Read Microsoft Word - Arthur NCSGNA Sept 2009 Decontamination outline.doc text version

DECONTAMINATION: Decreasing the Risk

Arthur Henderson, RN, BA, CNOR STERIS Corporation OBJECTIVES

Discuss the importance of the environment, personal protective equipment and

safe work practices during cleaning and decontamination

Describe the critical steps necessary in the decontamination process

DECONTAMINATION Physical or chemical Remove, inactivate, destroy blood borne pathogens Incapable of transmitting infectious particles Rendered safe for handling, use or disposal (OSHA 29 CFR 1910.1030)

Two step process

­Cleaning ­Microbial process ·Disinfection ·Sterilization

Association for the Advancement of Medical Instrumentation (AAMI ST 35, 2.6) DECONTAMINATION GOALS Reduce microorganisms

Reduce nutrient material Minimize risk of exposure Decrease device damage Render safe to handle Ready device for reuse

CLEANING Use detergent Removal visible soil Effective mechanical action Ready device for further processing (International Standards of Operations) FUNCTIONS and TYPES of CLEANING

Non-microbial

­Combined with microbial function ­Restores or improves appearance ­Eliminates non-organic traces ­Maintains functioning ­Prevents deterioration

FUNCTIONS and TYPES of CLEANING

Microbial function

­Decreases bioburden ­Decreases numbers of microorganisms ­Decreases potential harm from microorganisms ­Does not kill microorganisms ­May render item safe to handle

(non-critical patient equipment)

"YOU CAN CLEAN WITHOUT DISINFECTING OR STERILIZING, BUT YOU CANNOT DISINFECT OR STERILIZE WITHOUT CLEANING." (Dr. Spaulding) MICROBICIDAL PROCESSES

Provide a particular level of lethality (kill) Depending on the level of decontamination

needed, DISINFECTION OR STERILIZATION is used AFTER a device has been cleaned DISINFECTION

Destruction of microorganisms

­Thermal ­Chemical

Destroys most recognized microorganisms

­Not necessarily all bacterial spores

LOW LEVEL DISINFECTION

Capable of killing most bacteria, some viruses, some fungi

­Not tubercle bacillus or bacterial spores

Three required representative test organisms:

­Staphylococcus aureus ­Salmonella choleraesuis ­Pseudomonas aeruginosa

INTERMEDIATE LEVEL DISINFECTION

Capable of killing tubercle bacillus, vegetative bacteria, most viruses, most fungi Not necessarily bacterial spores Effective against:

vegetative bacteria (g+ and g-), TB, fungi, lipid/non-lipid and medium/small viruses

COMPLIES with OSHA Blood HIGH LEVEL DISINFECTION

Capable of killing all microorganisms

Borne Pathogen Standard

­Exception - high numbers of bacterial spores

Effective against some spores, most fungi, all ordinary vegetative bacteria, TB,

small/medium viruses and lipid/non-lipid viruses RESISTANCE OF MICRORGANISMS CHAIN OF INFECTION

INFECTION PREVENTION

Bioburden ­ type & number of microorganisms Susceptibility of individuals Route of transmission

BIOBURDEN

Microbial load and resistance Examples:

­Bloody gastroscope ­Colonoscope with Clostridium difficile spores ­Bronchoscope with Mtb

SUSCEPTIBILITY OF EMPLOYEE/PATIENT Injury / Illness ROUTES OF TRANSMISSION

Direct/indirect contact

­Hands/objects

Droplets/aerosols

­Hopper ­Water splashing

Percutaneous transfer

­Sharps ­Breaks in skin

STANDARD PRECAUTIONS Assume that all blood and body fluids may contain harmful microorganisms PROTECT YOURSELF FROM DIRECT CONTACT!

DECONTAMINATION AREA

Physical location/centralized Adequate size Work flow Spatial separation

­"dirty to clean"

ADEQUATE SPACE FOR DECONTAMINATION ADEQUATE SPACE? REPROCESSING AREA

Separating areas of dirty and clean

REPROCESSING AREA

Spatial separation Flow of

"dirty to clean" DECONTAMINATION ENVIRONMENT Traffic Ventilation Lighting Surfaces Emergency eye wash station Patient care areas Infectious spills Liquid waste management Personal protective equipment Hand washing

TRAFFIC

Restricted to personnel working in the area

­Personnel properly attired ­Door closed

VENTILATION

Negative pressure 10 air exchanges/ hour Door/windows closed No fans

NEGATIVE AIR FLOW DOORS & PASS-THROUGH CLOSED NO FANS CONTROLLED ENVIRONMENT Prevent microbial growth:

­Temperature 60­65 F ­Relative humidity 30%­60% Recorded daily

LIGHTING

Adequate overhead and task lighting Does not cast shadows

ENVIRONMENTAL SURFACES Surfaces in good condition ­Easy to disinfect ­Non-porous, smooth ­Withstand daily cleaning and disinfection ­Avoid cross contamination SMOOTH SURFACES PROTECTIVE WORK PRACTICES

Awareness of soiled / clean work areas is imperative to avoid cross contamination

ENVIRONMENTAL DECONTAMINATION

Reduction of microorganisms from all environmental surfaces Environmental surfaces hosts microorganisms Pathogenic Opportunistic

ENVIRONMENTAL DECONTAMINATION EMERGENCY EYE WASH/SHOWER

Use of any acid/caustic chemicals Eye wash unit immediately adjacent to the hazard Accessible within 10 seconds travel time of all chemical usage locations Hands-free operation No hot water

Can You Tell Dirty From Clean? Dirty / Clean ??? What is Wrong Here?

PATIENT CARE AREAS

Surfaces swarming with bacteria Start high and work down Contain biohazardous fluids Clean restrooms Wet or damp mop entire floor surface

INFECTIOUS SPILLS

Have Spill Kits available Wear PPE's Control traffic to area Contain spill Use mechanical means to remove sharps Place hazardous material in biohazard container

INFECTIOUS SPILLS

Clean area with disinfectant using clean applicator Place spill control equipment in red bags Place PPE in red bag SEAL BAG Wash hands

LIQUID WASTE MANAGEMENT

Suction canisters, connectors, tubing Collection/disposal poses significant risk May contain significant numbers of pathogens Reduce exposure

­Minimize splashing, ­

­Sealed impervious ­Prevent spillage ­Wear PPE

spraying, splattering

Minimize risk of exposure

container

Disposal in non-patient care area Avoid contaminated aerosols

Engineering control systems Provide microbial inactivation Reduce risk of exposure Solidifying products Follow state/local regulations for disposal

PERSONAL PROTECTIVE EQUIPMENT

Fluid resistant gowns Face/eye protection Gloves Hair/shoe covers No jewelry, acrylic nails Necessary at ultrasonic

REMOVAL OF PPE'S

Protect yourself Remove shoe covers Remove gown Gloves next Remove mask, hair cover Inspect uniform ­clean/dry? If not, shower, spot wash, change scrubs WASH HANDS/ARMS TO ELBOWS

HAND WASHING

Hand washing sink separate from decontamination sinks Prefer hands-free equipment Waterless alcohol-based, hand hygiene agents

HAND WASHING STEPS IN THE DECONTAMINATION PROCESS

Sorting Remove sharps Reusable/disposable Preparation for transport Pre-cleaning/enzyme soaks Disassembly

POINT OF USE

Wipe off organic soil to prevent drying

Irrigate all endoscope channels Soak / spray rigid instruments Sort used / not used, delicate items Discard disposables, sharps Prepare for transport

CONTAINMENT / TRANSPORT

Wear PPE when preparing Avoid risk of exposure

devices for transport

Solid bottom, closed container Avoid contaminating outside of container

DECONTAMINATION PROCESS Sorting

­Sharps (biopsy forceps separate from endoscopes) ­Delicate items ­Level of contamination

DECONTAMINATION PROCESS Follow manufacturer's instructions for:

­Cleaning ­Disassembly ­Inspection

DECONTAMINATION PROCESS

Disassembly

­Valves, buttons, irrigators, stopcocks ­Hinged instruments open

Inspection

­Damage, tears, slits, holes ­Corrosion, pitting, crack

PRECLEANING FLEXIBLE ENDOSCOPES Follow manufacturer instructions Separate accessories Leak test prior to immersion GENTLE cleaning SOAK, BRUSH, FLUSH, RINSE Proper size channel brushes Access ALL channels ENZYME CLEANERS

Provide effective cleaning of medical devices Cleaning studies should be available Assure compatibility with devices

ULTRASONIC CLEANER

Work on principle called cavitation Wear PPE's "De-gas" before using new solution Clean/disinfect chamber Does not disinfect instruments

ULTRASONIC CLEANER

Ultrasonic Detergent

­5-10 minutes in warm water/mild detergent ­Specifically designed for ultrasonic ­Chelating ability to prevent hard water deposits ­Change solution when visibly soiled

DECONTAMINATION PROCESS

DO NOT use compressed air

­For removing debris ­For blowing out channels

BECAUSE:

­Employee safety ­Contamination from aerosols ­Device damage

USE:

­Suction

SPEED REDUCES THE OVERALL FACTOR OF SAFETY

Shortcuts

­Turnover times ­Inadequate inventory ­Staff not trained ­Financial pressures ­Inadequate skills, training, education ­Unfamiliar with device designs

SPEED REDUCES THE OVERALL FACTOR OF SAFETY

Risky short cuts Improper processing More cases = more inventory

KEY POINTS TO REMEMBER

PROTECT YOURSELF! Begin decontamination process as soon as safely possible Choose correct products and process for the specific model device Operate equipment/chemicals properly and safely Ensure personnel follow OSHA and appropriate state and local regulations

References American Institute of Architects Academy of Architecture for Health, "Guidelines for Design and Construction of Hospital and Health Care Facilities", 2001. Washington DC: American Institute of Architects Press. Association for the Advancement of Medical Instrumentation, "Safe handling and biological decontamination of medical devices in health care facilities and in nonclinical settings", 2003. ANSI/AAMIST35, Arlington,Va,AAMI. Occupational Safety And Health Administration (OSHA), "Occupational exposure to blood-borne pathogens", Code of Federal Regulations (CFR), Title 29, Part 1910.1030. References OSHA, "Eye and face protection", CFR, Title 29, Part 1910.133. OSHA, "Medical and first aid", CFR, Title 29, Part 1910.151. Hewitt, A.: Infection Control Challenges with Endoscopic Instruments. Endo Nurse, Oct/Nov 2002. Querido, Robert, Reprocessing of Single-Use Instruments in the Endo Suite. Endo Nurse, December 2004, January 2005. Pyrek, Kelly M., Contain and Confine: Keeping Staff Safe From Infectious Spills. Infection Control Today, January 2005. Reichert, M. and J. Schultz. Don't Use Compressed air to Clean Scopes. Sterilization and Infection Control. January, 2002.

References DesCoteaux JG, Poulin EC,Julien M, etal. "Residual organic debris on processed surgical instruments." AORN Journal, 1995, 62:23-29. Hales, M. "Instrument decontamination methods that prolong instrument life." Infection Control Today. Sept. 1998, p. 12-18. Dix, Kathryn. "Cleaning and Disinfecting" Infection Control Today, January, 2005. Tydell, P, Donaldson, J. "Control of Infections in Liquid Waste Management. EndoNurse, Aug/Sept 2003. American National Standards Institute, "Emergency Eyewash & Shower Equipment", 1998, (ANSI Z358.1:1998).

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