1. Cleaning and Decontamination
Chapter 9
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2. Objectives
As a result of successfully completing this chapter, students will be able to:
 Discuss basic factors that impact cleaning and decontamination:
Design and location of decontamination area.
Environmental design and controls.
Housekeeping concerns.
Staff safety and personal attire.
Staff education and training.
 Describe important selection and usage concerns for cleaning agents (water, detergents, enzymes, and enzymatic detergents) and for lubricants.
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3. Objectives
 Explain details about cleaning and decontamination, and review manual procedures and mechanical methods to complete both processes.
 Discuss procedures to clean basic types of instruments:
General cleaning protocols.
Delicate and hard-to-clean instruments.
Instrument containers and basins.
Power equipment.
Mobile patient care equipment.
Verification and quality control tactics.
 Review procedures to manage infectious waste.
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4. Important Facts
Cleaning is the first step in device reprocessing after use.
You can clean without sterilizing, but you can never sterilize without cleaning.
Cleaning is the cornerstone of the sterilization process.
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5. Terminology
Cleaning – The removal of all visible and non-visible soil and any other foreign material from the medical device being reprocessed.
Decontamination – Removing or reducing contamination by infectious organisms or other harmful substances.
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6. Design of the Decontamination Area
Floors and walls should be constructed of materials that can tolerate harsh chemicals.
Traffic should be restricted and PPE is required.
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7. The Decontamination Area
Emergency Eyewash/shower equipment should be available within 10 seconds or 30 meters of a potential chemical exposure.
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8. Housekeeping
Horizontal work surfaces should be cleaned and disinfected at the beginning and end of each shift.
Spills should be cleaned immediately.
Floors should be cleaned and disinfected daily.
Biohazardous waste should be removed at frequent intervals.
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9. Personal Protective Equipment
PPE is required at all times.
Discard PPE that is soaked with blood or infectious materials.
Discard torn, punctured or nicked gloves.
Jewelry and acrylic fingernails are not permitted.
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10. Food or Drink is not permitted in the Decontamination area.
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11. Training
No employee should work in the decontamination area without training on:
Standard Precautions
PPE
Safety
Handwashing
Proper handling of contaminated items
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12. Water The primary vehicle in the cleaning process.
Water quality can impact cleaning outcomes.
pH, hardness, and temperature must be monitored
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14. Chelating Agents Sequestering Agents
Chemicals that hold hard water minerals in solution, and prevent soaps or detergents from reacting with minerals.
Sequestering Agents
Chemicals that remove or inactivate hard water minerals.
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15. An Overview of Effective Cleaning Agents
Are non-abrasive
Are low-foaming
Are free-rinsing
Allow for rapid soil dispersion
Are non-toxic
Are effective on all types of soil
Have a long shelf life
Are cost-effective
Can be monitored for effective concentration and useful life.
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16. Detergents
Substances that dislodge, remove, and disperse solid and liquid soils from the surface being cleaned.
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17. Detergents
Detergents are specially formulated for the specific uses. For example, manual cleaning or mechanical cleaning.
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18. Enzymes
Breakdown or “digest” large organic molecules to facilitate their removal.
Are very specific in their actions. Different enzymes work on different soils.
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19. Enzymes Protease – Breaks down blood, mucous, feces, and albumin.
Lipase – Breaks down fatty deposits such as bone marrow and adipose tissue.
Amylase – Catalyzes (changes) starch.
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20. Enzymes and Temperature
Temperatures above 400C (1400F) can affect chemical reactions.
Cool temperatures may not activate the enzyme.
Monitor water temperature and check manufacturer instructions for specific temperature requirements.
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21. Selecting an Enzymatic Detergent
Consider the following factors:
Water temperatures in the decontamination area
Room temperature in the decontamination area
Useful life and stability of the product
Expiration date of the product
The material used to construct the device to be cleaned
Whether it is approved and registered by the EPA
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22. Detergents for Ultrasonic Cleaners
Must be low-foaming to prevent interference with the cleaning process.
Are usually formulated with Surfactants and Chelating agents.
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23. Surfactant – A surface-acting agent that lowers the surface tension of a liquid so it can penetrate deeper. Surfactants also prevent debris from being re-deposited on items.
Chelating Agent – A chemical that holds hard water minerals in solution and prevents soaps or detergents from reacting with minerals.
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24. Instrument Lubricants
Prolong the life and function of instruments.
Instrument lubricants must be water-soluble.
Should be applied after cleaning.
Instrument lubricants cay be applied manually in the clean assembly area or mechanically as one of the final steps in a mechanical wash cycle.
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25. Cleaning
The removal; (usually with detergent and water) of both visible and invisible soil from the surfaces, crevices, serrations, joints and lumens of instruments, devices and equipment.
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26. Remove Gross Soil As Soon As Possible to:
Reduce the number of microorganisms on the item.
Reduce the nutrient material that can support microbial growth.
Reduce the potential for environmental contamination, aerosolization, or spillage.
Minimize damage to devices from blood and other substances.
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27. The Importance of Cleaning
Cleaning is the foundation of disinfection and sterilization.
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28. Decontamination
The use of physical or chemical procedures to remove, inactivate, or destroy bloodborne pathogens.
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29. Decontamination
How an item was, or will be used determines the level of decontamination required.
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30. Technology Creates Cleaning Challenges
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31. Manual Cleaning May be done: Prior to mechanical cleaning
When the decontamination area does not have mechanical cleaners
For delicate or complex instruments
For powered-surgical instruments
For instruments with lumens
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32. Facilitate Cleaning By:
Monitoring water temperature and hardness.
Measuring detergents accurately.
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33. Facilitate Cleaning By:
Opening hinged instruments to expose hinges, jaws, and box-locks.
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34. Cleaning Use a 3-Sink Set-up Wash sink Intermediate Rinse sink
Final Rinse sink
*Brush instruments under the surface of the water to prevent aerosols.
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35. Cleaning Brushes
Use the correct size brush for the item being cleaned.
Clean and disinfect/sterilize routinely or discard and replace.
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36. Mechanical Cleaning Washers
Automated equipment used to clean, decontaminate, or disinfect and dry medical devices.
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37. Ultrasonic Cleaners Use Cavitation Process
Superior to manual scrubbing/cleaning
Require non-foaming detergents
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39. Ultrasonic Cleaner Tips
Rinsing is necessary to remove residue that remains on instruments.
The tank must be routinely cleaned.
Instruments must be precleaned to remove gross soil.
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40. Ultrasonic Cleaner Tips
Must be degassed each time they are filled.
The cleaner’s lid should remain closed during operation.
All lumens should be completely filled with cleaning solution.
All instruments should be completely open and submerged.
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41. Ultrasonic Cleaners
Do not place these items in the ultrasonic cleaner:
Chrome-plated instruments
Ebonized Instruments
Plastic
Cork
Glass
Wood
Chrome
Rubber
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42. Automated Mechanical Washing
Impingement
The spray-force action of pressurized water against instruments being processed to physically remove bioburden.
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43. Mechanical Washers
Use several successive steps in their cycles to clean medical devices.
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44. Mechanical Washer Tips
Expose all surfaces.
Do not stack trays on top of one another.
Remove lids or covers from trays.
Check detergent levels frequently.
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45. Washers Need Direct Contact
Multi-level organizing trays may impede mechanical cleaning processes by shielding the instruments from the wash spray.
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46. Protect Instruments from Damage during Mechanical Cleaning
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47. Mechanical Washers
Choose the correct cycle for the items being processed.
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48. Automated Cart Washers
Automated Cart Washers use detergent and hot water to clean large carts.
With special racks, they may also be used to clean basins, pans, etc.
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49. Basic Instrument Cleaning Procedures
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50. Instrument Decontamination
The most important step in the sterilization process.
Instruments that have not been properly cleaned cannot be sterilized.
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51. Instrument Cleaning
Every instrument or device that enters the decontamination area must be treated as if it is potentially hazardous.
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52. Instrument Cleaning
Should begin within 15 minutes to 1 hour after use.
Prolonged delays in instrument cleaning can have negative impacts on instruments.
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53. Blood should never be allowed to dry on instruments.
Process instruments immediately, or:
Cover with a moist towel
If they can be immersed, place in a soak basin with the appropriate solution.
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54. Instrument Cleaning Disassemble multi-part instruments
Open boxlocks and hinges for cleaning
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55. Instruments with Lumens
Place under water to prevent aerosols when brushing
Brush lumens using an appropriate size brush
Force water and detergent through them using a syringe or cleaning nozzle
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56. Defective Instruments
When Instruments come back from Surgery tagged for repair they must be decontaminated before they are sent for repair.
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57. Clean All Items in Accordance with Manufacturers’ Instructions.
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58. Power Equipment Must be manually cleaned. Do Not Immerse.
Clean cannulations (lumens) thoroughly.
Follow Manufacturer’s instructions
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59. Mobile Patient Care Equipment
Follow OEM (Original Equipment Manufacturer’s) instructions.
Pay attention to details such as access doors, latches, etc.
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60. Cleaning Quality Control
Instruments are visually inspected for cleanliness in the clean assembly area.
There are some commercial monitoring products available to test the effectiveness of mechanical washers.
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61. Infectious Waste Not all healthcare facility trash is “Medical Waste”.
Healthcare facilities separate their waste.
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62. Waste Categories
General Trash – garbage disposed of as municipal solid waste.
Regulated Medical Waste or Infectious Waste – waste capable of transmitting infectious disease.
Hazardous Waste – May cause serious illness or death. Must be red-bagged.
Low-level Radioactive Waste – exhibits radioactive characteristics such as radioactive decay.
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63. Cleaning Summary
Follow established standards and manufacturers’ instructions.
Pay attention to detail.
Cleaning is the most important step in medical device processing.
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64. Questions?
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