Disinfection

measures in
the procedure
room

Ali yasin

Group 8
Disinfection

– Disinfection is a process which intends to kill or remove pathogenic micro-

organisms but which cannot usually kill bacterial spores.
– While disinfection is the process of eliminating or reducing harmful
microorganisms from inanimate objects and surfaces, sterilization is the
process of killing all microorganisms.
levels of Disinfection
– Disinfectants can be classified as high, intermediate, or low level, based on the
effectiveness and contact time of the solution and the biocidal activity of an
agent against bacterial spores, mycobacterium tuberculosis, lipid and nonlipid
viruses, and vegetative bacteria.

1. High level
2. Intermediate
3. Low level
 High level disinfection
– High level disinfection processes destroy vegetative bacteria,
mycobacteria ,fungi and enveloped (lipid) and nonenveloped (non lipid ) viruses
but not necessarily bacterial spores
– Items must be thoroughly cleaned prior to high level disinfection
Intermediate Disinfection

– Intermediate disinfection kills vegetative bacteria, most virus and most fungi
but not resistant bacterial spores
 Low level Disinfection
– Low level disinfection kills most vegetative bacteria and some fungi as well as
enveloped (lipid ) viruses (eg :hepatitis B ,C , hantavirus and HIV )
– Low level disinfectants don’t kill mycobacteria or bacterial spores.
– Low level disinfectants are usually used to clean environmental surfaces
 Factors of cleaning and
disinfection
– There are three important factors which together help ensure the cleaning
and disinfection practices within the healthcare facility are of a high
standard.
– These include: Cleaning chemicals, Cleaning equipment, Cleaning
techniques
– All cleaning services staff should be aware of the importance of each factor
and how they interrelate.
– For example, if the cleaning chemicals that are used in the facility are
adequate for the purpose, but cleaning equipment is dirty (e.g. unclean
mops or buckets) or the cleaning technique is poor, then the
cleaning/disinfection of the area will be sub-standard. This chapter
contains information about these three important factors.
 Chemical Disinfectants
– Alcohol
– Chlorine and chlorine compounds
– Formaldehyde
– Glutaraldehyde
– Hydrogen peroxide
– Quaternary ammonium compounds
– Peracetic acid
– Iodophors
– Phenolics
– Ortho-phthalaldehyde (OPA)
– Peracetic acid and hydrogen peroxide
Effectiveness of Chemical
Disinfectants
– Chemical Claims
• All claims regarding the efficacy of a chemical should be carefully assessed and
if necessary clarified. For example, a product may claim to kill Clostridium
difficile and be referring to the vegetative cells, not the spores.
• Cleaning and disinfecting agents should be reviewed and approved by Infection
Prevention and Control Coordinators to assure the chemicals meet the standard
and are effective for their intended use.
Effectiveness of Chemical
Disinfectants
– Chemical Concentration
• One of the most important aspects regarding the effectiveness of a disinfectant
is to ensure that the concentration of the cleaning solution is correct and in
accordance with the manufacturer’s specifications.
• Using a solution that is too weak will not reliably kill micro-organisms on the
surface.
• Using a solution that is more concentrated than specified is not cost effective,
may be detrimental to the life of fixtures and fittings and may be a work health
and safety risk.
Effectiveness of Chemical
Disinfectants

– Contact Time
• Contact time refers to the amount of time necessary for the disinfectant to be in
contact with the surface to inactivate micro-organisms.
• Staff should always adhere to the manufacturer’s specifications regarding
contact time to ensure maximal disinfection effectiveness
Cleaning Equipment

– In general, all cleaning equipment used in healthcare facilities should be fit for
purpose, cleaned and stored dry between use, well maintained and used
appropriately.
– Equipment such as cloths and mop heads which are used to clean blood or body
fluid spills or used in isolation rooms should either be disposable and discarded after
use, or if re-usable, changed immediately after use and placed in a plastic bag for
transport to the laundry
– Equipment such as buckets and containers should be washed with detergent and
disinfectant after each use and stored upside down and allowed to dry between use
– Buckets and containers should be inspected for cracks and replaced accordingly
– Mop heads and cleaning cloths should be changed and laundered daily or after use
(if used less frequently than daily) and changed when visibly soiled
Cleaning Techniques
– The flow of cleaning should be from areas which are considered relatively clean
to dirty. This means that areas/elements which are low touch or lightly soiled
should be cleaned before areas/elements which are considered high touch or
heavily soiled.
– When cleaning a bathroom, the toilet should be cleaned last as it is likely to be
the most contaminated element in that area
– In a patient room, items that would be considered high touch would include the
patient bed, call-bell, locker, overway table, light switches, control knobs, hand
basin etc., and low touch areas would include the walls, windows and floors.
Cleaning Techniques

– The flow of cleaning should generally be from high to low reach surfaces.
– When dusting horizontal surfaces in a patient room, high areas such as those
above shoulder height should be done first followed by all other elements.
– Dusting technique should not disperse the dust, (i.e. use damp cloths).
 Cleaning Techniques

– When using cloths and bucket/solution system to clean:

– to maximize the use of cleaning cloths, they should be folded and rotated in a
manner so as all surface areas of the cloth, including the front and back, are
used progressively as elements are cleaned
– more cloths may be required to clean ‘high-touch surfaces’ compared to the
same surface area of ‘low-touch surfaces’.
– Upon completion, the whole area should be visually checked to ensure the area
is thoroughly cleaned and that elements have not been missed.
Personal Protective Equipment
(PPE)
– PPE refers to a variety of protective clothing and items used alone or in
combination to protect healthcare workers from contact with micro-organisms
and chemicals. There are three types of PPE that cleaning staff may need to use
during the course of their routine activities.
– gloves
– gowns or aprons
– safety glasses
– masks
– face shield.
Before cleaning

– check whether transmission-based precautions apply

– remove clutter where possible
– follow manufacturer’s instructions for proper dilution and contact time for
cleaning and disinfecting solutions
– gather materials required for cleaning before entering the room
– perform hand hygiene upon entering the room
– apply required PPE.
During cleaning

– progress from the least soiled areas (low-touch) to the most soiled areas (high-touch) and from high
surfaces to low surfaces
– avoid ‘double dipping’ of used cloths into clean solution. Doing this can contaminate the remaining clean
cloths which are in the solution and result in spreading microorganisms to surfaces that are wiped
thereafter
– change cleaning solutions regularly; more frequently in heavily contaminated areas, when visibly soiled,
and immediately after cleaning blood and body fluid spills
– vacuum carpets using vacuums fitted with HEPA filters
– be alert for needles and other sharp objects; pick up sharps using a mechanical device e.g. tongs, and
place into sharps container and report incident to the supervisor)
– collect waste, handling plastic bags from the top (do not compress bags with hands)
– perform hand hygiene upon leaving the room.
 Handling Waste
– When handling waste, healthcare facilities should:
– apply standard precautions to protect against exposure to blood and body fluids
during handling of waste
– ensure waste is contained in an appropriate receptacle (i.e. identified by colour
and label) and disposed of according to the facility waste management plan
– ensure healthcare workers are trained in the correct procedures for waste
handling.
After Cleaning

– tools used for cleaning and disinfecting must be cleaned and dried between
uses
– launder mop heads daily; all washed mop heads must be dried thoroughly
before re-use
– disposable mop heads should be used for transmission-based precaution cleans
and/or blood/body fluid spills
– clean the housekeeping trolley
– complete the required documentation and sign off sheets
– report any elements that are in poor condition.
THANK YOU