Infection

Prevention
& Control

CSSD &
Endoscopy

Hand & Skin

Sanitization

Cleaning and
Decontamination
Ram Singh
CEO / Technical Director
Amity International

Objectives
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.

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.

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.

Manual reprocessing Chart

Operation
Room
Storage

sterilizer

Pre-Treatment

Washing &
Disinfecting
process

Basics
The reprocessing cycle
Dirty Side

Clean Side
Use/Re-use.

Sterile Storage

Pre-Treatment

Sterilisation

Cleaning
Documentation

Packaging

Disinfection

Control

Drying

Cleaning Organic soils

What types of contaminants are we faced with and need to
be removed?
Organic soils

body fluids
blood
skin
excrements
proteins
fats
germs.

Cleaning Inorganic soils

What types of contaminants are we faced with and need to
be removed?
Inorganic soils

silicates
calcium carbonate
other salts
rust
other corrosions
other mineral deposits.

Basics
Cleaning power vs. Material compatibility
10

10

organic

0
0

acid

mild acid

pH
neutral

10

mild
alkaline

11

12

13

high
alkaline

14

Cleaning power

Material compatibility

inorganic

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.

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.

The Decontamination Area

Emergency Eyewash/shower
equipment should be available
within 10 seconds or 30 meters
of a potential chemical exposure.

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.

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.

Food or Drink is not permitted in the Decontamination area.

Training
No employee should work in the
decontamination area without
training on:

Standard Precautions
PPE
Safety
Hand washing
Proper handling of contaminated
items.

Water
The primary vehicle in the
cleaning process
Water quality can impact cleaning
outcomes
pH, hardness, and temperature
must be monitored.

pH Scale
0

9 10 11 12 13 14

pH is used to measure acidity or alkalinity.

Acids turn litmus paper RED.
Alkalies (sometimes called bases) turn litmus paper
BLUE.

 Chelating 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.

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.

Detergents
Substances that dislodge,
remove, and disperse solid and
liquid soils from the surface
being cleaned.

Detergents
Detergents are specially
formulated for the specific uses.
For example, manual cleaning or
mechanical cleaning.

Enzymes
Breakdown or digest large organic molecules to facilitate their
removal
Are very specific in their actions. Different enzymes work on
different soils.

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.

Enzymes and Temperature

Temperatures above 600C (1400F) can
affect chemical reactions
Cool temperatures may not activate the
enzyme
Monitor water temperature and check
manufacturer instructions for specific
temperature requirements.

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.

Detergents for Ultrasonic Cleaners

Must be low-foaming to prevent
interference with the cleaning
process

Are usually formulated with

Surfactants and Chelating agents.

 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.

Instrument Lubricants
Prolong the life and function of instruments
Instrument lubricants must be water-soluble and steam permeable
Should be applied after cleaning
Instrument lubricants should be applied manually in the clean
assembly area.

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.

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,
aerosolisation, or spillage
Minimize damage to devices from
blood and other substances.

The Importance of Cleaning

Cleaning is the
foundation of
disinfection and
sterilization.

Decontamination
The use of physical or chemical procedures to remove,
inactivate, or destroy bloodborne pathogens.

Decontamination
How an item was, or will be used
determines the level of
decontamination required.

Technology Creates
Cleaning Challenges

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.

Facilitate Cleaning By:

Monitoring water temperature
and hardness
Measuring detergents accurately.

Facilitate Cleaning By:

Opening hinged instruments to
expose hinges, jaws, and box-locks.

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
aerosolisation.

Cleaning Brushes

Use the correct size brush for the item being cleaned
Clean and disinfect/sterilize routinely or discard and replace.

Mechanical Cleaning
Washers
Automated equipment
used to clean,
decontaminate, or
disinfect and dry medical
devices.

Ultrasonic Cleaners
Use Cavitation Process
Superior to manual
scrubbing/cleaning
Require non-foaming detergents.

Cavitation:
Ultrasonic vibrations create tiny air bubbles that grow larger until
they implode (collapse). That implosion dislodges soil from the
instruments surface, as well as crevices, hinges, and other hard
to reach areas within the instrument.

Implosion
Implosion

Ultrasonic Cleaner Tips

Rinsing is necessary to remove residue that remains on instruments
The tank must be routinely cleaned
Instruments must be pre-cleaned to remove gross soil.

Ultrasonic Cleaner Tips

Must be degassed each time they are filled
The cleaners lid should remain closed during operation
All lumens should be completely filled with cleaning solution
All instruments should be completely open and submerged.

Ultrasonic Cleaners
Do not place these items in the ultrasonic cleaner:

Chrome-plated instruments
Ebonized Instruments
Plastic
Cork
Glass
Wood
Chrome
Rubber.

Automated Mechanical Washing

Impingement
The spray-force action of
pressurized water against
instruments being processed to
physically remove bioburden.

Mechanical Washers
Use several successive steps in
their cycles to clean medical
devices.

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.

Washers Need Direct Contact

Multi-level organizing
trays may impede
mechanical cleaning
processes by shielding
the instruments from
the wash spray.

Protect Instruments from Damage during Mechanical

Cleaning

Mechanical Washers
Choose the correct cycle
for the items being
processed.

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.

Basic Instrument
Cleaning Procedures

Instrument Decontamination
The most important
step in the sterilization
process

Instruments that have

not been properly
cleaned cannot be
sterilized.

Instrument Cleaning
Every instrument or device that
enters the decontamination area
must be treated as if it is
potentially hazardous.

Instrument Cleaning
Should begin within 15 minutes to
1 hour after use
Prolonged delays in instrument
cleaning can have negative
impacts on instruments.

Blood should never be allowed to dry on instruments.

Process instruments immediately,
or:
Use Foam or Gel to keep
instruments moist
Cover with a moist towel
If they can be immersed, place in
a soak basin with the appropriate
solution.

Instrument Cleaning
Disassemble multi-part
instruments

Open box-locks and hinges for

cleaning.

Instruments with Lumens

Place under water to prevent
aerosolisation when brushing
Brush lumens using an appropriate size
brush
Force water and detergent through
them using a syringe or cleaning nozzle
or appropriate equipment.

Defective Instruments
When Instruments come back
from Surgery tagged for repair
they must be decontaminated
before they are sent for repair.

Clean All Items in Accordance with Manufacturers

Instructions.

Power Equipment
Must be manually cleaned
Do Not Immerse

Clean cannulations (lumens)

thoroughly
Follow Manufacturers
instructions.

Mobile Patient Care Equipment

Follow OEM (Original Equipment
Manufacturers) instructions
Pay attention to details such as
access doors, latches, etc.

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.

Infectious Waste

Not all healthcare facility trash is Medical Waste

Healthcare facilities separate their waste.

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.

Cleaning Summary
Follow established standards
and manufacturers
instructions
Pay attention to detail
Cleaning is the most
important step in medical
device reprocessing.

Thank you

Q & A