Decontamination in the Hospital and Primary Care Setting

Question 1

Objective of infection control

Answer 1

To prevent potential pathogenic micro-organisms from reaching a susceptible site on a patient in sufficient numbers to cause infection

Question 2

Define decontamination

Answer 2

a process which removes or destroys contamination and thereby prevents micro-organisms, or other contaminants, reaching a susceptible site in sufficient numbers to initiate infection or other harmful response.
Includes cleaning, disinfection and sterilisation.

Question 3

What micro-orgs are commonly found in areas without adequate cleaning regimes?

Answer 3

MRSA, MSSA, C. difficile, gut and throat/mouth flora.

Question 4

What is the role of ‘The Health Act’ 2006?

Answer 4

Ensures risks of HCAI are as low as possible

Advises on environmental cleanliness, hand hygiene and decontamination of multi-use equipment.

Question 5

What is the MHRA?

Answer 5

The medical and healthcare products regulatory authoirt

Question 6

What role does the MHRA play?

Answer 6

Responsible for safety, quality and effectiveness of all medical devices used in healthcare
Manufacturers have to provide information/details on how to decontaminate multi-use items they supply. including compatibility with different decontamination process and chemicals used e.g. detergents and disinfectants.

Question 7

What is the single most important measure to prevent and control the transmission of infection?

Answer 7

hand hygiene

Question 8

When it is appropriate to decontaminate your hands with soap and water?

Answer 8

if hands visibly soiled or following a dirty procedure

Question 9

when is it appropriate to use alcohol gel as HH?

Answer 9

between patient care if hands visibly clean.

Question 10

What organisms are alcohol hand gel not suitable against?

Answer 10

C. difficile and norovirus

Question 11

Define cleaning

Answer 11

Physical removal of contaminants and organic material (protect micro-orgs)
Render environment socially clean but does not necessarily destroy micro-orgs.

Question 12

What will inadequate cleaning result in?

Answer 12

Failure to remove organic material or visible contamination will render sterilisation/decontamination in-effective.

Question 13

Define disinfection

Answer 13

Reduces the number of viable micro-organisms, not necessarily effective against bacterial spores or some viruses.

Question 14

What and when are hypochlorite based environmental disinfectants used?

Answer 14

Manual disinfectants with a broad microbiological range.
Cleaning a side room after the vacation of a known infectious patient or cleaning a ward/nursing home after an outbreak.

Question 15

What and when is hydrogen peroxide gas machine used ?

Answer 15

Automated disinfection of an environment, particularly useful for spores.
Cleaning a side room after the vacation of a known infectious patient or cleaning a ward/nursing home after an outbreak.

Question 16

Disadvantages to cleaning and use flexible endoscopes?

Answer 16

Cannot be autoclaved
Must be cleaned before disinfected.
Disinfected with high controlled automated system - endoscope preprocessor.

Question 17

Limiting factors of disinfection?

Answer 17

Ineffective range of activity - some disinfectants do not affect spores, viruses or TB.
Variation in working conc - alter effective range of activity
Contact time - few offer instant results
Inhibition or loss of activity - disinf inhibited by organic material and other chemicals; loose potency on exposure to air
User errors - manual vs. automated disinfection, manufacturers guidance must be followed.

Question 18

What situations should disinfection be used?

Answer 18

Only used on equipment which contacts intact mucous membranes
if sterilisation or use of single use equipment is impractical.

Question 19

Define sterilisation

Answer 19

A process which renders an object free from viable micro-organisms including bacterial spores and viruses.

Question 20

What situations should sterilisation or sterile equipment be used?

Answer 20

Single use i.e. disposable equipment.

instruments used/in contact with breaks in the skin or mucous membranes and those that enter body cavities.

Question 21

Why is single-use equipment advantageous?

Answer 21

Logistics - practicality, safety and acceptable.e

Question 22

Factors for consideration when purchasing equipment in terms of decontamination

Answer 22

Equipment design and intended use
Manufacturers guidance for maintenance and cleaning - resources in place? achievable?
National guidance/best practice guidelines for cleaning
storage facilities for resources post decontamination.
staffing for decontaminatiin
transportation - methods and TATs

Question 23

What does sterile equipment include?

Answer 23

Single use items
Items/equipment processed by sterile service departments, under strict conditions to ensure sterility is achieved either by autoclaving or through wet heat.

Question 24

How is equipment sterilised?

Answer 24

Autoclaving
Wet heat
Ethylene oxide sterilisation
Hydrogen peroxide gas plasma sterilisation

Question 25

Documentation required for decontamination procedures

Answer 25

Decontamination protocols - must be in place, evidence based practice. Need to state who cleans what and how.

Tracking and traceability - sufficient to very effectiveness of each and avery stage of the decont process of surgical instrument/endoscope. Who and which patient before and after.

Training and training records

Auditing - compliance monitored. - actions agreed and implemented to rectify non-compliance.

Question 26

How is compliance monitored?

Answer 26

Check cleaning and decontamination records are in place.
Visual and observational inspections - practice and environment compliant with policy.
Chemical testing and microbiological sampling where national standards set.

Question 27

CJD decontamination guidance

Answer 27

Disinfection/sterilisation may not prevent CJD transmission.
Procedures with High and medium risk tissues with patients with probable/possible CJD/RF’s - re-usable equipment = quarantined.
Remain in quarantine until a decision has been made to either discard or reprocess and re-use.
Single use equip encouraged where cost and quality are acceptable.

Question 28

Instrument Requirements for high risk procedues (CJD)

Answer 28

Adequate supply of instruments to meet regular and unexpected needs.
Practice should be audited
Stringent tracking and traceability of all surgical instruments allowing patient association.
Effective pre cleaning of instruments is essential prior to sterilisation.

Question 29

Choice of decont method and risk assessment of equipment = low risk

Answer 29

minimal patient contact/healthy skin

Detergent/sanitising wipe or detergent and water

Question 30

Choice of decont method and risk assessment of equipment =medium risk

Answer 30

contact with mucous membranes

Cleaning then Disinfection

Question 31

Choice of decont method and risk assessment of equipment = high risk

Answer 31

contact with sterile body cavities or breaks in the skin/mucous membranes
Must be sterile or disposable. Preceded by effective cleaning.