, then return to SSD

Laryngoscope blades

After each use

Disposable blades or send to SSD after single use Detergent and water, Ensure dried thoroughly Detergent and hot water or detergent wipe Dry thoroughly See Spillage Policy for procedure for checking mattress integrity Disposable or detergent and hot water Rise and store dry DO NOT LEAVE TO DRAIN Clean inside and out after each patient Examine mattress in between patient for staining, cover integrity and moisture collection. Renew mattress if cover is no longer impervious to body substances Medicine pots to be washed in the kitchen May be suitable for ward dishwasher if racking system available

Lockers (Bedside) Mattresses: Refer to manufacturers instructions for specialist mattresses or covers Medicine pots

Surfaces daily and following spillage Following spillage, after each patient use or prior to leaving ward area

After each use

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ITEM Manual handling aidsMachinery

Manual handling aidsSlings

Nail Brushes Nebuliser chamber and mask

COMMONLY USED EQUIPMENT/ITEMS METHODS FOR DISINFECTION ALTERNATIVE PROCEDURES OR FREQUENCY ROUTINE OTHER RECOMMENDATIONS Following spillage and as part Detergent and hot water, dry thoroughly Disinfect with Hypochlorite if blood/body of ward schedule for substances present equipment. Twice weekly clean preferable Launder centrally, label appropriately to ensure Do not use a visibly contaminated sling on any Single patient sling if return to ward patient. Where possible do not use a sling used available for isolated patients on other patients unless it has been laundered Disposable only Disposable only Not recommended for use except in Theatres After each use Wash with detergent and hot water Rinse and store dry For single patient use only. Can be used as a disposable item if decontamination not achievable Wipe with detergent and dry Do not leave to drain ensure dried thoroughly.

Notices

Opthalmoscope Razors Electric Wet Resuscitation mask Rooms

Following contamination. After each use for isolation.Weekly as part of ward schedule After each use After each use Disposable After each use Daily according to ward cleaning schedule Isolation cleans in between as requested According to task and at the end of each shift if own scissors are used Disposable scissors or return to SSD if able to be processed

Wash with detergent or wipe with alcohol impregnated wipe Not for communal use Disposable type only if patients own; rinse and store dry Wash with detergent Store dry Detergent and hot water Hypochlorite for blood or body substances

Clean patients razor with brush after each use Ensure disposal of wet razors into Sharpsbin

For isolation rooms or bays detergent and hot water Hypochlorite for blood or body substances Ensure disposable cloths are used.

Scissors

When sterility not required, wash with detergent and water and clean with 70% alcohol (Mediswab)

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ITEM Sharps containers *Sharps trays

Shaving brushes

COMMONLY USED EQUIPMENT/ITEMS METHODS FOR DISINFECTION ALTERNATIVE PROCEDURES OR FREQUENCY ROUTINE OTHER RECOMMENDATIONS When visibly contaminated, or Wipe any blood contamination with alcohol Dispose of Sharps bins used in isolation rooms if in use for longer than a impregnated wipe following patient discharge week eg; used in an isolation *Sharps trays to be cleaned twice weekly with room detergent, alcohol wipe when visibly contaminated After each use if patients own Communal use not recommended, use aerosol foam unless patients own Shower cubicle and chair after each patient use. Shower curtain weekly as part of routine cleaning schedule Daily, unless greater frequency required Detergent and water unless blood or body substances present Shower screens preferable to curtains due to cleaning difficulties

Shower cubicle/curtain or chair

Sinks Handwash basins

Detergent, hot water clean inside and outside. Dry thoroughly

Hypochlorite sanitiser for stains and build up Scouring pad and detergent for build up of lime scale and soap Hypochlorite for blood or body substances Scourer for build up of deposits/lime scale

Equipment sinks (sluice area) and Bucket sluice (Domestics room) Hopper/body substances disposal unit (sluice area) Sphygmomanometer cuffs Stethoscopes

Daily, unless greater frequency required

Detergent, hot water and dry.

Daily, unless greater frequency required Dependent on material At least daily if used communally between staff. Encourage single staff use In between patient use or when visibly soiled. Twice weekly for longer stay patients After each use and in between patient use

Hypochlorite sanitiser, rinse and wipe surfaces dry where possible Alcohol wipe if material allows Wipe head with alcohol wipe between patients. Ear pieces to be cleaned daily with Steret or hot soapy water Detergent and water, dry thoroughly Avoid material cuffs on non-intact skin

Stands/holders for urine bags etc

Hypochlorite for blood or body substances.

Detergent and water, dry thoroughly

Use disposable liners for fluid collection

Suction Units

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ITEM Theatre footwear

Thermometers; tympanic

Tonometer heads Toys

Vaginal specula Vaginal ultra sound probe

Wash bowls

W.C.

X-Ray equipment

COMMONLY USED EQUIPMENT/ITEMS METHODS FOR DISINFECTION ALTERNATIVE PROCEDURES OR FREQUENCY ROUTINE OTHER RECOMMENDATIONS Automated wash preferable. Specialist areas to develop local protocols for Automated wash daily or Adequate PPE required for manual cleaning the cleaning of theatre footwear following theatre session Must be cleaned when visibly contaminated . Wipe handpiece with detergent wipe when Disposable cover must be visibly contaminated, after use in each bay and disposed of after each patient after use in an isolation area use and not re-used Single use for each patient Disposable products only advocated by the Infection Control team Fabric toys not suitable for use in isolation When visibly contaminated, Vinyl/plastic wash with detergent weekly or rooms or after use by each patient when visibly soiled Fabric toys not suitable for communal play areas After each use Disposable preferred. If not, return to SSD for processing After each use Wash thoroughly with detergent. Wipe with Disposable sheath to be used additionally Tristel wipe(chlorine dioxide) allowing contact time of 30 secs Rinse and dry thoroughly prior to use Each patient to have an Detergent and hot water individual wash bowl for the Dry thoroughly inside and store dry after each duration of their stay. Ensure use. Do not stack whilst wet thoroughly cleaned on discharge and after each use. Twice daily unless greater Inside of bowl and rim with Hypochlorite frequency required sanitiser and toilet brush. Rinse brush in clean flush water Disposable cloth for cistern, handle,seat and bowl Twice weekly. After patient Damp dust with detergent and water according If disinfection or a less moist wipe is required, use if visibly contaminated to frequency of use, or use detergent wipes use a wipe impregnated with 70% alcohol

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Considering Decontamination prior to Purchase

It is vital that decontamination methods are considered before any piece of equipment is purchased. The following points should be considered and if necessary discussed with the Infection Prevention and Control Team; What is the equipment going to be used for? For example; Single patient use Same patient, multiple use Multiple patient use How invasive is the piece of equipment? If skin, orifices or mucous membranes are breached, what level of disinfection or sterilisation is needed? Is there a single use alternative that may ultimately prove cost effective in terms of cleaning time and other resources? How can the equipment be safely decontaminated? Is detergent satisfactory or are other specific agents required? (Consider COSHH requirements) Is the equipment easy to clean? For example; smooth surfaces and edges, constructed of a non-porous material. Additionally, consider crevices, ridges present, or hollow parts that are inaccessible If a Hypochlorite or alcohol solution is required, will the integrity of the equipment be affected. Additionally, will the device or piece of equipment withstand regular cleaning?

If adequate methods of decontamination cannot be identified due to the structure or material of an item, the Infection Prevention and Control Team (IPCT) will recommend that it is taken out of service if already in use, or not purchased in the first instance. Whilst considering items for purchase, ensure that the manufacturer or representative provide as much information as possible with regard to cleaning requirements or restrictions. A Pre-Purchase Questionnaire/Requisition form (PPQ form) requires completion prior to ordering some items of equipment. This form will be reviewed by EBME prior to the item of equipment being ordered and the section detailing decontamination methods considered in conjunction with the IPCT. Not every piece of equipment requires a PPQ form, therefore it is advisable that decontamination methods are discussed with the IPCT to ensure that appropriate decisions are made, risks can be minimised and that resources are not wasted.

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Decontamination of Healthcare Equipment Prior to Inspection, Service or Repair

The following procedures outline safe systems of work in relation to health care equipment which has been in contact with blood or body substances or other undesirable substances, eg, dust, soil, chemical residues, etc. Procedures outlined are applicable to all staff likely to be involved both directly and indirectly in patient care and the use of equipment. All equipment must be decontaminated by the user prior to being presented to or sent to third parties for maintenance, service, inspection or repair. If contamination is not apparent, the item must be physically cleaned before being presented for service or repair. Usually general-purpose detergent and water is adequate for this task. Visible soiling MUST BE REMOVED by the user before being presented to a third party. Manufacturers instructions must be adhered to at all times. The decontamination procedure must be detailed on the contamination status label. The label is to be used when a request is made for inspection, service or repair of an item of healthcare equipment. Completion of the contamination status label will confirm to the inspecting/servicing department that the required decontamination/cleaning procedure has been completed. Some items of equipment cannot be decontaminated without being dismantled by an engineer. In such instances, the relevant section of the contamination status label must be completed and discussion with the receiving department or firm must take place before the item is left with them. A suitable method of bagging or covering must be decided upon before transportation can occur. Appropriate personal protective equipment must be worn during handling, service or repair of the item. Any items of equipment dispatched from Trust premises or returned to the manufacturer must be packaged carefully and according to Post Office regulations. The contamination status label must be accurately completed and enclosed in the packaging. If a full decontamination procedure has not been carried out, it is the responsibility of the ward/department to advise the recipient accordingly.

EQUIPMENT FOR REPAIR OR SERVICING WITHOUT THE COMPLETED CONTAMINATION STATUS LABEL WILL NOT BE ACCEPTED. ITEMS THAT ARE VISIBLY SOILED OR CONTAMINATED WILL NOT BE ACCEPTED. WARDS/DEPARTMENTS WILL BE ASKED TO CLEAN THE ITEM THOROUGHLY PRIOR TO THE COMPLETION OF SERVICE OR REPAIR. 20

Prior to purchasing any new equipment for clinical purposes, staff must ensure that effective cleaning and decontamination can be performed. Advice must be sought from the manufacturer and the Infection Prevention and Control Team prior to purchase. If equipment is purchased that cannot be safely decontaminated, in the interest of patient and staff safety, the IPCT may recommend its withdrawal from service.

Handling and Transportation of Equipment to the Sterile Services Department

For items of equipment/instruments requiring re-processing within the Sterile Services Department, care must be taken to ensure safe methods of handling and transportation are employed. Please refer to the SSD Policy (return of used medical devices) the procedures required to facilitate safe and legal re-processing of medical devices.

Roles and Responsibilities

It is the responsibility of every member of staff within MCHT to ensure that procedures within the Decontamination and Disinfection policy are carried out. Infection Prevention and Control Team: To provide advice and support to any department/member of staff in relation to decontamination and disinfection. To liaise with manufacturers company representatives and experts in the field of decontamination to ensure that advice given is accurate, appropriate and evidence based. To ensure national initiatives or guidance is incorporated into policies and practice within MCHT.

Legislation, Guidance & References

Ayliffe G, Coates, D & Hoffman P (1986) Chemical Disinfection in Hospitals Ayliffe, Fraise, Geddes and Mitchell (2000) Control of Hospital Infection A Practical Handbook (4th edition). Arnold: London 21

British Medical Association (1989) A Code of Practice for the Sterilisation of Instruments and control of Cross Infection BMA: London Control of Substances Hazardous to Health Amendment Regulations (2003) HMSO: London Department of Health and Public Health Laboratory Service (1995) Hospital Infection Control Guidance on the Control of Infection in Hospital Department of Health: London Health & Safety At Work Act (1974) HMSO: London HSG (93) 26 Decontamination of Equipment prior to inspection, service or repair NHS Management Executive Medical Devices Agency (2000) Single-use Medical Devices: Implications and Consequences of re-use. MDA DB2000 (04) August 2000 NHS Estates CD-Rom Decontamination Guidance on NHS website www.doh.nhsweb.nhs.uk/health/decontamination-guidance.htm Pratt et al (2001). The epic Project: Developing National Evidence-based Guidelines for Preventing Healthcare Associated Infections. The Journal of Hospital Infection, Vol. 47. Supplement January 2001 Sterilisation, Disinfection and Cleaning of Medical Services and Equipment: guidance on decontamination. Microbiology Advisory Committee to Department of Health Medical Devices Agency 1996. Medical Devices Agency

Policy Management
The Decontamination and Disinfection policy has been issued in Dec 2004 and has been ratified by the Infection Control Committee and Health and Safety Committee. Compliance with the policy is required by all members of staff within MCHT. NB. A policy audit is available for this particular policy. Refer to the appendix of the policy entitled Guidelines for the Review of Infection Control Practice. 22

The policy is due for revision on or before Dec 2006 and will be updated by the Infection Prevention and Control Team. Policies to be read in conjunction with the decontamination and disinfection policy; Good Practice guidelines Hand Hygiene guidelines Blood and Body Substances Policy Universal Precautions Policy

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