Decontamination, You, and Biofilms

Presented by SPSmedical Largest sterilizer testing Lab in North America with over 50 sterilizers Develop and market sterility assurance products that offer advanced technologies Provide full day sterilization Seminars and on-site Facility audits for compliance with best practices Corporate member: CSA and AAMI, serving on numerous sterilization working groups

Objectives At the end of this program, participants will be able to… describe general decontamination recommendations, list OSHA’s Bloodborne Pathogen requirements, identify CS/SPD personnel attire requirements. practice the methods for proper transporting and decontamination of soiled items.

Traffic Control Decontamination should be restricted to authorized personnel only. Staff and visitors can carry microorganisms into decontamination areas, increasing the potential for environmental contaminants in these areas. It also protects them from exposure to contaminated items.

Example of Floor Plan

Biohazard Area Universal symbol for biohazard area and should be prominently displayed.

Facility Design Separate functional work areas with walls or partitions to: control traffic flow, contain contaminants generated during processing.

Ventilation Minimum Air Exhausted Functional Area Air Flow Air Exchanges to Outdoors Decontamination Negative (in) 10 per hour Yes AAMI Table 3, ST-46 Separate from other areas with floor, walls, ceiling and work surfaces made of nonporous materials to withstand frequent cleanings and wet conditions. Air should be flow into the decontamination area and exhausted to the outdoors via a nonrecirculating system.

Facility Design Pass thru window to prep area. 3 section sink is recommended. Ideal sink size is 36” high, 8-10” deep and wide enough to allow instrument trays to lay flat. Staff safety, proper cleaning and comfort are the priorities. Eyewash station.

Facility Design Here’s an example of an inexpensive eye wash system that attaches to the existing cold water faucet. The hot and cold water should be blended that meets OSHA standards. Available from most Lab Supply Dealers

Personnel Technicians should be: competent in standard precautions knowledgeable in all aspects of sterilization knowledgeable in worker safety knowledgeable in the operation of their facility’s decontamination equipment

Personnel In accordance with OSHA’s Bloodborne Pathogens Standard, written policies should be in place and communicated to all employees covering: hand washing procedures clean hair, body and nails at all times no nail polish or artificial nails permitted change wet or soiled attire immediately

Personnel BLOODBORNE PATHOGENS FINAL STANDARD: SUMMARY OF KEY PROVISIONS PURPOSE: Limits occupational exposure to blood and other potentially infectious materials since any exposure could result in transmission of bloodborne pathogens which could lead to disease or death. SCOPE: Covers all employees who could be "reasonably anticipated" as the result of performing their job duties to face contact with blood and other potentially infectious materials. Fact Sheet No. OSHA 92-46

Bloodborne Pathogens EXPOSURE CONTROL PLAN METHODS OF COMPLIANCE HEPATITIS B VACCINATION POST-EXPOSURE EVALUATION AND FOLLOW-UP HAZARD COMMUNICATION INFORMATION AND TRAINING RECORDKEEPING

EXPOSURE CONTROL PLAN Requires employers to identify, in writing, tasks and procedures as well as job classifications where occupational exposure to blood occurs--without regard to personal protective clothing and equipment. METHODS OF COMPLIANCE Mandates standard precautions, (treating body fluids / materials as if infectious) emphasizing engineering and work practice controls. Bloodborne Pathogens

Hand Washing Facilities should be located in the Decontamination area as well as personnel support areas. Staff should wash their hands before the beginning and at completion of work activities. Also wash; after handling contaminated items, after removing gloves, after touching the face, before leaving the decontam area, and after using the toilet.

Hand Washing According to the CDC… hand washing is the single most important act in the prevention and spread of disease and infections. Be sure to wash often and feel free to use waterless systems if no soil is present.

Decontamination Attire Per OSHA’s bloodborne pathogen regulations: General purpose, utility gloves Liquid resistant covering with sleeves - Level 4 barrier performance per AAMI PB70 standard Eye protection and high filtration mask if risk of splash or aerosols is present Reusable gloves, aprons and eye protection should be cleaned at least daily. Before leaving the area, remove all protective attire, being careful not to contaminate skin or clothing, and wash hands.

Decontamination Attire Hair covering Face mask with shield Waterproof disposable gown Gloves Scrubs Shoe covers

Transporting Soiled Items Think confinement: point of use to the decontamination area. Select containers that prevent spillage: bins w/lids impermeable bags enclosed or covered carts closed sterilization containers

What about Biofilms?

Most of the bacteria in the world, live in micro- ecosystems filled with hundreds of different other microorganisms. And most of the microorganisms are not free- floating (as we may imagine in a culture tube) but instead grow attached to surfaces in complex communities called biofilms. Biofilms

Biofilms are tenacious polysaccharide structures formed by bacteria that cling to surfaces. Once formed, it takes direct friction or oxidizing chemicals to remove them. Prompt cleaning reduces or eliminates bio-films.

Bacteria become attracted to surfaces for a number of reasons. One is gravity, as organisms may just settle out and end up resting on a surface. Bacteria (who often have a negative charge associated with their outer envelop) may also be attracted to the positive charges on some inorganic surfaces. Why and how do these biofilms form?

Biofilms But there is evidence that biofilm formation is much more than random physical forces. Many surfaces attract and concentrate nutrients, and many bacteria have the capacity to detect and move toward high concentrations of nutrients (an ability called chemotaxis).

Biofilms may form.. - on solid substrates in contact with moisture, - on soft tissue surfaces in living organisms, - at liquid air interfaces.

Ways to reduce bioburden and formation of biofilms: Clean at point of use (POU), e.g. wipe instruments as needed with sterile surgical sponges moistened with sterile water during the procedure to remove gross soil. Irrigate instruments with lumens with sterile water as needed throughout the surgical procedure. Treat instruments with an enzymatic solution prior to transport. Avoid leaving instruments to dry. Clean ASAP as time is a factor.

Ways to reduce bioburden and formation of Biofilms: The more that can be done on the front end, the better the results. If blood, protein and fats are left to dry on surgical instruments, the greater the bioburden, the greater the difficulty in cleaning the instrument. If you can not clean, you can not sterilize!

Decontamination Cleaning and rinsing are considered the first and most important steps in decontamination. Always follow the device mfg.’s instructions whether using manual or mechanical means.

Decontamination Mechanical cleaning: is recommended because it provides a high level of cleaning that is difficult to replicate using manual methods. Ultrasonic cleaners should be used only after gross soil has been removed.

Decontamination Mechanical cleaners are available as: Ultrasonic Washer-sanitizers Utensil washers Cart washers Pasteurization Washer-disinfectors / decontaminators Washer sterilizers

UltrasonicWasher/Disinfector Cart washer Washer/Decontaminator

Decontamination Manual cleaning may be needed for certain devices: Temperature sensitive Solution sensitive Size limitation Mixed metals Power equipment Three section sinks are recommended for manual cleaning of instruments (soaking, cleaning and rinsing)

Decontamination When manual cleaning is needed, wash below the water line surface to reduce aerosols. Brushes and other cleaning implements should be disinfected or sterilized daily. Aerosols are a cloud of solid or liquid particles in a gas form, created by the scrubbing motion. Be sure to select and use a Level 4 class of barrier protection apparel per AAMI standard PB70

Decontamination Be sure to use lukewarm water (80°F-110°F) and detergent solutions. To prevent coagulation, do not exceed 140°F. The temperature of the soaking solution should be monitored and documented.

Decontamination Do not use abrasive cleaning compounds, and/or implements such as metal scouring pads, as they can damage devices. When cleaning lumens, be sure to consult with the device manufacturer for information regarding the proper brush size and brush type.

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Purchasing AAMI Standards If your organization is not a member of AAMI, you may purchase the Standards directly from SPSmedical at our member discount. The member discount saves you 40-50% depending on the document. For example: ORDER CODE: AAMI ST:79 List Price: $220 Member Price: $110

References & Resources Association for the Advancement of Medical Instrumentation 1110 North Glebe Road, Suite 220, Arlington, VA Fax: Association of periOperative Registered Nurses 2170 South Parker Road, Suite 300 Denver, CO Canadian Standards Association 5060 Spectrum Way Mississauga, Ontario L4W 5N6 CANADA Fax: (416) Certification Board for Sterile Processing & Distribution 2 Industrial Park, Suite 3 Alpha, NJ International Assoc. of Healthcare Central Service Materiel Management 213 W. Institute Place, Suite 307 Chicago, IL Fax: