CLEANING AND DISINFECTION POLICY

Transcription

1 CLEANING AND DISINFECTION POLICY First Issued by/date BWW/BW PCT March 01 Issue Version Purpose of Issue/Description of Change Planned Review Date 2 Revised update. Dec 2012 Named Responsible Officer:- Approved by Date Infection Prevention and Control Infection Control Dec 10 Lead Committee 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

2 Contents Page Introduction 3 Policy Aim 3 Policy outcome 3 Target group 4 Specific responsibilities 4 Related policies 5 Evidence 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 Page 2 of 21

3 NHS Wirral 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 infection 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. Page 3 of 21

4 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. Page 4 of 21

5 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. 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: Page 5 of 21

6 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 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 Medium Low Items in close contact with a break in the skin or mucous membrane Items introduced into sterile body cavities Items in contact with intact mucous membranes Items/environment contaminated with potentially virulent or readily transmissible organisms Items prior to use on immunocompromised patients Items in contact with intact healthy skin Items/environment not in contact with the patient Single use Sterilization by accredited CSSD (Podiatry Service only) (Benchtop steam sterilization preceded by cleaning Dental Services only) Thorough cleaning followed by disinfection or sterilisation (appropriate service only) Single use Cleaning Page 6 of 21

7 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. Page 7 of 21

8 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. Page 8 of 21

9 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 (NaDCC) 10,000 ppm* e.g. spill pack e.g. Propulse Ear syringes and water chamber Cleaning and disinfection of leg ulcer buckets and Wheelchair Service loan equipment Blood and Bloodstained Body Fluid spillage (see below for guidance) Sodium Dichloroisocyanurate 70% alcohol hard surface wipes Disinfection of previously cleaned hard surfaces and equipment where Page 9 of 21

10 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 Ultra sonic bath Suction Unit Washer disinfector detergent DAC Handpiece machine Sterilox (electrochemically activated water) Gigasept 500g (enzyme based cleaner & disinfectant) Orotol 2.5 litres Pulijet plus 1 litre Dekomed detergent AER 300 detergent 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. Page 10 of 21

11 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): guidelines Follow manufacturers 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. Page 11 of 21

12 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. Page 12 of 21

13 Equipment/Environment A-Z Equipment Airways Ambu bags Auroscope ear pieces Baby changing mat Baby weighing scales Bath (Bathing Centre) Bed (CES*)(patients home) Bowls (used for cleaning purposes) Blood pressure equipment Decontamination Method Single Use Single Use/clean with detergent followed by appropriate disinfectant. Single use 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 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 Clean with detergent between each client using colour coded single use disposable cloth Remove body fluid contamination as it occurs using detergent/detergent wipe and disinfect if blood or faeces Empty, rinse with clear water and store inverted to dry 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 (Chlorclean) between patients and at the end of the session Store buckets inverted to drain Page 13 of 21

14 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 Doppler ultrasound probe Drip Stands Ear syringe - Propulse Sterilised Single use Single use Single Use Remove gel, clean with detergent/detergent wipe, do not immerse in water Clean with detergent/detergent wipe between patients Follow disinfection procedure in Ear Care Procedure ECG equipment: Electrodes Straps/Leads/Machine Examination couches Single Use Clean with detergent/detergent wipe, do not immerse in water 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 Gym equipment All single use 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 Page 14 of 21

15 (Consider single use for patients with multi resistant organism where appropriate and laundry facilities are not available) Minor surgical Instruments Nebulisers Disposable Single use 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 Pillows Physiotherapy equipment 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 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 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 Page 15 of 21

16 Pressure relieving aids (patients home) Pulse oximeter Scissors: Clean with detergent/detergent wipe weekly Contact CES for advice on disinfection Clean weekly with detergent/detergent wipe and between patients 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 Suction machines Syringe driver Thermometer Tourniquet Treatment chairs Trolleys Single use Follow manufactures guidance Contact CES if further advice required Clean with detergent wipe Do not immerse in water. Disposable sheath for each patient Clean handpiece weekly with detergent/detergent wipes Do not immerse in water. 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. Clean daily with detergent/detergent wipes 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. Page 16 of 21

17 Soft Weighing scales Work surfaces Vaccutainer needle holder Vaginal speculum Vaginal ultrasound probes Wheelchair Not suitable for healthcare facilities Clean weekly with detergent/detergent wipe Clean with detergent/detergent wipe at the end of each session Single use Disposable single use Cover with condom during use, clean with detergent/detergent wipes after removal Do not immerse in water 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 coded 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. Page 17 of 21

18 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 - 3 rd 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 Infection Control Committee Page 18 of 21

19 APPENDIX 1 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: If blood or bloodstained fluids are identified, please clean area/equipment using a Spillpak. Wear appropriate Personal Protective Equipment (PPE) i.e. disposable gloves and apron and follow manufacturers instructions for use. White buckets (reusable) and white disposable mops are available for use by clinical staff for all other spillages (please refer to ). 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. NHS Wirral Implemented by the Infection Control Team June 2008 Review date November 2012

20 Cleaning checklist for clinic-based staff 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: 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. NHS Wirral Implemented by the Infection Control Team June 2008 Review date November 2012

21 Cleaning checklist for clinic-based staff PLEASE ADD ADDITIONAL ITEMS SPECIFIC TO YOUR AREA Clinic Room... Week commencing: Mo Monitored by Designated Person (Please print ) Signature: Designation: Date: NHS Wirral Implemented by the Infection Control Team June 2008 Review date November 2012