Infection Control Today

MAY 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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10 ICT May 2019 By Nancy Chobin SPD dialogue RN, AAS, ACSP, CSPM, CFER Q Q: Our department was reviewed by a consultant who indicated we should not be performing high-level disinfection (HLD) in the decontamination area. Can you explain why this is not acceptable? A: For many years, HLD was performed in the decontamination area. The thought process was that the device was contaminated, so until it was high-level disinfected, it should not be passed through to the clean side. Over the years, as new evidence became available as all practices were reviewed, it was debated that — once the device was cleaned and high-level disinfected — how was the device going to be transferred to the clean area without re-contaminating the device? AAMI ST-58 states, "Designated areas for chemical sterilization and high-level disinfection are strongly encouraged. Chemical sterilization/ high-level disinfection should occur in a clean environment to prevent recontamination of the medical device as it is removed from the process. High-level disinfection should be performed in an area separated from the cleaning area and should not be located in patient-procedure areas or in areas designated for personnel support." Devices should be cleaned in the decon- tamination area and then passed through to the preparation and packaging area, where HLD should be performed. (In some healthcare facilities, there is a separate room for HLD.) Because some HLD processes are wet, these activities should take place near a sink (a separate one for rinsing) and away from sterilizers, packs or trays. Emergency eyewash stations should be in all locations where chemicals are used. The area designated for HLD processes should: • have the necessary engineering controls for mitigating potential employee exposure to hazardous chemicals and/or vapors • have adequate space for the containers used to soak and rinse items for the disinfection process • provide adequate space to accommodate the type and quantity of supplies, equipment, and instrumentation to be processed • contain the equipment needed for manual and automated HLD Where to Locate High-Level Disinfection in the SPD • provide for traffi c control (restricted access) • allow effi cient work fl ow from decon- tamination to high-level disinfection to storage or use • provide adequate space for storage of necessary PPE • provide adequate space for staff to don and remove PPE • provide hand hygiene facilities that are separate from the sinks used for disposal of chemicals after use and include conve- niently located alcohol-based waterless hand hygiene solution dispensers • allow unobstructed access to eyewash facilities • accommodate the disposal of hazardous substances • provide adequate storage space for supplies and chemicals, such as disin- fectants, rinsing solutions, and products for testing the effi cacy of HLD solutions • allow temp erature and humidit y control so that the temperature can be maintained in accordance with ANSI/ ASHRAE/ASHE 170, based on when the heating, ventilation, and air conditioning (HVAC) system was installed or last updated, and so that the humidity can be maintained within the ranges recom- mended by device manufacturer's IFUs (ANSI/AAMI ST79); NOTE: The Facility Guidelines Institute recommends that the relative humidity in all work areas not exceed 60 percent and that the relative humidity be at least 20 percent in the sterile storage area (FGI, 2014). • have a minimum of 10 air exchanges per hour (ANSI/AAMI ST91) • have floors, walls and ceilings with non-porous surfaces that will withstand frequent cleaning and wet conditions. The devices being processed should fl ow from the decontamination (cleaning area) to the chemical sterilization/high-level disinfection (clean) area. After the item is processed, it should be stored or distributed and protected from recontamination. AAMI recommends that when possible, there should be solid walls to separate the cleaning area from the high-level disinfection area. Since other departments may also be performing HLD, there should be standardized policies for HLD throughout your facility. The policies and procedures should specify any needed engineering controls (i.e., special ventilation requirements), the recommended personal protective equipment (PPE) and safe work practices. The clean area of the SPD should have space available for the HLD activities. For example, the HLD area can be located on the clean side of the mechanical washers since this area already has a water source and drain lines. A sink can be installed to rinse the HLD. If needed, install a counter as the work area for the HLD. Ensure the HLD area is not located near the sterilizers or packaging areas where items can possibly be splashed with the HLD or water. In other areas of the facility where HLD is being performed, a risk analysis should be performed in conjunction with the infection prevention and control department to assess the location of the HLD processes to determine if changes need to be made. In summary, there are many factors that can contribute to successful high-level disinfection; all of them must be followed. This includes thorough cleaning of the device before HLD is attempted, selection of the recommended HLD (based on the device manufacturer's testing), following the HLD manufacturer's written IFUs for use, including rinsing of the device and protection of the device after HLD to prevent recontami- nation. However, the location where the HLD is performed cannot be overlooked as it can contribute to recontamination of the device as well. Nancy Chobin, RN, AAS, ACSP, CSPM, CFER, is a sterile processing consultant and educator. References: ANSI/AAMI: ST79:2017. "Comprehensive Guide to Steam Sterilization and Sterility Assurance in Healthcare Facilities." Basics of Sterile Processing 6th Edition. Sterile Processing University, LLC. Lebanon, N.J.

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