CLEANING AND DISINFECTION
POLICY
First Issued by/date Issue Version Purpose of Issue/Description of Change Planned Review Date BWW/BW PCT March 012 Revised update. Dec 2012
Named Responsible Officer:- Approved by Date
Infection Prevention and Control Lead
Infection Control Committee
Dec 10
Policy File:-
Infection Control Policy No 7
Impact Assessment Screening Complete- Yes Full Impact Assessment Required- No
Key Performance Indicator
1. Infection Prevention and Control audit
2. Attendance levels at Infection Control Core Training
3. Compliance with The Health and Social Care Act 2008 Code of Practice for health and adult social care on the prevention and control of infections and related guidance
UNLESS THIS VERSION HAS BEEN TAKEN DIRECTLY FROM THE PCT WEB SITE THERE IS NO ASSURANCE THIS IS THE CORRECT VERSION
Contents
Page
Introduction 3 Policy Aim 3 Policy outcome 3 Target group 4 Specific responsibilities 4 Related policies 5Evidence to support policy 5
Background 5
Legal obligations 6
Assessment of risk 6
Cleaning - Detergents 7
Manual cleaning of equipment 8
Disinfecting - Disinfectants 9
Blood/Blood Stained Body Fluid management 11
Single Use Device 12
Equipment/Environment A-Z 13 Environmental Cleaning 17 Training 18 Audit 18 Archiving 18 Risk Assessment 18 References 18
List of those consulted in drafting process 18 Appendix 1 – Cleaning Checklist 19
NHS Wirral
Cleaning and Disinfection Policy
Introduction
Decontamination of medical equipment and cleaning of the healthcare environment is essential to the effective delivery of patient care regardless of the care environment.
Guidance on the appropriate purchase, maintenance, repair and disposal of medical equipment is incorporated in the Medical Devices Management Policy.
This policy covers cleaning and disinfection to comply with national guidance. The only service authorised to sterilise instruments within primary care or provider services is Dental Services. This is reflected within this policy. Equipment which needs to be sterile or to have been sterilised must be pre sterilised single use or processed by an external accredited CSSD.
Policy Aim
The aim of this policy is to give general guidance on the approved cleaning and disinfection products and methods for healthcare equipment and environment, and outline cleaning responsibilities throughout NHS Wirral, to allow staff to correctly use the appropriate product and cleaning and/or disinfection method.
Safe and correct decontamination of equipment between patients is an essential part of routine infection control practices.
Policy outcome
Equipment used throughout NHS Wirral will be decontaminated appropriate to the level of risk to ensure risk of cross inf ection is minimised. For items not detailed in this policy, a risk assessment should be completed by staff for specific items. The clinical environment will be maintained to ensure safe, clean care.
General Practitioners and General Dental Practitioners are responsible for the management of risks within their practice as part of Health and Safety responsibilities and the Code of Practice duties. To support them in this duty and to provide evidence of compliance with the Code of Practice and HTM 01-05, this policy is available as an example of best practice.
Target group
All staff employed by NHS Wirral.
Shared as best practice with Independent General Practice staff, and General Dental Practice staff and where relevant, Independent Pharmacists and Optometrists.
Specific responsibilities
Chief Executive
The Chief Executive has overall responsibility for ensuring infection prevention and control is a core part of the Trusts governance and patient safety
programmes.
Board
The Board has collective responsibility for ensuring assurance that appropriate and effective policies are in place to minimise the risks of health care associated infections.
Director of Infection Prevention and Control
It is the responsibility of the Director of Infection Prevention and Control to oversee the development and implementation of infection prevention and control policies.
Infection Prevention and Control Team
It is the responsibility of the Infection Prevention and Control Team to ensure this policy is reviewed and amended at the review date or prior to this following new developments in decontamination research.
Service Managers
It is the responsibility of managers to ensure that staff are aware of this policy, have a suitable and adequate supply of cleaning and disinfection products appropriate to the care environment and use appropriate dilutions effectively and safely and compatible with the manufacturers decontamination guidance. It is the responsibility of managers to ensure that no domestic grade cleaning products are bought or used by staff in the healthcare environment.
Staff
It is the responsibility of staff to ensure they are aware of appropriate cleaning and disinfection products as detailed in this policy and that they use approved cleaning products.
Related Policies
Please refer to related NHS Wirral policies and procedures.
Evidence to support policy
National Resource for Infection Control. Clinical Practice. Cleaning. www.nric.org.uk
NPSA – National Patient Safety Agency
Background
Decontamination Process:
This is a combination of processes, including cleaning, disinfection and sterilisation, which when used in combination make a re-usable item safe for re-use.
Cleaning
This is a process which physically removes soil e.g. dust, dirt and organic matter e.g. body fluids, from environmental surfaces and equipment.
Cleaning must precede disinfection.
Disinfection
Disinfectants reduce the number of micro-organisms present but cannot be guaranteed to remove all e.g. spores. Efficiency of this process is dependant on:
Efficient prior cleaning
Appropriate disinfectant for the micro-organisms present Appropriate strength of the disinfectant
Compatibility of the equipment Appropriate contact time
Sterilisation:
This is the only process which destroys all micro-organisms including spores. This can be achieved by:
Pre sterilised single use equipment – All provider services and Independent General Practice.
Pre Sterilised re-usable equipment decontaminated in an accredited external CSSD – NHS Wirral Podiatry services only.
Sterilised prior to re-use in an appropriately maintained benchtop
steam sterilizer – NHS Wirral Dental and General Dental Services only.
Legal obligations
The Health and Safety at Work etc. Act (1974).
The Control of Substances Hazardous to Health Regulations 2002.
The Health and Social Care Act 2008 – Code of Practice for health and adult social care on the prevention and control of infections and related guidance.
Assessment of risk – Infection Risk to patient from contact
with an item of equipment/environment
The method of decontamination selected should consider the risk of the item acting as a source or vehicle of infection and the process that it will tolerate.
Risk Application Recommendation
High Items in close contact with a break in the skin or mucous membrane
Items introduced into sterile body cavities Single use Sterilization by accredited CSSD (Podiatry Service only) (Benchtop steam sterilization preceded by cleaning – Dental Services only)
Medium Items in contact with intact mucous membranes Items/environment
contaminated with potentially virulent or readily transmissible organisms
Items prior to use on immuno-compromised patients Thorough cleaning followed by disinfection or sterilisation (appropriate service only) Single use
Low Items in contact with intact healthy skin
Items/environment not in contact with the patient
No new cleaning agent, disinfectant or sterilisation method may be introduced into NHS Wirral without the specific authorisation of the Infection Prevention and Control Team.
Cleaning - Detergents
Healthcare grade general purpose detergent diluted according to the manufacturers instructions should be used for general cleaning in all clinical areas. The solution must be discarded on completion of each task.
It is important to dry all surfaces and items after cleaning as bacteria thrive in moist conditions.
Bowls/buckets used for the dilution of detergents must be rinsed and stored inverted to drain.
DETERGENT USE
General purpose detergent e.g. Hospec
General environmental cleaning
Uncontaminated equipment cleaning
General purpose detergent/and/or disinfectant wipe
All equipment and environmental cleaning if appropriate
NB: Detergents/Disinfectants used must be risk assessed for Control of Substances Hazardous to Health (COSHH), included in COSHH inventories and safety data sheets held if appropriate.
Detergents and disinfectants
Dual action detergent and disinfectant wipes may be appropriate for use on patient equipment and in healthcare environments where use of bowls of water may be hazardous e.g. baby clinics, patient’s homes and electrical equipment.
Manual cleaning of equipment
Equipment may be decontaminated following the principles outlined below.
Immersion method
If debris present use sink designated for washing of equipment.(Clinical hand basins should not be used for cleaning of equipment).
Fill the equipment washing sink or container with warm water and the appropriate amount of detergent or detergent disinfectant. Equipment in the low risk category can be decontaminated using a detergent solution. Equipment in the medium risk category requires cleaning with a detergent and a disinfectant.
NB: It is important that the decontamination product is compatible with the equipment and is diluted to the correct strength.
Clean items under the surface of the water, were possible use a disposable cloth and discard after use.
Allow equipment to drain then rinse in fresh warm water to remove residues of the detergent or detergent/disinfectant.
If either the cleaning solution or the rinse water becomes obviously soiled or contaminated, it should be changed and the process repeated.
Dry with disposable paper.
Store hollow items i.e. buckets, inverted between use.
Disinfect reusable cleaning items with the detergent/disinfectant, rinse and dry with disposable paper.
Non-immersion method
Non immersion hand washing methods are appropriate for certain equipment where items will become compromised by soaking in aqueous solutions e.g. electrical and electronic equipment, fixed in position or are large items.
Always disconnect electrical items from the mains supply before commencing the cleaning procedure.
Immerse a disposable cloth in an appropriate solution of detergent and warm water and wring thoroughly.
Wipe the item thoroughly ensuring that the detergent solution does not enter electrical components where appropriate.
Rinse the disposable cloth in fresh water and repeat the above step. Discard disposable cloth after use.
Dry the equipment using disposable paper towel.
Disinfecting - Disinfectants
When a patient is known to be positive for Clostridium Difficile please refer to Policy on the Prevention and management of Clostridium Difficile infection for guidance on specific cleaning for equipment used by patient.
Sodium Dichloriosocyanurate (NaDCC) is a broad spectrum anti-microbial agent which is effective against bacteria (including MRSA, E Coli and Pseudomonas), fungi, viruses (including HIV and Hepatitis). It is more stable and therefore more effective than liquid forms of Sodium Hypochlorite. Tablets have a longer shelf life and are more convenient to use and correctly prepared give an accurate strength. Once made preparations will lose their strength over time,
NB: all solutions must be discarded after 24 hours.
DISINFECTANT USE:
Disinfection of previously cleaned equipment and hard surfaces NaDCC 1,000 ppm*
e.g. Actichlor or
Chlor-Clean (combined cleaner and
disinfectant) Follow manufacturers
instructions for dilution
e.g.
Propulse Ear syringes and water chamber
Cleaning and disinfection of leg ulcer buckets and Wheelchair Service loan equipment
(NaDCC) 10,000 ppm*
e.g. spill pack
Sodium Dichloroisocyanurate
Blood and Bloodstained Body Fluid spillage (see below for guidance)
70% alcohol hard surface wipes Disinfection of previously cleaned hard surfaces and equipment where
facilities are not available to make up a chlorine disinfectant or may not be safe to do so.
Faecally soiled baby changing mats Faecally soiled baby scales
Electrical equipment Within patients homes Minimal blood spills
General Dental Environment Disinfectants
Chlor clean tablets
Hospec 1 litre General purpose neural liquid detergent
Sani cloth 70 disposable disinfection wipes (contains 70% alcohol) Sani cloth multi surface wipes (no alcohol or disinfection)
Dental Disinfectants
Dental Unit Water Lines Sterilox (electrochemically activated water)
Ultra sonic bath Gigasept 500g (enzyme based
cleaner & disinfectant)
Suction Unit Orotol 2.5 litres
Pulijet plus 1 litre Washer disinfector detergent Dekomed detergent
AER 300 detergent DAC Handpiece machine Nitra clean tablets
* Concentrations of NaDCC solutions are expressed as parts per million of available chlorine.
Health and Safety considerations when using chlorine based products.
Always ensure manufacturer’s decontamination advice is compatible with the disinfectant intended to be used.
Wherever possible ensure good ventilation when using any chlorine based product.
Disinfectant is not necessary for routine cleaning.
Never mix disinfectants with other disinfectants or detergents. Disinfectants may react causing a chemical reaction and detergents may reduce the strength of the available chlorine. Only use pre prepared combination products where this is necessary e.g disposable single use Chlor-clean as these are manufactured to be compatible.
Always wear appropriate protective clothing i.e. gloves and aprons. Store disinfectant products in a locked cupboard to comply with Control
of Substance Hazardous to Health Regulations.
Blood/Blood stained body fluid spillage management
It is the responsibility of any suitably trained member of staff to undertake the prompt and safe removal of the hazard particularly within a general clinic environment. Spill packs are held by receptionists in multi use clinics for NHS Wirral staff use.
Always wear disposable single use gloves and apron and consider eye protection. Ensure the area is adequately ventilated and cannot be accessed by patients/visitors.
Hard surface procedure (using spill packs): Follow manufacturers guidelines
Lightly cover small spill with chlorine releasing granules, leave for 2 minutes.
Wipe up with paper towels or disposable cloths.
Place contaminated paper towels/disposable cloths in a clinical waste sack for incineration.
Following procedure wash area with general purpose detergent and hot water and dry with paper towels if required.
Soft surface procedure:
Spillages of blood/blood stained body fluid on furnished or carpeted surfaces may not be able to be disinfected using the above method as the granules may bleach the fabric or not adequately decontaminate interior foams.
Blood/Body fluid spills on carpets may be removed by
Covering blood/blood stained body fluid spillage with cold water to dilute blood.
Absorb the liquid with disposable paper towels.
Place contaminated paper towels/disposable cloths in a clinical waste sack.
The area may then require cleaning with a carpet cleaner by Support Services (NHS Wirral areas only).
For advice on the decontamination of soft furniture contact the Infection Prevention and Control Team.
Single use device:
Single use means that the medical device is intended to be used on an individual patient during a single procedure and then discarded. It is not intended to be reprocessed and used on another patient.
This is an item that is to be used only once and then discarded. The items will carry the following marking on its packaging:
Prior to purchasing new equipment
It is the responsibility of Services to ensure that equipment purchased can be effectively decontaminated in line with NHS Wirral policy.
Equipment/Environment A-Z
Equipment Decontamination Method
Airways Single Use
Ambu bags Single Use/clean with detergent followed by appropriate disinfectant.
Auroscope ear pieces Single use
Baby changing mat Cover with disposable paper between babies Clean with detergent at end of the session.
If contaminated with blood/body fluids – clean then disinfect before next baby in line with policy
Baby weighing scales Cover with disposable paper between babies Clean with detergent at end of the session.
If contaminated with blood/body fluids – clean then disinfect before next baby in line with policy
Bath (Bathing Centre) Clean with detergent between each client using colour coded single use disposable cloth
Bed (CES*)(patients home)
Remove body fluid contamination as it occurs using detergent/detergent wipe and disinfect if blood or faeces
Bowls (used for cleaning purposes)
Empty, rinse with clear water and store inverted to dry
Blood pressure equipment
Wipe cuff and monitor with detergent/detergent wipe, pat dry with paper towel between patient use, do not immerse cuff in water.
Disposable single use cuff/cuff cover for use when a patient has a multi resistant organism
Buckets for leg ulcer washing
Clean and disinfect with 1,000pm NaDCC (Chlor-clean) between patients and at the end of the session
Commode (patients home)
Remove body fluid contamination as it occurs using detergent/detergent wipe and if contaminated with blood or faeces – disinfect.
Dental equipment: Treatment sets Endodontic files Reamers Aspirator tips Sterilised Single use Single use Single Use Doppler ultrasound probe
Remove gel, clean with detergent/detergent wipe, do
not immerse in water
Drip Stands Clean with detergent/detergent wipe between patients
Ear syringe - Propulse Follow disinfection procedure in Ear Care Procedure ECG equipment:
Electrodes
Straps/Leads/Machine
Single Use
Clean with detergent/detergent wipe, do not immerse
in water
Examination couches Cover with disposable paper towel between patients Clean with detergent at the end of the session Clean and disinfect with NaDCC if contaminated with blood/blood stained body fluid
Family planning: Speculum
Trial size caps IUCD equipment Sub-dermal
contraceptive implants
All single use
Gym equipment Clean seat and handles of equipment with detergent/ detergent wipe between patients
Hoist (CES*) (Patients home)
Frame Sling
Clean weekly with detergent/detergent wipes
Slings can be laundered if contaminated – contact CES for advice
(Consider single use for patients with multi resistant organism where appropriate and laundry facilities are not available)
Minor surgical Instruments
Disposable Single use
Nebulisers Wash mask and chamber with detergent, rinse and leave to dry on disposable paper
Do not wash tubing Peak flow
meters/spirometry
Follow manufacturers guidance
Disposable single use mouth pieces with one way valve or filter (change filter as directed by manufacturer)
Clean machine weekly with detergent/detergent wipe Pelvic stimulator
electrodes
Single patient use
Clean with detergent/detergent wipe to remove any residues
Wrap in paper roll and replace in carry case Return to patient for cleaning at home following manufacturers instructions
Pillows All pillows should be protected with plastic (sealed) or vapour permeable cover
Wipe with detergent/detergent wipe in between patients and at end of session.
Disinfect with NaDCC if contaminated with blood/blood stained body fluid
Physiotherapy equipment
Clean weekly with detergent/detergent wipe or if contaminated, disinfect with NaDCC if contaminated with blood/blood stained body fluid
Podiatry instruments: Nail surgery
Nail/foot treatment packs
Podiatry foot tray
Single use
Cleaned and sterilized at external accredited CSSD
Cover with disposable paper between patients
Clean with detergent/detergent wipe at the end of the session
Disinfect with NaDCC if contaminated with blood/ blood stained body fluid
Pressure relieving aids (patients home)
Clean with detergent/detergent wipe weekly Contact CES for advice on disinfection
Pulse oximeter Clean weekly with detergent/detergent wipe and between patients
Scissors: Single use
NB: Bandage/Dressing scissors – clean between patients with detergent/detergent wipe, disinfect if required
Stethoscope Clean between each patient use with detergent wipe Sticks/frames/crutches Clean with detergent/detergent wipe between users Stitch/staple removers Single use
Suction machines Follow manufactures guidance
Contact CES if further advice required Syringe driver Clean with detergent wipe
Do not immerse in water.
Thermometer Disposable sheath for each patient
Clean handpiece weekly with detergent/detergent wipes
Do not immerse in water.
Tourniquet Wipe with detergent/detergent wipe pat dry with paper towel between patient use
or
Disposable single patient use if appropriate in specific services. If reusable tourniquet grossly contaminated – dispose of. Ensure adequate supply available.
Treatment chairs Clean daily with detergent/detergent wipes
Trolleys Clean with detergent/detergent wipe prior to/following use
Toys:
Hard Clean weekly with detergent/detergent wipe or after use if used as part of treatment/assessment
All hard toys must be made of suitable material to withstand disinfection if required.
Soft Not suitable for healthcare facilities
Weighing scales Clean weekly with detergent/detergent wipe Work surfaces Clean with detergent/detergent wipe at the end of
each session Vaccutainer needle
holder
Single use
Vaginal speculum Disposable single use Vaginal ultrasound
probes
Cover with condom during use, clean with detergent/detergent wipes after removal
Do not immerse in water
Wheelchair Clean with detergent/detergent wipe weekly
*CES – Community Equipment Store
Environmental Cleaning
Colour Coding of Cleaning Equipment
Equipment used by the contracted cleaning service is colour c oded according to the area of use. This equipment is not for the use of NHS Wirral staff.
For large spills e.g. urine and vomit, initially contain with paper towels – dispose of into clinical waste bags.
Clinical staff are to use white buckets (reusable) and white single use disposable mops to decontaminate the area with the relevant cleaning detergent/disinfectant. Mops and buckets are stored in Domestic Services cupboards. Following use, rinse out bucket and store inverted. Dispose of mop head after use in the appropriate waste stream.
NHS Wirral staff are responsible for
The cleaning and/or disinfection of all medical equipment they use. Management of blood/blood stained body fluid and non hazardous
spills.
The general cleaning and/or disinfection of the tops of medical couches, trolleys and worksurfaces they use.
The cleaning and/or disinfection of children’s toys. The cleaning and/or disinfection of Patient equipment.
Patient Equipment and General Cleaning Checklist
This is for use as a guide for clinic based staff to ensure that cleaning of patient equipment is a priority. The checklist can be adapted for use by specific services and must be regularly monitored by a designated person. (available on IPC website for downloading).
Training
Included in Core Infection Control Training.
Audit
As part of the Infection Prevention and Control Audit programme.
Archiving
Hard and/or electronic copies of previous versions of this document will be held by the Infection Prevention & Control Team for the retention period required under current NHS guidance.
Risk Assessment
Included in Service Risk Assessment, clinic and procedure risk assessment.
References
Medicines and Healthcare Regulatory Agency (MHRA) Sterilization - 3rd
edition May 2010, Disinfection and Cleaning of Medical Equipment. Guidance on Decontamination from the Microbiological Advisory Committee to the Department of Health (The MAC Manual) London. MHRA.
List of those consulted in drafting process
APPENDIX 1
NHS Wirral
Patient Equipment and General Cleaning Checklist
for Clinic-Based Staff (All Health Care Workers)
Depending on the function of patient equipment in use, cleaning requirements may be classified as either:
after patient contact between patient contact on a daily basis
on a weekly basis
All equipment should be assessed and cleaned thoroughly. The cleaning checklist should be completed after each clinic session.
Equipment must be cleaned using detergent/detergent wipes. The following is the exception to this:
White buckets (reusable) and white disposable mops are available for use by clinical staff for all other spillages (please refer to Cleaning and Disinfection Policy).
The clinical environment must be tidied daily and kept clutter-free.
Any non-essential notices or displays on walls, windows or doors throughout the clinic should be removed in order to ensure that the general environment is maintained in a tidy and ‘de-cluttered’ fashion. Notices or posters need to be laminated if possible in order that they can be cleaned/wiped as necessary.
If any equipment is found to be in a poor state of repair, it must be taken out of use and reported, repaired or replaced as soon as possible.
N.B. This list is not exhaustive. Any specialist equipment relating to your area of practice should be added to this cleaning schedule and must be assessed,
cleaned thoroughly and monitored according to its function.
If blood or bloodstained fluids are identified, please clean area/equipment using a Spill-pak. Wear appropriate Personal Protective Equipment (PPE) i.e. disposable gloves and apron and follow manufacturers’ instructions for use.
Clinic Room………... Week commencing:
Mo
Any individual monitoring equipment
Wall-mounted suction units/suction apparatus
Wall-mounted oxygen points/oxygen masks
Sphygmomanometer cuffs
Portable monitoring equipment/stands
Electronic thermometer units
Stethoscopes Patient chairs Work surfaces dressing trolleys examination couch
Lifting devices – Hoist
Bathroom (Oxton)
inc. bath/hoist, bath chair
Monitored by Designated Person (Please print __________________________________)
Signature: __________________________ Designation: ___________
Date: __________________________
Cleaning checklist for clinic-based staff
N.B. This list is not exhaustive. Any specialist equipment relating to your area of practice should be added to this cleaning schedule and must be assessed,
NHS Wirral
Clinic Room………... Week commencing:
Mo
Monitored by Designated Person
(Please print ______________________________________)
Signature: __________________________ Designation: ___________
Date: __________________________