Decontamination in the Hospital and Primary Care Setting Flashcards
Objective of infection control
To prevent potential pathogenic micro-organisms from reaching a susceptible site on a patient in sufficient numbers to cause infection
Define decontamination
a process which removes or destroys contamination and thereby prevents micro-organisms, or other contaminants, reaching a susceptible site in sufficient numbers to initiate infection or other harmful response.
Includes cleaning, disinfection and sterilisation.
What micro-orgs are commonly found in areas without adequate cleaning regimes?
MRSA, MSSA, C. difficile, gut and throat/mouth flora.
What is the role of ‘The Health Act’ 2006?
Ensures risks of HCAI are as low as possible
Advises on environmental cleanliness, hand hygiene and decontamination of multi-use equipment.
What is the MHRA?
The medical and healthcare products regulatory authoirt
What role does the MHRA play?
Responsible for safety, quality and effectiveness of all medical devices used in healthcare
Manufacturers have to provide information/details on how to decontaminate multi-use items they supply. including compatibility with different decontamination process and chemicals used e.g. detergents and disinfectants.
What is the single most important measure to prevent and control the transmission of infection?
hand hygiene
When it is appropriate to decontaminate your hands with soap and water?
if hands visibly soiled or following a dirty procedure
when is it appropriate to use alcohol gel as HH?
between patient care if hands visibly clean.
What organisms are alcohol hand gel not suitable against?
C. difficile and norovirus
Define cleaning
Physical removal of contaminants and organic material (protect micro-orgs)
Render environment socially clean but does not necessarily destroy micro-orgs.
What will inadequate cleaning result in?
Failure to remove organic material or visible contamination will render sterilisation/decontamination in-effective.
Define disinfection
Reduces the number of viable micro-organisms, not necessarily effective against bacterial spores or some viruses.
What and when are hypochlorite based environmental disinfectants used?
Manual disinfectants with a broad microbiological range.
Cleaning a side room after the vacation of a known infectious patient or cleaning a ward/nursing home after an outbreak.
What and when is hydrogen peroxide gas machine used ?
Automated disinfection of an environment, particularly useful for spores.
Cleaning a side room after the vacation of a known infectious patient or cleaning a ward/nursing home after an outbreak.
Disadvantages to cleaning and use flexible endoscopes?
Cannot be autoclaved
Must be cleaned before disinfected.
Disinfected with high controlled automated system - endoscope preprocessor.
Limiting factors of disinfection?
Ineffective range of activity - some disinfectants do not affect spores, viruses or TB.
Variation in working conc - alter effective range of activity
Contact time - few offer instant results
Inhibition or loss of activity - disinf inhibited by organic material and other chemicals; loose potency on exposure to air
User errors - manual vs. automated disinfection, manufacturers guidance must be followed.
What situations should disinfection be used?
Only used on equipment which contacts intact mucous membranes
if sterilisation or use of single use equipment is impractical.
Define sterilisation
A process which renders an object free from viable micro-organisms including bacterial spores and viruses.
What situations should sterilisation or sterile equipment be used?
Single use i.e. disposable equipment.
instruments used/in contact with breaks in the skin or mucous membranes and those that enter body cavities.
Why is single-use equipment advantageous?
Logistics - practicality, safety and acceptable.e
Factors for consideration when purchasing equipment in terms of decontamination
Equipment design and intended use
Manufacturers guidance for maintenance and cleaning - resources in place? achievable?
National guidance/best practice guidelines for cleaning
storage facilities for resources post decontamination.
staffing for decontaminatiin
transportation - methods and TATs
What does sterile equipment include?
Single use items
Items/equipment processed by sterile service departments, under strict conditions to ensure sterility is achieved either by autoclaving or through wet heat.
How is equipment sterilised?
Autoclaving
Wet heat
Ethylene oxide sterilisation
Hydrogen peroxide gas plasma sterilisation
Documentation required for decontamination procedures
Decontamination protocols - must be in place, evidence based practice. Need to state who cleans what and how.
Tracking and traceability - sufficient to very effectiveness of each and avery stage of the decont process of surgical instrument/endoscope. Who and which patient before and after.
Training and training records
Auditing - compliance monitored. - actions agreed and implemented to rectify non-compliance.
How is compliance monitored?
Check cleaning and decontamination records are in place.
Visual and observational inspections - practice and environment compliant with policy.
Chemical testing and microbiological sampling where national standards set.
CJD decontamination guidance
Disinfection/sterilisation may not prevent CJD transmission.
Procedures with High and medium risk tissues with patients with probable/possible CJD/RF’s - re-usable equipment = quarantined.
Remain in quarantine until a decision has been made to either discard or reprocess and re-use.
Single use equip encouraged where cost and quality are acceptable.
Instrument Requirements for high risk procedues (CJD)
Adequate supply of instruments to meet regular and unexpected needs.
Practice should be audited
Stringent tracking and traceability of all surgical instruments allowing patient association.
Effective pre cleaning of instruments is essential prior to sterilisation.
Choice of decont method and risk assessment of equipment = low risk
minimal patient contact/healthy skin
Detergent/sanitising wipe or detergent and water
Choice of decont method and risk assessment of equipment =medium risk
contact with mucous membranes
Cleaning then Disinfection
Choice of decont method and risk assessment of equipment = high risk
contact with sterile body cavities or breaks in the skin/mucous membranes
Must be sterile or disposable. Preceded by effective cleaning.
