Cleaning, Disinfecting and Sterilizing

Office Instruments

 

CPSA Guideline

 

 

January 1994

This information is designed to aid practitioners in making decisions about appropriate care. This document does not define a standard of care nor should it be interpreted as legal advice. Variations in practice may be warranted based on the needs of the individual patient, resources, and limitations unique to the institution or type of practice.

These guidelines have been developed out of concern for patient care, safety and infection control, especially in light of the increasing number of procedures being done in physicians' private offices.

I. DEFINITIONS

1. CLEANING

All instruments to be disinfected or sterilized must first be thoroughly cleaned to remove all organic matter (blood and tissue) and other residue. This must precede disinfection and sterilization procedures as organic matter shields organisms from destruction and may inactivate some disinfectants. Disinfection time increases when more organisms are present.

Technique:

• The cleaning process is carried out using appropriate protective apparel - gloves, masks and gowns or aprons if splashing is anticipated.

• Those personnel responsible for cleaning, disinfecting and sterilizing sharps should be urged to be immunized against Hepatitis B as should others who have direct contact with patients and biological specimens.

• The articles are washed in hot sudsy water with bottle or special brushes, scrubbers etc. keeping below the water line when possible, to reduce aerosolization.

• Care must be taken to remove all organic matter as appropriate to the article, (eg. with fiberoptic endoscopes - getting into the ports and channels which should be flushed or suctioned with water immediately after use to prevent drying of organic materials, especially inside suction channels)

2. DISINFECTION

Process that eliminates many or all pathogenic micro-organisms on inanimate objects with the exception of bacterial spores.

Technique:

Use of liquid chemicals - 2% glutaraldehyde, 6% hydrogen peroxide, peracetic acid, chlorine dioxide are the only chemicals sufficiently sporicidal to accomplish sterilization with an exposure time of 6-10+ hours. In the case of critical items sterile water must be used for rinsing. boiling - should be for 5 full minutes after water reaches the boiling point.

disinfectant: a chemical agent that inactivates most recognized pathogenic micro-organisms (exception - spores) on inanimate objects.

antiseptic: a chemical agent for use on skin or tissue; it should not be used as a disinfectant unless label instructions indicate this is permissible.

3. STERILIZATION

Complete elimination or destruction of all forms of microbial life.

Technique:

• autoclave - steam under pressure (Should be used unless the instrument will be damaged by heat, pressure or moisture.) 128 Celsius or 260 Fahrenheit for 20 minutes for most loads.

• chemical sterilization - cold tray sterilization.

(Use only for instruments intolerant of heat eg. fiberoptic endoscopes.)

• dry heat sterilization - acceptable method but takes approximately 24 hours longer to produce sterility than steam autoclaving.

• sterile items to be stored must first be completely dry, and should be packaged, sealed and dated before sterilization. Use should occur within 30 days.

• if sterility need not be maintained (eg: speculums) such items can be stored in a clean cabinet or drawer in the examining room.

2. Rationale for cleaning, disinfecting, or sterilizing reusable patient care equipment can be understood more readily if medical devices, equipment and surgical materials are divided into three categories based on the potential risk of infection involved in their use.

Spaulding's classification of devices/medical instruments

Spaulding's Levels of Disinfection according to type of micro-organisms

1. Includes asexual spores but not necessarily chlamydospores or sexual spores.

2. Plus sign indicates that a killing effect can be expected when the normal use concentrations of chemical disinfectants or pasteurization are properly employed. A negative sign indicates little or no killing effect.

3. Only with extended exposure times are high-level disinfectant chemicals capable of actual sterilization.

4. Some intermediate-level disinfectants can be expected to exhibit some sporicidal action.

5. Some intermediate-level disinfectants may have limited viricidal activity.

III. DISPOSABLE ITEMS

Those labelled "Disposable, for single use only" by the manufacturer.

These items should only be reused with written manufacturers' instructions or, in hospitals, under approval and policies of hospital "Reuse of Disposables" Committees.

IV. POLICIES AND PROCEDURES

Policies and procedures should be developed by each office concerning cleaning, disinfecting and sterilizing office instruments. These should be consistent with the above recommendations and/or manufacturers' suggested guidelines for specific products. In addition, personnel should receive specific training regarding this responsibility.

Questions may be directed to Infection Control Practitioners and/or Sterile Processing Department (Central Supply) staff at the larger active treatment hospitals.

Acknowledgement to the Infection Control Unit, Caritas Health Group for assistance in preparing this document.

REFERENCES

1. J.V. Bennett, P.S. Brachman. Hospital Infections. 3rd Edition, Little, Brown & Co., Boston, Toronto; 1992

2. Laboratory Centre for Disease Control (LCDC), Health Services and Promotion Branch, Department of National Health and Welfare, Ottawa, 1985, Infection Control Guidelines: Cleaning, Disinfecting and Sterilizing Patient Care Equipment

3. William A. Rutala. APIC Guidelines for Selection and Use of Disinfectants. American Journal of Infection Control, Volume 18, No. 2, April, 1990, pages 99-117

4. William A. Rutala. Disinfection and Sterilization: What's New - From Presentation at 10th National Community and Hospital Infection Control Association - Canada Educational Conference, Edmonton, Alberta, April, 1993

5. D.C. Drummond. The Prevention of Cross Infection in the Physician's Office for Committee on Office Medical Practice Assessment, College of Physicians and Surgeons of British Columbia, February, 1992

6. J. Arlette, A. Carruthers. Basic Instruments and Sterilization Equipment for Minor Skin Surgery. Medicine, North America, January, 1992, pages 3548-3551

7. D.C. Drummond, A.G. Skidmore by permission of the publisher, CMAJ 1991; 145(8) and The College of Physicians and Surgeons of British Columbia

8. E. Henderson, T. Louie. Sterilization and Disinfection: Helpful Hints in Office Practice. The Canadian Journal of CME, September, 1993, pages 73-80

C = critical item, SC = semicritical item, NC = noncritical item, St = sterilization, HLD = high-level disinfection

ILD = intermediate-level disinfection, LLD = low-level disinfection

Notes:

Bleach may corrode stainless steel.

Glutaraldehyde immersion should be for 20 minutes or according to manufacturers' instructions.

Boiling should be for 5 minutes after water reaches the boiling point.

C = critical item, SC = semicritical item, NC = noncritical item, St = sterilization, HLD = high-level disinfection,

ILD = intermediate-level disinfection, LLD = low-level disinfection

Note:

Bleach may corrode stainless steel.

Glutaraldehyde immersion should be for 20 minutes or according to manufacturers' instructions.

Boiling should be for 5 minutes after water reaches the boiling point.

Reprinted from DC Drummond and AG Skidmore, by permission of the publisher, CMAJ 1991;145(8) and the College of Physicians and Surgeons of British Columbia with modifications by the College of Physicians and Surgeons of Alberta.

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