Conwy & Denbighshire NHS Trust. Ymddiriedolaeth GIG Siroedd Conwy a Dinbych Conwy & Denbighshire NHS Trust

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1 Ymddiriedolaeth GIG Siroedd Conwy a Dinbych POLICY FOR ANTISEPTICS AND DISINFECTANTS YELLOW 09 Policy Details: Author job title: Senior Nurse - Infection Control Dept/Working Group(s): Infection Control Validating Body: Clinical Risk Group Date validated: 26 August 2003 Current review changes: Addition of paragraph 5.3 Periacetic Acid - Perasafe Antiseptics & Disinfections Ratifying Body: Medical Director Date ratified: 30 September 2003 Date operational: 10 October 2003 Date to be reviewed: 01 March 2005 Refers to the following policies: Review History: First Operational: June 1996 Previously Reviewed: Dec 1997 July 1998 Sept 2000 Updated yes/no: yes no yes Yellow 09 10/10/03 Page 1 of 5

2 POLICY FOR ANTISEPTICS AND DISINFECTANTS Contents 1. Cleaning: 2 2. Disinfection: 2 3. Sterilization: 2 4. Antiseptics: Alcohol: Biguanides, e.g. chlorhexidine - (Quaternary ammonium compounds, e.g. cetrimide): Halogens, e.g. iodine and iodophors (povidone-iodine): 3 5. Disinfectants: Aldehydes: Halogens, e.g. hypochlorite (Domestos): Periacetic Acid (e.g. Perasafe): 4 1. Cleaning: A process that removes contaminants, including soil, dust, large numbers of microorganisms and other organic matter, e.g. faeces, blood. Cleaning is an essential prerequisite to disinfection and sterilization. 2. Disinfection: This implies that the disinfected object has been made safe to handle by the destruction of sufficient, if not all, pathogenic micro-organisms. This does not include bacterial spores. 3. Sterilization: This is a process designed to kill ALL living organisms, including bacterial spores and viruses. These terms are used widely in the context of the prevention of infection in hospitals. However, it should be stressed that they must each be used correctly. Antiseptics are substances, which may be used to reduce bacterial levels and are gentle enough to be applied to skin and living tissues. Disinfectants are substances, which may be used to reduce bacteria levels, but are too irritant, toxic or caustic to use on skin. They are only used for disinfection of objects, e.g. equipment, trolleys, bowls etc. NB Although certain 'antiseptics', e.g. alcohol, chlorhexidine, may be used to disinfect objects, 'disinfectants', e.g. glutaraldehyde, hypochlorites, must NEVER be applied to skin. 4. Antiseptics: 4.1. Alcohol: 70% alcohol is the optimal strength for killing organisms. Alcohol in a gel form is used for hand disinfection prior to sterile barrier procedures. The combination of antiseptics and alcohol, e.g. 0.5% chlorhexidine in 70% alcohol (or povidone-iodine in alcohol), enhances the anti-bacteria effect and is used to provide the best disinfection of intact skin (before surgery). Yellow 09 10/10/03 Page 2 of 5

3 4.2. Biguanides, e.g. chlorhexidine - (Quaternary ammonium compounds, e.g. cetrimide): Chlorhexidine should not be used for environmental disinfection (wall, floors etc) as it is inactivated by the presence of dirt and organic debris. Chlorhexidine antiseptics are formulated primarily for use on the skin and mucous tissues, and are highly active against vegetative Gram-positive organisms. They are less active against Gram-negative organisms. 4.3 Halogens, e.g. iodine and iodophors (povidone-iodine): These have a wide range of anti-bacterial activity and are rapid in action. Iodine preparations have the added advantage of being sporicidal, and are thus often employed pre-operatively, or as 'surgical scrub' for pre-operative treatment of the hands. The main disadvantage of iodine is that it can provoke skin reactions in sensitive individuals and also stain the skin. Reactions of this type have now been considerably reduced by the introduction of preparations called iodophors, which are complexes of iodine, incorporating a detergent, e.g. povidone-iodine (Betadine/Videne). 5. Disinfectants: 5.1 Aldehydes: Glutaraldehyde (e.g. 'ASEP') has a good antibacterial spectrum, but is not suitable for environmental disinfections, as it does not penetrate organic matter. Unlike most other disinfectants, glutaraldehyde is effective against bacterial spores. Because of high cost and instability of 'activated' solutions, glutaraldehyde should be reserved only for disinfecting special equipment, which may be damaged by heat (e.g. endoscopes) Health Hazard: Glutaraldehyde is a liquid with a pungent odour. Exposure can cause eye, skin and lung irritation and allergic skin reaction. The solution, once activated for use, must be kept in a well-ventilated room with a low extract ventilator unit - refer to the Policy and Procedure for the use of glutaraldehyde Protective Clothing: Full protective clothing, gloves, oversleeves, eye protection plastic to be worn at all times when in contact with solution Halogens, e.g. hypochlorite (Domestos): Hypochlorites are cheap and effective, acting by the release of free chlorine solutions. They are unstable and have a limited shelf life. Hypochlorites are used mainly for disinfecting relatively clean surfaces, such as food preparation areas, where the use of a non-toxic agent is essential. Because hypochlorites are readily inactivated by organic matter, the best results are obtained by a two-step process, in which the surface is first cleaned with a compatible detergent, and then disinfected by suitable dilution of hypochlorite. It is important that only general purpose detergent is used, otherwise the disinfectant will be inactivated. Hypochlorites may damage certain materials, e.g. some plastics, some metals and fabrics, if the contact time is prolonged. Where the presence of viruses is suspected, a hypochlorite disinfectant should always be used. Yellow 09 10/10/03 Page 3 of 5

4 Health Hazard: Never mix hypochlorite disinfectants with other cleaning agents, since the free chlorine produced will be harmful. Always make up a fresh solution for each episode. Hypochlorite loses its effectiveness within 24 hours. Always use general purpose detergent for cleaning surfaces before disinfecting with a hypochlorite to make sure the hypochlorite activity is maximal. Protective clothing - gloves and apron must be worn when using hypochlorite to protect against skin sensitisation. Hypochlorite solution must not be used for skin disinfection Blood Spillage: Sodium Hypochlorite 1% solution is required available from Pharmacy. The hypochlorite solution must be used neat when dealing with any blood spillage for environmental cleaning. Refer to Infection Control Manual Yellow Periacetic Acid (e.g. Perasafe): Perasafe is a free running powder. It is inactive in its powder form but becomes active on contact with water releasing Periacetic Acid; it includes a Corrosion inhibitor and is buffered to PH8 in solution. It acts; by oxidizing protein and cell membrane residues in inactivate them, and is used to sterilize non-autoclavable instruments. Perasafe is safe and non-toxic to users and there are no ventilatory requirements. CONWY & DENBIGHSHIRE NHS TRUST POLICY FOR THE USE OF DISINFECTANTS DISINFECTANT Environmental disinfection Alcohol 70% wipe (Alcowipe) Chlorhexidine 0.5% in 70% IMS with sodium nitrite 0.1% Chlorine releasing 500mg tablets Chlorine releasing 0.1% (1000ppm) solution Chlorine releasing 1% (10,000ppm) solution USE consult infection control manual for further information Hard surface disinfectant following cleaning with general purpose detergent Ophthalmic use only. Disinfection of baby bottles/breast pumps after washing with general purpose detergent Ophthalmic use only. For dealing with blood spillage Chlorine releasing solution 5% Disinfection following cleaning with general (50,000) (Domestos) purpose detergent General purpose detergent Routine environmental cleaning Glutaraldehyde 2.2% solution Disinfection of heat sensitive e quipment e.g. endoscopes Industrial Methylated Spirits 70% Disinfection of equipment in I.T.U, gastroenterology and audiology only Yellow 09 10/10/03 Page 4 of 5

5 Periacetic Acid (e.g. Perasafe) Disinfection of heat sensitive equipment. Patient disinfection Alcohol 70% swab (Mediswab) Chlorhexidine gluconate 0.5% aqueous solution (Unisept) Chlorhexidine gluconate 4% surgical scrub Chlorhexidine gluconate 0.5% in 70% IMS spray Chlorhexidine gluconate 0.5% in 70% } IMS } Chlorhexidine gluconate 0.5% } aqueous solution } Chlorhexidine gluconate 1% obstetric cream (Hibitane) Chlorhexidine/Cetrimide aqueous solution (Tisept) Chlorhexidine/Cetrimide irrigation (Travasept) Povidone- iodine 10% aqueous antiseptic solution (Betadine/Videne) Triclosan 2% skin cleaner (Aquasept) Staff disinfection Soap Alcohol 70% gel (Leverline) Chlorhexidine 0.5% in 70 % IMS hand rub Povidone iodine 7.5% surgical scrub (Betadine/Videne) Skin disinfectant prior to Venflon siting Ophthalmic use only Second line pre-operative hand wash Disinfection of skin prior to epidural insertion Second line skin disinfectant prior to invasive procedures SCBU use only for skin disinfection prior to invasive procedures For use before and during labour For dermatology and family planning use only For Urology use only First line skin disinfectant prior to invasive procedures Routine skin wash prior to surgical procedures Routine hand washing between patients First line hand disinfection prior to sterile/barrier procedures after washing with soap Second line hand disinfection prior to sterile/barrier procedures after washing with soap. For use when no access to alcohol wall dispensers First line pre-operative hand wash Yellow 09 10/10/03 Page 5 of 5

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