Decontamination process for reusable instruments
Decontamination process for reusable instruments
Central sterilization services department has the full responsibility and accountability for reprocessing of the reusable contaminated items in any health care facility the process for sterilizing any instruments started from transportation to the CSSD , sorting, disassembling , Cleaning , Inspection disinfection (inside the decontamination area) , packaging , sterilization (Inside the clean processing area) , storing then distribution to the end users. All those activities is done by CSSD staff as a routine daily work and each step has its monitor checklist and quality indicator to measure the process compliance and CSSD staff has to be familiar with all those steps in the way to provide the top quality service in the way they are protecting themselves from acquiring any pathogen and Appling all manufacturer instruction for all items they are handling to avoid any harm to, instrument, patient, themselves or other persons as we see the half of the process is done inside the decontamination area that we are focusing in this article.
As long as the decontamination area is too much risky mainly for the staff because of dealing with all contaminated items that carry the pathogen from all hospital areas so the first administrative support is the proper designing for the area that include a physical barrier between the decontamination area and the other work areas outside the processing area and inside the processing area. Floors and walls should consist of non-particulate/non-fibrous shedding material that can withstand wet vacuuming and washing, ceiling should have a flush surface with enclosed fixtures and be made from a non-particulate/non-fibrous material and never to be made from small tiles fixed together to control the pressure inside the area ,The work surfaces should be covered with a nonporous material that can withstand frequent cleaning with germicides. The ventilation of the area should have negative air pressure with at least 6 air change per hour (ACH), Temperature in between 20-23o C with relative humidity of 30-60 %. Hand washing facilities should be easily accessible to staff. Eyewash stations is too much important in the decontamination area as long as the staff have risk of chemical and body fluid eye exposure so proper timely intervention is very important by placing eyewash station and train people how to use it .
CSSD staff are working in a risky area by handling soiled instruments contaminated with human blood and other body fluids that place them in a risk of acquiring blood borne pathogen handling of soiled instruments and equipment increases the risk for blood-borne virus exposure for the central services worker in addition to other disease-producing organisms. Proper design of the area plus the ventilation and use of personal protective equipment (PPE) is critical to ensure a safe work environment. Due to risk of splashes to eye and mucus memberane of the nose and mouth , safety goggles or face-shields, should be worn at all times when cleaning soiled equipment. Surgical cap should be used to cover hair and a fluid-resistant mask should cover the nose and the mouth. A fluid-resistant gown should cover the arms and clothing. Gloves should be worn to protect users from contact with blood and body fluids, protect from exposure to chemical cleaning agents, and offer some protection against sharp objects. Heavy-duty, latex-free, or plastic gloves are often used to provide more protection than traditional medical examination gloves. If r heavy-duty gloves are used, the manufacturer’s recommendations for cleaning, disinfecting, and duration of use should be followed. Staff should dedicate a shoe to be used inside the decontamination area or using shoe covers, sharp boxes has to be available to discard any sharp objects preset with immediate reporting, and because of presence of chemicals using contact lenses is not allowed inside the decontamination area
Remember: drinking or eating is forbidden in the central processing department
As long as the decontamination area is receiving all contaminants from all hospital corners so special attention has to be applied to clean every :work tables, counter top and other high-touch horizontal surfaces and floors ,case carts, storage containers, and transportation carts ,walls, storage shelves, and storage areas all need to be routinely cleaned then disinfected.
The cleaning process is the most critical step in the sterilization process and we could never say this item is sterile unless it is cleaned as per our previous discussion Sterilization and factors affecting its efficacy. Selecting the correct cleaning product e.g. enzymatic detergent and using it properly is the first step to ensure proper cleaning. They enzymatic detergent work by lowering the surface tension, breaking down fats, oils and grease, and soil into smaller particles and suspending them in solution. Proteolytic products remove protein; lipolytic products remove fatty material. Enzymatic products may be used to soak instruments with crevices or dried-on proteins or fats. After the instruments have been adequately cleaned, disinfectants (mainly by using washer disinfector) to render the item safe for handling.
Manufacture instruction has to be followed to avoid instrument damage especially for the PH of the chemical we are using as high acidic or alkaline chemicals can destroy certain items
Mainly we are using manual washing for delicate items e.g. ophthalmology instruments that may be damaged if processed through an automated system also for equipment that cannot be submerged. It is critical to disassemble instruments and equipment before cleaning. All the time when cleaning devices with a sprayer, a brush, or other friction-causing process, immersion under water to minimize blood and body fluid aerosolization, decreasing the staff’s risk for exposure and remember never hold the instrument during brushes in front of your eyes and keep your hands all the time below the water level and remember to clean and disinfect or sterilize the reusable brushes. Lumens and channels need to be irrigated or cleaned by suction. The selection of the proper cleaning product for manual cleaning depends on the type of debris or soil left on items, the length of time between use and cleaning, compatibility with the item being cleaned, and the point at which the product makes items safe for handling. Items need to be rinsed between each chemical agent used, and rinsing should be the final step in the cleaning process. A lubricant bath or rinse (e.g., milk bath) may be used on instruments to maintain the function of hinges, cleaning has to be performed as fast as it possible after using the instrument to avoid any materials to stick hard to the instrument and it is advisable to use instrument transportation gel / foam to keep the instrument wet (caution to avoid any spillage during transportation) after being used until processed in the central department
automatic cleaning systems use high-frequency sound waves to remove particles. The sound creates bubbles on the instrument in the water bath; the bubbles then implode and draw out the tiny particles from the crevices of the instrument. Chemical agents can be added to the water to improve the cleaning process. Final rinse is necessary if the ultrasonic has no rinsing cycle. There are two approaches for using ultrasonic equipment. The first involves cleaning items before immersion into an ultrasonic unit; the second involves removing gross debris, rinsing, processing the instruments in the ultrasonic unit, and then continuing the cleaning process with equipment such as a washer/sanitizer. The cover of the ultrasonic has to be closed all the time during processing to avoid any aerosolized material generated from its operation that can be inhaled by the processing staff which pose infection risk to the staff
the process includes wash, rinse, and hot water bath (49°–95°C) with enzymatic detergent and other chemicals automatically added to the cycle, such as a disinfectant a final rinse is required if not included in the automatic cycle.
Reprocessed items need to be inspected after being decontaminated. This step may occur in the decontamination area but it is better to occur in the packaging and assembly (clean) area. A transfer method needs to be established that facilitates the return of unclean items from the clean area to the decontamination area. Also items need to be inspected for proper function and defects as well as to ensure that all soil has been removed. The cleaning of orthopedic and neurosurgical instruments pose a significant challenge to central services personnel for the possibility of prion. It is preferably to use manual lubricant for the joints at this step .Integrity, correct functioning, and the need to replace parts should be addressed at this point. The sharpness of cutting surfaces should be checked. Lighted magnifying glasses should be available at work stations to assist with detailed inspections.
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