decontamination 87 Flashcards
life cycle of a re-usable surgical instrument
acquisition - purchase, loan
cleaning
disinfection
inspection –> disposal - scarp/return to lender
packaging
sterilisation
transport
storage
use
transport
at all stages of life cycle of re-usable surgical instrument consider
location
facilities
equipment
management
policies/procedure
facilities consideration in life cycle of surgical instrument
segregation of clean from dirty
linear flow
continuous production line in a single room
location consideration in life cycle of surgical instrument
is it in the correct location to service the surgeries
equipment consideration in life cycle of surgical instrument
does it have the correct equipment to make the instrument safe for the patent
management consideration in life cycle of surgical instrument
is the proper managament structure in place with quality managament system fit for purpose
policies and procedures consideration in life cycle of surgical instrument
are we aware of current recommendations and is the staff trained to appropriate levels
policy
is an overall statement of intent or is a set of rules or requirements to be followed
to achieve a given process/outcome
procedure
guidelines of major methods used to meet the policies as defined by teh company or practice
usually defined by WHO or at department level
objective
landmark event in pursuit of overall intent usually subject to regular review and amendment
work instruction
specific steps needed to carry out the procedure
or basically instructions on how to do it
cleaning
use recommended detergents
adhere to manufacturers instructions for dilution rate and temperature
nerve immerse handpieces etc - use non-linting towels and not wire brushes as this creates aerosol spray
disinfection
destruction of most pathological organism by PHYSICAL rather than CHEMICAL means
less lethal than sterilisation
still leaves bacterial spores
possible disinfection temps and timings
65-70o for 10mins
73-78o for 3mins
80-85o for 1min
90-95o for 12secs (most common in healthcare)
things to remember for manual washing
- PPE - full face visor, gloves, marigold type gloves
- follow work instructions
- immersion method (most instruments)
- non immersion method (lumened or cannulated such as handpieces)
- detergent - should be neutral enzymatic (we use: endozyme AW plus) 30ml to 8l water
- water temp 30-35oC
- no metal brushes (plastic only)
- rinse/immerse instruments in purified water (not handpieces) after cleaning and then dry
inspection methods
visual check
lit magnifier
protein residue
packing
vacuum pack the items for sterilisation
Type N sterilisation
normal
- for non wrapped solid products
- air passively displaced by gravity due to stem production
- hollow or lumened items should not be used here
- should be used immediately after sterilisation and not packaged for storage
‘sterilised’ but not sterile!
Type B sterilisation
better
- cycle is intended for the sterilisation of wrapped solid, hollow and porous products
- have _vacuum pump to actively remove air from the chamber and loa_d
- a.k.a benchtop vacuum sterilisers
- once packaged the instruments can be classed as ‘Sterile’
Heath and Saftey at Work Act 1974
- up to date standard operating procedures for sharp injuries
- all staff shuld know how to prevent and control sharp injuries
- must ensure all members of staff are familiar with the safety policy
- legal duty to protect the health of your employees and the general public
PPE at work at 1992
all equipment which is intended to be work or held by a person at work and which protects them against one or more risks to their health and safety
Consumer protection act
must put appropriate safety info or warnings on products
Medical Device Directive
standardised european law to govern how medical devices are used to keep things consistent
general practice single room local decontamination unit
Separate Hand washing facility with PPE storage
- Set down area for dirty instruments
Washing sink with detergent for cleaning instruments
- Set down area for washed instruments
U/S cleaner
Rinsing sink
- set down area for rinsed instruments
Automated washer/disinfector (that includes drying cycle)
Setting down area with task lighting and magnifier for inspection of all instruments
Dental Handpiece lubricator
Area for wrapping instruments (only if you use a vacuum steriliser)
Steam steriliser
- An area for setting down and wrapping instruments sterilised in a non-vacuum sterliser
4 elements of sinner circle
time
temperature
mechanical
chemical
RED ZONE in LDU includes
transport
acquiring medical device
cleaning
disinfection
AMBER ZONE in LDU includes
inspection
packaging
GREEN ZONE in LDU includes
sterilisation
transport
storage
acquiring medical device in LDU
instruments arrive in box from clinic and are placed in recieving area of the LDU
6 steps of hand hygiene performed and PPE donned
cleaning stage in LDU
- U/S bath turned on and cleaning agent and water added (see manufacturers instructions) may need enzymatic cleaner and deionised water or by reverseosmosis
- Open any hinged instruments
- Dispose any residual single use items
- U/S trays then removed and finished items are placed in a new separate tray to betransported to the washer disinfector area
*NEVER PUT HANDPIECES IN U/S BECAUSE IT WILL DAMAGE TURBINE
disinfection stage in LDU
Handpieces are loaded onto the washer disinfector recepticles
Load instrument casettes into the washer disinfector too but not on top of each other
Single instruments i.e couplands should be placed in a mesh basket
Stages of disinfection (w/ reverse osmosis water)
- Flushing - removes gross contamination - 45*C
- Washing - removes any remaining soil
- Rinsing - removes any additives from cleaning process
- Disinfection - temp must reach 90*C for 1 minute
- Drying - purges load and chamber with heated air to remove excess moisture
PPE removed, and disposed
new PPE donned Hand hygiene carried out and worktop cleaned with wipes
PPE then disposed again
U/S receipt printed and recorded along with one from the Washer Disinfector too and record
- Date
- Time
- Cycle number
- Temperature
- Holding time
Don new PPE and carry out hand hygiene
Protein test (1x per week)
- Vigorously swab an instrument and test in protein reagent for 10 secs, if turns brown to blue then its a failed test
Handpieces lubricated
inspection stage in LDU
PPE re-donned
check under light and magnifier that the lumened instruments are clear
check for rusting, debris or hinge fracture
Packaging stage in LDU
placing handle of instrument into packaging pouch first
tip protectors for sharp instruments
seal bag with envelope style sticky backing
cassettes are wrapped in sterilisation wrap sheet paper and are taped with autoclave tape (this paper changes colour when sterilisation occurs)
sterilisation in LDU
Type B vacuum steam steriliser used (Autoclave)
Tests for autoclave (daily and weekly)
- RO water pumped in
- warm up cycle done in the morning before tests carried out
- vacuum test done on first working day of the week
- Bowie and Dick test done daily - 134oC for 3.5 mins (for uncondensed gases) - light colour to even dark colour
Validation tests - record and report all failures
Sterilising - 134oC for 3-4 mins
Remove kits while wearing heat resistant gloves
Inspect pouches for wetness, colour indicators have changed and that theres no tears in the pouches
transport stage in LDU
sterilised instruments moved to storage area
storage stage in LDU
sterile items should be separate from unsterilse wrapped items
use of sterilised instruments
open when pt arrives using peelback technique
5 reasons for cleaning
- remove oragnic matter
- remove restorative material
- restore functionality
- aid disinfection and sterilisation
- medico-legal requirement
manager role
responsible for LDU
user role
day-to-day running of LDU, maintains records, ensures tests and maintenance carried out
operator role
uses equipment, simple housekeeping and maintenance
authorising engineer (decon)
free NHS Scotland service, advises on validation, maintenance and testing
test person
conduct and report on validation and periodic tests, must be qualified with >2yrs experience
maintenance person role
routine and requested maintenance, qualified
competent person role
responsible for perssure vessels
daily checks for ultrasonic cleaner
check paper levels
change water
clean and maintain as necessary
degass solution as if there is residual oxygen then it inhibits cavitation and causes less intense bubbles
change water every 4hrs or if visible soiled
weekly checks for ultrasonic cleaner
daily tests as above
protein tests (brown to blue if it fails?)
quaterly checks for ultrasonic cleaner
foil ablation test
annual checks for ultrasonic cleaner
according to SHTM30
visual display of cycle complete
daily checks for automatic washer disinfector
wipe door seal
check spray arms
clean filter
automatic control test (ACT) with print out
weekly checks for automatic washer disinfector
act
cleaning efficacy test (protein test strip)
staple result into log book
protein test
quarterly checks for automatic washer disinfector
according to SHTM30
visual display of cycle complete
values within normal limits
door cannot be opened till cycle complete
no mechanical or other anomaly
recorded into log book
daily checks for sterilisers
wipe clean
change water
automatic control test (ACT)
steam penetration test - bowie dick or helix
weekly checks for sterilisers
ACT
steam penetration test
vacuum leak test
air detector function test
vacuum leak test
is programmed into steriliser to be able to do this
pulls a deep vacuum and holds it
any loss in pressure indicates a leak so fails
air detector function test
programmed into steriliser
vacuume is pulled and at the same time air is let into the chamber
thermocouple should detect this due to change in temperature
