Documents
Resources
Learning Center
Upload
Plans & pricing Sign in
Sign Out

Sterilization and Disinfection for Dummies

VIEWS: 47 PAGES: 31

									Mission Accomplished:
Sterilization &
Disinfection

Robin Haag
Sherry Chisholm 2011 Awardee
Baltimore, Maryland
What I Attended ?
   Anything and Everything related to
    sterilization and disinfection
     No matter how repetitive
     No matter how boring
Why this topic?
   We “assume” others are doing the right thing
   Corners get cut
   Salary and titles do not equate with knowledge
    or expertise
   Common sense is not common
   TJC and CMS citations
   We are ultimately responsible
Bill Rutala says……
   Current surface
    disinfection practices
    are not effective
       65% of high touch areas
        are not cleaned
   Inadequate terminal
    cleaning puts the next
    patients at risk for
    acquiring MDROs
   Improved methods are
    needed
Risk of Acquiring MRSA, VRE and
C Dif from Prior Occupants
   Admission to previously occupied MRSA or VRE room
    significantly increases odds of acquisition
       Huang et al Arch Intern Med 2006; 166;1945.
   Prior environmental contamination measured by
    environmental culture or VRE colonized patients
    increases risk
       Drees et al Clin Infect Dis 2008; 46:678.
   Prior room occupant with CDAD significantly increase
    risk
       Shaughnessy et al. ICHE 2011; 32:201
Novel Methods of Room
Decontamination
   No touch methods
        Supplement, do not replace standard cleaning/disinfection
   Ultraviolet lights
        Work best in direct line of sight
        ~15 minutes for MDROs
        ~50 minutes for c dif spores
   Hydrogen Peroxide Systems
        May take hours
        Rooms need sealing
   Proposed self disinfecting surfaces
      Silver or silver ion impregnated
      Copper
      Sharklet pattern
             Deflects organisms from adhering
New Approaches to Room
Decontamination
UV Decontamination Advantages

 Reliable biocidal activity
 Surface and equipment decon
 Room decon
     ~15 min for vegetative bacteria
     HVAC can stay on
     Room need not be sealed
     Low operating cost
UV Decontamination
Disadvantages

 No studies regarding HAI reduction
 Not for daily cleaning
     Terminal   cleaning only
 Initial capital equipment cost
 Does not remove dust or stains
 Need to determine UV parameters
Hydrogen Peroxide
Decontamination Advantages
 Reliable biocidal
 Surface and equipment decontamination
 Decreases C difficile
 Residual free
     Minimal   health or safety concerns
   Can use on complex equipment
Hydrogen Peroxide
Decontamination Disadvantages

 Can only be used for terminal cleaning
 All patients and staff may not be in room
 Process takes 3 – 5 hours
 HVAC must be disabled
 Room must be sealed with tape
 Does not remove dust or stains
 Need to determine HP concentration
C. difficile
   Factors that facilitate transmission
     Survives in environment for hours to days
     Remains virulent in the environment
     Low inoculating dose
     Colonizes patients
     Surface contamination
          Frequently touched by HCWs
     Direct transmission from contaminated hands
     Relative resistance to antiseptics and disinfectants
Controlling the Spread of C dif
   Practice
     Contact precautions
     Ensure thorough disinfection
     Products
          5000 – 6000 ppm chlorine
          Products with c dif claims
     When
          Areas with increased C dif rates
          All patient rooms?
Surface Disinfection
   Exposure time
     Close      attention by TJC and CMS
          Following manufacturers’ directions
                Dilution
                Contact time: may require repeat applications
                Appeals denied by for following findings of peer reviewed
                 studies supporting shorter exposure times
     Wipes
          Wet time
          Size of wipe
2011 Multi-Society for
Reprocessing Flexible Endoscopes
   Changes since 2003
       High level disinfectants
       Automated reprocessors
       Endoscopes
       Endoscopic accessories
   HLD efficacy is unchanged
       Principles remain valid
   Outbreaks associated with:
       ASCs
       Unfamiliarity with endoscope channels, accessories and
        attachments
Endoscope Procedure
Transmission: Non scope related

 IV lines
 Anesthesia administration
 Medication administration
     Multidose vials
     Reuse of needles and syringes
     IV tubing
Endoscope Procedure
Transmission: Scope related

 Failure to sterilize forceps between
  patients
 Lapses in reprocessing channels used in
  irrigation
Unresolved Endoscope Issues
   Interval of storage between reprocessing
    and scope use
     Data  suggests negligible contamination 7 –
      14 days
     Insufficient data to determine maximal
      duration
   Need for microbiologic surveillance
Disinfection Boot Camp:
Rose Seavey and Martha Young
   Evidence based
    Guidelines
   Focus on AAMI/ANSI
    Standards 2010
   NPSGs
   AORN 2011
   CDC 2008
Environmental Concerns
   68 – 70° F in clean area
   60 – 65° F in decon area
   30 – 60% humidity in decon area
   Not over 70% humidity in sterile storage
   Separate housekeeping and decontamination cleaning
    supplies
   Eye wash stations
       60 – 100° F
       Test weekly for 3 minutes
   Use AAMI Work flow diagrams
       Dirty to clean
Decontamination Personnel Attire
   Scrubs
   Cover all facial hair
   No artificial nails
     Prefer   no nail polish
   No jewelry
   Bouffant caps only
   Heavy long gloves, not surgical
   Face masks with full protection splash guards
Decontamination
   Decrease bioburden
        Prepare devices
        Disassemble
        Lubricate
        Keep instruments moist
        Brush and clean under water
        Use disposable brushes or decontaminate once per shift
        Prefer automatic washers
   Water
        Initial rinse can be tap water
        Final rinse should be sterile, de-ionized, distilled
   Sterilization
        Do not use preset parameters for cycles
        Maintain sterility in storage
             Event related sterility
Potential Problems With Automated
Cleaners

 Wrong water temperature
 Wrong detergent concentration
 Problem with mechanical functioning
 Human element
     How   machine is loaded
    How Do You Know Your
    Automatic Washer is Working
    Right?
   Verification of Cleaning
     TOSI   (Test Object Surgical Instruments)
        Monitoring of the Cleaning Efficiency of Washer-
         Disinfectors
        Surrogate device for surgical instruments soiled
         with blood
        Test weekly, preferably daily

     Maintain   records
Sterilization Caveats
   Count sheets should not be
    inside sets or containers              Do process audits
                                             Load configuration
     Ink transfers
                                             Item density
     Paper shreds
                                             Your hand should fit between
   Peel packs                                items
     No more than 1 or 2 small light
                                           Cooling in a high AC
      items
                                            environment
     Double packing not needed
                                               May lead to wet packs
     No folds in packs
                                           Immediate use sterilization
   BIs preferred daily
                                               Old “flash sterilization”
   Do not exceed 25 lbs
    including container and                Loaners
    wrapper                                    Have in 3 days ahead of time
                                           Keep repair logs
Storage
   75°F
   4 air exchanges per hour
   Under 70% humidity
   Don’t stack
   Keep items covered
   8 – 10 inches above floor
       Solid bottom shelf
   2 inches from outside wall
       Prevents condensation
   No corrugated boxes
   No shipping boxes
Tracer Activity
   Trace a set from patient
    in OR through
    reprocessing
   Look for competencies
       Certification within 2 years
        of hire
   Review all paperwork for
    reprocessing parameters
   Better that staff look like a
    deer in headlights with
    you, than with a TJC or
    CMS surveyor
Implants
   Require a BI in each load
   Quarantine loads until BI results are known
   Early release of implant loads
     Can  only be released by the surgeon
     A written policy is required

   In an emergency a Class 5 indicator can be
    used
Sterilizer Qualification Testing
   Testing a sterilizer after certain events
    3 consecutive cycles
     Events may adversely impact process
            Installation of new sterilizer
            Relocation of sterilizer
            Sterilizer malfunction
            Process failures
            Major repairs
                  Gasket replacement
                  Welding
            After annual boiler maintenance
            After a water main break
In Summary……Why this topic?
   We “assume” others are doing the right thing
   Corners get cut
   Salary and titles do not equate with knowledge
    or expertise
   Common sense is not common
   TJC and CMS citations
   We are ultimately responsible
Don’t Get Caught With Your Pants
Down
   Class 6 process
    challenge packs
       Not a substitute for Class 5
        integrating BIs
            No matter what the sales
             rep told the reprocessing
             administrator
   Sharing memos and
    recall notices
   Credentialing
   Inservice records

								
To top