What s New in IPAC at PHO! Refresher on Reprocessing

Transcription

1 What s New in IPAC at PHO! Refresher on Reprocessing Francine Paquette Infection Control Consultant South Western Ontario Infection Control Network Public Health Ontario

2 What s New in IPAC at PHO Updated Tool for MERS- CoV Novel Respiratory Infections Infectious Disease report in August: CDI In the works: Core Competencies: Additional Precautions Reprocessing resources UTI resources CRMD resources

3 MERS-CoV List of revisions in the front of the document ID and management of patients who present with severe acute respiratory infection that may be due to MERS-CoV

4 Novel Respiratory Infections Contents include: Summary table - surveillance results / actions to take Initial Response IPAC Measures: PPE, Cleaning, Accommodation, Aerosol Generating Procedures (AGPs), Patient/Resident Movement and Visitor Restrictions

5 CDI Highlights PHO does a Monthly Infectious Diseases Surveillance Report Some issues feature a focused subject, for example the August Issue was on CDI

6

7

8 Construction, Renovation, Maintenance and Facility Design Toolkit A toolkit: free, practical, easily accessible and relevant documents to assist ICPs The tools were development in collaboration with stakeholder focus groups

9 Organization of the Toolkit Guidelines, Checklists, Information sheets and PowerPoint Presentations Will be posted to the PHO website as writeable and downloadable pdf s Planning Phase Work Phase Commissioning Phase

10 Refresher on Reprocessing Instrument Reprocessing in Long-Term Care Image Credit: Istockphoto.com/Suze777

11 What is Reprocessing? Reprocessing Principles Application in LTC 11

12 What is Reprocessing? The steps performed to prepare used medical equipment/devices for use (e.g. cleaning, disinfection, sterilization). Best Practices for Cleaning, Disinfecting and Sterilization of Medical Devices/Equipment, 2013, pg. 6 Image Credit: Public Health Ontario,

13 13

14 Medical Equipment/Devices Any instrument, apparatus, appliance, material, or other article, whether used alone or in combination, intended by the manufacturer to be used for human beings for the purpose of diagnosis, prevention, monitoring, treatment or alleviation of disease, injury or handicap; investigation, replacement, or modification of the anatomy or of a physiological process; or control of conception. PIDAC Best Practices for Cleaning, Disinfection and Sterilization in All Health Care Settings, May 2013, p5

15 Best Practices for Cleaning, Disinfection and Sterilization: All medical equipment/devices that will be purchased and will be reprocessed must have written device-specific manufacturer s cleaning, decontamination, disinfection, wrapping and sterilization instruction. If disassembly or reassembly is required, detailed instructions with pictures must be included. Staff training must be provided on these processes before the medical equipment/device is placed into circulation. Best Practices for Cleaning, Disinfection and Sterilization in All Health Care Settings, May 2013, page 28 15

16 Education and Training The manager and all supervisors involved in reprocessing must, as a minimum, have completed a recognized qualification/certification course in reprocessing practices. Best Practices for Cleaning, Disinfection and Sterilization in All Health Care Settings, page 21 16

17 Education and Training In settings where surgical procedures are done (including IHF, OHP) and where reprocessing is performed on site, there must be a designated individual(s) responsible for reprocessing, with: training to the level that is required for the volume and complexity of the equipment to be reprocessed documentation of training, including a training manual that is reviewed annually and updated as required ongoing continuing education. Infection Prevention and Control for Clinical Office Practice, page 53 17

18 Education and Training 1. Manufacturer s Instructions Medical devices Reprocessing Equipment 2. PHO Education on Best Practice 3. Core Competencies 18

19 IPAC Core Competency Education 19

20 Why is Reprocessing Important? To prevent transmission of organisms To minimize damage to medical equipment and devices from foreign material Image Credits: Public Health Ontario, 2014, Istockphoto.com/ILLYCH 20

21 Reprocessing Principles Spaulding s Classification Dr. E. Spaulding first proposed this concept in 1957 developed the concept further through the 1960s and published it in 1971 He believed that how an object should be disinfected depended on its intended use.

22 Spaulding s Classification CRITICAL Enters sterile body cavity, contacts sterile tissue SEMI-CRITICAL Contacts non-intact skin or mucous membranes NON-CRITICAL Touches only intact skin or does not touch resident Image Credits: Tudor Barker/Flickr Creative Commons; de:benutzer:kalumet/wikipedia Commons; Public Health Ontario,

23 Cleaning The physical removal of foreign material (e.g., dust, soil) and organic material (e.g., blood, secretions, excretions, microorganisms). Cleaning physically removes rather than kills microorganisms. It is accomplished with water, detergents and mechanical action. 23 Image Credit: Public Health Ontario, 2013

24 Cleaning The physical removal of foreign material (e.g. dust, soil) and organic material (e.g., blood, secretions, excretions, microorganisms). Cleaning physically removes rather than kills microorganisms. It is accomplished with water, detergents and mechanical action. Best Practices for Cleaning, Disinfection and Sterilization in All Health Care Settings, page 3

25 Cleaning Cleaning is always essential prior to disinfection or sterilization. An item that has not been cleaned cannot be assuredly disinfected or sterilized. Health Canada. Hand Washing, Cleaning, Disinfection & Sterilization. CCDR. 1998; 24S8

26 Before you clean: Device must be disassembled prior to cleaning (unless otherwise recommended by the manufacturer) Sort like products together Segregate sharps and/or delicate equipment to prevent injury A soak may be used to prevent drying of soil Don t use saline May use a detergent based product (including enzymes) Cleaning

27 NON-CRITICAL Touches only intact skin or does not touch resident Requires low level disinfection Image Credit: Public Health Ontario,

28 Low Level Disinfection Eliminates vegetative ( live ) bacteria, some fungi and enveloped viruses Only used to disinfect and must not be used as general cleaning agents, unless combined with a cleaning agent as a detergent/disinfectant 28

29 Low Level Disinfection Examples of LLDs are: 60-90% ethyl or isopropyl alcohol Chlorine Sodium hypochlorite or calcium hypochlorite Phenolics Quaternary Ammonium Compounds ( QUATs ) Hydrogen peroxide enhanced action formulation 29

30 Public Health Ontario s online bleach dilution calculator: 30

31 Low Level Disinfection Examples of equipment requiring LLD: Shared bedpans, urinals, commodes Stethoscopes Blood pressure cuffs Lift slings Baby scales Environmental surfaces (e.g. IV poles, wheelchairs, beds) Fingernail care equipment that is single-resident use 31

32 Image Credits: de:benutzer:kalumet/wikipedia Commons SEMI-CRITICAL Contacts non-intact skin or mucous membranes Requires high level disinfection 32

33 Disinfection The inactivation of diseaseproducing microorganisms. Disinfection does not destroy bacterial spores. Medical equipment/devices must be cleaned thoroughly before effective disinfection can take place. Image Credit: Public Health Ontario,

34 High Level Disinfection Eliminates vegetative bacteria, enveloped viruses, fungi, mycobacteria, and non-enveloped viruses Sterilization is the preferred method for reprocessing semi-critical devices Examples of HLD are: 2% glutaraldehyde (20 minutes) 6% hydrogen peroxide (30 minutes) 0.2% peracetic acid (30-45 minutes) 2-7% hydrogen peroxide enhanced action formulation (HP-EAF) 0.55% ortho-phthaladehyde (OPA) Pasteurization 34

35 High Level Disinfection Examples of equipment requiring HLD: Endoscopes Specula (nasal, anal, vaginal) disposable strongly recommended Respiratory therapy equipment Anaesthesia equipment Ear syringe nozzles Breast pump accessories CPR face masks Ear cleaning equipment Fingernail care equipment used on multiple residents 35

36 Remember: There is no longer intermediate level disinfection! 36 Image Credit: Public Health Ontario, 2013

37 Image Credits: Tudor Barker/Flickr Creative Commons CRITICAL Enters sterile body cavity, contacts sterile tissue, enters vascular system Requires sterilization 37

38 Why Sterilize? Preferred over HLD Wider margin of safety than disinfection Two most commonly used methods: Sterilization using heat and pressure Liquid chemicals requiring prolonged submersion in a chemical sterilant 38

39 Sterilization Eliminates all disease-producing microorganisms, including spores Preferred method for heat-resistant items is STEAM If steam is not possible, consider: 2 % glutaraldehyde (10 hours at 20 C) 0.2 % peracetic acid (12 min at C) 6-25 % hydrogen peroxide liquid (6 hours) 2 % enhanced action formulation hydrogen peroxide (6 hours at 20 C) 7 % enhanced action formulation hydrogen peroxide (20 min at 20 C) Image Credit: Public Health Ontario,

40 Sterilization Examples of equipment requiring sterilization are: Surgical instruments Endoscopes that enter sterile spaces (e.g. laparoscopes) Implantable devices Biopsy equipment Dental equipment Foot care equipment Image Credit: Public Health Ontario,

41 CLASS OF MICROORGANISM Prions e.g. Creutzfeldt-Jakob disease (CJD) and variant CJD MOST RESISTENT MINIMUM LEVEL OF REPROCESSING REQUIRED Prion Reprocessing Required Bacterial spores e.g., Clostridium difficile Protozoa with cysts (e.g., Giardia, Cryptosporidium) Mycobacteria (e.g., TB) Sterilization High Level Disinfection Non-lipid or small viruses e.g., polio virus, coxsackie High Level Disinfection Fungi e.g., Candida, Aspergillus Lipid or medium sized virus e.g., herpes, HIV, hepatitis B/C Vegetative bacteria e.g. Staphylococcus, Pseudomonas LEAST RESISTENT High-level Disinfection, some Low Level Disinfection Low Level Disinfection Low Level Disinfection PIDAC Infection Prevention and Control for Clinical Office Practice, page 49

42 IPAC for Clinical Office Practice: Appendix I and K 44

43 Checking in Critical Semi- Critical Non-Critical Image Credit: Microsoft Clip Art 45

44 Checking in Critical Semi- Critical Non-Critical Image Credit: Microsoft Clip Art 46

45 Checking in Critical Semi- Critical Non-Critical Image Credits: de:benutzer:kalumet/wikipedia Commons 47

46 Checking in Critical Semi- Critical Image Credit: Microsoft Clip Art Non-Critical 48

47 Checking in Critical Semi- Critical Non-Critical Image Credit: Public Health Ontario,

48 Checking in Critical Semi- Critical Non-Critical Image Credit: Microsoft Clip Art 50

49 Factors Affecting Reprocessing 1. Cleanliness of the surface of the equipment/device 2. Characteristics of equipment/device 3. Type and concentration of the product 4. Duration and temperature of exposure to the product 5. Physical and chemical properties of the reprocessing environment 51

50 Re-usable vs. Single Use Re-usable equipment Withstands cleaning in a detergent without rusting or becoming dull Withstands sterilization Single use items Discarded after use Or may be assigned to client Reprocessing Challenges: Equipment 52 Image Credit: Istockphoto.com/Arno Massee

51 Reprocessing Challenges: Equipment Materials (e.g. rubber and plastic) will not withstand steam sterilization Rubber or synthetic materials handles of instruments may not tolerate prolonged exposure to chemical sterilants Will become brittle or cracked 53

52 Reprocessing Challenges: Equipment Inspect hinges, cracks and crevices closely - can harbour soil, debris and microorganisms Difficult to clean equipment (e.g. power equipment, narrow lumens on endoscopes) Image Credit: Istockphoto.com/shutswis

53 Monitoring Sterilization Routine Monitoring of Sterilizers: Verifies process and sterility Validate and test as per manufacturer s instructions Requires qualified staff Done on installation, before general use and routinely

54 Performance monitoring using all three types of indicators/monitors must be completed in all sterilizers to ensure that effective sterilization has been achieved. Best Practices for Cleaning, Disinfection and Sterilization in All Health Care Settings,2013, p 38 56

55 Types of Monitoring Physical Monitoring Chemical Indicators Biological Indicators Image Credit: Public Health Ontario,

56 Monitoring HLD Also required to monitor HLD because, over time, contact with organic matter can decrease concentration of disinfectant Chemical concentrations can be monitored using test strips Frequency depends on how frequently the solution is used 58

57 All reprocessing of medical equipment/devices, regardless of source, must meet this guideline whether the equipment/device is purchased, loaned, physician/practitioner-owned, used for research or obtained by any other means, and regardless of where reprocessing occurs. PIDAC Best Practices for Cleaning, Disinfection and Sterilization in All Health Care Settings, May 2013, p12 59 Image Credit: Istockphoto.com/Ekaterina Molchanova

58 Reprocessing Challenges: Space Requirements for Reprocessing Space: Designated, segregated area Reprocessing work are physically separated from clean area Surfaces easily cleaned and disinfected 60

59 Many microorganisms are on the feet. Risks Associated with Foot Care They can be transmitted to instruments, equipment and others. They include bacteria, viruses, fungi, yeast, spores and blood borne pathogens (Hepatitis B,C, HIV). There is a risk that foot care instruments may come in contact with broken skin. Image Credit: Istockphoto.com/AlexRaths

60 The overall goal of infection prevention practices for foot care is to eliminate the risk of transmission of pathogens between clients and between clients and the health care worker eliminate the client risk of acquiring infections. Health Canada (Public Health Agency of Canada). Infection Control Guidelines : Foot Care By Health Care Providers. CCDR. Supp. 23S8; December 1997.

61 Applying Concepts to Foot Care Equipment Best Practices for Cleaning, Disinfection and Sterilization in All Health Care Settings, page 74

62 Applying Concepts to Foot Care Equipment

63 Questions to Ask! Foot Care: Who is doing the foot care in your facility? Do you have a contracted provider? Does your staff do foot care? Who is responsible for reprocessing? How is medical equipment reprocessed? How does it need to be reprocessed? (Clean first, then disinfect or sterilize?)

64 More Questions To Ask! Do they use single-use/disposable or multi-use equipment? Do they have the right tools/products/space to reprocess this item? Do they have the manufacturer s recommendations for reprocessing this item? How do you know it is really clean/disinfected/sterile? Can you be sure they know what they are doing?

65 Recommendations Identify all equipment that is reprocessed Determine method and frequency of reprocessing Have written policies and procedures for each piece of equipment. Review annually. Audit reprocessing practices. Implement quality improvement based on audit results. Use hospital grade chemical and medical grade equipment

66 Best Practices for Reprocessing Review when new equipment being considered for purchase A centralized area for reprocessing Written P&Ps for each item requiring reprocessing Training of all staff performing reprocessing Validation of cleanliness, sterility and function of the device Continual monitoring of reprocessing procedure Corporate strategy for dealing with single-use devices Recall process for improperly reprocessed devices 71

67 Questions Contact us! Phone: Image Credit: istock_mark_gnet 72

68 Thank You! Please take a few moments to complete the evaluation for today s session. Your feedback is extremely valuable. 73

69 References Ontario Agency for Health Protection and Promotion, Provincial Infectious Diseases Advisory Committee (PIDAC): Routine Practices and Additional Precautions in All Health Care Settings. 3rd edition. Toronto, ON: Queen s Printer for Ontario; November Best practices for cleaning, disinfection and sterilization of medical equipment/devices. 3rd ed. Toronto, ON: Queen s Printer for Ontario; May Infection Prevention and Control for Clinical Office Practice. 1st Revision. Toronto, ON: Queen s Printer for Ontario; April Health Canada (Public Health Agency of Canada). Infection Control Guidelines : Foot Care By Health Care Providers. CCDR. Supp. 23S8; December