CLEANING AND DISINFECTION POLICY

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. May 2011 Named Responsible Officer:- Approved by Date Infection Prevention and Control Infection Control Lead Committee 6 th August 2008. Policy File:- Infection Control Policy No 7 Impact Assessment Screening Complete- August 2008 Full Impact Assessment Required- No Key Performance Indicator 1. Infection Prevention and Control audit 2. Attendance levels at Infection Control Training 3. Compliance with Code of Practice UNLESS THIS VERSION HAS BEEN TAKEN DIRECTLY FROM THE PCT WEB SITE THERE IS NO ASSURANCE THIS IS THE CORRECT VERSION

Contents Page Introduction 3 Policy Aim 3 Policy outcome 3 Target group 4 Specific responsibilities 4 Cross reference related PCT policies 5 Evidence to support policy 5 Background 5 Legal obligations 6 Assessment of risk 6 Cleaning - Detergents 7 Manual cleaning of equipment 7 Disinfecting - Disinfectants 8 Blood/Vomit spillage management 10 Equipment/Environment A-Z 11 Environmental Cleaning 15 Training 15 Audit 15 Archiving 16 Risk Assessment 16 References 16 List of those consulted in drafting process 16 Page 2 of 16

Wirral PCT 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 Policy. This policy covers cleaning and disinfection to comply with national guidance. The only service authorised to sterilise the majority of instruments within PCT 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 and approved by the Infection Prevention and Control Team. * PCT Podiatry Services are authorised to sterilise instruments in general treatment packs (excluding Podiatric nail surgery packs which may only be single use), for a time limited period until the external CSSD contract commences. This authorisation will be reviewed by the Decontamination Lead on a monthly basis. 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 the PCT, to allow staff to correctly use the appropriate product and cleaning and/or disinfection method. Policy outcome Equipment used throughout the PCT will be decontaminated appropriate to the level of risk to ensure risk of cross infection is minimised. 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 this policy is available as an example of best practice. Page 3 of 16

Target group PCT salaried staff. 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 16

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 never use domestic cleaning products in the healthcare environment. Cross reference related PCT policies Use of Personal Protective Equipment Single Use Policy Decontamination of Used Medical Devices (Dental Services only) Control of Substances Hazardous to Health (COSHH) Policy Medical Devices Policy NB: Always use most current versions of PCT policies as may be superseded at any time. Evidence to support policy National Resource for Infection Control. Clinical Practice. Cleaning. www.nric.org.uk 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 Page 5 of 16

Sterilisation: This is the only process which destroys all micro-organisms including spores. This can be achieved by: Pre sterilised single use equipment All provider services and Independent General Practice. Pre Sterilised re-usable equipment decontaminated in an accredited external CSSD PCT Podiatry services only. Sterilised prior to re-use in an appropriately maintained benchtop steam sterilizer PCT 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 2002. Assessment of risk The level of decontamination required is determined by the type of equipment and/or environment and the intended use. Risk Application Recommendation High Items in close contact with a break in the skin or mucous membrane Items introduced into sterile body cavities Medium Items in contact with mucous membranes Items/environment contaminated with potentially virulent or readily transmissible organisms Items prior to use on immunocompromised patients Sterile single use Sterilized in 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 Page 6 of 16

Low Items in contact with healthy skin Items/environment not in contact with the patient Thorough cleaning No new cleaner, disinfectant or sterilisation method may be introduced into the PCT 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 all 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 to dilution of detergents must be rinsed and stored inverted to drain. DETERGENT General purpose detergent e.g. Hospec USE General environmental cleaning Uncontaminated equipment cleaning General purpose detergent wipes e.g. Deb Cutan, Sanicloth (available in pack or bucket dispenser) Uncontaminated equipment cleaning where use of bowls of water may be hazardous e.g. baby clinics, patients homes, electrical equipment. Detergents used must be risk assessed for Control of Substances Hazardous to Health (COSHH), included in COSHH inventories and safety data sheets held if appropriate. Manual cleaning of equipment Equipment may be decontaminated following the principles outlines below for the immersion or non immersion method dependent on the type of equipment to be cleaned e.g. it would be hazardous to immerse electrical equipment. Page 7 of 16

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. 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 where possible using a brush or disposable cloth. 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. At the end of the session: 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. Wipe the item thoroughly ensuring that the detergent solution does not enter electrical components where appropriate. Rinse the cloth in fresh water and repeat the above step. Page 8 of 16

Dry the equipment using disposable paper. Disinfecting - Disinfectants 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, therefore all solutions must be discarded after 24 hours. DISINFECTANT NaDCC 1,000 ppm* e.g. Actichlor (2x5g tablets dissolved in ½ litre cold water) or Chlor-Clean (combined cleaner and disinfectant) Diluted 1 tablet to 1 litre cold water in dedicated Chlor-clean diluter Sodium Dichloroisocyanurate (NaDCC) 10,000 ppm* e.g. Haz Tab spill pack Chlor-clean: Combined detergent and NaDCC 1,000ppm 70% alcohol hard surface wipes e.g. Azowipes, Cliniwipes, Tuffi wipes USE Disinfection of previously cleaned equipment and hard surfaces Leg ulcer treatment buckets Propulse Ear syringes and water chamber Blood and Body Fluid spillage (see below for guidance) Cleaning and disinfection of leg ulcer buckets and Wheelchair Service loan equipment Disinfection of previously cleaned hard surfaces and equipment where 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 Auroscope ear pieces (single use is best practice) Minimal blood spills Page 9 of 16

PCT Dental disinfectants Sterilox (Electrochemically Activated Water) Full strength 2% solution 10% solution Gigasept Orotol Puli-Jet General disinfection Disinfection of Dental Unit water lines Disinfection of impressions Ultrasonic baths Suction/aspiration unit Suction/aspiration unit (Oxton Dental Clinic only) * 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. If in doubt contact the Infection Prevention and Control Team. 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 (Chlor-clean) as these are manufactured to be compatible. Always wear appropriate protective clothing for the task performed. Store disinfectant products in a locked cupboard to comply with Control of Substance Hazardous to Health Regulations. Blood/Vomit spillage management The PCT has no housekeeping service for out of hours spill 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 PCT staff use. Always wear disposable gloves and apron and consider eye protection. Ensure the area is adequately ventilated and cannot be accessed by patients/visitors. Page 10 of 16

Hard surface procedure (using spill packs): 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 hazardous waste sack for incineration. Wash area with general purpose detergent and hot water and dry with paper towels. For larger spills, especially of contaminated urine, initially contain with paper towels dispose of into hazardous waste bags then proceed as for small spills. Soft surface procedure: Spillages of blood or 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. Body fluid spills on carpets may be removed by Cover blood spillage with cold water to dilute blood. Absorb the liquid with disposable paper towels. Place contaminated paper towels/disposable cloths in a hazardous waste sack. The area may then require cleaning with a carpet cleaner by Support Services (PCT areas only). For advice on the decontamination of soft furniture contact the Infection Prevention and Control Team. Equipment/Environment A-Z Equipment Airways Ambu bags Auroscpoe ear pieces Decontamination Method Single Use Single Use Preferred single use or Clean with detergent and hot water(use cotton bud to clean channel). Disinfect with alcohol wipe after each use Page 11 of 16

Baby changing mat Baby weighing scales Bath (Bathing Centre) Bed (CES*)(patients home) Bowls (used for cleaning purposes) Blood pressure equipment Cover with disposable paper between babies Clean clean with detergent at end of the session Contaminated clean then disinfect with alcohol wipe before next baby Cover with disposable paper between babies Clean clean with detergent at end of the session Contaminated clean then disinfect with alcohol wipe before next baby Clean with detergent between each client using colour coded single use disposable cloth Remove body fluid contamination as it occurs using detergent wipe and alcohol wipe if blood or faeces Empty, rinse with clear water and store inverted to dry Wipe cuff and monitor with detergent (e.g. detergent wipe), pat dry with paper towel between patient use, do not immerse cuff in water. Disposable single patient use when patient has a multi resistant organism Buckets for leg ulcer washing Clean and disinfect the combined cleaner/1,000pm NaDCC (Chlor-clean) between patients and at the end of the session Store buckets inverted to drain Commode (patients home) Dental equipment Treatment sets Endodontic files Reamers Aspirator tips Doppler ultrasound probe Remove body fluid contamination as it occurs using detergent wipe and alcohol wipe if blood or faeces Sterilised Single use Single use Single Use Reduce potential contamination by use of disposable cover or thin plastic film as barrier (check manufacturers recommendations) Remove gel, clean with detergent (i.e. wipe), do not immerse in water Drip Stands Clean with detergent between patients Page 12 of 16

Ear syringe - Propulse ECG equipment: Electrodes Straps/Leads/Machine Follow disinfection procedure in Ear Care Procedure Single Use Clean with detergent, do not immerse in water Examination couches Cover with disposable paper towel between patients Clean with detergent at the end of the session Clean and disinfect with NaDCC if contaminated with body fluid Family planning: Speculum Trial size caps IUCD equipment Sub-dermal contraceptive implants Gym equipment Hoist (CES*) (Patients home) Frame Sling Minor surgical Instruments Nebulisers All single use Clean seat and handles with general purpose wipes between patients Clean weekly with detergent wipe Slings can be laundered if contaminated contact CES for advice Consider single use for patients with multi resistant organism where appropriate laundry facilities are not available Disposal 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 Pelvic stimulator electrodes Single patient use Clean with detergent wipe to remove any residues Wrap in paper roll and replace in carry case Return to patient for cleaning at home following Page 13 of 16

manufacturers instructions Pillows Physiotherapy equipment Podiatry instruments: Nail surgery Nail/foot treatment packs Podiatry foot tray Pressure relieving aids (patients home) Pulse oximeter Scissors: Stethoscope All pillows should be protected with plastic (sealed) or vapour permeable cover Wipe with detergent Disinfect with NaDCC if contaminated with body fluid Clean weekly with detergent or if contaminated Single use Clean and sterilized at external accredited CSSD Cover with disposable paper between patients Clean the detergent at the end of the session Disinfect with NaDCC 10.000 ppm if contaminated with blood Clean with detergent wipe weekly Contact CES for advice on disinfection Clean weekly with detergent and between patients Single use Clean between each patient use with detergent wipe Sticks/frames/crutches Clean with detergent between users Stitch/staple removers Suction machines Syringe driver Thermometer Tourniquet Single use Follow manufactures guidance Contact CES if further advice required Clean with detergent wipe and disinfect with alcohol wipe between patients Disposable sheath for each patient Clean handpiece weekly with detergent wipes Do not immerse in water Wipe with detergent (e.g. detergent wipe), pat dry with paper towel between patient use or Disposable single patient use Page 14 of 16

Treatment chairs Trolleys Toys: Hard Clean daily with detergent wipes Clean with detergent prior to/following use Clean weekly with detergent or after use if used as part of treatment/assessment All hard toys must be made of suitable material to withstand disinfection Soft Weighing scales Work surfaces Not suitable for healthcare facilities Clean weekly with detergent Clean with detergent at the end of each session Disinfect body fluid spills with NaDCC 10.000 ppm Vaccutainer needle holder Vaginal speculum Vaginal ultrasound probes Single use Disposable single use Cover with condom during use, clean with detergent after removal Do not immerse in water Wheelchair Clean with detergent 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 PCT staff. White buckets (reusable) and white disposable mops are available for staff use. These are kept in Domestic Services cupboards. Rinse out bucket after use and store inverted. Dispose of mop head after use in the appropriate waste stream. Never leave the mop standing in used water. PCT staff are responsible for The cleaning and/or disinfection of all medical equipment they use. Page 15 of 16

Management of 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. Training Included in Essential 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) 2002. Sterilization, 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 16 of 16