Cleaning,disinfection and sterilization of equipment

Decontamination is a process by which pathogens are removed, inactivated or destroyed. A decontaminated item is unable to transmit infection and is safe to use. Decontamination always involves cleaning and is followed by disinfection and/or sterilization. Cleaning physically removes infectious materials and the organic matter on which they thrive, but does not destroy the microorganism itself. Disinfection eliminates pathogenic organisms except for bacterial spores. Sterilization is the complete destruction of all forms of microbial life, including spores. Mechanical, chemical and biological indicators monitor the efficacy of these processes. Hospital-acquired infections place a huge socioeconomic burden on the NHS: each year they cause 500 deaths and cost the NHS £1 billion. The microorganisms that cause hospital-acquired infections use medical equipment as a reservoir on which they flourish. The Microbiology Advisory Committee provides guidance on decontamination, disinfection and sterilization of equipment in the NHS. This guidance is fundamental to minimizing the risk of cross-infection.     

Disinfection,sterilization and disposables

Medical devices are one way by which healthcare-associated infections can be transmitted. Medical equipment can be categorized based on its risk of spreading infection and these categories aid decisions about whether to decontaminate or dispose of a used medical device. Decontamination is the process by which a reusable device is rendered safe for further use through cleaning and either disinfection or sterilization. It is frequently an automated process which usually involves thermal or chemical techniques and is subject to extensive quality control. Most microorganisms are inactivated or destroyed by disinfection but sterilization is required to eliminate resistant organisms and bacterial spores. Single-use medical devices are now commonplace and avoid the need for decontamination altogether.     

Disinfection,sterilization and disposables

Medical devices are one way by which healthcare-associated infections can be transmitted. Medical equipment can be categorized based on its risk of spreading infection and these categories aid decisions about whether to decontaminate or dispose of a used medical device. Decontamination is the process by which a reusable device is rendered safe for further use through cleaning and either disinfection or sterilization. It is frequently an automated process which usually involves thermal or chemical techniques and is subject to extensive quality control. Most microorganisms are inactivated or destroyed by disinfection but sterilization is required to eliminate resistant organisms and bacterial spores. Single-use medical devices are now commonplace and avoid the need for decontamination altogether.     

Validierung von Reinigungs-, Desinfektions- und Sterilisationsverfahren

The validation of the reprocessing of medical devices and healthcare equipment is a duty requirement for medical practice and hospitals, provided that they reprocess medical products. Stable, documented course of procedures are the requirements for valid procedures. The validation of cleaning, disinfection and sterilization processes consists of installational qualification, operational qualification and performance qualification and is regulated in appropriate technical standards. The effectiveness of cleansing, disinfection and sterilization procedures is decisively influenced even by the most modern equipment by the operating conditions existing on site. Hence, the performance qualification checks the respective course of procedures. Because standard loadings are not practicable, critical checkpoints must be included.     

消毒供应中心参与医学美容科医疗器械清洗包装质量管理的效果

研究消毒供应中心参与医学美容科医疗器械清洗包装质量管理的效果。方法 选择蒙阴县人 民医院2022年6月-2023年6月的15名消毒供应中心工作人员，按照随机数字表法分为基础组（7名）和科研 组（8名）。基础组采取常规管理，科研组采取医疗器械清洗包装质量管理，比较两组消毒灭菌质量、不 良事件及工作人员满意度。结果 科研组管理后器械拆装、消毒质量、清洗质量、包装质量评分均高于基 础组（P ＜0.05）；科研组不良事件发生率低于基础组（P ＜0.05）；科研组满意率为100.00%，高于基础组 的57.14%（P ＜0.05）。结论 消毒供应中心参与医学美容科医疗器械清洗包装质量管理可提高消毒灭菌质 量，保证器械消毒合格并避免发生不良事件。     

Disinfection,sterilization and single use

Healthcare-associated infections continue to place a significant burden on healthcare organizations with anaesthetic and intensive care practice contributing to this burden. Knowledge and understanding of methods to mitigate transmission is key to reducing its impact. Decontamination is the process where reusable medical devices are rendered safe for reuse through cleaning and then either disinfection or sterilization. Cleaning is the physical process of removing foreign matter from an object. Disinfection removes most, but not all microorganisms whilst sterilization eliminates all viable microorganisms. Single-use medical items are sterilized during manufacture and avoid the requirement for further decontamination altogether by being disposable.     

Microbiological evaluation of UV disinfection effectiveness in a specialist cystic fibrosis clinic

The aim of the study was to evaluate the impact of manual cleaning and manual cleaning followed by Ultraviolet-C disinfection on the colony forming units of bacteria retrievable from equipment and surfaces within clinic rooms following a CF outpatient encounter. While UV disinfection has proven to be effective within general healthcare settings, it has not been evaluated in a CF centre.Microbiological sampling was performed following outpatient encounters involving 11 adult patients with CF and chronic infection with P.aeruginosa, MRSA or E. coli ESBL.The results of this study suggest that manual cleaning followed by UV-C disinfection is more effective than manual cleaning alone at reducing environmental contamination within a CF clinic and that UV-C isinfection is likely to reduce the risk of fomite transmission in the CF outpatient setting.     

Endoscope disinfection

Economic considerations currently limit the idea of the disposable flexible endoscope, which would guarantee absolute safety against the transmission of infections. Since the endoscope is made of a heat-sensitive material, it is impossible to sterilize it by autoclave. A disinfection procedure must therefore be applied, which, although it does not guarantee the same level of safety as classical sterilization, provides a sufficient reduction in the microorganism load. This procedure is carried out in two steps: first cleaning by mechanical action using a detergent, then the actual disinfection by soaking in a disinfectant bath. As urine is a sterile milieu, a high-level disinfection--bactericide, virucide, fungicide, and sporicide--should be implemented by soaking for 30 min in a peracetic acid bath. Prion risk, which must systematically be taken into account, can be controlled by a double cleaning method eliminating all proteic debris and by replacing glutaraldehyde with peracetic acid.     

Infection control and prevention in intensive care: environmental aspects

Surveillance is understood as the monitoring over time of the onset of preventable infection and/or microbial colonization in patients in intensive care units (ICU), where the prevalence of nosocomial infections, particularly those caused by microorganisms multiresistant to antibiotics, is alarmingly high. Surveillance deals with: 1) pathogens responsible for infection and their patterns of antibiotic resistance; 2) epidemics; 3) endemic infections selected according to predictability; 4) frequency of use of specific invasive procedures, where the greater the use, the higher the frequency of nosocomial infections associated with them; 5) use of antibiotics. Surveillance is operated through: 1) the microbiology laboratory, which is responsible for accurate surveillance of hospital infections; 2) the active surveillance on the wards, which concerns: a) identification of infections either on admission or during hospitalization or both, b) use of invasive procedures, control of parameters, and data collection, c) type of patients treated, identification of infected patients and data analysis and interpretation. Infection prevention complementary to surveillance starts with the adoption of strategies and interventions based on the application of universal precautions and/or on the route of transmission. A crucial point is the sterilization and disinfection of medical devices. In recent years there has been a steady rise in the number of infections caused by medical devices, most likely because of the increasing use of sophisticated and complex equipment that is often difficult to decontaminate and because of the rise in the number of immunocompromised patients or those susceptible to infections.     

思维导图模式在提升消毒供应中心器械灭菌质量改进中的应用效果

目的 探讨思维导图模式在提升消毒供应中心器械灭菌质量改进中的应用效果。方法 选择2021年 4月-2022年7月在我院消毒供应中心进行灭菌的手术器械为研究对象,2021年4月-11月灭菌的300件器械设为对 照组,2021年12月-2022年7月灭菌的300件器械设为观察组。对照组按照消毒供应中心的灭菌流程对器械进行 常规灭菌,观察组在常规灭菌流程的基础上增加了思维导图模式,比较两组器械包装完好情况、器械完整性及 医护满意度。结果 观察组包装合格率为100.00%,高于对照组的的97.00%（ P ＜0.05）;观察组器械完整率、满 意度评分均高于对照组（ P ＜0.05）。结论 思维导图模式在提升消毒供应中心器械灭菌质量改进中的应用效 果确切,可有效提高器械包装合格率及器械完整性,医护人员对于器械灭菌质量的满意度较高。     

外来器械与植入物的双闭环管理

目的完善外来器械与植入物的管理流程,降低植入物提前放行率,确保医疗安全。方法采用双闭环管理模式对外来器械与植入物进行管理。医院层面闭环管理是利用医院耗材管理系统,实现外来器械与植入物的信息化管理,使临床科室、供应商、医学工程科、消毒供应中心、手术室、财务科各部门对外来器械的管理工作环环相扣;消毒供应闭环管理是将CSSD质量追溯系统与医院耗材管理系统对接,实现接收、清洗、消毒、包装、灭菌、使用、使用后再清洗消毒处理的信息化管理。结果实施闭环管理后植入物提前放行率由实施前的8.20%降低至1.59%。结论闭环管理模式明确了医院相关部门在外来器械与植入物管理环节中的职责,使临床科室医生对外来器械与植入物使用的风险有了足够的认识;使医院管理更趋精细化和规范化,有效规避因各环节过程管理中的疏漏带来的医疗风险,保障医疗安全。     

Guideline for the prevention of health care‐associated infection in urological practice in Japan

For developing the Japanese guideline for the prevention of health care‐associated infection in urological practice, we surveyed the literature including standard precautions, environmental considerations in both the inpatient and outpatient settings, the management of urinary catheters, endoscopy techniques, and the disinfection and sterilization of instruments used in endoscopies and related procedures. The concept of this guideline is to show the minimum precautions that urologists and other medical professionals should observe when they work in the urological field. Standard precautions based on hand hygiene and the use of personal protective equipment should be observed in both the inpatient and outpatient settings. In the inpatient setting, the management of the toilet is important. Collecting urine should be restricted only when it is necessary to determine a patient's urinary output. The management for urinary catheter and infection are created based on the “European and Asian guidelines on management and prevention of catheter‐associated urinary tract infections”. In addition, we propose that nephrostomy should be carried out after maximum barrier precautions have been taken. Urinary catheters are replaced in the event of an occlusion or if there are signs that an occlusion might occur, but the same catheter cannot be left in place for more than 2 months. Regarding the handling of urine containing Mycobacterium tuberculosis, airborne infection countermeasures are unnecessary, except for the laboratory personnel. For the procedures using urological endoscopes, aseptic techniques are recommended. Endoscopes and related devices should be used by sterilization or high‐level disinfection, but formaldehyde gas cannot be used.     

广西医院消毒供应中心硬件配置及管理现状的调查

目的 了解医院消毒供应中心清洗消毒灭菌设施的配置及管理现状并分析存在的问题,为改进医院消毒供应中心设备设施管理提供参考.方法 采用分层抽样法抽取广西143所医院对其消毒供应中心负责人进行问卷调查,对其中47所进行现场调查.结果 143所消毒供应中心中,2所医院的清洗消毒灭菌委托他院处理;其中隔离衣、手套、口罩、帽子配置率达95.7%,防护面罩80.1%,洗眼装置68.8%;压力蒸汽灭菌器配置率为91.4%～100%,低温灭菌器配置率普遍较低（0～37.1%）.结论 各级医院需强化硬件实力与管理效能的双向促进作用,规范设备设施准入管理,遵循原则审核包装材料资质,以通畅的系统功能保障消毒供应中心高效能的发挥作用.     

Nebulizer cleaning and disinfection practices in families with cystic fibrosis: The relationship between attitudes,practice and microbe colonization

BackgroundThe daily burden of health maintenance for children and families with cystic fibrosis (CF) is immense with respect to time and complexity of care. Infection control practices, specifically nebulizer cleaning and disinfection, are a recommended component of home health care for CF families due to colonization of home respiratory equipment with lung pathogens. To better inform education interventions at our center, we were interested in studying how families' views on infection prevention and awareness of CF Foundation infection prevention and control (IP&C) guidelines correlate with actual home nebulizer care and the presence of microorganisms on their nebulizers.MethodsTwenty families who have children with CF were surveyed to better understand attitudes toward infection prevention, awareness of CFF IP&C guidelines and nebulizer cleaning and disinfection practices in the home. Their nebulizers were also cultured for microbes to correlate recovery with infection control behaviors.ResultsA subset of families recognizes the importance of germ avoidance but do not recognize nebulizer cleaning and disinfection as very important for infection control practices. Decreased frequency of disinfection, but not cleaning, was correlated with the recovery of organisms on the nebulizers.ConclusionsThe study questionnaire results identify a gap between recognizing the importance of infection prevention and consistently implementing CFF IP&C guidelines in the home. This demonstrates the need at our center for new educational interventions to promote cleaning and disinfection of home nebulizers after each use as recommended by the CFF.     

Microbiological, microstructure, and material science examinations of reprocessed Combitubes after multiple reuse

Reprocessing (repeated cleaning, disinfection, and sterilization) and reuse of single-use medical devices has been performed safely with some devices. The aim of our study was to analyze whether reprocessing of the Combitubes (Kendall-Sheridan, Argyll, NY) airway device, used for emergency endotracheal intubation and difficult airway management, is possible and can be performed appropriately and safely. Microbiological, microstructure, and material science examinations were performed with unused, as well as multiple reused and reprocessed Combitubes. The reprocessing procedure consisted of a cleaning, a disinfection, a final inspection, and a sterilization. Microbiological examinations of multiple reused and reprocessed Combitubes found no test organisms in quantitative cultures. A microbial reduction between four and five log levels compared with nonreprocessed tubes was found. Microstructure analysis for the examination of topographical alterations and changes in the chemical composition of the surface demonstrated nonsignificant alterations between new and reprocessed medical devices. In material science examinations, cuff burst pressures were not different between unused and multiple reprocessed Combitubes. The results of all examinations proved that the decontamination process is adequately effective, and that no significant superficial alterations are generated by the multiple reuse and reprocessing of the Combitubes. To assure uniformly good results, a quality management system must be established and only validated methods should be used. IMPLICATIONS: Reprocessing of single-use medical devices offers the opportunity of significant savings and is already performed with some devices. Microbiological, microstructure, and material science examinations proved that reprocessing of multiple reused Combitubes (Kendall-Sheridan, Argyll, NY), mainly used for emergency airway management, is possible and safe.     

Profile of anesthetic infection control in Taiwan: a questionnaire report

Study ObjectiveTo evaluate compliance of anesthesiologists and nurse anesthetists with personal hygiene and anesthetic equipment disinfection procedures in Taiwan.DesignSurvey instrument.SettingAnesthesiologists and nurse anesthetists working in medical and non-medical centers in Taiwan.Participants81 anesthesiologists and 181 nurse anesthetists working in medical and non-medical centers.Measurements and Main ResultsQuestionnaires were sent to 500 anesthesiologists and nurse anesthetists in Taiwan. Two hundred sixty-two (52%) completed questionnaires (127 from medical centers and 135 from non-medical centers). Completed questionnaires were divided into two groups: those from medical centers (Group A) and those from non-medical centers (Group B). There was no significant difference in personal hygienic practices (wearing gloves and washing hands) between Groups A and B. There were significant differences between anesthesiologists and nurse anesthetists in wearing gloves (65.3% vs. 82%; P = 0.001) and hand washing (52.6% vs. 70.4%; P = 0.003). Medical center anesthesiologists and nurse anesthetists performed better than their non-medical-center counterparts when using disinfection procedures and disinfectants for laryngoscope blades and the cleaning of fiberscopes.ConclusionsTeaching programs should include anesthesia infection control in the curriculum for anesthesiologists and nurse anesthetists.     

Levels of bacterial contamination affecting podiatric equipment

This study aimed to ascertain the efficacy of standard equipment disinfection procedures by quantifying the level of bacterial contamination during a busy podiatric clinic. Sixteen cubicles were randomly paired and the footrest of the patient’s chair, the light handle and the trolley were sampled over 8 weeks at three times during the day; before the first patient (prior to disinfection), immediately after disinfection with a standard hard surface preparation and again at the end of the day. A template and the cotton swab technique were employed to obtain samples and control swabs. The swabs were plated, incubated aerobically and the number of colony forming units was counted. Samples from three cubicles were investigated further for the presence of pathogens. The contamination level decreased on all equipment following disinfection and the change was significant for the light handle and trolley (P<0.01). Contamination levels increased significantly on all equipment between the first disinfection and the end of the day (P<0.01). The light handle was the most contaminated and the footrest the least. Control swabs were negative for growth. Staphylococcus aureus was identified at different sampling times on all equipment and on the light handle after apparent disinfection. Coagulase negative staphylococci and Bacillus were also identified. While equipment disinfection initially had a significant impact on bacterial contamination, this was not maintained throughout the day. Disinfection procedures proved ineffective in eliminating the pathogen S.aureus, which raises concerns regarding the risk of cross-infection. Cleaning and disinfection procedures require review, audit and reinforcement. Particular attention should be given to disinfection of the light handle.     

五峰县少数民族基层医疗机构消毒效果监测现状

目的：为了解五峰县少数民族基层医疗机构消毒工作现状。方法根据卫生部《消毒技术规范》对2009～2013年全县医疗卫生机构消毒灭菌效果进行监测。结果5年共检样品6668份,平均合格率为86.25%,2009～2013年合格率依次为67.55%,81.10%,87.03%,92.18%,94.34%,经统计学处理,差异有统计学意义（x2=82.88,P＜0.05）;县乡村合格率依次为96.46%,87.93%,80.51%。各类样品消毒效果监测结果为：室内空气合格率为79.49%;已经使用的消毒液合格率为99.02%;物体表面合格率为76.60%;医务人员的手合格率为76.18%;医疗器材灭菌质量合格率为98.08%;压力蒸汽合格率为97.84%;紫外线灯管辐射强度合格率为77.56%。结论结果表明少数民族地区基层医疗机构消毒质量整体水平逐年有所提升,村级医疗机构合格率较低。     

Specific hygiene issues relating to reprocessing and reuse of single-use devices for laparoscopic surgery

OBJECTIVE: To determine whether reprocessed single-use devices (SUD) would (1) meet regulatory standards for sterility, and (2) meet the same material standards as new devices or if they pose an infection risk to other patients. DESIGN: The study included in the first stage single-use laparoscopic dissection devices and in the second stage a variety of clinically used and reprocessed SUDs. The suitability of these devices for cleaning, disinfection, and sterilization was examined. METHODS: Testing of cleanability was conducted on devices contaminated with radioactively labeled blood. Instruments were cleaned using hospital recommended practices. Gamma counts/second were determined before and after cleaning to localize contaminants, which were additionally visualized using light and scanning electron microscopy (SEM). X-ray photoelectron spectroscopy (XPS) was used to quantify contamination elements on the materials tested. Residual bioburden testing on instruments contaminated with microorganisms suspended in blood prior to reprocessing was carried out to establish the efficacy of disinfection and sterilization. RESULTS: During the first stage of the study all devices remained contaminated after cleaning, but were effectively disinfected. Sterilization could not eliminate the challenge microorganisms completely. The findings during the second stage--examination of clinically used devices--were as follows: 11% of the sterile packages were damaged; 33% of the devices were incomplete and parts were missing; 54% did not meet the criteria for functionality; light microscopy, SEM, and XPS showed contamination on the outside and inside of all devices. Of the tested SUDs, 40% remained unsterile following resterilization.CONCLUSIONS: None of the reprocessed SUDs were effectively cleaned or sterilized. This may provide an opportunity for survival and growth of non-resistant or nosocomial organisms and viruses. The use of such inadequately reprocessed SUDs increases the risk for the patient, and can lead to nosocomial infection and to legal consequences for the health care facility.     

Wirkung verschiedener Verfahren zur Keiminaktivierung auf die BMP-Aktivität von Knochengewebe

The sterilisation of allogeneic bank bone without significant loss of biological transplant activity makes high demands on the procedure used. For reliable sterilisation of hard tissues it is necessary to use harsh chemical and/or physical methods, which on the other hand should not exert significant adverse effects on the biological properties of the transplants. The effects of disinfection by moderate heat treatment, sterilization by γ-irradiation and low temperature conservation on osteoinductive factors in bone matrix were examined comparatively in an experimental animal study. The quantitative determination of residual BMP activity demonstrated a significant loss of 50% of starting activity by heat disinfection at 80°C. Irradiated matrix implants revealed a non significant reduction of only 6% of initial activity and frozen bone showed a slightly increased activity of 10%. Among the procedures currently used γ-irradiation seems to be most appropriate because of its known strong sterilization effects and preservation of the biological activity of bone transplants based on a pronounced resistance of BMP to irradiation.