Cleaning and Decontamination of Equipment, Medical Devices and the Environment (including the management of blood and body fluid spillages)

Transcription

1 Cleaning and Decontamination of Equipment, Medical Devices and the Environment (including the management of blood and body fluid spillages) This document describes the processes and procedures for cleaning and decontamination of equipment and devices within the healthcare setting. This policy has been developed for staff working within Community Health Services, Community Inpatient Facilities and Primary Care. Key Words: Version: 6 Infection Prevention & Control, Cleaning, Decontamination Adopted by: Date Adopted: Main author: Name of responsible committee: Quality Assurance Committee TBC Amanda Hemsley Infection Prevention and Control Committee Date issued: March 2015 Review date: February 2018 Expiry date: 1 August Target audience: Type of Policy: All LPT Staff Clinical Non Clinical

2 Contribution List Key individuals involved in developing the document Name Amanda Hemsley Una Willis, Antonia Garfoot, Fiona Drew, Mel Hutchings Designation Senior Nurse Advisor, Infection Prevention and Control Infection Prevention and Control Team Circulated to the following individuals for consultation Name Diane Postle Emma Wallis Neil Hemstock Emma Wallis Dr Margaret Leverment Kathy Feltham Claire Armitage Michelle Churchard Smith Bernadette Keavney Kerry Palmer Janet McNally Sarah Clements Linda Bull Jo Bale Katie Willetts Paul Williams Francisco Guerra Louise Carpenter Designation Head of Professional Practice and Education Lead Nurse, CHS Lead Nurse, FYPC Lead Nurse, Physical Health CHS Division Occupational Health Physician Lead Nurse, MHSOP, CHS Division Lead Nurse, AMH&LD, community Lead Nurse, AMH&LD, Inpatient Head of Trust Health and Safety Compliance Medical Devices Manager Team Manager Matron Loughborough & Hinckley Matron Coalville Community Hospital Nursing Operational Lead Senior Nurse, Specialist Nursing FYPC Team Manager, Langley Ward Senior Matron, Oakham House Inpatient Lead, AMH 2

3 Contents Definitions that apply to this policy Summary Introduction Purpose Justification for the document Cleaning and Decontamination of Equipment, Medical Devices and the Environment (including the management of blood and body fluid spillages) Cleaning Decontamination of Medical Devices Classification of Infection Risk Associated with the decontamination of the Medical device Methods of Decontamination Selecting a Chemical Disinfectant Sterilisation methods Benchtop Steam Sterilisers Decontamination of equipment prior to maintenance/service request/ Decontamination status certificate Medical equipment in patients own homes Toys Procedure following a spillage of blood, other body fluid and known contaminated material Management of body fluid spillage Cleaning and Disinfection Methods Cleaning and Decontamination procedures Training References and Associated documents 23 Appendix 1 National Colour Coding Scheme for Cleaning Appendix 2 Safe System of Work.. 26 Appendix 3 Declaration of Contamination Status Certificate. 27 Appendix 4 Management of Body Fluid Spillages Poster

4 Version Control and Summary of Changes Version Comment Date number s Version Sept 09 Replaces K027 V1 and K028 V1 Version 3, Oct 09 Review by A. Howell; Version 4 Nov 09 Changed from guideline to a policy and associated CQC requirement changes made Version 5 Nov 09 CDT Core pathway incorporated into overall policy document Version 5 Draft 1 Nov 09 Further changes made following consultation with LCCHS staff and external specialists Version 5 Draft 2 Nov 09 Revisions to incorporate requirements of the NHSLA standards Version 5 Draft 3 Nov 09 Further changes made following consultation with LCCHS staff Version 5 Final May 10 Policy approved at the Clinical Governance Committee. Version 6 Aug 10 Harmonised in line with LCRCHS, LCCHS, LPT (Historical organisations) Version 7 November 2014 Review of document in line with changes to products used and the management of blood and body fluid spillages For further information contact: Infection Prevention and Control Team 4

5 Definitions that apply to this policy Autoclave Biological agent Cleaning Contamination Decontamination Disinfectant Impervious Infectious Infection LPT Organisms Personal Protective Equipment (PPE) Sanitiser Sterilisation A piece of equipment used for sterilisation, which uses steam Under pressure. (Heat is commonly used in sterilisation; moisture and especially high-pressure steam increase the susceptibility of vegetative bacteria and spores). Any bacteria, virus or toxin A process, which physically removes micro-organisms and Organic matter but does not necessarily destroy infectious agents. Cleaning is an essential prerequisite to disinfection or sterilisation. This term refers to the soiling of inanimate objects or living Material with harmful, potentially infectious or unwanted matter. The process of cleansing an object or substance to remove contaminants such as micro-organisms or hazardous materials, including chemicals, radioactive substances, and infectious diseases. A chemical agent, which destroys vegetative micro-organisms, but not necessarily spores. Incapable of being penetrated, a material impervious to liquid Caused by a pathogenic micro-organism or agent that has the capability of causing infection This is an organism present at a site and causes an inflammatory response or where the organism is present in a normally sterile site. Leicestershire Partnership Trust This is defined as any living thing, in medical terms we refer to bacteria and viruses as organisms Specialised clothing or equipment worn by employees for Protection against health and safety hazards. Gloves, aprons, gowns, masks and eye protection A chemical that both cleans and disinfects. Refers to the killing or removal of all viable micro-organisms, including spores. Prions are not affected. This may be achieved by heat, chemical means, Gamma-irradiation or ultraviolet light. 5

6 1.0 Summary This document provides Trust wide guidance for cleaning and decontamination of equipment, medical devices and the environment used by healthcare workers. It contains specific information on what type of products to use on the equipment in relation to potential or real infections that patients may be experiencing; it also encompasses information in relation to aspects of decontamination. Further guidance for healthcare workers and other staff who work in Prisons and places of detention can be found in Prevention of infection and communicable disease control in prisons and places of detention A manual for healthcare workers and other staff 2.0 Introduction The provision of healthcare carries with it inherent risks to the healthcare worker and the patient. The purpose of the document is to ensure that all staff is aware of their responsibilities with respect to reducing the risk of health care associated infections. This will support the provision of appropriate precautionary measures to protect themselves, their co-workers and their patients. This policy identifies staff member s responsibilities and provides them with the information they require to enable them to minimise the risk of health care associated infections. It identifies the principles, responsibilities and methods associated with cleaning and decontamination of equipment and the environment. This policy also includes information regarding the cleaning and decontamination of equipment used or taken into a patient s own home/environment. The general public and staff have a right to expect that any potential hazards in a healthcare environment are adequately controlled. All staff must possess an appropriate awareness of their role in cleaning and decontamination. Not only is this part of their professional duty of care to the patients with whom they are involved, but it is also their responsibility to themselves, to other patients and members of staff under the Health and Safety at Work Act (1974). The control of substances hazardous to Health (COSHH) Regulations (2002), require actions to be taken to control the risk of hazardous substances, including biological agents. 3.0 Purpose The purpose of this policy is to inform healthcare workers of the different processes for cleaning and decontamination for both equipment and the environment in relation to health care delivery. It includes the products that should be used and the correct procedure when dealing with a blood or body fluid spillage. 4.0 Justification for the Document Infection prevention and control safety is a legal requirement under the Health and Safety at Work Act This document provides information on the processes required for the cleaning and decontamination of equipment and the environment for patients receiving healthcare. This will support the prevention of cross infection 5

7 within the organisation and ensure equipment used by/on patients identified with suspected or confirmed vomiting and / or diarrhoea is cleaned appropriately This information is relevant for all areas where care delivery is provided and is not restricted to health buildings. The document has been produced in accordance with published evidence and national best practice guidelines. As a duty of care LPT must ensure that staff is given guidance as to the appropriate steps they need to undertake to ensure that they can protect the patients within their care. 5.0 Cleaning and Decontamination of Equipment, Medical Devices and the Environment (Including the management of blood and body fluid spillages) 5.1 Cleaning The Trust has adopted the National Patient Safety Agency (NPSA) National Colour coding for Safer Practice Notice 15, Appendix 1 Environmental cleaning Good environmental hygiene is an integral and important component of a policy for preventing healthcare-associated infections in community hospitals and other healthcare settings. The environment must be visibly clean, free from dust and soil and acceptable to patients, their visitors and staff. A clean environment reflects the overall appearance, structure and efficient function of Leicestershire Partnership NHS Trust. The environment is known to play an important role in cross infection during increased incidents or outbreaks of infection. Door handles, flush handles, taps, toilet rolls etc. have all been implicated at some point in this potential risk. Therefore accumulation of dust, dirt and liquid residues may increase the risks and must be reduced to the minimum. This can be achieved by regular cleaning and by good design features in buildings, fittings and fixtures. A programme for monitoring the standard of hygiene is in place across all clinical settings via the environmental audits, top ten markers and cleaning audit programme. Cleaning Equipment Cleaning equipment must be stored clean and dry in a designated area. Colour coding of cleaning equipment with materials (mop heads, gloves and cloths) should be in accordance with NPSA National Colour coding Safer Practice. (Appendix 1). Mop-heads should be laundered or replaced daily following use or be disposable. All equipment used for wet cleaning should be washed, dried and stored inverted after use. Items should not be left soaking. Gram negative micro-organisms can quickly contaminate solutions and wet residues. 6

8 Cleaning Schedule A written cleaning schedule should be displayed, which includes the regular removal of dust by damp dusting high and low horizontal surfaces. This should specify the persons responsible for cleaning, the frequency of cleaning and the methods used. Couches, work surfaces and floors in clinical rooms must be made of materials that are impermeable to fluids, easy to clean and kept in good condition i.e. not torn or split Carpets are not supported for use in clinical areas or areas that are a potential risk of being contaminated with body fluids. Where carpets are provided there should be procedures (or contracts) in place for steam cleaning and for dealing with spillages. (If it is a large spill that cannot be cleaned adequately then consider the removal of the carpet). Curtains (including disposable curtains) should be changed:- when soiled after an outbreak or increased incident when a patient is discharged and has a known or suspected infection routinely every six months in clinical areas and yearly in non-clinical areas. An adequate supply of curtains should be purchased to facilitate this and changes following an outbreak of infection. Certain window dressings may not meet infection prevention and control cleaning requirements, and advice must be sort when replacing such items. Where blinds are already in place, then these must be part of an identified cleaning schedule. 5.2 Decontamination of Medical Devices Decontamination must always be carried out in line with manufacturer s instructions and LPT s Infection Prevention and Control Policy. Decontamination must be appropriately documented for assurance purposes via an identified system. The term medical device covers all products except medicines used in health care for the diagnosis, prevention, monitoring or treatment of illness or disability. Further information can be located within LPT s Medical Devices Policy. Three Types of Equipment a. Single use only which means that the manufacturer intends the item to be used once, then discarded. Re-use of single use devices can affect safety, performance and effectiveness, exposing staff and patients to unnecessary risks. Therefore the re-use of single use medical devices has legal, technical and economic implications for the user and may render them liable to prosecution. If in doubt, refer to the manufacturers recommendations. 7

9 Single use symbol: b. Single patient use which means that the item can be reused if re-processed using an appropriate method and is used on the same patient only (equipment must be checked to ensure that it can be used as single patient use prior to cleaning). c. Re-usable equipment, which should be appropriately decontaminated between patients. 5.3 Classification of Infection Risk Associated with the Decontamination of Medical Devices Patients can be protected against infection by ensuring that disease-producing microbes are removed from potential sources of infection. This involves the cleaning, disinfection and sterilisation of contaminated materials, equipment and surfaces. The choice of method can be based on the infection risks to the patient, which can be classified as high, intermediate and minimal risks (Ayliffe et al 2002). Risk Application of Term Recommendation High Intermediate Minimal (Low) Items in close contact with Non intact skin, Non intact mucous membranes or entering a sterile body cavity E.g. surgical instruments Items in contact with intact mucous membranes, body fluids, Virulent or readily transmissible organisms or items used for highly susceptible patients or sites e.g. respiratory equipment such as laryngoscopes nasal specula, laryngeal mirrors and other equipment such as vaginal specula (for vaginal examination) Items in contact with healthy skin, or not in contact with the patient e.g. tables, bedside tables, chairs Sterilisation Cleaning followed by Disinfection Cleaning 8

10 5.4 Methods of Decontamination Cleaning is a process, which physically removes visible contamination but does not destroy micro-organisms; is an essential pre-requisite to disinfection and sterilisation. Disinfection is a process that uses heat or chemical agents to reduce the number of viable micro-organisms but does not necessarily inactivate viruses or bacterial spores. Sterilisation is a process used to render objects free from viable microorganisms, including spores and viruses but excluding prions. NB: Manufacturers guidance for decontamination must be adhered to at all times. Cleaning Methods The recommended method of cleaning surgical instruments is by using an automated system such as a washer-disinfector or ultrasonic cleaning bath. Cleaning agents used for medical devices must be CE marked, as they are classified as an accessory to a medical device. CE is an abbreviation of the French phase Conformite Europeene, which literally means European Conformity. Dish washing detergents are designed for washing dishes and not surgical instruments and may leave soil residues that cannot be seen by the naked eye. The cleaning agent also needs to be compatible with both the device and reprocessing equipment. Damage to the medical device, their components or reprocessing equipment may occur following contact with incompatible decontamination agents. Manufacturers of reusable medical devices are required to provide information on how to decontaminate their devices and these instructions must be adhered to. The preferred method of cleaning instruments is by using an automated system such as a washer-disinfector or ultrasonic cleaning bath. Cleaning standards can be more easily measured and controlled using automated methods. They also have the advantage of reducing exposure of the user and environment to microorganisms and chemicals. Disinfection Methods Cleaning is an essential requirement prior to disinfection; disinfection should not be used as a substitute for sterilisation. 9

11 Chemical Disinfection a. Chemical disinfectants can be toxic, flammable, corrosive or have other material incompatibilities, so their use should be avoided wherever possible. Chemical disinfection is not as effective as disinfection by heat and should never be used as a substitute for sterilisation or when alternatives such as single use items are available b. Chemical disinfectants may be ineffective if:- used on items which have not been cleaned adequately not freshly made up made up to the wrong concentrations mixed with incompatible substances or materials c. Chemical disinfectants must be stored, reconstituted and used in accordance with the Control of Substances Hazardous to health (COSHH) Regulations. A written risk assessment must be made on each chemical in use. 5.5 Selecting a Chemical disinfectant Chlorine preparations These contain Sodium hypochlorite and Sodium Dichloroisocyanurate (NaDCC), which have good activity against viruses. They usually present in the form of tablets, powders or granules, which can be reconstituted into the required concentration. Solutions should be changed within 12 hours. In liquid form they are less stable and have a shorter shelf life. NaDCC releases chlorine slowly and has a more prolonged effect than Sodium hypochlorite. Chlorine preparations are corrosive to metals and are inactivated by organic matter (NaDCC) to a lesser extent). Large amounts of Chlorine solution products are not advised for direct use on urine/vomit as they may release hazardous vapour, care must be taken when using this product and safe systems of work must be put into place. (Appendix 2). Alcohol preparations Alcohol preparations are useful chemical disinfectants because they are ready diluted and can be used immediately. They are effective against most bacteria and viruses, but have poor penetration so should only be used on physically clean surfaces. They are also flammable and must not be used near a naked flame. Store in a cool dry place, most commonly used is 70% isopropyl alcohol. Combined Detergent-Disinfectants (e.g. chlorclean, Actichlor plus) Products are available that combine a detergent and a chlorine-based disinfectant for use when cleaning the environment including sanitary equipment. This product cleans and disinfects, negating the need to clean prior to disinfection Sterilisation Methods Cleaning is an essential pre-requisite to effective sterilisation, as sterilisers are not designed to wash or clean equipment. Dirty instruments placed in an

12 autoclave may not be sterilised as the contaminant may coagulate and form a barrier through which the steam may not penetrate. Such instruments must be regarded as non-sterile and they must not be used until they have been cleaned thoroughly and re-sterilised. The Medicines and Healthcare Regulatory Agency (MHRA) recommends the use of a Sterile Services Department (SSD) or Hospital Sterilisation and Disinfection Units (HSDU) wherever possible as they have the expertise, equipment and economy of scale, they have also established methods of tracing instruments, which is now a requirement in health care. 5.7 Benchtop Steam Sterilisers Autoclaving (steam under pressure) is the most reliable way of sterilising equipment i.e. instruments. Use of bench top sterilisers applies to Podiatry services within Leicestershire Partnership Trust, and dental services within the healthcare service provision provided under contract with HMP Leicestershire. They must not be used by any other services within LPT unless an agreed service delivery model has been identified through the formal service development route. 5.8 Decontamination of Equipment Prior to Maintenance/ Service Request/Decontamination Status Certificate (including equipment moved between locations for any reason including loan) a. Infection can be transmitted from contaminated medical equipment and devices that come into contact with patient or their blood/body fluids. b. All equipment must be cleaned and properly decontaminated in accordance with these procedures, prior to maintenance, repair, lending or returning a loan or any other reason for movement. c. The items must be accompanied by a Declaration of Contamination Status Certificate to ensure that procedures have been followed to manage and decontaminate the instruments/equipment ( Appendix 3) Medical Equipment in patients own home This refers to equipment the patient may use including clinical equipment i.e. walking aids, moving and handling equipment, thermometers stethoscopes, sphygmomanometer, blood glucose monitoring and INR monitoring etc. If the equipment is owned by the patient and becomes contaminated the relatives and carers should be advised to clean with detergent and water. If the equipment is contaminated with blood it should be cleaned with detergent and water and disinfected with non-diluted bleach providing the equipment can withstand bleach. (As the equipment belongs to the patient they may choose to use an alternative product). This does not refer to patients own furnishings.

13 Equipment provided by the Integrated Community Equipment Services (ICES) contract currently with NRS will be cleaned and disinfected by the NRS in accordance with this policy. If LPT owned equipment is to be brought back to LPT premises and is contaminated with blood it should be cleaned in the patient s own home with a chlor clean wipe. Clean and Dirty equipment must be stored separately. If visiting a patient with a known infection, the equipment cannot be used on another a patient until it has been cleaned and disinfected appropriately. This may mean returning to LPT premises between patient visits to access the correct cleaning materials. If it is safe and acceptable to do so a chlor clean wipe can be used in the area the equipment is housed (prior to returning it to LPT) Toys To reduce the risk of cross infection, all toys must be made of a material that where possible allows for effective cleaning and decontamination. All toys must be cleaned, on a weekly basis if not in use. For toys in use they should be cleaned after each session, after each child if visibly contaminated or has been used by a child with a known or suspected infection. Toys used by staff away from their base should be transported in plastic lidded containers, ( dirty or used toys should never be placed in container with clean toys). After cleaning check all toys and equipment to ensure they remain fit for purpose! Should any toy or pieces of equipment become contaminated with blood or body fluids or used by a child with known infection these will require cleaning and disinfecting with a chlor clean wipe. All toys must be CE marked to ensure they are safe for use. Staff employed by LPT are not expected to clean toys belonging to other organisations, however it is the responsibility of the staff to ensure that they are clean and fit for purpose prior to using them, however if toys become contaminated during activities it is the responsibility of LPT employees to bring this to the attention of that organisation to prompt decontamination, and should not be used further until this process has taken place and assurance should be sought prior to using the toy. Soft Toys Soft toys must not be kept for general use in healthcare settings because they are porous, support microbial growth and can be difficult to decontaminate. There may be occasions when soft toys form an essential part of a therapy 12

14 session; where this is the case soft toys must be subject to machine washing after each episode of care and thorough air/tumble drying (according to manufacturer s instructions). These toys should be single patient use and laundered between patients. Any soft toys that are contaminated with blood or body fluids must be disposed of. Repeated decontamination of soft toys can compromise the integrity of the fabric and crate a choking hazard, therefore ensure thorough checking takes place before and after use. Industrial washing machines and industrial dryers must be used. Hard Surface Toys All toys must have a smooth, non-porous surface that is easy to clean. Toys with moving parts or openings can harbour dirt and germs in the crevices; they must be washed and scrubbed using detergent and warm water or a detergent wipe. The utensil used to scrub/clean the toy with; must be single use and discarded after use. Mechanical/Electrical Toys Mechanical/Electrical toys must have the surfaced wiped weekly using detergent wipe. These must be PAT tested if they are able to be connected to the electrical supply. Note: Do not submerge electronic / battery operated toys / equipment in water. Books Books must be inspected weekly and the surfaces wiped using a disposable detergent wipe. As they may have a potential of soaking up liquid, books with signs of dampness or mildew must be discarded. They may require frequent replacement. Ball Pools They should be inspected daily for cleanliness, debris and foreign items. Routine cleaning for the balls and pool must be carried out on a monthly basis using warm water and neutral detergent and then dried thoroughly. Dressing up Clothing Dressing up can form an important part of a child s therapy or rehabilitation, however, only use when necessary for therapy the following should be taken into consideration All clothes must be washable and washed at a temperature of 60 degrees centigrade for 10 minutes. Clothes must be washed and dried after use. Clothes should be inspected on a monthly basis and laundered if required, the storage bins must also be washed at the same time using a detergent wipe or detergent and warm water. An industrial washing machine and industrial tumble dryer must be used. 13

15 Distraction boxes These are the responsibility of all staff and should be checked and cleaned following each individual use or on a weekly basis (if not in use). These should not be stored with general toys. Preparation Toys These toys must be regularly inspected and cleaned using an appropriate cleaning method as described above. Second Hand Toys Second hand toys must not be accepted by services within LPT Individual Play Therapy Prior to use; children s or patient s hands must be cleaned before and after use and skin lesions must be covered. Play Dough This must be single patient use only and must not be shared with other children or patients. Play Sand Sand pits are not to be used for general play purposes, however, for individual play therapy; sand may be used for that child and discarded after use. Staff undertaking home visits Staff undertaking home visits or working in premises where cleaning of toys cannot be carried out on premises should work in line with the follow guidance: 14 On arrival of the visit, only remove those toys likely to be used for the session. Where possible staff should use the toys that are available to them in the family home. (these must be clean and free from blood and body fluids) Any toy or piece of equipment contaminated with blood or body fluids or used by a child/young person with a known infection must be cleaned and/or decontaminated using chlor clean wipes before it is re used with another child/ young person. If it is not possible to do this immediately bag the toy and return to base for effective cleaning before re use. Containers used for transportation must be cleaned on a weekly basis or when the container becomes contaminated. Clean and dirty toys must be transported separately. The container carrying the dirty toys must be cleaned and decontaminated at the same time as the toys.

16 5.11 Procedure following a spillage of blood, other body fluids or known contaminated material In clinical areas it is the responsibility of the clinical staff to ensure that spillages of blood, vomit, urine, faeces and other body fluids are cleaned up immediately and effectively. It is vital that all staff take all reasonable precautions to protect themselves and patients from transmission of infections. Non-clinical areas are the responsibility of domestics who have undergone an appropriate level of training. Disposable non-latex gloves and disposable plastic aprons must be worn for all cleaning and decontamination procedures. Appropriate face protection must be worn if there is a risk of splashing into the eyes or mouth. Where applicable the correct colour coding of equipment should be adhered to in line with the NHS Cleaning Manual and NPSA National Colour Coding Safer Practice (Appendix 1) Management of Body Fluid Spillages ALL spilled blood or body fluids should be regarded as potentially infectious, and should be treated accordingly, for patients and staff. The Management of Body fluid spillages poster should be followed (Appendix 4). When treating a spillage, staff must wear disposable nitrile gloves and a disposable plastic apron. Eye/face protection is required if there is a risk of splashing. Always improve the ventilation in an area where you are clearing a body fluid spillage (where possible). Refer to COSHH note on the product label and check the expiry date. Blood spillages of any size and all blood-stained body fluid spills (i.e. where there is visible blood): Step 1 Following the manufacturer s instructions, use a DRY Chlor-Clean Wipe to absorb the spill If one wipe is not enough use more dry wipes to completely absorb the spill: each wipe will absorb approximately 30ml of liquid Discard used wipes as clinical waste. Step 2 Moisten a NEW Chlor-Clean Wipe with cold tap water and gently squeeze any excess water out over the sink Use the moistened wipe to clean and disinfect the area of the spillage Dispose into clinical waste 15

17 All body fluid spillages where there is no visible blood: Warn any persons in the area that in the case of urine there will be an unpleasant smell whilst the spill is treated; in the case of vomit there will be a slightly stronger smell of chlorine. Step 1 Remove any solid matter using disposable paper towels. Absorb any remaining liquid using either paper towels or a mop depending on the size of the spill. Dispose of all waste in clinical waste bags and remove the washable mop head for laundering. The mop head must be sent for laundering in the appropriate colour coded bag. Step 2 Clean and disinfect the area using either a Chlor-Clean solution and a clean mop head or a moistened Chlor-Clean Wipe (as above) Dispose of any waste in a clinical waste bag and if a washable mop head has been used, bag for laundering. Blood Spillage on Absorbent Surfaces (Carpets/Soft Furnishings) owned by LPT Disposable nitrile gloves and a plastic apron must be worn. If blood is splashed or spilled onto soft furnishings the item must be condemned after being disinfected with Chlor-clean. Gloves, apron and all paper towels must be discarded into a clinical waste bag for disposal. If blood is spilled onto clothes, treat as infected linen. Blood Spilled on Staff Intact skin The spilled blood should be washed off with copious warm running water and liquid soap, paying particular attention to the fingernails. No further action is necessary. Broken skin The spilled blood should be washed off with copious warm running water and soap. The incident must then be reported and an incident form completed. The LPT Management of Sharps and Exposure to Blood Borne Virus Policy must be followed. Mucous membranes Splashes of blood or body fluids entering the eye should be removed by immediate irrigation. Ideally sterile saline "eye-wash" packs should be used if available, but if not, running mains water (drinking water) can be used instead. Irrigation should be continued until all traces of the contaminating material have been removed. The incident must then be reported immediately to the line manager and Occupational 16

18 Health; an incident form must be completed. The LPT Management of Exposure to Blood Borne Virus Policy must be followed Cleaning and disinfection methods Clean Rinse Disinfect Disinfect (blood and body fluids Dry Use hot water and neutral detergent or detergent wipe Use clean water Use Chlor-clean solution NB: Chlor-clean solution cleans and disinfects so negates the need to clean prior to disinfection Chlor-Clean Wipes (Appendix 4) Use disposable paper towels 5.14 Cleaning and Disinfection procedures This is not an exhaustive list; if the equipment is not listed here and you need advice please contact the infection control team. All equipment must be cleaned between patients. Cleaning for each piece of equipment is identified in the table below. Unless otherwise stated: If used with a patient with a known or suspected infection, clean and decontaminate using chlor clean solution. If visibly soiled with blood or body fluids clean and decontaminate using chlor clean wipes On discharge of the patient/terminal clean; clean and decontaminate with chlor-clean solution 17

19 Equipment AUROSCOPE Ear pieces BABY SCALES BABY CHANGING MATS Must be made of a material that is wipeable and impervious to liquid TRANSFER BOARD BASIN clinical hand wash BEAN BAGS Must be wipeable and impervious to liquid BED TABLES BLOOD GLUCOSE MONITORING EQUIPMENT BUCKETS (Plastic used for the immersion of legs i.e. leg ulcer treatment) CHAIRS Wipeable and impervious to liquid Must be condemned and dispose of if surface is not intact CLIPPERS (Hair) Head pieces COMMODES DRESSING TROLLEY 18 Recommended Action Clean external surface with detergent and water or detergent wipes following use. Disposable single use, discard following use Line the scales with disposable paper towel before each use. After use discard paper and clean with detergent wipe Line the mat with disposable paper towel before each use. After use discard paper and clean with detergent wipe Clean external surface with detergent and water or detergent wipes following use. If provided as single patient use to be cleaned and decontaminated using chlor clean solution on discharge or the patient or when the patient no longer requires it. Clean with hot water and neutral detergent, rinse and dry. Clean external surface with detergent and water or detergent wipes following use. Clean external surface with detergent and water or detergent wipes following use. Clean external surface with detergent wipes following use. Clean and decontaminate with chlor clean solution. Clean surface with detergent wipes following use. Clean external surface with detergent and water or detergent wipes following use. Disposable single use, discard following use Clean and decontaminate with Chlor-clean after every use, ensuring all surfaces including the frame are cleaned. This involves removing the seat from the frame to enable access to all areas of the commode. Clean with hot water and detergent, rinse and dry. Clean and disinfect with chlorclean solution and place single use paper towel across the flat surfaces during storage.

20 DRUG FRIDGE Outside (weekly) Inside (weekly) DYNAMAP ECG LEADS AND MACHINE ECG Electrodes ENTERAL FEEDING PUMP Check manufacturer s instructions EQUIPMENT (moving and handling) Including but not limited to: Chair/Scales Pat Slide Rotunder Standing Aids Walking stick Wheelchair Zimmer Frame EXAMINATION COUCHES Material must be wipeable and impervious to liquid Must be condemned and dispose of if surface is not intact FANS OUTER CASING Clean with detergent wipes After emptying clean using chlor-clean Clean surface with detergent wipes following use. Clean surface with detergent wipes following use. Disposable single use, discard following use Clean surface with detergent wipes following use. Clean surface with detergent wipes following use. Cover couch with single use paper towel role, and change between each patient. Clean after each session with a detergent wipe. Couch covers must be replaced if not-intact. If unable to replace the item must be condemned and alternative couches must be used. Avoid blankets/linen unless these can be changed between patients Damp dust daily with detergent and hot water or detergent wipes to remove dust, dirt, debris and moisture. FINS FOAM WEDGES Must be heat sealed and impervious to liquid Must be condemned and dispose of if surface is not intact FOOT STOOLS Must be heat sealed and Must be part of the cleaning schedule (staff must not dismantle the fan) Clean surface with detergent wipes following use. Clean surface with detergent wipes following use. 19

21 impervious to liquid Must be condemned and dispose of if surface is not intact GLUCOMETERS HAIR BRUSHES/COMBS HOIST Frame Sling Allocate to individual patient or use a disposable sling. Disposable slings to stay with the patient for the duration of the care episode Note slings must not be tumble dried as this can interfere with the integrity of the material and make it unsuitable to use INR MONITORING EQUIPMENT Clean surface with detergent wipes following use. Single patient use only Clean surface with detergent wipes following use. On patients discharge send reusable equipment to the laundry using the return to sender service If contaminated with body fluids send to the laundry in a red soluble bag and the blue outer bag using the return to sender service. Clean surface with detergent wipes following use. INTRAVENOUS INFUSION PUMPS Clean surface with detergent wipes following use. INTRAVENOUS INFUSION STANDS Clean surface with detergent wipes following use. KEYBOARDS Clean surface with detergent wipes following use. LAMINATED PATIENT LEAFLETS Clean surface with detergent wipes following use. LARYNGOSCOPE Hand piece Clean and disinfect with chlor clean between uses. Blade LIGHT CORD PULL Must be covered with plastic outer covering LOCKERS Must be single patient use, dispose after use. Clean daily with detergent wipe Clean daily with detergent wipe 20

22 MATTRESSES AND BEDFRAMES Mattress (Air) Owned by LPT Mattress (Air) Rented Mattress (Non-Air) Bedframes (Rented or Owned) MEDICINE POTS Single use recommended Re-usable medicine pots MOBILATOR NAIL BRUSHES Single use only NEBULISER MASKS Single patient use NOTE HOLDERS NURSING BAGS Must be wipeable and impervious to liquid OXYGEN CONDENSER HUMIDIFIER (concentrator) bottles Oxygen sponge filter (at the back of the machine) used with a humidifier. Must be cleaned between patients PEAK FLOW METRES Digital or Manual machine Mouthpiece PERCHING STOOL PILLOWS Must be wipeable and impervious to liquid with heat sealed seams PRESSURE RELIEVING CUSHION Must be wipeable and impervious to liquid with heat sealed seams 21 For Infections such as Clostridium difficile please seek further advice from the IP&C team and/or the manufacturer Clean with detergent wipe (clinell wipegreen and white packet) Clean with detergent wipe (clinell wipegreen and white packet, or manufacturer s instructions). Clean with detergent wipe (clinell wipegreen and white packet) Clean with detergent wipe (clinell wipegreen and white packet) Dispose after use Must be washed in a dishwasher between uses. (ensure appropriate racks are used to prevent obstructing the machine) Clean after each use with detergent wipe Dispose after use Clean after each use and then dispose once the patient has been discharged Clean with detergent wipe Clean daily with detergent wipe Single patient use (Salter E7600) Wash with detergent and water and leave to air dry. Clean after each use with detergent wipe Single use, dispose after use Clean after each use with detergent wipe Clean after each use with detergent wipe Clean after each use with detergent wipe

23 PULSE OXIMETERS RAISED TOILET SEATS SLIDING SHEETS Allocate to individual patient SYPHYGMAMOMANOTER STETHOSCOPE Clean after each use with detergent wipe Clean and disinfect after each use with Chlor clean solution Must be stored on a rack or hook On patient discharge send to the laundry service, using the return to sender service. Clean after each use with detergent wipe Clean after each use with detergent wipe In the event of soiling or used by a patient with a known infection: clean with chlor-clean solution SUCTION EQUIPMENT Suction equipment outer casing/machine Tubing and suction catheters SYRINGE DRIVER Do not soak or immerse any part of the equipment in water or any other solution TELEPHONE Staff Patient THERMOMETERS (Digital) Ear piece Hand Piece TOILETS Communal patients URINALS/URINE JUGS VAGINAL SPECULA On discharge of the patient/terminal clean: clean with chlor-clean solution Clean after each use with detergent wipe single use only Clean the unit in-between patients using a lint free cloth lightly dampened with warm water and mild detergent. Disinfect using chlor clean solution. Turn off pump and remove battery before cleaning. Once per month (or as required) clean the lead screw thread beneath the accuvator and guiding rods with a small dry brush to remove debris. Clean daily with detergent wipe Clean daily with detergent wipe Single use only dispose after use Clean after use with a detergent wipe Sanitise daily according to domestic schedule Single use only, dispose after use Single use only, dispose after use 22

24 6.0 Training There is a need for training identified within this policy. In accordance with the classification of training outlined in the Trust Human Resources & Organisational Development Strategy this training has been identified as mandatory and role development training. The course directory e source link below will identify: who the training applies to, delivery method, the update frequency, learning outcomes and a list of available dates to access the raining. A record of the event will be recorded on Ulearn as appropriate. The governance group responsible for monitoring the training is the Infection Prevention and Control Committee and Quality Assurance Committee. 7.0 References and Associated documents LPT Documents LPT Infection Prevention and Control Policies available via the intranet References BHTA British Healthcare Trades Association (2012) Protect, Rinse and Dry BHTA guidance on the care, cleaning and inspection of healthcare mattresses BSI, PAS 5748(2014) Specification for the planning, application, measurement and review of cleanliness services in hospitals. DH (1993) HSG (93) 26 Decontamination of equipment prior to inspection, service or repair. DH (2010) The Health and Social Care Act 2008: Code of practice for health and adult social care on the prevention and control of infections and related guidance. DH (2006) Essential Steps to Safe, Clean Care: Reducing Healthcare Associated Infections: Great Britain (1974) the Health & Safety at Work Act Great Britain (1999) The Control of Substances Hazardous to Health Regulations HSC 1999/179 Controls Assurance in Infection Control: Decontamination of Medical Devices Department of Health 1999 MDA DB 9501 The Reuse of Medical Devices Supplied for Single Use only 23

25 Medical Devices Agency Merrimean E, Corwin P & Ikram R, (2002) Toys are a potential source of cross infections in general practitioner s waiting rooms. British Journal of General Practice 52; MDA SN 9619 (1996) Compatibility of medical devices and their accessories and reprocessing units with cleaning, disinfecting and sterilising agents. Medical Devices Agency Adverse Incident Centre. Microbiology Advisory Committee to the Department of Health (1997) Sterilisation, Disinfection and Cleaning of Medical Equipment: Guidance on Decontamination Medical Devices Agency. NHS National Patient Safety Agency, The NHS Cleaning Manual Dept. of Health, Health Protection Agency. Prevention of infection and communicable disease control in prisons and places of detention A manual for healthcare workers and other staff July Gateway reference HPA 11-02, DH

26 Appendix 1 25

27 Appendix 2 SAFE SYSTEM OF WORK Substance: Chlor clean tablets & water for dilution Use: used for cleaning/disinfection of work surfaces, floors, equipment, walls and contact areas e.g. door handles Procedure to be followed: Making up the solution: 1. Put the minimum correct amount of cold water (from the cold tap) into designated carrying/mixing receptacle depending on usage required either 1 litre or 2 litre quantity. 2. When adding the Chlor- clean tablet to the water ensure that any window and doors are left open DO NOT MIX SOLUTION IN AN UNVENTILATED AREA. 3. Put on gloves, apron and goggles prior to removing the Chlor- clean tablets from tub, carefully remove lid and remove the required amount of tablets either 1 for 1litre of water or 2 for 2 litre of water. 4. Carefully place the tablet into the water in the carrying/mixing receptacle. The lid on the receptacle shouldn t be fully closed until the tablets have finished dissolving. 5. Replace lid securely on the Chlor-clean tablets and stow away in a locked, dry area. 6. The solution should not be used until the tablets have been completely dissolved into the water. Decanting of made up solution from mixing receptacle 1. Whilst still wearing your correct personal protective equipment (PPE), gloves apron and goggles, carefully decant the solution into the cleaning bucket/bowl that you will be using. Usage of mixed solution 1. When using the solution you must ensure that you continue to wear the appropriate PPE. 2. Depending on the surface cleaned, use a paper towel to rinse off and dry residual solution e.g. table, chair Disposal of mixed solution after use. Discard solution into sluice or toilet and flush after disposal has taken place you must ensure that you are wearing your correct PPE when this task is undertaken. 26

28 Appendix 3 DECLARATION OF DECONTAMINATION STATUS LPT MEDICAL EQUIPMENT Please complete all appropriate sections of the below form prior to the return & inspection of any Trust owned medical equipment. Equipment will not be accepted for service / repair without completion of this form. Department: Address: Asset Number or Serial No: Equipment Type / Model: Nature of request: Routine Maintenance Fault Acceptance Other (Please State) Give any details related to request: NB: Dispose of contents as per procedure. Please return equipment with all leads and accessories (e.g. batteries). CONTAMINATION STATUS Please tick box A if applicable. Otherwise, please tick & complete all parts of B on page 2, providing further information as requested or appropriate A This equipment/item has not been used in any invasive procedure or been in contact with blood, other body fluids, respired gases, or pathological samples. It has been cleaned in preparation for inspection, servicing, repair, or transportation. 27

29 B Has this equipment/item been exposed internally or externally to hazardous materials as indicated below: Blood, body fluids, respired gases, pathological samples Other biohazards Chemicals or substances hazardous to health Other hazards YES NO Has this equipment/item been cleaned and decontaminated? YES NO Indicate the methods and materials used: If the equipment/item could not be decontaminated indicate why: ** Such equipment must not be returned/presented without the prior agreement of the recipient whose reference or contact name must be given above. Has the equipment/item been suitably prepared to ensure safe handling/transportation? YES NO DECLARATION: I, the undersigned, declare that I have taken all reasonable steps to ensure the accuracy of the above information in accordance with HSG (93) 26. SIGNED: PRINT NAME: POSITION: DEPARTMENT: DATE: TEL NO: 28

30 29 Appendix 4