Infection Control Today

MAR 2019

ICT delivers to infection preventionists & their colleagues in the operating room, sterile processing/central sterile, environmental services & materials management, timely & relevant news, trends & information impacting the profession & the industry

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Page 8 of 28

8 ICT March 2019 By Nancy Chobin SPD dialogue RN, AAS, ACSP, CSPM, CFER Q Q: I was counseled recently because I failed to check the temperature of the high-level disinfectant I was using. I never heard of this. I have been using this product for some time now. Can you explain what I did wrong? A: As with all processes, you must follow the manufacturer's written instructions for use (IFU). This includes high level disinfectants. The IFU contains essential information to protect you, the device you are processing and the patient. Safety Sheet – Before using a chemical, you should review the Safety Data Sheet (SDS) for information about health and safety issues. Make sure you have the most current SDS on fi le. Personnel Protective Equipment (PPE) − The required PPE may be different than that routinely worn in the department. Some disinfectants might be incompatible with the materials of which routine PPE is made. For example, a particular disinfectant might permeate the material, causing personnel exposure or damage to the PPE (latex gloves can actually be destroyed by some disinfectants). Therefore, it is essential that you use the correct PPE and apply and remove it correctly. You will only know this information from the SDS and the disinfectant manufacturer's written IFU. Cleaning – The device must be fi rst cleaned according to the device manufacturer's written IFUs. Cleaning is important because any residual debris or bioburden can interfere with effective high-level disinfection. In addition, after cleaning, the device must be thoroughly rinsed to remove all residue and detergent. IFUs − Manufacturer's IFUs (instructions for use) - High-level disinfectants (HLD) have a shelf life and a use life. The shelf life is indicated by the date stamped on the container, which is the date by which the bottle must be used. The use life is the length of time for which the HLD can be used after it is opened and placed into use. It is important to note that there are many factors that can affect the use life; including gross contamination of the items to be processed and the placement of wet items into the solution (the water on the items dilutes the solution). Solutions should never be used beyond their stated use life. It is essential that the device be fully immersed for the exposure time recommended by the HLD manufacturer. This means you must have a container large and deep enough to ensure complete immersion. Unless contraindicated by the device manufacturer, all surfaces of the device must be exposed to the HLD. For devices with lumens, it is important to use a syringe to pull the HLD solution into the lumen to make sure the lumen is fi lled with the HLD. Failure to do so could result in ineffective high-level disinfection of the device. It is recommended that a timer be used to ensure that the recommended exposure (soak) time is achieved. In addition, if the HLD manufacturer recommends a minimum temperature for the solution to be effective, a thermometer should be available for use. The temperature should be verifi ed before submerging the device in the HLD and monitored throughout the exposure time. Document the temperature on your High Level Disinfection log form. The thermometers used should be calibrated or replaced annually. Physical and Chemical Factors – According to the CDC – "Several physical and chemical factors also infl uence disinfectant procedures: temperature, pH, relative humidity, and water hardness. For example, the activity of most disinfectants increases as the temperature increases, but some exceptions exist. Furthermore, too great an increase in temperature causes the disinfectant to degrade and weakens its germicidal activity and thus might produce a potential health hazard. An increase in pH improves the antimicrobial activity of some disinfectants (e.g., glutaraldehyde, quaternary ammonium compounds) but decreases the antimicrobial activity of others (e.g., phenols, hypochlorites, and iodine). The pH infl uences the antimicrobial activity by altering the disinfectant molecule or the cell surface". Therefore, the need for the recommended temperature of the solution is critical to the effectiveness of the HLD process. Minimum Effective Concentration Testing of High-Level Disinfectants – Because of concerns about the potential dilution of the active ingredients of some HLDs, a minimum effective concentration (MEC) test (also referred to as a minimum recommended concentration [MRC] test) is required before each use of the solution. The MEC is the "minimum concentration of a liquid chemical sterilant/high-level disinfectant that achieves the claimed microbicidal activity; the MEC is determined by dose response testing" (FDA, 2000). In the MEC/MRC test, a test strip available from the disinfectant manufacturer is used to measure the concentration of the solution and, thus, verify its effectiveness. Before a test strip is used, the expiration date should be checked; expired strips should not be used. A record of the performance and results of Manual High-Level Disinfection: The Importance of Temperature Thermometer probe inside a soak container of high level disinfectant Ò Several physical and chemical factors also inf uence disinfectant procedures: temperature, pH, relative humidity, and water hardness. For example, the activity of most disinfectants increases as the temperature increases, but some exceptions exist.

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