Cleaning of medical equipment and devices that are essential for the care of patients
Medical equipment and surgical instruments are examples of devices that are essential for the care of patients. However, because they typically are designed for reuse, they also can transmit pathogens if any of the steps involved in reprocessing, cleaning, disinfection or sterilization are inadequate or experience failure.
Because the vast majority of pathogens are present in organic matter, e.g. visible soil, the first step in reprocessing and cleaning is the most important. Any failure to remove soil at this point, creates the potential for transmission of infection, as the efficacy of subsequent disinfection or sterilization will be compromised.
Decontamination is the process by which microorganisms are removed or destroyed in order to render an object safe. It includes:
• Disinfection; and
All hospitals and health care facilities should have a decontamination policy and help staff to decide what decontamination process should be used for which item of equipment.
Risks of infection from equipment:
The risks of infection from equipment may be classified into three categories. Placing instruments and equipment into one of the following categories can be helpful in choosing the proper level of disinfection or sterilization needed in order to protect the patients and the health care personnel.
Low risk (noncritical items)
Noncritical items are items that come into contact with normal and intact skin (e.g. stethoscopes) or with the inanimate environment (e.g. walls, floors, ceilings, furniture, sinks, etc.). Cleaning with a detergent and drying is usually adequate. Stethoscopes are usually cleaned. In rare cases they should be disinfected if used on an infectious patient or highly susceptible patient.
Intermediate risk (semi-critical items)
Semi-critical items are items that do not penetrate the skin or enter sterile areas of the body, but that are in close contact with mucous membranes or with non-intact skin. Cleaning, followed by HLD, is usually adequate. Examples include respiratory equipment, flexible endoscopes, laryngoscopes, specula, endotracheal tubes, thermometers and other similar instruments.
High risk (critical items)
High-risk items are items that penetrate sterile tissue, such as body cavities and the vascular system. These items are called critical items, because of the high risk of infection if such an item is contaminated with any microorganism, before penetrating the tissue. Cleaning, followed by sterilization, is required. High-level disinfection may sometimes be appropriate if sterilization is not possible, e.g. flexible endoscopes. Examples of high-risk items include surgical instruments, intrauterine devices, vascular catheters, implants, etc.
Cleaning is the removal of all foreign material (dirt and organic matter) from the object being reprocessed. Two key components of cleaning are friction to remove foreign matter, and fluids to remove or rinse away contamination. Thorough cleaning will remove most organisms from a surface and should always precede disinfection and sterilization procedures. If instruments and other items have not been cleaned, sterilization and disinfection may not be effective, because microorganisms trapped in organic material may survive sterilization or disinfection.
Cleaning is normally accomplished by the use of water, detergents and mechanical actions. Detergent is essential to dissolve proteins and oil that can reside on instruments and equipment after use. Cleaning may be manual or mechanical. Mechanical cleaning includes ultrasonic cleaners or washer/disinfectors that may facilitate cleaning and decontamination of some items and may reduce the need for handling. The solution used most often to clean, is an enzymatic presoak (protease formula that dissolves protein). Alternatively, a detergent can be used.
Detergents lower surface tension and lift dirt or oil away from the device. Studies have shown that thorough cleaning alone can provide a 10 000 fold reduction in contaminant microbes from endoscopes. Cleaning can be very effective in removing microbial contaminants from surgical devices.
All items requiring disinfection or sterilization should be dismantled before cleaning. Cold water is preferred; it will remove most of the protein materials (blood, sputum, etc.) that would be coagulated by heat and would subsequently be difficult to remove. The most simple, cost-effective method is to thoroughly brush the item, while keeping the brush below the surface of the water in order to prevent the release of aerosols. The brush should be decontaminated after use and should be dried. Finally, items should be rinsed in clean water and then should be dried. Items are then ready for use (noncritical items) or for disinfection (semi-critical items) or for sterilization (critical items).
Manual cleaning is necessary when:
• Mechanical cleaning facilities are not available;
• Delicate instruments have to be cleaned;
• Complex instruments need to be taken apart to be cleaned; and
• Items with narrow lumens need to be cleaned (endoscopes).
Manual or hand-cleaning must be done with extreme caution. The staff should follow the set procedure.
Steps for cleaning:
Wear heavy-duty rubber gloves, a plastic apron, eye protection and a mask during cleaning.
Soak the instruments in normal tap water, containing a detergent.
Scrub instruments and other items vigorously to completely remove all foreign material, using a soft brush or old toothbrush, detergent and water.
Hold items under the surface of the water while scrubbing and cleaning to avoid splashing. Disassemble instruments and other items with multiple parts, and be sure to brush in the grooves, teeth and joints of items where organic material can collect and stick.
Flush through lumens with an adapted water jet.
Rinse items thoroughly with clean water to remove all detergent. Any detergent left on the items can reduce the effectiveness of further processing.
Inspect items to confirm that they are clean.
Allow items to air-dry or dry them with a clean towel if chemical disinfection is going to be used. This is to avoid diluting the chemical solutions used after cleaning. Items that will be high-level disinfected by boiling or steaming do not need to be dried.
IQ Surfactant is a surfactant and detergent solution created in the process of electrolysis of NaCl, containing liquid ionised sodium hydroxide with an alkaline pH of 10 to 12.5).
o The solution contains no caustic soda and is safer to use than most surfactants.
o SABS tested – SANS 1344:2009.
Potential health effects:
May cause mild to moderate eye irritation.
May cause slight skin irritation.
May cause gastro-intestinal irritation with vomiting.
Immediately flush eyes with large quantities of water for 15 minutes. Hold eyelids apart to ensure complete flushing. Do not attempt to neutralise with chemical agents. Obtain medical attention.
Remove contaminated clothing and flush with water. Obtain medical attention if irritation persists.
Obtain medical attention.
Move patient to an area with fresh air. If symptoms of respiratory discomfort persist, obtain medical attention.
SABS tested – SANS 1344:2009.
Contains NO CAUSTIC SODA.
Store below 25 °C.