Cleaning, Disinfection and Sterilization (Decontamination) Guidelines

Transcription

1 Cleaning, Disinfection and Sterilization (Decontamination) Guidelines This guideline sets out to provide information on: methods of decontamination to be used within the Trust responsibilities for cleaning, disinfection and sterilization (decontamination) the process whereby assessment of risk can be determined linked to decontamination type of wipes to be used in the Trust safe management of spillages use of single use devices process linked to decontamination certificates promoting adherence to best practice with regard to decontamination and providing a framework for monitoring practices in compliance with the Health and Social Care Act 2008 (updated 2015). Advice is available from the Infection Prevention and Control Team on or out of hours from the on call medical microbiologist via switchboard at either Worcestershire Royal Hospital or the Alexandra Hospital Redditch.

2 CLEANING, DISINFECTION AND STERILIZATION (DECONTAMINATION) GUIDELINES Document Type Infection Prevention and Control Guidelines Document Purpose To promote knowledge and standard practices linked to cleaning, disinfection and sterilization procedures within the Trust to enhance patient and staff safety. This guidance sets out to provide instruction on the most appropriate and safe methods of decontamination of the environment and commonly used shared patient care equipment. It should be read in conjunction with the Trust Strategic Cleaning Plan. Document Author Infection Prevention and Control Team Target Audience All staff working within healthcare settings Responsible Group Infection Prevention and Control Committee Date Ratified First Issue: Updates: July 2004; October 2008; November 2013; November 2017 Expiry Date November 2021 The validity of this guideline is only assured when viewed via or via the Trust intranet site. If this document is printed into hard copy or saved to another location, its validity must be checked against the internet version using the review data in the footer of the guideline. The internet version is the definitive version. Learning and Development Worcestershire Health and Care NHS Trust recognises the importance of ensuring that its workforce has every opportunity to access relevant training. The Trust is committed to the provision of training and development opportunities that are in support of service needs and meet responsibilities for the provision of mandatory and statutory training. All staff employed by the Trust are required to attend the mandatory and statutory training that is relevant to their role and to ensure they meet their own continuous professional development.

3 CONTENTS CLEANING, DISINFECTION AND STERILIZATION 2 METHODS OF DECONTAMINATION 3 RESPONSIBILITIES 4 USE OF WIPES 5 CATEGORISING EQUIPMENT BY RISK 6 CLEANING EQUIPMENT AFTER USE 7 CHEMICAL DISINFECTANTS GUIDELINES FOR GENERAL USE 8 ENVIRONMENTAL DISINFECTANTS 9 GUIDELINES FOR THE USE OF SKIN DISINFECTANTS 10 SINGLE USE/SINGLE PATIENT USE EQUIPMENT 11 SYMBOLS USED ON MEDICAL DEVICES 12 CLEANING OF AN AREA POST ISOLATION NURSING/OUTBREAK TERMINAL CLEAN 13 MANAGEMENT OF BLOOD OR BODY FLUID SPILLAGES 14 USE OF HYPOCHLORITE AND STRENGTHS OF SOLUTION 14 PREPARATION AND USE OF HYPOCHLORITE BASED SOLUTIONS 15 DECONTAMINATION OF INSTRUMENTS/EQUIPMENT 16 DECONTAMINATION OF MEDICAL OR LABORATORY EQUIPMENT 19 DECONTAMINATION CERTIFICATE 20 A-Z OF EQUIPMENT AND ITEMS 21 COMMODE CHAIR CLEANING PROTOCOL 43 REFERENCES AND BIBLIOGRAPHY 44 Every healthcare worker needs to be clear about their specific responsibilities for cleaning equipment and clinical areas (especially those areas in close proximity to patients). They must be educated about the importance of ensuring that the hospital environment is clean and that opportunities for microbial contamination are minimised. I C Guidelines Section C 1-C November 2017

4 CLEANING, DISINFECTION AND STERILIZATION Medical and surgical devices may serve as a vehicle for the transmission of infectious disease to susceptible hosts (Damani 2012). This section compliments sections on safe working practices (Section B) and the management of infections (Section F) to ensure that the process of cleaning and decontamination within the patient environment is thorough and follows best practice for all equipment and devices. Environmental cleaning is detailed within the Trust Strategic Cleaning Plan (2016). Definition Decontamination is a general term that is used for the destruction or removal of microbial contamination to render an item safe. This will include methods of cleaning, disinfection and sterilization (Fraise and Bradley 2009). Aim To promote the removal of visible soil/dirt and invisible micro-organisms thus making the patient s equipment and environment safe to prevent cross infection between patients; to protect personnel from potentially infected items and equipment and to instil confidence in those visiting the area. Key points for ongoing consideration include: Cleanliness and decontamination of near patient equipment and environments Reducing the risk of cross contamination/infection Embedding importance of decontamination practices into daily work routine. Context The Health and Social Care Act 2008 Code of Practice (2015) states that audits of key procedures for the prevention and control of infection are in place to assess whether patients are cared for in a clean environment. The healthcare professional in charge of a patient/service user area eg nurse in charge of a ward has direct responsibility for ensuring that cleanliness standards are maintained throughout that shift. Cleaning and decontamination are important in their own right, for public confidence as well as for supporting infection prevention and control. National specification for cleanliness linked to inpatient settings (2007) and primary medical care (2010) have been drafted by the National Patients Safety Agency (NPSA) and provide outline specifications reflected in the Trust Strategic Cleaning Plan (2016). KEY POINTS Equipment which cannot be cleaned must be risk assessed or designated for single patient use. Alternative products with attainable decontamination guidance should be sought. Local decontamination guidance from the Infection Prevention and Control Team and Medical Engineering departments must be sought as required. Single use items must not be reused under any circumstances. All staff must be aware of their responsibilities regarding cleaning and decontamination. undertaking decontamination, whether of the environment or equipment, must be trained in the correct procedures and have access to appropriate materials, products and personal protective equipment. A clutter free environment and the adoption of local clean as you use practices provides the foundation for delivering high quality care in a clean, safe place. When new items of equipment are considered for purchase, the manufacturer s advice on decontamination must be sought and training, if necessary, must precede use. Clear identification of cleaned items and a visibly clean environment will provide reassurance to patients that they are receiving safe care in a clean environment. Appropriate designated areas and cleaning products should be accessible and available for the cleaning of equipment to take place and to ensure appropriate storage. I C Guidelines Section C 2-C November 2017

5 METHODS OF DECONTAMINATION Decontamination is a general term that is used for the destruction or removal of microbial contamination to render an item safe. This will include methods of cleaning, disinfection and sterilization (Fraise and Bradley 2009). Cleaning and Drying A process which removes soil, eg dust, dirt and organic matter along with a large proportion of micro-organisms; a further reduction will occur on drying as microorganisms cannot multiply on a clean, dry surface. Thorough cleaning with soap/detergent and hot water is adequate for most surfaces, efficient cleaning removes a high proportion of micro-organisms present including bacterial spores. All cloths/towels used must be disposable. Cleaning is an essential prerequisite to disinfection and/or sterilization. Disinfection by either heat or chemicals will destroy micro-organisms but not bacterial spores. The process does not necessarily kill or remove all micro-organisms but reduces their level to one that is not harmful to health. Disinfection can be achieved by moist heat (thermal disinfection) and a combination of cleaning and thermal disinfection is used in washer disinfectors, washing machines and dishwashers. Chemical disinfectants should only be used if heat treatment is impractical or may cause damage to the equipment. This process may be described as high level disinfection. Chemicals used to kill micro-organisms on skin or living tissue are known as antiseptics. Sterilization is a process that can achieve the complete destruction or removal of microorganisms including bacterial spores. Equipment and materials used in procedures involving a break in the skin or mucous membranes must be sterile, eg surgical instruments, products for parenteral use or instillation into sterile body cavities. Sterilization can be achieved by physical methods such as heat, low temperature steam or by the use of a chemical such as Ethylene Oxide. Bench Top Steam Sterilizers (BTSS) are not recommended for use within GP Practice or Trust settings with the exception of dental practice where stringent national guidance must be adhered to Health Technical Memorandum (HTM) The use of single use items or access to a central sterilization reprocessing unit is recommended for all other items. A BTSS is unsuitable for heat labile items eg flexible endoscopes, plastic devices etc. Devices must be processed in a manner that is appropriate and proportionate to the risk they pose based on tasks undertaken. All healthcare staff using or processing instruments must understand the difference between Sterile and Sterilized. Accordingly, instruments may be defined as sterilized to render them safe to use on a subsequent patient rather than sterile at the point and time of use (a somewhat different approach from that in invasive surgical procedures). In some instances, decontamination processes may not generate full sterilization, (eg reprocessing of dental hand pieces following cleaning in a BTSS; reprocessing of baby bottles in a steam sterilizer). Dependent upon manufacturer s guidance this may be considered adequate and offer a high level of disinfection as opposed to sterilization. The choice of method used depends mainly on the type of material, level of decontamination required for the procedure and micro-organisms involved. REMEMBER: Appropriate Personal Protective Equipment (PPE) must be worn and hand hygiene undertaken. I C Guidelines Section C 3-C November 2017

6 RESPONSIBILITIES Within healthcare settings it is imperative that the environment, fixtures, fittings and equipment are decontaminated appropriately. The responsibility for this is shared amongst all staff with key responsibilities as below. The Chief Executive has ultimate responsibility for the implementation and monitoring of practices within the Trust and ensuring sufficient resources are made available to enable provision of a clean and appropriate environment which facilitates the prevention and control of infection. The Director of Nursing and Quality, Director of Infection Prevention and Control (DIPC) has the lead responsibility for the development and implementation of this guidance. This role will provide assurance to the Trust Board that systems and processes are in place to ensure compliance with agreed standards. The Infection Prevention and Control Team will have responsibility for ensuring this guidance is implemented and monitored across the Trust and updated to reflect any changes. The team will also provide education and support to clinical staff and ensure that a robust audit programme is in place to support clinical areas in maintaining standards of cleanliness and identifying appropriate actions required. Matrons have responsibility for ensuring that a clean and safe environment is provided. This includes making sure that clinical areas level of cleanliness are reflective of Trust standards and that staff are supported in identifying and resolving any areas of concern in conjunction with the Infection Prevention and Control Team. Effective systems and processes need to be in place for the appropriate cleaning of equipment used at the point of care (eg commodes, hoists, mattresses), and that there is a system in place to identify items of equipment that require decontamination in addition to ensuring that clean equipment is stored appropriately. Ward/Departmental Managers are responsible for ensuring that all staff are aware of, and comply with guidance and understand the link between cleaning and the transmission of infection. They are also responsible for ensuring that the importance of cleaning and cleanliness is embedded into the clinical area and that consistent provision of clean safe care can be attained. All Employees are responsible for ensuring standards of cleanliness are maintained to protect patients and others and understanding their individual responsibilities in relation to environmental cleaning and decontamination of equipment, including, but not limited to, the equipment they use. All staff must also be knowledgeable on how to raise concerns in relation to failures in cleaning processes in addition to attending training linked to this as required. KEY POINTS The healthcare environment must be visibly clean; free from non essential items and equipment, dust and dirt; and acceptable to patients, visitors and staff with appropriate levels of cleaning to minimise the risks of cross contamination. Shared pieces of equipment used in the delivery of patient care must be cleaned and decontaminated after each use with products recommended by the manufacturer with single use items used as such. This guidance will cross reference to the Trust Strategic Cleaning Plan (2016) and bespoke cleaning schedules in addition to commode cleaning schedules. I C Guidelines Section C 4-C November 2017

7 USE OF WIPES Within the Trust the use of wipes for decontamination of surfaces or equipment has been standardised, a range of products is available to ensure effective decontamination. Each product comes in a variety of presentations to enhance ease of point of use cleaning. The use of wipes is increasing as a means to decontaminate low risk patient equipment or environmental surfaces by healthcare staff. Removal of soiling is the main purpose of a wipe but on occasion the antimicrobial activity as a result of the inclusion of a disinfectant may be helpful on visibly clean surfaces. Wipes promoted in the Trust include those detailed below which link through to the decontamination A-Z detailed from page 21 of this guidance. s for quick and easy cleaning of items that require cleaning. Wipes come in small self sealing packs or larger buckets, purchase containers of an appropriate size. Detergents are essential to the cleaning process, acting to release dirt from a surface (for example, the immediate patient environment or equipment). Following use, dirt and a proportion of the micro-organisms will be retained by the wipe and removed on it. Any micro-organisms not removed from the surface will remain inactivated but available for transfer to patients or other locations via the wiped equipment or hands of staff. Hard Surface Disinfectant Wipes (70% Alcohol) used on visibly clean hard surfaces. This is the only routine hard surface disinfectant wipe used within the Trust. It must be noted that unless a surface is visibly clean a disinfectant wipe will have a limited efficacy as these wipes are only suitable for items that appear visibly clean otherwise the disinfectant will be inactivated as well as failing to penetrate through to the target micro-organisms. Surfaces after wiping must be left to dry. Chlorine Based Wipe (1000ppm) enable disinfection of visibly clean surfaces (on advice from IPCNs use of these wipes may be considered during an outbreak of viral gastro-enteritis or if there are problems accessing standard chorine preparations). Caution: can cause surface degradation. KEY POINTS Wipes must be considered as single use products unless specifically designed to be reused in line with the manufacturer s recommendations. Maintenance of wipe efficacy must be considered and to enhance this: o o o o o o Manufacturer s instructions for storage; where to store and length of storage life must be followed. Wipes should be available in the vicinity of where they are required to promote timely decontamination eg adjacent to whiteboards, lap tops in clinical areas, on diagnostic monitors and in areas of high use eg dirty utility. staff must ensure stock rotation and undertake regular checks for wipes in packets/containers to make sure these have not dried out or expired. The need to clean wipes container/packet depending on risk of contamination of external container surfaces must be considered, buckets and brackets must always appear visibly clean. All staff must ensure that wipes are only used for their intended purpose according to decontamination guidance, for example detergent or disinfectant wipes specifically for use on the environment must not be used for decontamination of skin. who use wipes must be aware of how to use them appropriately, have received training on how and when to use them including direction of cleaning from clean to dirty, one wipe for one task, ensuring wipes are moist, disposed of if soiled and thought is given to when wipes require changing to help guarantee consistency and efficacy of use in practice.1 I C Guidelines Section C 5-C November 2017

8 CATEGORISING EQUIPMENT BY RISK All equipment should be categorised as to the risk it poses for patients/service users. Single patient use equipment must never be used on more than one patient/service user and single use equipment must always be used according to the manufacturer s recommendations. The risks of infection from equipment may be classified into four categories, (Coates and Hutchinson 1993). All items should be placed in one of the following categories to assist in ascertaining the appropriate level of decontamination needed to protect the patients/service users and staff. RISK CATEGORY Minimal Risk Low Risk Intermediate Risk High Risk DEFINITION AND EXAMPLES Items some distance away from the patient/service user such as environmental surfaces and fittings, eg walls, floors, ceilings, sinks and drains. Items in close proximity to the patient but unlikely to be contaminated with a significant number of pathogens, eg bed frames, lockers, flower vases. Items in contact with normal intact skin. eg stethoscopes, wash bowls, crockery, cutlery, mobile telephones. Items in contact with intact mucous membranes, eg respiratory equipment, clinical thermometers, gastroscopes. Items in contact with particularly virulent or readily transmissible organisms eg commodes during an outbreak of diarrhoea. Items to be used on highly susceptible patients/service users. Items in close contact with a break in the skin or mucous membranes, eg dressings. Items introduced into a normally sterile body site, eg surgical instruments, needles, implants, urinary catheters. DECONTAMINATION LEVEL Cleaning and Drying adequate Cleaning and Drying usually adequate Disinfection Sterilization Where patients indicate that they are in a high risk group for a Transmissible Spongiform Encephalopathy, advice must be sought from the Infection Prevention and Control Team. Guidance provided by the Advisory Committee on Dangerous Pathogens Working Group (ACDP-TSE WG) will be followed ( The guidance suggests that special precautions beyond full instrument decontamination will not be necessary however specific advice is available and must be sought. Further advice is also detailed in Section F under Creutzfeldt Jacob Disease. I C Guidelines Section C 6-C November 2017

9 CLEANING EQUIPMENT AFTER USE BY/OR ON A PATIENT WITH A KNOWN OR SUSPECTED INFECTION OR IN A CONTAMINATED AREA Location of cleaning activity Patient equipment located in isolation areas must be cleaned prior to its removal from that area and then cleaned again in a general area prior to reuse/storage. Correct hand hygiene Undertake hand hygiene, as per Section B, prior to and following the cleaning of equipment. Personal Protective Equipment (PPE) Correct PPE (single use disposable apron and gloves as a minimum) is worn. Use of eye protection should be considered if a risk of splashing is identified. Following use dispose of PPE into hazardous waste stream (yellow bag). Cleaning and decontamination Decontamination, (cleaning and if required disinfection) is carried out immediately following use of the equipment by the patient/service user or member of staff. Equipment is decontaminated in accordance with the manufacturer s guidance. This will usually be with a general purpose detergent, wherever possible the use of multi surface detergent wipes should be considered. Use of either a 70% alcohol wipe or 1,000 ppm chlorine containing disinfectant solution may be required in some instances and as second process following cleaning. Systematic cleaning of items (top down) should be undertaken and should commence with the cleanest section and move towards dirtiest area. Storage Cleaned and decontaminated equipment should be stored separately from used items and away from areas where cleaning is taking place, to reduce risk of recontamination. Documentation Where indicated, cleaning must be documented. CLEANING EQUIPMENT AFTER USE ON A NON - INFECTED PATIENT AND IN A NON - CONTAMINATED AREA Location of cleaning activity Equipment is cleaned in a designated area, insitu if appropriate to do so but must be in an area away from clean items to minimise contamination. Correct hand hygiene Undertake hand hygiene, as per Section B prior to and following the cleaning of equipment. Personal Protective Equipment (PPE) Correct PPE (single use disposable apron and gloves as a minimum) is worn. Use of eye protection should be considered if a risk of splashing is identified. Following use dispose of PPE into offensive waste stream (yellow bag with black stripe). Cleaning Decontamination, (cleaning and if required disinfection) is carried out immediately following use of the equipment by the patient/service user or member of staff. Equipment is decontaminated in accordance with the manufacturer s guidance. This will usually be with a general purpose detergent, wherever possible the use of multi surface detergent wipes should be considered. Use of either a 70% alcohol wipe or 1,000 ppm chlorine containing disinfectant solution may be required in some instances and as second process following cleaning. Systematic cleaning of items (top down) should be undertaken and should commence with the cleanest section and move towards dirtiest area. Storage Cleaned and decontaminated equipment should be stored separately from used items and away from areas where cleaning is taking place, to reduce risk of recontamination. Documentation Where indicated, cleaning must be documented. I C Guidelines Section C 7-C November 2017

10 CHEMICAL DISINFECTANTS GUIDELINES FOR GENERAL USE There are a number of important factors that must be considered when using chemical disinfectants: o the efficacy of chemical disinfection is often uncertain and depends on: o the nature of surface, o the dilution of disinfectant, o the circumstances of the contact time, o disinfectant efficacy and o knowledge and diligence of supervisor. Wherever possible, disinfection by heat is preferable to chemical methods where surfaces will withstand this. If using both methods eg clean following Carbapenamase producing Enterobacteriaceae (CPE) patient then following cleaning a steam clean is recommended prior to the final chemical disinfection (bleach clean). All chemical disinfectants must be: o clearly labelled and used within the expiry date, o freshly prepared and used in accordance with manufacturer s guidance, o used at the correct concentration and o stored in an appropriate container. Chemical disinfectant solutions must not be mixed or detergents added unless there is documented guidance to state they are compatible. Do not prep concurrently with povidone iodine and chlorhexidine. Disinfectant or detergent solutions must not be prepared and stored in multi use containers for occasional use. Solutions prepared and stored in this manner may easily become contaminated with micro-organisms; using such solutions will therefore readily contaminate a surface rather than clean it. Manufacturer s instructions must be consulted on compatibility of materials with the method of disinfection or sterilization. Disinfectants, including alcohol do not penetrate well into organic matter and therefore must only be used on surfaces that are physically clean. A Control of Substances Hazardous to Health (CoSHH) (Health and Safety Executive (TSE) (2013)) assessment must be available in addition to the manufacturer s safety data sheet for each disinfectant stored or in use. I C Guidelines Section C 8-C November 2017

11 ENVIRONMENTAL DISINFECTANTS It is essential that any equipment or surface is physically clean prior to a disinfectant being applied (Wilson 2006). Environmental disinfectants can be used for a wide range of tasks including: Rapid disinfection of equipment and surfaces. Treatment of spillages of potentially hazardous matter, (wear apron and gloves). Disinfection of reusable items of equipment that are heat labile. Cleaning during outbreaks on the advice of the Infection Prevention and Control Team. The properties of disinfectants vary from one product to another and also the concentration of disinfectant being used. DISINFECTANTS MUST BE MADE UP AS REQUIRED AT THE TIME OF USE UNLESS ADVICE FROM MANUFACTURER INDICATES OTHERWISE AGENT TRADE NAME INDICATION FOR USE Alcohol 70% Sani-Cloth 70 IPA Alcowipes Azowipes Rapid disinfection of certain items of equipment and hard surfaces. Hypochlorites Sodium Dichloroisocyanurates (NaDCC) Chloros Domestos Milton Presept granules Sanichlor Actichlor Covchlor Chlorine based solutions should be used for blood/vaccine spillages where surface can withstand, terminal cleaning of an isolation area, cleaning during outbreaks of infection and for disinfecting surfaces and equipment if recommended. Dilutions for tasks are shown on page 14-C. Clear soluble phenolic Clearsol 1% Must only be used for terminal cleaning of an isolation room after confirmed Tuberculosis or clearing up sputum from a known Tuberculosis patient. DISINFECTANTS FOR INSTRUMENTS/INVASIVE DEVICES Instruments must be physically clean prior to being disinfected. AGENT TRADE NAME INDICATION FOR USE Chlorine Dioxide Tristel A useful disinfectant for equipment that cannot be heat sterilized such as nasendoscopes, ultrasound probes etc. It has a wide range of bacterial, viricidal and fungicidal activity. Chlorhexidine 2% with 70% isopropyl alcohol PDI Sanicloth CHG 2% Ensure compatible with device For use when cleaning hub or port prior to accessing a vascular device. I C Guidelines Section C 9-C November 2017

12 GUIDELINES FOR THE USE OF SKIN DISINFECTANTS There are three principles for removing or reducing the number of micro-organisms present on the skin or mucous membranes: to reduce the number of skin micro-organisms present prior to an invasive procedure. to remove or destroy potentially pathogenic micro-organisms present on the hands of staff. to treat a carrier/disperser of a resistant, virulent or highly communicable strain of bacteria. AGENT TRADE NAME INDICATION FOR USE Steret/Mediswab Alcohol 70% impregnated swab Alcohol (70%) with glycerol Alcohol hand gel products Purell/GoJo Products Rapid disinfection of skin, eg prior to injection. The swabbed area must be allowed to dry prior to considering as disinfected. Rapid decontamination of visibly clean hands, either as an adjunct to hand washing or as a single process. If caring for someone with diarrhoea and/or vomiting hand washing must occur prior to use of gel. Hands must also be washed prior to food service. For use prior to cannulation or as a skin prep prior to joint injections or minor surgery. Chlorhexidine 2% with 70% ChloraPrep isopropyl alcohol Chlorhexidine Gluconate 4% Hibiscrub Hand disinfection for surgery or aseptic procedures. Chlorhexidine Gluconate Hydrex 2.5% in an alcohol solution Pre-operative preparation. Chlorhexidine Gluconate 5% Hibitane Obstetric For use in obstetrics/gynaecology as an in a water miscible basis antiseptic or lubricant. Chlorhexidine 0.015% with Ti-sept Cetrimide 0.15% Benzalkonium chloride 0.1 % chlorhexidine hydrochloride 0.1%. Dermol 500 Lotion Skin and wound disinfection but not routinely recommended. Previously may have been used for cleansing insertion site prior to urinary catheterisation. An option for treatment of Staphylococcus aureus skin colonization in patients with underlying dermatology conditions. Industrial Methylated Spirit IMS BP Disinfection for physically clean hands where alcohol based hand gel or hand washing facilities/wipes are unavailable or unsuitable. Octenidine Povidone Iodine 7.5% in aqueous solution Povidone Iodine 10% Povidone Iodine 10% with Alcohol Octenisan Wash Lotion Videne Surgical Scrub Videne Antiseptic Solution Videne Alcoholic Tincture A mild and gentle wash lotion for the skin and hair to treat Staphylococcus aureus skin colonization. Hand disinfection for surgery or aseptic procedures where additional content of alcohol not suitable. Pre-operative skin preparation. Pre-operative skin preparation. NOTE: All areas should be physically clean (ie cleaned with soap and water and dry) prior to being disinfected (Fraise and Bradley 2009). I C Guidelines Section C 10-C November 2017

13 SINGLE USE/SINGLE PATIENT USE EQUIPMENT The appropriate use of items designated for single use is paramount to the safety of patients/service users. The Medicines and Products Regulatory Agency (MHRA) updated their guidance in 2013, this states the following: Devices designated for single use must not be reused under any circumstances. The reuse of single use devices can affect their safety, performance and effectiveness, exposing patients and staff to unnecessary risk. The reuse of devices has legal implications. The practice of reusing medical devices labelled by the manufacturer for single use only is therefore not permitted within the Trust. DEFINITIONS SINGLE USE Any items which have the phrase single use or the following symbol should not be reused under any circumstances. The manufacturer intends the item to be used once and then discarded; and considers that it is not suitable for use on more than one occasion. Within healthcare numerous products will display this symbol. All staff are responsible for checking the labelling on products they are using and when purchasing medical devices or equipment. SINGLE PATIENT USE The MHRA define this as more than one episode of use of a medical device on one patient only, the device may undergo some form of reprocessing between each use. The manufacturer s advice and guidance on how to clean/decontaminate the device must be followed and it is important that this information is kept on all reusable devices to ensure safe use. It is imperative that the device is only reused in accordance with the manufacturer s recommendations and must be kept in a clean condition, stored appropriately and only reused by the same patient. Some devices are intended by their manufacturer to be used more than once and with different patients provided that they are appropriately decontaminated in between each use. Where reprocessing may affect the performance and safety of the device the manufacturer, when asked, must supply details of the recommended cleaning process to be followed and the number of reuses which may be undertaken. Reuse may be defined as repeated episodes of use of a device in circumstances which make some form of reprocessing necessary. The procedure might consist of cleaning, disinfecting, sterilizing, refilling, resharpening, or any like procedure. Problems relating to reprocessing that is not in line with manufacturer s recommendations: Inadequate cleaning and decontamination Material alteration Mechanical failure Potential for cross infection Reactions to endotoxins Residue from cleaning chemicals/agents. All staff who use medical devices/equipment must follow the manufacturer s guidelines on use and reuse. I C Guidelines Section C 11-C November 2017

14 SYMBOLS USED ON MEDICAL DEVICES The symbols below are the most common ones appearing on medical devices and their packaging. They are explained in more detail in the British and European Standard BSEN 960: (1997) Graphical symbols for use in the labelling of medical devices. Symbols appearing on medical devices and/or their packaging must not be ignored, if a user does not understand a symbol they must look at the instructions for use or user manual for an explanation. The above poster is available from the Infection Prevention and Control Team. Information contained on packaging may also provide information on product sterility. Examples of this are shown below: STERILE METHOD OF STERILIZATION: Ethylene Oxide METHOD OF STERILIZATION: Irradiation METHOD OF STERILIZATION: Steam or Dry Heat I C Guidelines Section C 12-C November 2017

15 CLEANING OF AN AREA POST ISOLATION NURSING/OUTBREAK TERMINAL CLEAN PROCESS Terminal cleaning of a room is indicated when a patient/service user has been under source isolation and is discharged or transferred to another area. The following procedure must be followed. When special cleaning arrangements are required the housekeeping team must undertake and be informed of the risk of infection not the patient s clinical diagnosis. 1. Housekeeping staff must cleanse hands and wear a disposable plastic apron and single use disposable gloves. Terminal cleaning should commence only after the patient/service user and his/her belongings have been removed from the room or the area. This includes the removal of linen undertaken by nursing staff. 2. Any disposable items or equipment must be discarded as hazardous yellow bag waste. 3. Seal all waste bags before leaving the room and place in appropriate areas for collection. 4. Place all screens, curtains etc. into the appropriate bags as undertaken with bed linen and ensure they are sealed prior to leaving the room or area. Remove any items of nursing equipment to the dirty utility area for cleaning and disinfection or reprocessing. 5. Within arm s reach, spot clean walls as necessary, dust/clean the high ledges, windows, curtain tracks, ledges, fixtures and fittings, including taps and door handles. Use a disposable cloth and normal cleaning solution, take care to change cloths and solution as they become soiled. Work in the following order: curtain tracks and high ledges; furniture and fittings; patient equipment, such as drip stands; alcohol gel; soap and paper towel dispensers; bed frame; wash hand basin, shower and toilet. 6. The bed mattress must be cleaned using multi surface detergent wipes and dried thoroughly. If disinfectant is indicated, wipe with a freshly prepared hypochlorite (1000 ppm) solution or chlorine based wipe, note, this would not be a routine requirement of the terminal clean process. (This may be undertaken by healthcare staff). 7. Vacuum clean fixtures, fittings and floor and then mop floor using normal cleaning solution and methods. Submerge the mop into the cleaning solution and remove excess using the wringer so that the mop is fairly dry. Mop the floor in 1-2 metre square sections. Mop edges with straight strokes and use a figure of eight pattern on the remainder of the section, turning the mop frequently. The floor should be fairly dry on completion. Move to the next section and repeat the process. Replace the mop head and solution as required throughout the cleaning process. Use of microfibre mopping system would also be appropriate if in use within the area. 8. Repeat steps 5 and 7 above using a hypochlorite solution (1000ppm). When preparing the disinfectant solution ensure that the area you are working in is well ventilated. Make up the solution in accordance with manufacturers guidance, generally adding to correct amount of water to minimise splashing. The use of cold water is also recommended. 9. If the area is carpeted, steam clean carpet and clean with appropriate detergent solution. Rinse and ensure all areas are thoroughly dry. 10. On completion, ensure cleaning equipment is managed appropriately (eg disposed of, laundered, stored). 11. Remove and dispose of single use gloves, apron and other protective wear. Wash hands. 12. The room may be used again for patients/service users when all surfaces are clean and dry. If the patient is isolated in an open ward, then the entire surrounding area up to the next bed should be cleaned as above. Seek advice from the Infection Prevention and Control Team if you require specific advice or information. I C Guidelines Section C 13-C November 2017

16 MANAGEMENT OF BLOOD OR BODY FLUIDS SPILLAGE Spillages of blood and body fluids must be disinfected and cleaned promptly. Spillage kits can be purchased but the use of a chlorine based solution (or Presept granules) is recommended for blood spillages in areas that will not be damaged by the use of bleach. The alternative method should be used for blood spills in areas where a chlorine based solution cannot be used or when the spillage is of urine or non blood based body fluids (Lewis and Meese 1997). Single use disposable plastic apron and gloves must be worn. RECOMMENDED METHOD (for spillages of blood or vaccine or surfaces that withstand bleach/chlorine based products) Cover spill with NaDcc powder, (Saniclor/Precept) or 1% hypochlorite (bleach) solution. Leave for a few minutes, then mop up with paper towel. Clean area with a detergent solution. ALTERNATIVE METHOD (for spillages of blood and vaccine on surfaces that will not withstand bleach/chlorine based products and all spillages of urine, faeces or vomit) Remove as much of the spillage as possible with paper towels. Clean the area with a detergent solution. Leave as dry as possible. If appropriate and surface can withstand, use a 1% hypochlorite bleach solution following cleansing. Remove gloves and apron, undertake hand hygiene and dispose of waste into appropriate waste stream. RECOMMENDED METHOD: For use on spillages of blood or vaccines that are on surfaces not damaged by bleach based products. ALTERNATIVE METHOD: For use on spillages of urine, vomit or diarrhoea. Also to be used for spillages of blood/vaccine on surfaces that are damaged by bleach based products. Only use a bleach based product following cleaning if surface will withstand. USE OF HYPOCHLORITE AND STRENGTHS OF SOLUTION Prior to using hypochlorite solutions, surfaces/equipment must be physically cleaned using standard cleaning products or a multi surface detergent solution or wipe, except in the case of blood or vaccine spills on surfaces that will withstand bleach based products. DILUTION OF STOCK AVAILABLE CHLORINE USE SOLUTION % PPM** Undiluted 10* * Blood spills 1 in Laboratory discard 1 in Environmental disinfection 1 in Disinfection of clean instruments 1 in Infant feeding utensils, catering surfaces and equipment 1 in *Approximate value of some brands, eg Chloros, Domestos ** PPM parts per million I C Guidelines Section C 14-C November 2017

17 Hypochlorite Preparations Actichlor tablet 2.5g (not 5g or 500 mg tablet Actichlor tablet 1.7g Milton tablet (800mg) Domestos solution Covchlor tablets PREPARATION AND USE OF HYPOCHLORITE BASED SOLUTIONS Strength To prepare Uses To make concentrated solution (10,000 PPM) 7 tablets in 1 litre of water To make dilute solution (1,000 4 tablets in 5 litres of water PPM) To make concentrated solution (10,000 PPM) 10 tablets in 1 litre of water To make dilute solution (1,000 1 tablet in 1 litre of water PPM) To make concentrated solution (10,000 PPM) Add 50mls water To make dilute solution (1,000 PPM) To make concentrated solution (10,000 PPM) Add 500mls water Dilute 1:10 in water (add bleach solution to water and not vice versa) To make dilute solution (1,000 Dilute 1:100 in water PPM) To make concentrated solution (10,000 PPM) 1 tablet in 100mls of water Decontamination of blood and body fluid spills, especially if the spill may contain a pathogenic virus, eg Hepatitis B, HIV. Decontamination of surfaces that may be lightly (ie not visibly) contaminated with pathogenic viruses. Decontamination of blood and body fluid spills, especially if the spill may contain a pathogenic virus, eg Hepatitis B, HIV. Decontamination of surfaces that may be lightly (ie not visibly) contaminated with pathogenic viruses. Decontamination of blood and body fluid spills, especially if the spill may contain a pathogenic virus, eg Hepatitis B, HIV. Decontamination of surfaces that may be lightly (ie not visibly) contaminated with pathogenic viruses. Decontamination of blood and body fluid spills, especially if the spill may contain a pathogenic virus, eg Hepatitis B, HIV. Decontamination of surfaces that may be lightly (ie not visibly) contaminated with pathogenic viruses. Decontamination of blood and body fluid spills, especially if the spill may contain a pathogenic virus, eg Hepatitis B, HIV. Decontamination of surfaces that may be lightly (ie not visibly) contaminated with pathogenic viruses. To make dilute solution (1,000 1 tablet in 1 litre of water PPM) Always check dilutions with product instructions. If in doubt, follow manufacturer s guidelines. Use preparation as soon as it is made up. I C Guidelines Section C 15-C November 2017

18 DECONTAMINATION OF INSTRUMENTS/EQUIPMENT INCLUDING USE OF BENCH-TOP STEAM STERILIZERS There are many factors to be taken into account when considering the provision of sterile equipment. Where possible sterile disposable equipment should be utilised, if this is not appropriate then items used must be sterilized by a recognised Sterile Services Department. Dental areas within the Trust are the only service permitted to undertake localised decontamination involving pre-cleaning, cleaning and localised sterilization. Dental staff must refer to their own infection prevention and control guidance to promote the safe and effective decontamination of equipment and ensure that automated methods are used in compliance with manufacturer s guidance. involved in decontamination must be able to demonstrate current immunisation for Hepatitis B and subject to local assessment, tetanus. must be informed of the benefits (eg protection against serious illness, protection against spreading illness) and contraindications of vaccination. PRE-CLEANING/CLEANING OF INSTRUMENTS Pre-cleaning/Cleaning is an essential part of the decontamination process. The sterilization process will not be effective if the item is contaminated with organic matter. A dedicated sink must be used for pre-cleaning/cleaning instruments. In addition to this, a dedicated hand wash facility must be available in areas where decontamination is undertaken. Personal Protective Equipment (PPE) (plastic apron, eye protection and appropriate gloves) must be worn for cleaning of instruments or equipment. Effective cleaning before sterilization is of the utmost importance to reduce the risk of transmission of infectious agents. Research suggests that items cleaned as soon as possible after use are more easily cleaned than those left for a number of hours before reprocessing. Neutral detergent designed for the task and warm water of an appropriate temperature is sufficient for pre-cleaning. Instruments must be submerged whilst being cleaned, rinsed thoroughly and dried with disposable paper towel. Care must be taken throughout these procedures to avoid splashing and/or the creation of aerosols. Instruments must be transferred from the point of use to the decontamination/sluice areas as soon as is practical to ensure that processing or placement in transport boxes for offsite decontamination takes place as soon as possible after use. It must be noted that certain solutions are corrosive to stainless steel instruments and will cause pitting and then rusting if allowed to remain on instruments for any length of time. Users must consult with the suppliers/manufacturers of decontamination agents to ensure that the products used are appropriate and unlikely to cause significant long term corrosion (refer to HSE (2013) for further advice). All instruments/equipment that have been through any cleaning procedure, including processing by a washer disinfector, must be inspected to ensure they are clean, functional and in good condition. Any instruments that are blunt, bent or damaged or show any signs of pitting or other corrosion should be discarded. An illuminated magnifier is recommended because it makes it much easier to see residual contamination, debris or damage. I C Guidelines - Section C 16 - C November 2017

19 Users must ensure that: there is free movement of all parts and that joints do not stick; the edges of clamping instruments meet with no overlap and that teeth mesh together; scissor edges meet to the tip and move freely across each other with no overlap or burrs (rough edges); all screws on jointed instruments are tight and have not become loose during use. Instruments must be inspected for any visible soiling such as blood matter. It is especially important to check joints, hinges or the serrated surfaces of jaws, which are difficult to clean. If there is any residual contamination, the instrument must be rejected and must undergo another cycle of the cleaning process. Inspection processes must ensure that the standards of cleaning achieved are visually satisfactory that instruments are free from particulate contamination, salt deposits or marked discoloration. Occasional use of a lubricant may be required where hinged instruments are found to be stiff. A non oil based lubricant should be used to avoid it interfering (ie preventing the steam coming into contact with the instrument surface) with the sterilization process. Instruments may become damaged during use or suffer from general wear and tear over their lifespan. If devices are found to be faulty or damaged during inspection and function testing or if users identify that they are faulty, they must be taken out of use and either repaired or replaced. Instruments for repair must be decontaminated, labelled to identify they have been through the decontamination process and then returned to either the manufacturer or a reputable repair company. Instruments and equipment must be checked for wear or damage (eg joints move freely but are not loose, scissors are sharp, forceps align correctly etc.). Items identified as defective must be immediately taken out of use, sent for repair or discarded and replaced. Washer Disinfectors are an effective way of disinfecting instruments or items following cleaning, in some instances a pre-clean may form part of the washer disinfector cycle. Washer disinfectors must be used in accordance with the manufacturer s instructions. Washer disinfectors must only be used in dental services within the Trust, Dental Infection Prevention and Control Guidance must be followed. Bench Top Steam Sterilizers (BTSS) are only to be used in Trust Dental settings, log books must be maintained and populated with necessary test data in support of programme of validation and compliance checks. Refer to the Trust Dental Infection Prevention and Control Guidance. A BTSS must not be used until the daily tests and housekeeping tasks have been carried out and the results found to be satisfactory. Equipment used to decontaminate instruments must be fit for purpose and validated. This means that the device must be commissioned, maintained and periodically tested by a Competent Person (Decontamination) or service engineer. Records of maintenance must be kept and correct functioning must be monitored and recorded. A documented training protocol should be in operation with individual training records for all staff engaged in decontamination, it is recommended that protocol specific training is given and, where required, the advice of equipment manufacturers/suppliers sought. A designated log book is available for every Trust owned Bench Top Steam Sterilizer. I C Guidelines - Section C 17 - C November 2017

20 INSTRUMENTS Instruments used for vaginal examination and the insertion/removal of intrauterine devices must have been sterilized. Those used in conjunction with intrauterine devices fittings must be sterile at point of use. Disposable instruments used for these purposes must be discarded as clinical waste immediately after use. Instruments to be used in minor surgical procedures must be sterile at point of use, single use disposable items are the Trust preferred option unless instruments are processed by a recognised sterile services department. All staff using surgical instruments must ensure, for reusable items, that traceability data is fully completed. Disposable sharps must be disposed of by the operator following use, if appropriate a safety device should be accessed. MOVEMENT OF INSTRUMENTS TO AND FROM AREAS The measures below set out to reduce the risk of cross contamination. Procedures must be in place to ensure the safe transfer of contaminated items from the treatment area to the sluice/decontamination area. Sterilized instruments and single use instruments must be clearly separated from those that have been used and are awaiting decontamination. Transport containers for instruments should be such as to protect both the product during transit and the handler from inadvertent contamination, and therefore must be: leak proof; easy to clean; rigid, to contain instruments, preventing them becoming a sharps hazard to anyone handling the goods and to protect them against accidental damage; capable of being closed securely; robust enough to prevent instruments being damaged in transit. Where contaminated instruments are to be transported outside of the healthcare premises on a public highway, those responsible for such transportation must refer to the requirements of the Carriage of Dangerous Goods and Use of Transportable Pressure Equipment Regulations 2009 (HSE 2009)and the Health and Safety at Work Act A protocol for transportation that ensures the segregation of contaminated products from clean/sterilized instruments must be followed. Where instruments travel in a vehicle with a healthcare professional or other expert person, record keeping may be simplified to cover the date and location only until back at base, this would relate to domiciliary visits. STORAGE OF STERILIZED INSTRUMENTS/DEVICES It is essential that stored instruments are protected against the possibility of recontamination by pathogens. Instruments must be stored dry and covered to protect them from dust. The storage area must be appropriately designed and managed to prevent damage to instruments and to allow for the strict rotation of stocks. Cupboards must be capable of being easily cleaned and used in conjunction with sealed view packs or covered/sealed trays. Products must be stored above floor level, away from direct sunlight and water in a secure, dry and cool environment. I C Guidelines - Section C 18 - C November 2017

21 DECONTAMINATION OF MEDICAL OR LABORATORY EQUIPMENT Action in response to HSG 93/26 Decontamination of Equipment prior to Inspection, Service or Repair and subsequent guidance DB2003 (05) (MHRA 2003). Where equipment requires servicing or repair, documentation must accompany the equipment stating whether the item has or has not been decontaminated (the only exception is for items being returned to the Integrated Community Equipment Service whereby all items are considered as requiring decontamination). Anyone who inspects, services or repairs medical and laboratory equipment either on NHS premises or elsewhere has the right to expect that articles have been properly treated so as to remove or minimise the risk of infection. Equipment and articles used for invasive procedures, analysis and diagnosis which comes into contact with blood, body fluids/tissue or other pathological specimens will require decontamination prior to examination. Equipment which is visibly soiled with blood/body fluids and is accessible to cleaning must never be presented or sent to a third party for maintenance or repair. All decontamination procedures should be undertaken by suitably qualified staff. The method of decontamination used must be one that does not damage the article or any of it s components. In cases of doubt about the appropriate method, advice can be sought from: The manufacturer or agent Estates Department/EBME Sterile Services Department The Infection Prevention and Control Team Where appropriate, Hospital Engineers/EBME technicians should have sight of equipment before any further action is taken. A Declaration of Contamination Status (page 20-C) must be fully completed by an authorised person in the department before the equipment is sent for repair. This should be given to the porter/technician when equipment is collected for repair/service, and remain with the equipment until it reaches its final destination. If equipment is being sent to an outside company/agency for repair/service: A Declaration of Contamination Status (page 20-C) must be completed by an authorised person in the department before the equipment is collected for repair/service. The declaration should be attached to the outside of the equipment and marked examine enclosed document before unpacking. User department must always ensure safe packaging and despatch of goods with official order to repair company and enclose a Declaration of Contamination Status form. In certain situations equipment may not be decontaminated prior to inspection, service or repair, either because the equipment is subject to investigation as the result of a complaint or it may not be adequately decontaminated without engineering assistance. In such cases the advice of the investigating body should be sought. If such an item is to leave the Trust, the following precautions must be taken: A prior warning should be given to the intended recipient. The condition of the item should be clearly labelled on outer packaging. The packaging must be suitably robust to ensure contamination will not occur during transportation. The agreement of the transporter may be required. I C Guidelines - Section C 19 - C November 2017

22 WORCESTERSHIRE NON ACUTE NHS DECLARATION OF CONTAMINATION STATUS prior to inspection, servicing, repair, investigation or return of medical and laboratory equipment FROM (Consignor): ADDRESS TO (Consignee): ADDRESS REFERENCE EMERGENCY TEL REFERENCE EMERGENCY TEL TYPE OF EQUIPMENT MANUFACTURER DESCRIPTION OF EQUIPMENT OTHER IDENTIFYING MARKS MODEL No. FAULT SERIAL No. IS THE ITEM CONTAMINATED? YES* NO DON T KNOW * State type of contamination: blood, body fluids, respired gases, pathological samples, chemicals (including cytotoxic drugs), radioactive material or any other hazard HAS THE ITEM BEEN DECONTAMINATED? YES NO WHAT METHOD OF DECONTAMINATION HAS BEEN USED? Please provide details CLEANING DISINFECTION STERILIZATION PLEASE EXPLAIN WHY THE ITEM HAS NOT BEEN DECONTAMINATED? DON T KNOW NAME SIGNATURE DATE CONTAMINATED ITEMS SHOULD NOT BE RETURNED WITHOUT PRIOR AGREEMENT OF THE RECIPIENT This item has been prepared to ensure safe handling and transportation: POSITION TEL NO. I C Guidelines - Section C 20 - C November 2017

23 DECONTAMINATION RECOMMENDATIONS A-Z FOR EQUIPMENT AND ITEMS ITEM TO BE CLEANED PRODUCT FREQUENCY RESPON- SIBILITY COMMENTS Manufacturer s guidelines must always be checked prior to carrying out the decontamination process. Acupuncture Needles Not Applicable Single Use Disposable. Airways Not Applicable Single Use Disposable. Ambu Bags Not Applicable Single Use Disposable. Ampoules/ Rubber Bung Multi Dose Vials Anaesthetic Circulatory (tubing) Apnoea Alarm Aprons Arm Rest Phlebotomy Chair 70% Alcohol Hard Disinfectant Wipe Not Applicable Single Use Disposable Immediately prior to use and allow to dry. Repeat following use. Single Patient Use Refer to manufacturer s guidance. Between each loan/use. Store clean and dry. Check guidance and if appropriate use a 70% Alcohol Hard Surface Disinfectant Wipe. Between each task. Between dirty and clean tasks with the same patient. Between each patient use and when noted to be visibly soiled. Discard needles directly into appropriate sharps container immediately after use. Discard as hazardous waste immediately after use. Do not reprocess or reuse. Discard as hazardous waste if single use disposable. If reusable protect with filter. Change filter between patients and decontaminate bag as per manufacturer s guidance. Where possible minimise the use of multi-dose vials. After wiping ensure surface is dry before drawing up medication. In accordance with manufacturer s guidance, protect tubing with filters and discard disposable filters and tubing as stated. Advice if on loan to decontaminate with warm water and detergent in absence of a after any soiling. Use disposable aprons and discard them after each task or episode of care. (Different local policies may recommend use of colour-coding for different tasks such as serving patient meals). Ensure surface remains intact and impervious. Cracked/Damaged equipment must be removed from service. Report malfunction immediately. I C Guidelines - Section C 21 - C November 2017

24 ITEM TO BE CLEANED PRODUCT FREQUENCY RESPON- SIBILITY COMMENTS Manufacturer s guidelines must always be checked prior to carrying out the decontamination process. Assisted Technology Equipment Baby Bath Baby Changing Mats Baby Feeding Equipment Baby Scales Banana Board and Immoturn Detergent Wipe/Launder 70% Alcohol Hard Surface Disinfectant Wipes can be used for extra decontamination Not Applicable Between each patient and when visibly soiled with the same patient. Between each use and at the start and end of a session. Start and end of each session and between each use. Only use 70% Alcohol Hard Surface Disinfectant Wipes on visibly clean surfaces. Single Use Disposable. Following each use. Between each use and at the start and end of a session. If visibly soiled treat as a spillage (see page 14-C). Between use with each patient. Ensure manufacturer s guidelines are obtained and followed, single use and single patient use items must be used as such. Decontamination and reuse must be as specified. After each use also rinse with warm water thoroughly prior to cleaning with wipe. Store dry. Cover with disposable paper towel. Change between each baby. If visibly soiled, treat as a spillage (see page 14-C). If the plastic covering becomes torn or damaged, the mat must be thrown away. If equipment is suitable for single patient use, refer to the manufacturer s guidance on decontamination and NHS bottle feeding advice. Cover with disposable paper roll. Change between each baby. Between use, if not soiled, can for ease be wiped with a 70% Alcohol Hard Surface Disinfectant Wipe. At start and end of session, clean with. Store/Use when dry. Store clean, dry and protected from contamination. If there is visible soiling with blood or body fluids (see page 14-C). Cracked/Damaged equipment must be removed from service. Report malfunction immediately. I C Guidelines - Section C 22 - C November 2017

25 ITEM TO BE CLEANED PRODUCT FREQUENCY RESPON- SIBILITY COMMENTS Manufacturer s guidelines must always be checked prior to carrying out the decontamination process. Bandages Single Use Single Use Bath Bedding Bed - Frame Bed Mattress Bed Pan/Urine Bottle Bed Pan/Slipper Pan and/or Holders Bed railings, monkey poles, cradles Single Patient Use Neutral Detergent s Single Use Disposable Between each patient use and when noted to be visibly soiled. When visibly soiled and daily if colonised with MRSA. Daily check clean, when noted to be visibly soiled and after patient discharge. Housekeeping as per Strategic Cleaning Plan. Weekly, following each patient use and when noted to be visibly soiled. Pulp products only for receptacle. Weekly, following each patient use and when noted to be visibly soiled. Check clean each time bedding changed. Full clean on change of occupancy. Daily Check Clean House keeping as agreed schedule Not to be washed and reused. Contact Infection Prevention and Control for advice if using specialised bandaging. Housekeeping staff will decontaminate on a regular basis. Cream cleanser may be used for stain and scum removal. Refer to Laundry guidance in Section B. Must be kept visibly clean throughout patient stay. Housekeeping procedure: Raise/Lower to a convenient height. Clean frame, starting from top and working down to the base. Remove any grease marks or stains. Leave to dry and return to original position. For foam mattress, unzip, check inner weekly and on patient discharge. Macerator or dispose of in appropriate waste stream. In community, single patient use reusable items may be used and cleaned by patients using neutral detergent. Return to the community equipment service between users. Pulp products must be used, holders must be intact and free from stains. Must always appear visibly clean, always store clean and dry. Cracked/Damaged equipment must be removed from service. Report malfunction immediately. I C Guidelines - Section C 23 - C November 2017

26 ITEM TO BE CLEANED PRODUCT FREQUENCY RESPON- SIBILITY COMMENTS Manufacturer s guidelines must always be checked prior to carrying out the decontamination process. Bed side: -Chair -Light -Locker (inside and out) Blood Glucose Monitor and Box Bowls for Patient Washing Breast Pumps loaned out in community settings - Pump Box - Accessory Kit/Pump Collection Kit - Hand Pumps Single use pulp product (disposable) OR Single patient use If these are not designed for healthcare use and do not have decontamination guidance then they must be used as single patient use. for casing only When noted to be visibly soiled and after patient discharge. On each day and immediately if noted to be visibly soiled. If single patient use, wipe clean with a after each use. Ensure manufacturer s guidance is followed at all times. Any items which are reprocessed must be sterilized in approved sterile services department between each individual loan. also responsible for patient education and checking suitability of equipment Must be kept visibly clean throughout patient stay. Housekeeping to clean outer locker and light on a regular basis. Also after each patient use. Bowls must be labelled for specific patient if reusable and disposed of on discharge. Must be stored dry and protected from contamination. Single patient use pulp product preferred option. Whilst equipment is on loan it is the responsibility of the user to ensure it is adequately decontaminated. Trust staff must ensure users have been given the correct instructions for this and the importance of adequate cleaning prior to disinfection or steam sterilization. Buckets for use in leg ulcer clinics and/or 70% Alcohol Hard Surface Disinfectant Wipe Use Detergent Wipe at start and end of session and on removal of liner if visibly soiled. If clean, use of a 70% Alcohol Hard Surface Disinfectant Wipe could be considered. Please label bucket/bowl for leg ulcers and line for each use. Ensure buckets are clean and dry prior to lining for use. Store buckets dry and inverted, where space allows do not stack directly together. Cracked/Damaged equipment must be removed from service. Report malfunction immediately. I C Guidelines - Section C 24 - C November 2017

27 ITEM TO BE CLEANED PRODUCT FREQUENCY RESPON- SIBILITY COMMENTS Manufacturer s guidelines must always be checked prior to carrying out the decontamination process. Carpets Setting Catheter Stands Cleaning cloths (domestic) Clean Linen Trolley Commodes Computer Keyboard and Mouse Conical Measures Contact Points eg door handles, light pulls, grab rails etc. Clean carpets by vacuuming in accordance with agreed cleaning schedules if not designated as single patient use Single Use Disposable Carpet is not recommended for use in clinical rooms or areas. Single patient use manage as such. Must always be kept visibly clean. Single use, dispose of on change of area/room or completion of task. Check clean when in use. Separate schedule and signing sheet. Daily as a minimum and when noted to be soiled. Keyboards must always appear visibly clean and free from dust. must only use with clean hands. Please refer to specific advice. Constant check cleans and prompt cleaning of soiling. House keeping House keeping All users Clean periodically by hot water extraction using general detergent. Stain removal should occur promptly and if carpet is contaminated with blood or body fluids manage as a Spillage of Blood or Body Fluids (see page 14-C). Single patient use promoted, dispose of on discharge. Use disposable cleaning cloths and change in accordance with colour coding guidance. Only use for clean laundry/linen. Clean from top to bottom, pay particular attention to the arm rests and under the base. If visibly soiled, treat as spillage (see page 14-C). During outbreaks of gastroenteritis clean as normal then wipe with a 70% Alcohol Hard Surface Disinfectant Wipe or 1000 ppm chlorine. Care should be taken to ensure that hands are clean when office equipment is touched. NOTE use of keyboard covers will not routinely be promoted as cleaning is still required. Housekeeping staff will decontaminate on a regular basis. Cracked/Damaged equipment must be removed from service. Report malfunction immediately. I C Guidelines - Section C 25 - C November 2017

28 ITEM TO BE CLEANED PRODUCT FREQUENCY RESPON- SIBILITY COMMENTS Manufacturer s guidelines must always be checked prior to carrying out the decontamination process. Crockery and Cutlery Couch Surface Curtains (Bed/Cubicle) Curtains (Minor Surgery) Curtains (Privacy) Curtains (Shower) Dental Instruments Diagnostic/ Montoring and Near Patient Equipment eg infusion pump, thermometer, BP monitor/ cuff, auriscope, pulse oximeter, opthalmascope. Check clean daily, planned clean annually Check clean daily, planned clean six monthly Check clean daily, change on a three monthly schedule Check clean daily, change on a three monthly schedule or on change of occupancy of an ensuites room Full clean after each use, check clean on each use. Store clean and dry. Weekly if not used otherwise following each patient use and when noted to be visibly soiled. All staff at each use. to discuss with Housekeeping. Refer to Dental specific guidance for further information. Following each use, must be stored clean, dry and protected from contamination. Catering/ House keeping/ After use, discard any residual food into a waste container and clean in an automated dishwasher. Within healthcare settings this should achieve 80 o C on a final rinse. In the event of this not being available, hand wash in hot water and rinse thoroughly in clean water, dry with disposable paper towels. Housekeeping staff will decontaminate frame on a regular basis, remember to check underside of surface and contact points. Curtains must always appear visibly clean. Additional cleans will be required following outbreaks or as part of terminal cleans. Disposable curtains may be in use and should be disposed of at set frequency and launderable curtains washed, consideration can be given for a steam clean on advice from IPC Team. Ensure use of disposable covers/mouthpieces where necessary. Consider aspects of item which could be contaminated and clean between use with each patient. Cracked/Damaged equipment must be removed from service. Report malfunction immediately. I C Guidelines - Section C 26 - C November 2017

29 ITEM TO BE CLEANED PRODUCT FREQUENCY RESPON- SIBILITY COMMENTS Manufacturer s guidelines must always be checked prior to carrying out the decontamination process. Dirty Linen Skips/Basket Dirty Utility Mop and Bucket (spill bucket) Domicilliary Bags used by community staff Dopplers Dressing Trolley (for aseptic and wound care tasks) Drugs Fridge Drug Trolley Duvets waterimpermeable cover ECG Machine Fan Blades Rinse thoroughly Launder or dispose of mop heads and 70% Alcohol Hard Surface Disinfectant Wipe 70% Alcohol Hard Surface Disinfectant Wipe Not Applicable When visibly soiled/contaminated. Ensure disposal/laundering of mop heads occurs. Immediate action if noted to be soiled. Daily check clean and weekly full clean. Prior to and following each use. Following each use or prior to using 70% Alcohol Hard Surface Disinfectant Wipe if visibly soiled. Prior to each use. Must only be used on visibly clean and dry trolley. Monthly and when visibly soiled. Check clean following each use. Check on cover change, on change of patient. Weekly, following each patient use and when visibly soiled. Check clean by healthcare prior to each use with referral for cleaning. Estates Check clean when using and always leave clean. The bucket/mop must be left clean and dry. Follow spillage guidance when dealing with blood/body fluids (see page 14-C). While working keep bag closed to prevent contamination of contents. Bag must be kept visibly clean, tidy and free from debris. After use remove excess gel with a damp paper towel and when dry and visibly clean, wipe with a 70% Alcohol Hard Surface Disinfectant Wipe. Start from cleanest area and include wheels. Trolleys must always be visibly clean. Trolleys must only be used for dressings/clinical procedures. Daily check clean when accessing. Refer to Pharmacy guidance. Check stock is replenished. De-clutter. Always clean up spills. Always use with a cover, clean immediately if visibly soiled. Store clean and dry. Trolley must be cleaned at least weekly or if noted to be visibly soiled. Start from cleanest area and include wheels. Must always be visibly clean. Report to Estates for cleaning. Cracked/Damaged equipment must be removed from service. Report malfunction immediately. I C Guidelines - Section C 27 - C November 2017

30 ITEM TO BE CLEANED PRODUCT FREQUENCY RESPON- SIBILITY COMMENTS Manufacturer s guidelines must always be checked prior to carrying out the decontamination process. Feeding Bottles, Dummies, Teething Rings etc (for use with the same individual) Flotron Pressure Machine Cuffs Foot Stool Furniture and Fittings Glide Sheets Handling Belts (fabric) Single patient use disposable or for reusable products disinfection by heat or chemical. Take care when handling any equipment that may be hot. Discard single use disposable bottles and teats after each use. For reusable equipment, parent should reprocess. Always follow the manufacturer s instructions and adhere to local procedures and policies. After each use, check clean prior to use. Following each use and when visibly soiled. Daily check clean if stored in a general patient area. Always store clean. All furniture purchased for clinical areas must be wipeable. Scheduled cleans completed by Housekeeping staff. Single Patient Use. Dispose of as per manufacturer s guidance OR if washable, launder as per manufacturer s guidance. Detergent Wipes/Launder Between each patient. Hands See Hand Hygiene Guidance in Section A1. Headphones Height Measure Between each patient. Daily check clean with bedspace. Following use and if visibly soiled. to complete spot check Advice should be provided on how to clean, importance of rinsing and need to make sure all traces of milk and debris are removed. Dry using disposable paper towels before disinfecting the equipment by using an appropriate method. Chemical, Steam or Microwave. Hand Hygiene is essential prior to removing processed items. If washable launder after use with each patient in accordance with manufacturer s guidance. If stored as not in use, wipe before use and ensure stored protected from contamination. Regularly damp dust furniture and fittings according to the agreed cleaning schedule by housekeeping. If there is visible soiling manage as a Spillage of Blood or Body Fluids on (see page 14-C). Follow manufacturer s guidance, must always appear visibly clean. Allocated for individual patient use unless patient is fully dressed and a low infection risk. Replace ear foams between use with each patient. Must be cleaned at least weekly. Cracked/Damaged equipment must be removed from service. Report malfunction immediately. I C Guidelines - Section C 28 - C November 2017

31 ITEM TO BE CLEANED Hoists PRODUCT FREQUENCY RESPON- SIBILITY COMMENTS Manufacturer s guidelines must always be checked prior to carrying out the decontamination process. Humidifier Ice Making Machines Interactive White Board/Touch Screen Interferential: External Interferential: Internal Use disposable units where possible Following each use and when visibly soiled. Daily check clean if stored in a general patient area. Always store clean. Daily unless more frequent changing indicated. If stored as not in use, ensure clean and protected from contamination. Wipe before use. For units that require refilling, empty daily and clean in accordance with manufacturer s guidance. Dry thoroughly before refilling with sterile water. Responsibility to be allocated as either Catering, Housekeeping or. Switch machine off and discard all ice. Wipe over with warm water and General Purpose Detergent (GPD). Rinse thoroughly to ensure no detergent remains. Ice should be handled using the scoop provided. The scoop should be cleaned with warm water and GPD daily, rinsed and left in a clean, dry uncovered container after each use. NEVER return unused ice to the ice storage chest. NEVER use a patient s water jug, glass or other utensils as a scoop. Access door must be kept shut when not removing ice. (refer to page 23-Section B). Single Patient Use Single Use Disposable Daily as a minimum and when noted to be soiled. Each use, ensure storage negates risk of contamination. Each use. /Admin Care should be taken to ensure that hands are clean when office equipment is touched. A single use disposable sleeve must be used to protect the internal applicator. The holder for the applicator should be cleaned using a Multi Surface and when dry wiped with a 70% Alcohol Hard Surface Disinfectant Wipe. Wipe electrode as above following each use. Cracked/Damaged equipment must be removed from service. Report malfunction immediately. I C Guidelines - Section C 29 - C November 2017

32 ITEM TO BE CLEANED PRODUCT FREQUENCY RESPON- SIBILITY COMMENTS Manufacturer s guidelines must always be checked prior to carrying out the decontamination process. Isolation Rooms Refer to guidance on page 13-C. IV/Drip Stands Jug (Body Fluid Measuring) Leg Ulcer Buckets Housekeeping products. In absence of Housekeeping products, Multi Surface s and Chlorine Based Wipes could be considered as an acceptable alternative. Rinse after use. and/or 70% Alcohol Hard Surface Disinfectant Wipe Clinical staff must inform Housekeeping staff which isolation rooms are in use and the PPE requirements. Housekeeping staff must report to the nurse in charge before entering the room to ensure that it is convenient for cleaning and to receive any additional instructions. Before and after each use, daily when in use, weekly check clean when stored. After each use. Within home environment, reusable jugs can be used to empty catheters but should be used for a single patient. Use Detergent Wipe at start and end of session and on removal of liner if visibly soiled. If clean, use of a 70% Alcohol Hard Surface Disinfectant Wipe could be considered. House keeping During occupancy, clean the room and all equipment with standard products followed by a chlorine based solution. Use a separate mop and bucket for each isolation room, and change mop head following use. If there is visible soiling with blood or body fluids, clean according to spillage policy (see page 14-C) Undertake a terminal clean prior to reoccupancy with a new patient/service user or when infection has resolved. If stored, ensure protected from contamination. Within healthcare settings, single use items must be used if in contact with patient or invasive device eg emptying of a catheter. If urine decanted into jug for measuring then this jug should be labelled and allocated for that purpose alone. Store dry in sluice. Please label bucket/bowl for leg ulcers and line for each use. Ensure buckets are clean and dry prior to lining for use. Store buckets dry and inverted, where space allows do not stack directly together. Cracked/Damaged equipment must be removed from service. Report malfunction immediately. I C Guidelines - Section C 30 - C November 2017

33 ITEM TO BE CLEANED PRODUCT FREQUENCY RESPON- SIBILITY COMMENTS Manufacturer s guidelines must always be checked prior to carrying out the decontamination process. Leg Ulcer Clinic/Leg Club Equipment Water (disposal) Leg Ulcer Floor Protector Lights (internal not over bed or over couch) Linen Macerator (outer and rim) Mattresses Specialist, Pressure Reducing (alternating air, pumps & carry bags) must dispose of water into a designated sluice facility. In some settings it may be appropriate to designate a toilet for disposal of water. This should be cleaned at the end of the clinic with a and 70% Alcohol Hard Surface Disinfectant Wipe. Not Applicable Between each patient and when contamination anticipated. One check clean weekly House keeping Prior to commencement of each clinic, the floor must be protected. This should either be disposable or withstand wiping using a Detergent Wipe following each treatment. Report to Estates if soiling noted. Refer to Section B for further information. After each patient use, place used linen directly into the appropriate colour coded laundry bag at the bedside. Handle used linen with care to minimise dispersal of microbes into the environment. Take care to ensure that only laundry is placed in the bags. Clean linen should be stored in a cupboard or on a covered trolley. It should not be stored on exposed shelves. Detergent Wipe/Cream Cleanser In Community Equipment Service, laundering of covers as indicated by manufacturer s guidance. Must always be free from soil and staining. Check on each use. Between use with each patient and check clean on each bed change, clean when visibly soiled. If a significant risk of infection or staining is identified, refer to the manufacturer s guidance. Pay particular attention to the rim. Do not store items adjacent to macerator. When in long term use ensure regular cleaning schedule is in place. For mattresses rented from a company, they should be returned to the rental company after cleaning, with a decontamination certificate. Mattresses owned by the Trust and used in the community should be returned to the Community Equipment Service for decontamination and servicing prior to reissuing. Cracked/Damaged equipment must be removed from service. Report malfunction immediately. I C Guidelines - Section C 31 - C November 2017

34 ITEM TO BE CLEANED PRODUCT FREQUENCY RESPON- SIBILITY COMMENTS Manufacturer s guidelines must always be checked prior to carrying out the decontamination process. Mattresses (standard foam) Medicine Pots Mop (bucket) Take care to adhere to colour coding Mops (dolly) Mops (dry dust attracting) Take care to adhere to colour coding of mops and handles Mop Handle Take care to adhere to colour coding of mops and handles In Community Equipment Service, laundering of covers as indicated by manufacturer s guidance Single Use Disposable (preferred) Reuse only permitted if not a single use item Neutral Detergent Single Use Disposable Launderable / Neutral Detergent Between use with each patient and check clean on each bed change, clean when visibly soiled. If a significant risk of infection or staining is identified, refer to the manufacturer s guidance. Single Use option preferred. Following use. Must be left free from debris, clean and dry. Dispose of following use in one area or for one task. End of each shift and if noted to be visibly soiled. If mop handle is visibly soiled, clean with detergent and warm water/multi Surface and leave dry. House keeping House keeping House keeping House keeping Mattresses must be covered with a waterproof cover. Discard the mattress cover if it is stained or damaged. Unzip mattress covers between each patient and regularly during long term use to check the foam interior for damage or soiling. If the inside of the mattress is wet or soiled, it must be condemned and replaced. Discard single-use disposable medicine pots after each use. Reuseable medicine pots should be washed and dried thoroughly in the kitchen area, preferably in a dishwasher. Do not wash in sinks dedicated for hand washing. Clean with detergent and warm water inside and out, at the end of each shift. Store inverted where possible. Not recommended for use unless treated as a disposable single use item. Discard disposable dust control mop heads when full or daily. If laundering after use is not possible, vacuum after each use and coordinate laundering schedule. If moving between different areas or potential for handles to be contaminated, clean immediately. Store clean and dry. Cracked/Damaged equipment must be removed from service. Report malfunction immediately. I C Guidelines - Section C 32 - C November 2017

35 ITEM TO BE CLEANED PRODUCT FREQUENCY RESPON- SIBILITY COMMENTS Manufacturer s guidelines must always be checked prior to carrying out the decontamination process. Mops (wet) Flat Mops (wet) Take care to adhere to colour coding of mops and handles Nail Brushes (surgeon s hands) Nail Brushes (ward areas) Launderable for general use Chemical Disinfection only if no other option Disposable - Discard disposable mop heads after each use (always use disposable mop heads in spill buckets). Single Use Disposable/ Sterile Rinse mops after each use, wring and store with mop head uppermost to allow head to dry. Launder mops in accordance with set schedule based on area and use. Use only if essential. Reusable nail brushes are not appropriate for use Nasal Atomizer Single Use Not Applicable. Nasendoscopes Nebuliser Neurological testing Oxygen Cylinder and Medical Gas Equipment Oxygen Flow Meter Oxygen Mask House keeping As per departmental guidance in areas where these are used eg OPD. for Compressor Box. Single Patient Use Tubing/ Mouthpiece Single Use Single Patient Use Following each use, must be stored clean, dry and protected from contamination. Not Applicable. Weekly, following each patient use and when visibly soiled. After use with each patient or if visibly soiled. Check each time patient reviewed. / Patient Place reusable mop heads in a laundry bag at agreed frequency and send for laundering in accordance with local policy. If laundry facility not available for a short period of time soaking in a hypochlorite solution can be considered. Solution must be disposed of following use and care should be taken to ensure COSHH regulations are met. If property of a patient please ensure labelled as such. After each patient use. Ensure use of single patient use disposable tubing/ mouthpieces where necessary and check clean prior to and after each use. Check expiry dates. Wipe the air flow meter and casing, dry thoroughly. Store clean and dry. Ensure calibrated. Must always be visibly clean and dry. Clean with a Detergent Wipe and dry thoroughly. Cracked/Damaged equipment must be removed from service. Report malfunction immediately. I C Guidelines - Section C 33 - C November 2017

36 ITEM TO BE CLEANED PRODUCT FREQUENCY RESPON- SIBILITY COMMENTS Manufacturer s guidelines must always be checked prior to carrying out the decontamination process. PAT Slide (Supine Transfer Board) Patient Clothing Patient Consulting Chair Patient Entertainment System Patient Notes Trolley Patient Tables/Surfaces Perching Stool Laundering Following each use and when visibly soiled. Daily check clean if stored in a general patient area. Always store clean. As and when indicated (daily/when visibly soiled) Between patients/activities if contamination anticipated and when visibly soiled. Housekeeping as per set schedule, staff on change of occupant or following contamination. Switch off the system before cleaning. Do not over wet the surfaces, and make sure you allow the equipment to dry before switching it on again. Weekly and when noted to be visibly soiled. Between patients/activities and when visibly soiled. Weekly, following each patient use and when noted to be visibly soiled. /Admin If stored as not in use, ensure clean and protected from contamination. Wipe before use. After use and whenever visibly soiled. Place individual s clothing directly into a disposable bag for carer to launder in home setting. Laundering of patient/service user clothing can be undertaken in healthcare settings if in compliance with local laundry policy and washing instructions. Housekeeping staff will decontaminate on a regular basis, remember to check underside of chairs and contact points. Protect the earpieces/head phones with disposable foam pads, a supply of which should be readily available. Change the foam pads regularly and always between each patient. Never use disinfectants to clean patient entertainment systems without the manufacturer s approval. Care should be taken to ensure that notes trolley does not get contaminated during routine use. Housekeeping staff will decontaminate on a regular basis, remember to check underside of tables and contact points. Check underside of seats, ensure surfaces are intact. Cracked/Damaged equipment must be removed from service. Report malfunction immediately. I C Guidelines - Section C 34 - C November 2017

37 ITEM TO BE CLEANED PRODUCT FREQUENCY RESPON- SIBILITY COMMENTS Manufacturer s guidelines must always be checked prior to carrying out the decontamination process. Perinometer Pillow Podiatry Instruments Pressure Reducing Cushions Proctoscopes Propulse Ear Syringe Single Use Single Use Disposable OR Sterilized s Single Use Disposable OR Sterilized As per manufacturer s instructions Not applicable In specific areas designated products may be recommended for use eg Tristel brand if compatible. Following each patient use and when noted to be visibly soiled. Single use dispose. If disposing of, ensure appropriate disposal of sharps. Reusable send for reprocessing. Following each use and when visibly soiled. Daily check clean if stored in a general patient area. Always store clean. Single use - dispose. Reusable send for reprocessing. As per manufacturer s instructions Radiator Grilles Not Applicable One check clean weekly Raised Toilet Seats Between each patient use and when noted to be visibly soiled. House keeping Where manufacturer recommends the probe for reuse, a condom should be used and removed after each use. The probe must then be decontaminated in accordance with the manufacturers guidance. All pillows must be contained in a wipe clean cover. Check integrity of cover regularly and dispose if foam interior stained/soiled. Ensure appropriate and segregated storage for clean and dirty items. If reusable, processing must occur through a validated sterile services unit. Check inner and cover integrity between each patient. If stored as not in use, wipe before use and ensure stored so as protected from contamination. Ensure appropriate and segregated storage for clean and dirty items. If reusable, processing must occur through a validated sterile services unit. Refer to Trust Guidance. Report to Estates if soiling noted. Check underside of seats, ensure surfaces are intact. Excessive scratching, cracks etc will make adequate cleaning difficult. In this instance seats should be discarded. Cracked/Damaged equipment must be removed from service. Report malfunction immediately. I C Guidelines - Section C 35 - C November 2017

38 ITEM TO BE CLEANED PRODUCT FREQUENCY RESPON- SIBILITY COMMENTS Manufacturer s guidelines must always be checked prior to carrying out the decontamination process. Razors (electric) Razors (safety and open) Resus. Trolley/Bag Sara Stedy Scales Scissors (general use nursing) reusable Scissors (general use nursing) Sterile single use Scissors (plaster cast removal etc) Sharps Bins Sharps Bin Tray Use disposable heads single patient use Use disposables single patient use 70% Alcohol Hard Surface Disinfectant Wipe Single Use Disposable 70% Alcohol Hard Surface Disinfectant Wipe 70% Alcohol Hard Surface Disinfectant Wipe Not Applicable Not Applicable Following use and if noted to be soiled in addition to regular schedule. Following each use and when visibly soiled. Daily check clean if stored in a general patient area. Following use and if visibly soiled. Following each use. Daily check clean. Must be used as such and disposed of following task. Following each use. Daily check clean. Following use only if contaminated or visibly soiled. Only clean with temporary closure insitu. Following/Prior to each use if visibly soiled. Following/Prior to each use. Must only be used on visibly clean and dry tray. Shaving Brush Single Patient Use Not Applicable. Must be disposed of as a sharp immediately after use. Always monitor cleanliness when checking the trolley. Always store clean. Must be cleaned at least weekly. Ensure calibration of scales as necessary. 70% Alcohol Hard Surface Disinfectant Wipe used after removal of visible soiling. Leave scissors clean and dry. Must be used for tasks where sterile scissors are indicated. Must be disposed of following use. 70% Alcohol Hard Surface Disinfectant Wipe used after removal of visible soiling. Leave scissors clean and dry. Do not put hands on aspects of the bin that cannot be seen. Ensure outer surfaces only remain visibly clean. Ensure trays are stored clean and dry, if stacked this is imperative to ensure prior to stacking. Ensure you only have the minimal amount of trays. Store clean and dry. Cracked/Damaged equipment must be removed from service. Report malfunction immediately. I C Guidelines - Section C 36 - C November 2017

39 ITEM TO BE CLEANED PRODUCT FREQUENCY RESPON- SIBILITY COMMENTS Manufacturer s guidelines must always be checked prior to carrying out the decontamination process. Shower Area Shower Chair Slings for Hoists Spacer Spillages Spirometer Splints Sputum Pots Standing Belts/Slings Stethoscope Stools (procedure stool) Storage Containers Rinse area with shower Shower must be checked by healthcare staff at regular intervals and following each use. Weekly, following each patient use and when noted to be visibly soiled. Single Patient Use dispose of as per manufacturers guidance OR if washable, launder as per manufacturer s guidance. Refer to page 14-C Single Patient Use or Single Patient Use Disposable Require Laundering and 70% Alcohol Hard Surface Disinfectant Wipe Single patient use device, check clean prior to and following use to ensure valve movement. Immediately on identification. Following each use, must be stored clean, dry and protected from contamination. Following use with each patient if not single patient use. As indicated. If visibly soiled, following use on someone with a known infection. Daily check clean and clean of contact points following each use. Must be stored clean and dry. Prior to and following a clinic session, following each case and when visibly soiled. Check clean before each use. Patient/ Member of staff who identifies spill All staff Housekeeping staff on a daily schedule. Estates staff to ensure shower head decontamination occurs. Check underside of seats, ensure surfaces are intact. Follow manufacturer s guidance, must always appear visibly clean. Must be stored clean, dry and protected from contamination. Area must be managed to ensure safety and staff dealing with spillage must wear appropriate PPE. After each patient use. Ensure use of disposable tubing/mouthpieces where necessary. If washable can also be laundered in accordance with wash label. If in contact with skin should be allocated for a single patient. If visibly clean, use 70% Alcohol Hard Surface Disinfectant Wipe. If soiled remove first with Multi Surface. Damaged covers must be replaced immediately. Pay particular attention to horizontal surfaces and underside or grooves where dust may collect. Frequencies will vary based on area, content and style. Cracked/Damaged equipment must be removed from service. Report malfunction immediately. I C Guidelines - Section C 37 - C November 2017

40 ITEM TO BE CLEANED Suction Machines PRODUCT FREQUENCY RESPON- SIBILITY COMMENTS Manufacturer s guidelines must always be checked prior to carrying out the decontamination process. Surgical Instruments Tape Measures Telephone Thermometers - Digital - Infra-red - Tympanic outer All suction machines in healthcare settings, where possible, should be fitted with a closed disposable liner system. Single Use Disposable OR Sterilized Single Use Disposable or (casing) Single Use (protective covers on probe) Daily check clean. In own home items must be returned to Community Equipment Service when no longer required. Single use dispose. If disposing of, ensure appropriate disposal of sharps. Reusable send for reprocessing. If using reusable must be cleaned after each session or after each use if contamination possible. Daily as a minimum and when noted to be soiled. Consider contact points and receiver. Prior to each check clean and following use/contamination. /Admin Used suction liners and tubing in healthcare settings must be disposed of as healthcare waste. If no liner, wear PPE (aprons, visor/spectacles and gloves). Empty contents down sluice, wash with detergent and warm water. Dry thoroughly. Catheters and tubing must be changed between each patient and on an appropriate schedule with the same patient. Ensure appropriate and segregated storage for clean and dirty items. If reusable, processing must occur through a validated sterile services unit. Single use disposable is the preferred option. If using reusable ensure cleaned appropriately and store dry. Ensure measure remains intact during cleaning. Care should be taken to ensure that hands are clean when office equipment is touched. Disposable covers must be changed between each patient. Infra-red devices provide a non-contact mechanism for temperature monitoring. Cracked/Damaged equipment must be removed from service. Report malfunction immediately. I C Guidelines - Section C 38 - C November 2017

41 ITEM TO BE CLEANED Toilet PRODUCT FREQUENCY RESPON- SIBILITY COMMENTS Manufacturer s guidelines must always be checked prior to carrying out the decontamination process. Designated general cleaning product (may contain citric acid) Clean from least contaminated area to most contaminated surface Clean regularly according to the agreed cleaning schedule using toilet brush and suitable cleaning products. Do not use toilet descaling products together with chlorine releasing agents. Toothbrush Single Patient Use Not Applicable. Tooth Mugs Toys (soft for developmental review) Toys (within clinic room) Toys (within waiting area) Tourniquet Trolley (clinical) see also DRESSING TROLLEY for aseptic and wound care tasks Trolleys (food) Single Use Disposable Detergent Wipes/Launder Single Use or 70% Alcohol Hard Surface Disinfectant Wipe Neutral Detergent or Not Applicable. Following each use and if visibly soiled. Following each use and if visibly soiled. Regular check clean with clean as indicated if visibly soiled. Start and end of session and following each use. Following each use or prior to using 70% Alcohol Hard Disinfectant Wipe if visibly soiled. Prior to each use. Must only be used on visibly clean and dry trolley. Prior to and following each use. House keeping Reception/ or House keeping Catering/ House keeping/ Include chain flush, external surfaces, seat including underside and bowl. Dispose of cloth after use. During outbreaks of viral gastro-enteritis use of a hypochlorite solution may be recommended in addition to increased cleaning frequencies. Must only be used by a single patient, store clean, dry and protected from contamination. Discard after each use. Must be cleaned at least weekly and be visibly clean, can consider laundering. Must be cleaned at least weekly and be visibly clean. Must be cleaned at least weekly but in areas of high use frequency may need to be each day. Must be visibly clean. Consider ease of effective cleaning with reusable tourniquets. Start from cleanest area and include wheels. Trolleys must always be visibly clean. Trolleys must only be used for dressings/clinical procedures. Start from cleanest area. Include wheels on a check clean. Trolleys must always be visibly clean. Cracked/Damaged equipment must be removed from service. Report malfunction immediately. I C Guidelines - Section C 39 - C November 2017

42 ITEM TO BE CLEANED PRODUCT FREQUENCY RESPON- SIBILITY COMMENTS Manufacturer s guidelines must always be checked prior to carrying out the decontamination process. Uniforms - staff -Catering staff -Housekeeping staff Urine Bottle Holders Vaccine Spillage Vacutainer Barrels Vaginal Speculae Vase Wash uniform separately from other items in a washing machine using the hottest temperature the material will stand. A clean uniform must be worn by staff for each shift. Further information is available in Trust Workwear Guidance. Prior to patient allocation, check clean when removing bottle. (See Spillages Guidance on page 14-C). Single Use Single Use Disposable OR Sterilized Detergent Wipe/Solution Reuse of barrels not acceptable. Single use - dispose. Reusable send for reprocessing. Refill with clean water regularly. After use, clean and store dry. Vent Grilles Not Applicable One check clean weekly Vitalograph Waiting Room Chairs Prior to and following each use clean outer casing with Detergent Wipes. Refer to manufacturer s guidance. Check clean on each time area visited. Chairs must always appear visibly clean. Respective member of staff House keeping Disposable aprons protect uniforms from soiling. should wear them when performing any task where splashing or soiling is likely to occur. Dry thoroughly, preferably in a tumble dryer, iron with a hot iron, store protected from contamination. Must be clean and intact, store clean and dry. Discard as a single unit with needle attached immediately after use into a sharps bin. Ensure appropriate and segregated storage for clean and dirty items. If reusable, processing must occur through a validated sterile services unit. In a designated area, clean flower vase as necessary with detergent and warm water, and rinse thoroughly. After use, clean and store dry. Report to Estates if soiling noted. Protect machine with bacterial/vitalograph filter. Change filter between patients. Keep tubing dry, use disposable non returnable mouth pieces. Housekeeping staff will decontaminate on a regular basis, remember to check underside of chairs and contact points. Cracked/Damaged equipment must be removed from service. Report malfunction immediately. I C Guidelines - Section C 40 - C November 2017

43 ITEM TO BE CLEANED Walls PRODUCT FREQUENCY RESPON- SIBILITY COMMENTS Manufacturer s guidelines must always be checked prior to carrying out the decontamination process. Walking Aids Washing Machine Water Jugs/Beakers Wheel Chairs or solution General Purpose Detergent for Dishes/ Dishwasher Daily check clean. In addition to intervals defined in Strategic Cleaning Plan or as specified as part of a deep/terminal clean. Clean immediately if visibly soiled. Inbetween use with each patient and if allocated to a patient, daily check clean. Check clean following each use. Daily full clean, check clean on each use. Following each use and when visibly soiled. Daily check clean if stored in a general patient area. Always store clean. If visibly soiled with blood or body fluids, clean according to spillage policy (see page 14-C). After cleaning, check that both footrests and sides are present, tyres are inflated and brakes are functional. Withdraw faulty wheelchairs from service. House keeping Users of the equipment Catering/ House keeping/ If there is visible soiling with blood or body fluids, clean according to spillage policy (see page 14-C). staff responsibility for spot cleaning. Arrange prompt repair and decoration of any damaged wall surfaces. Must always be visibly clean. Ideally, label for each patient. Ensure surfaces are clean. For drinking water jugs, use a dishwasher. Alternatively, return the jug to the Catering Department for machine washing, using a rinse temperature above 80 C. In the event of neither being available, hand wash drinking water jugs in hand hot water and detergent. Rinse the jug thoroughly in clean water and dry using disposable paper towels. If stored as not in use, wipe before use with a Multi Surface and ensure stored so as protected from contamination. Always follow manufacturer s guidance. Use of 70% Alcohol Hard Surface Disinfectant wipes can also be considered for hard surfaces on the chair which are visibly clean either as a sole method or as an adjunct following cleaning. Cracked/Damaged equipment must be removed from service. Report malfunction immediately. I C Guidelines - Section C 41 - C November 2017

44 ITEM TO BE CLEANED PRODUCT FREQUENCY RESPON- SIBILITY COMMENTS Manufacturer s guidelines must always be checked prior to carrying out the decontamination process. X Ray Apron At the end of each day and following each use where contamination or direct patient contact has occurred, always store dry. Always follow the manufacturer s instructions and adhere to local procedures and policies. X-Ray aprons must always be visibly clean. Cracked/Damaged equipment must be removed from service. Report malfunction immediately. I C Guidelines - Section C 42 - C November 2017

45 COMMODE CHAIR CLEANING PROTOCOL The importance of ensuring appropriate levels of cleaning for commodes is consistently implemented across inpatient settings and is imperative for provision of clean, safe care. POSTER SIGNING SHEET Within the Trust, standardisation has occurred for the majority of commodes in use within inpatient areas. The Design Bugs Out style is preferred to promote ease of effective cleaning. Specialist commodes for bariatric patients and to enhance rehab activities remain available within the Trust. Wherever possible the number of commodes has been minimised in each area to aid effective decontamination. When cleaning commodes a single use disposable plastic apron and disposable gloves must be worn. s must be used for cleaning contact points in addition to a check clean following each use and commodes left clean and ready for use. For a full clean the practice of cleaning from top to bottom is promoted with emphasis on paying particular attention to the arm rests and under the base (please see posters displayed in sluice or commode parking areas). During outbreaks of viral gastro-enteritis clean as normal then wipe with a 70% Alcohol Hard Surface Disinfectant Wipe or 1000 ppm chlorine wipe. Signing sheets on the ward must be completed with periodic spot checks promoted to enhance assurance. Copies of posters and signing sheets are available from the IPCNs in addition to outcomes from commode cleanliness reviews. I C Guidelines - Section C 43 - C November 2017