Section 10X - IX0600 (Equipment Cleaning) Page 1 A PRINTED copy of this guideline may not be the most recent version. The OFFICIAL version is located on IHNET at the Policies & Procedures Home Page IX0600: Equipment Cleaning EFFECTIVE DATE: February 2009 REVISED DATE: November 2010 December 2012, March 2013 REVIEWED DATE: 1.0 PURPOSE: To prevent the transmission of microorganisms from soiled equipment to patients. Cleaning is a shared responsibility between multiple departments and healthcare providers. 2.0 DEFINITION See the glossary in Appendix A for definitions 3.0 GENERAL PRINCIPLES 3.1 Dedicate equipment for a single patient. 3.2 Shared equipment must be cleaned and disinfected between patient uses. 3.3 Clean soiled equipment immediately must be cleaned prior to disinfection. 3.4 Disinfectant wipes should be used for point of care cleaning and disinfection of patient equipment; wipes must be kept wet and discarded if they become dry. 3.5 Never reuse single use equipment that is not appropriate to dedicate to single patient use (i.e. critical equipment) discard immediately after use. 3.6 Do NOT use tape that leaves a residue on patient equipment. 3.7 Report damaged equipment to manager for replacement. 3.8 Do NOT stockpile supplies and equipment in patient room clutter increases the risk of cross contamination in patient care areas (including hallways). 3.9 Personal care items (i.e. lotions, skin cleansers, razors) are single patient use and not to be shared between patients. 3.10 Assign responsibility for routine cleaning of equipment. 3.11 Foot care equipment must be sterilized between patient use if the equipment is assigned as single patient use, it can be low level disinfected between use on that same patient.
Page 2 4.0 PROCEDURE 4.1 Wear appropriate personal protective equipment (PPE) for the task. 4.2 Clean and disinfect reusable equipment in a designated area. Clean small items in patient rooms prior to use on another patient. Transport large items to the soiled utility room for cleaning. Avoid performing equipment cleaning in high traffic areas like hallways or where contact with clean items may occur (clean hallway carts). 4.3 Wipe equipment thoroughly if cloth/wipe comes away dirty, repeat until it comes away clean. 4.4 Allow equipment to air dry. Some items may require rinsing off prior to use ensure disinfectant has adequate contact time with the equipment/device before rinsing. 4.5 Designate a location for clean equipment (ideally, clean storage rooms or clean service rooms) where they are transported after cleaning. Implement a process where the item is identified as clean, disinfected and ready for use on another patient. 4.6 Cardboard/paper items Wipe laminated cardboard/paper with cloth or wipe if not laminated, discard after use. 4.7 Fabric items All fabric items used in patient care areas must be washable. Washing can take one of 3 forms: o Coated Fabric (i.e. vinyl) wiped using procedure above. o Non coated cloth launder. o Non-washable fabrics not recommended 4.8 Electronic items Wipe equipment thoroughly including all cables, avoiding any electrical or electronic connectors to prevent malfunction. Use approved screen cleaners Allow to air dry. 4.9 Toys REFER TO IX0700 TOY MANAGEMENT 4.10 Macerators (Vernacare) Dispose of cardboard items immediately after use into macerator and run cycle. Do not allow items to accumulate in macerator to avoid plugging the machine. 4.11 Washer/Disinfector (Deko) Place blue ware items used for elimination (i.e. bedpans, urinals) immediately in machine after use. Once items are cleaned and disinfected, ensure clean items are stored to facilitate complete drying. s can be used for any patient after completing this process.
Page 3 Establish a schedule for regular cleaning of blue ware (i.e. wash basins, denture cups). 4.12 Appendix B Equipment Cleaning Table 4.13 Appendix C information on hydrotherapy tubs and use of public pools for therapeutic interventions. 5.0 REFERENCES 5.1 Best Practices for Cleaning, and Sterilization in all Health Care Settings. Provincial Infectious Diseases Advisory Committee (PIDAC), Ontario; February, 2010. 5.2 Hand Washing, Cleaning, and Sterilization in Health Care. Health Canada - Canada Communicable Disease Report. 1998; 24 Supplement 8: i-xi, 1-55. 5.3 Infection Control Guideline for the Prevention of Healthcare Associated Pneumonia. Public Health Agency of Canada; 2010. 5.4 Infection Prevention and Control Manual. Capital Health. Cleaning and disinfection of non-critical patient care equipment. Policy IC 08-001; July 2012. 5.5 Montana State Hospital. Policy and Procedure Manual. Cleaning of non-critical, reusable patient care equipment. Policy IC-19; March 2010. 5.6 Saskatoon Health Region. Infection Prevention and Control Manual. Non-critical Patient Care Equipment Cleaning and. Policy 20-80; October 2006. 5.7 Seven Oaks General Hospital. Policy and Procedure Manual. Cleaning of non-critical, reusable patient care equipment. Policy Code: 7311-07-01; December 2007.
Page 4 APPENDIX A Antiseptic An antimicrobial chemical designed for use on the skin or mucous membranes that inhibits the growth and reproduction of microorganisms (i.e.) alcohol based hand rub (ABHR) for hand hygiene. Bioburden The number and types of viable microorganisms that contaminate the equipment/device. Cleaning The physical removal of dirt, dust or foreign material. Cleaning usually involves soap and water, detergents or enzymatic cleaners. Thorough cleaning is required before disinfection or sterilization may take place. Disinfectant A product that is used on medical equipment/devices, which results in disinfection of the equipment/device. Disinfectants are applied only to inanimate objects. Some products combine a cleaner with a disinfectant. High Level The process of using a chemical to kill all vegetative live bacteria, fungi, mycobacterium, and viruses. This does not necessarily kill bacterial spores. Intermediate Level : Inactivates M. tuberculosis, vegetative bacteria, most viruses, and most fungi, but does not necessarily kill bacterial spores. Low Level Using a chemical to kill most vegetative live bacteria and some fungi as well as enveloped viruses. This does not kill mycobacterium or bacterial spores. Noncritical Medical Equipment/Device Equipment/device that either touches only intact skin (but not mucous membranes) or does not directly touch the patient. Reprocessing of noncritical equipment/devices involves cleaning and may also require low-level disinfection. Personal Protective Equipment Barriers placed between the infectious source and ones own mucous membranes, airways, skin, and clothing to prevent exposure to blood and body fluids. Reprocessing The steps performed to prepare used medical equipment/devices for re-use (e.g., cleaning, disinfection, and sterilization). Sterilization The complete elimination or destruction of all forms of microbial life. Accomplished by either physical or chemical processes.
Page 5 APPENDIX B Recommended and Level and Frequency for Noncritical Client/Patient/Resident Care Equipment and Environmental s The following chart relates to non-critical patient care equipment only, i.e., equipment that comes into contact with intact skin. This chart also includes environmental surfaces and items that do not come into contact with skin. CL = Physical removal of visible soil dust or foreign material (may use soap and water, detergent or hospital grade disinfectant with detergent properties) = Soak item in or wipe surfaces with hospital grade disinfectant (wipe or cloth dampened with disinfectant), allow disinfectant to dry prior to reuse to allow item contact time for disinfection to occur and = Clean + Lowlevel Airflow sensors (Sleep Lab) clean with detergent and water before disinfection Apnoea Monitor Monitor/ Sensor Pad Arrest Cart See Resuscitation Cart Basin CL after each use dedicated to patient dry completely before use automated process recommended
Page 6 and = Clean + Lowlevel Bassinette weekly between newborns Bath Seat/ Raised Toilet Seat Single patient use when soiled ideally dedicated to each patient Multiple patient use between patients Bed Bedrail and extender daily Mattress clean between patients and when soiled Halo bed after each patient and when soiled Visitor cot change linen and clean between uses Bedpan and Urinal Disposable dispose immediately Multiple patient use between patients washer/disinfector recommended for reusable items after each use remove gross soil and fluids before automated disinfection unless machine equipped with flush cycle Bladder Scanner between patients
Page 7 and = Clean + Lowlevel Blood Pressure Cuff ideally stays with patient until discharge Breast Pump (Hospital Grade) Pump Kits Disposable:CL between uses dedicated to patient discard when damaged or heavily soiled dry completely before reuse store with patient/baby to avoid contact with other kits HLD(min) between uses between different patients dedicated to patient washed and completely dried after each use stored with patient/baby HLD/sterilized according to Manufacturer s instructions before use with another patient Pump Motor between uses Call Bell daily and between patients Cardiac Monitor daily and between patients Cast cutting Blades CL or disposable when soiled send for sterilization if contact with blood or body fluids Saws CL when soiled
Page 8 and = Clean + Lowlevel Chair daily and when soiled Includes recliners, patient chairs and shower chairs Chart Cover Binder and/ or clipboard charts and clipboards should not go into rooms on Additional Precautions replace worn binders Clippers (handle) Commode Chairs Surgical between patients disposable heads Single patient use when soiled ideally dedicated to each patient patients with VRE or C.difficile must have dedicated commode for C.difficile, consider cleaning with a sporicidal agent remove gross soil and fluids before cleaning and disinfection Cord Clamp Multiple patient use when soiled between patients remove gross soil and fluids before cleaning and disinfection must be single-use, disposable and discarded after use Cyclers (Peritoneal Dialysis) Defibrillator See Resuscitation Cart between patients
Page 9 and = Clean + Lowlevel Diagnostic Imaging Portable - Machine when soiled and on leaving Contact Precautions room Portable - portable grid/ film cassette between patients if not covered ideally should be covered (e.g., pillowcase) Mammography - paddles between patients Dopplers Transducers after each use Probes after each use wipe immediately after use to remove residual ultrasound gel before cleaning probes that contact mucous membranes or non-intact skin require high-level disinfection ECG Machine and Cables Electric Razor Razor body and Handle as required must be single patient use Electronic Devices Single patient use (e.g. Bedside monitors) when soiled between patients ideally dedicated to each patient patients with VRE or C.difficile should have device cleaned daily regardless of soilage for C.difficile, consider cleaning with a sporicidal agent remove gross soil and fluids before cleaning and disinfection consult manufacturers instructions for screen cleaning
Page 10 and = Clean + Lowlevel cleanable covers are highly recommended for difficult to clean components Multiple patient use/ Personal Devices used in patient areas (i.e. Tablets) when soiled between patients remove gross soil and fluids before cleaning and disinfection consult manufacturers instructions for screen cleaning Glucometer after each use cleanable covers are highly recommended for difficult to clean components Halo Bed See Bed Hydraulic Lift Hydrocollator Machine as required Sling Launder between patients and when soiled Interior every week Exterior every week dedicated to patient if possible launder if visibly soiled drain and thoroughly clean allow 10 mins contact time with disinfectant for interior surfaces then rinse well prior to refilling with water allow fresh water to reach appropriate temp prior to re-immersing packs regular temperature monitoring required as per manufacturers recommendations
Page 11 Ice Machine and = Clean + Lowlevel Interior every 6 months drain and thoroughly clean with a de-limer Exterior every 3 days Ice Packs do not use without a cover discard if damaged Intravenous (IV) Pumps, Poles, Warmers Isolette weekly Laryngoscope Handle Mattress See Bed Measuring Container (urine) Single patient use CL after each use Multiple patient use after each use one container per patient, labelled with name Ophthalmoscope Orthopedic Equipment Crutches, traction etc. Otoscope between patients Handle
Page 12 and = Clean + Lowlevel Ear speculum Disposable or HLD Otoacoustic Emission (OAE) screening tips Disposable or HLD Oxygen Delivery Systems Masks Disposable:CL daily dedicated to patient discard when damaged or heavily soiled rinse all disinfectants from surface before reuse with same patient dry completely before reuse with same patient NP/tubing Nebulizers Disposable:CL (externally only) Disposable:CL daily after use dedicated to patient discard when damaged or heavily soiled handle condensate carefully remove from tubing, do not drain back towards patient dedicated to patient discard when damaged or heavily soiled rinse after cleaning using sterile water dry completely before reuse with same patient Oximeter Probes between patients if single-use, discard after use refer to manufacturer s instructions for cleaning Physio/OT Equipment between patients and when soiled discard if damaged educate users to clean after use if appropriate
Page 13 and = Clean + Lowlevel clean personal splints prior to immersion Splint Baths weekly drain and thoroughly clean allow 10 mins contact time with disinfectant for interior surfaces then rinse well prior to refilling with water allow fresh water to reach appropriate temperature before reuse Sheepskin Launder between patients when soiled OT assessment Areas CL (e.g. kitchen/bathroom) after use Wax Bath (wax) Pillow between patients and when soiled Reflex Hammer pour wax into disposable plastic bag or washable container for individual patient use do not reuse wax discard if cracked Restraints CL and when soiled launder Resuscitation Cart/Arrest Cart weekly and after use avoid taking cart into Contact Precautions room, have a designated clean person to pass supplies as required Defibrillator after each use
Page 14 and = Clean + Lowlevel Trays after each use all items taken into Contact Precautions room must be discarded and not returned to the cart, even if unopened Scales Adult daily and when soiled Diaper after each use Newborn after each use do not use phenolics Speculum Light after each use Stretcher after each use Stethoscope after each use ideally use own stethoscope if shared, disinfect ear pieces Suction Machines Table Bedside Over bed daily Telephone Bedside/Nursing Station daily daily Portable Telemetry Equipment Monitor and Cables
Page 15 and = Clean + Lowlevel Thermometer (electronic) daily Tourniquet or disposable Transfer Belts CL once weekly Transfer Boards preferably dedicate to patient discard when soiled/ cracked use transfer belts on top of clean patient clothing/gown Transport Equipment Walker Wheelchair after each use Tub Bath board/jets/surfaces after each use Ultrasound Transducers Handle and Cable External Urinal See Bedpan Iodine and chlorine products may damage tub surfaces use high-level disinfection for transducer probes if they touch mucous membranes or non-intact skin Urine Measuring Container See Measuring Container Vacutainer Holder Single patient use preferred Ventilator Machine CL daily discard if visibly soiled
Page 16 and = Clean + Lowlevel Ventilator Circuit In-line monitoring devices (i.e.temp. probes) disposable or sterilized between patients disposable or sterilized between patients ventilation circuits used on an individual patient should not be routinely changed based on duration of use only when visibly soiled or mechanically defective Walker See Transport Equipment Wall-mounted Oxygen and Suction Fixtures Warming Cupboard Exterior CL weekly Interior CL every 6 months Water Jug CL daily clean in dishwasher if disposable, change daily Wheelchair See Transport Equipment This document /excerpt was adapted with permission from the Ontario Agency for Health Protection and Promotion (Public Health Ontario)/Provincial Infectious Diseases Advisory Committee (PIDAC). PIDAC documents contain information that requires knowledgeable interpretation and is intended primarily for use by health care workers and facilities/organizations providing health care including pharmacies, hospitals, long-term care facilities, community-based health care service providers and pre-hospital emergency services in non-pandemic settings. Public Health Ontario assumes no responsibility for the content of any publication resulting from changes /adaptation of PIDAC documents by third parties.
Page 17 APPENDIX C Part 1: Infection Control Recommendations for Hydrotherapy Recommendations for Hydrotherapy are required to prevent infections to pool participants and staff, as well as to prevent contamination of the pool. 1. Contraindications: According to the BC Swimming Pool, Spray Pool and Wading Pools Regulations, it is contraindicated for residents, staff, community clients or their attendants to enter the pool with the following: Open areas of the skin (unless covered by a waterproof bandage). Fungal infections (i.e. Athlete s foot, fungal infections of the groin). Unmanaged fecal incontinence. Fever, diarrhea or vomiting. Any other identified infections may be a contraindication. Appropriateness of swim session for these cases will be at the discretion of the nurse, physiotherapist, doctor, health care assistant, in consultation with the lifeguard. 2. Hand Hygiene: Hand hygiene is the single most effective measure available to prevent infections. Hand hygiene should be done: Before and after direct care with a client. Before and after working with gloved hands. Before and after working with open areas/dressings, urinary equipment, ostomy equipment or body fluids. Between working with different clients. 3. Urinary Incontinence: The bladder must be emptied before entering the pool. 4. Fecal Incontinence: Swimmers with fecal incontinence are requested to arrange their pool time around their bowel habits. Swimmers are requested to have a bowel movement prior to bathing. Swimmers should wear properly fitting waterproof pants/incontinence product. 5. Ostomy Appliances: Must be firmly secured and able to withstand pool related activities (temperature, moisture, body movements and exercises). It is the responsibility of the client, or the client s attendant, to ensure that the bag is secured to the body and free from seepage. Ostomy bags must be clean before entering the pool. 6. Skin lesions and Rashes: It is the responsibility of the client, or nurse, to check the skin for any wounds before the pool session. If open wounds are present prior to swimming, the session should be cancelled. If the wound is small and can be completely covered and sealed by one waterproof dressing, then the session can continue once the bandage had been properly applied. Waterproof dressings can include various brands of waterproof bandages. Water resistant bandages will allow water to move through the bandage therefore allowing organisms to be carried to and away from the wound.
Page 18 Non waterproof bandages, tape, dressings, etc must be removed before entering the pool. Rationale: These items, if dislodged, become trapped in the pool filter system resulting in mechanical breakdown. Also, if an open area is covered by an inadequate dressing, the pool will potentially be contaminated.
Page 19 Part 2: Infection Control Practices for Pool Usage Pool users are required to adhere to the following practices when using the pool: 1. All pool users are required to wash their hands upon arrival and before leaving the pool facility. An antiseptic hand sanitizer solution is an option, if the hands are not visibly soiled. 2. All pool users are required to place a clean towel or other adequate barrier on the change bench to sit on as well as place their clothing on while changing. 3. All clothing and personal belongings are to be stored neatly away in either the lockers or underneath the benches after changing and while using the pool. 4. All pool users are required to take a cleansing shower using warm water and soap before entering the pool. 5. No person shall enter the pool whom: Is obviously ill. Has an open wound that has not been appropriately covered. Has sore or infected eyes. Has a discharge from the ears or nose. 6. Disinfecting wipes should be supplied in each change room and should be used to wipe benches between each use. Clients and staff are encouraged to use these wipes before and after using the benches. The wiped surface is left to air dry for effective disinfecting. 7. Disinfecting wipes are also used to wipe the grab bars and lifts after each use. 8. Disinfecting wipes are used to wipe the sling back and lift after each use. Lift slings should be washed after each use. 9. Change rooms should be cleaned and sanitized thoroughly once daily, or more often, as needed. 10. The pool deck should be cleaned and sanitized thoroughly once daily, or more often, as needed. 11. Wheelchairs that have been contaminated with body fluids are cleaned in the following manner: excess contaminant is absorbed with paper towel. The chair is then rinsed under a shower with a continuous flow of clean water. Disinfectant is then sprayed on the item and left for a minimum of 10 minutes (or per manufacturer instructions). The chair is then rinsed under clean water again, before storing it its regular location. 12. Head floats that have been contaminated with feces or blood will be thrown out. Other body fluids contaminating the head floats can be either wiped with a hospital approved disinfectant or washed in the washer. 13. Body fluid spills, (outside the pool basin) are first soaked up using paper towel. Dispose of the paper towel in the garbage. A hospital approved disinfectant is then used to wipe the area, which is left to air dry. A mop can be used for large spills after the paper towels have absorbed as much of the spill as possible. Mop head must be washed and disinfected before reuse on another surface. 14. Vomit in the pool may create a higher risk for infection.
Page 20 Part 3: Infection Control Guidelines for Staff 1. Staff are expected to follow the same infection control guidelines set out for community clients. These include washing hands upon arriving at work, protecting open wound with waterproof dressings, putting a towel down on any bench you use to change on, ensuring your belongings are tucked away while working and having a cleansing shower before and after using the pool. 2. Staff are also expected to ensure a clean environment by doing the following: Remind community clients to wash their hands upon arrival. Remind community clients to take a cleansing shower before entering the pool. Remind community clients to place their towel down upon the bench to sit on while changing. Wipe the benches in the change room with a hospital approved disinfectant as often as time permits, preferably between each client. 3. Staff are expected to wear appropriate footwear around the pool following the footwear guidelines for pool staff. 4. Staff should encourage clients to wear appropriate footwear around the pool facility. 5. Do not allow any open wounds that are not appropriately covered in the pool. Part 4: Responding to Fecal Accidents in Rehabilitation Swimming Pools Information from the Center for Disease Control (Atlanta, Georgia) addresses fecal accidents in pools. In recent times, there have been increasing concerns about the transmission of Cryptosporidium parvum in swimming pools. While this parasite can cause self-limited diarrhea in healthy people, the diarrhea can be much more significant in those with severe immunosuppresion. The infecting dose of Cryptosporidia is quite small, and even a small visible fecal spill of liquid can contaminate an entire pool. Most bacteria are very susceptible to low concentration of free chlorine, however, Cryptosporidia are not. Chlorine (2ppm) kills Escherichia coli in less than 1 minute, while Cryptosporidia may require as long as 8 hours. Although Cryptosporidia may be found in the stool of people who have persistent diarrhea and nausea, investigators from the CDC have demonstrated Cryptosporidia are not carried as normal human enteric flora, and is not found in formed stool. In order to address the potential hazards of Cryptosporidia parvum, pool protocols have been designed to combat this organism. This has lead to the recommendation of raising chlorine concentrations for up to 8 hours, and to maintain the pool unused for 3-4 filtration cycles for 24 hours. The consequences of these policies have been significant on pools used for rehabilitation patients. Many individuals may have incompetent sphincter control, resulting in minor incontinence without diarrhea or being unwell. Small accidents, which have been totally contained within the bathing suit, are a relatively common occurrence. Unfortunately, these occurrences have been sufficient to trigger pool-closure responses, which last 24 hours. The consequence is that pools may be closed as often as they are open. This results in severe restrictions, inconvenience, and loss of valuable therapeutic pool time for many individuals. To address pools potential contaminated with feces or vomit, please refer to the Fouled Pool Remedial Procedure.
Page 21 REFERENCES BC Health Act, SWIMMING POOL, SPRAY POOL AND WADING POOL REGULATIONS, B.C. Reg. 289/72,O.C. 4190/72 Responding to fecal accidents in disinfected swimming venues. CDC MMWR weekly. May 25, 2001. 50(20); 416-417. Vancouver Coastal Health. Guidelines for the Stan Stronge Pool. Provincial Infection Control Network of British Columbia. Appendix 7: Pools. PICNet Antibiotic Resistant Organism Provincial Guidelines. Draft Two. April 18, 2008. Interior Health Fouled Pool Remedial Procedures