Categories of
instruments and equipment used in patient care and its reprocessing
1.
Critical: These items confer a high risk for
infection if they are contaminated with any microorganism. The
items/instruments Entry or penetration into sterile tissue, cavity or blood
Stream. High-level disinfection and sterilization is required.
The process as follows;
·
Sterilize
after cleaning by steam under pressure
·
If
heat or moisture sensitive, sterilize through an automated low temperature
chemical sterilant system, other liquid chemical sterilants or ethylene oxide
sterilisation
Examples of items/instruments
·
Invasive
surgical and dental equipment e.g. surgical oral instruments, arthroscopes,
laparoscopes, rigid and flexible bronchoscopes, heat stable scopes.
·
Cardiac
and urinary catheters, implants and ultrasound probes used in sterile body
cavities
Storage:
Sterility must be maintained:
·
packaged
items must go through a drying cycle and then be checked to ensure drying has
taken place before use or storage
·
the
integrity of the wrap must be maintained
·
wraps
should act as an effective biobarrier during storage
2.
Semi-critical: These items come into contact with
mucous membranes or non-intact skin, and should be single use or sterilized
after each use.
The process as follows;
·
Clean
thoroughly as soon as possible after using
·
Steam
sterilization is preferable
·
If
the equipment will not tolerate steam use a high level chemical
Examples of items/instruments
·
Respiratory
therapy and anaesthesia equipment, some endoscopes, vaginal speculae,
laryngoscope blades, cystoscopes,
·
Probes
including transoesophagal echocardiogram, transrectal ultrasound and
transvaginal probes
Storage:
Store to prevent environmental contamination
3.
Non critical: These items come into contact with
intact skin but not mucous membranes. Thorough cleaning is sufficient for most
non-critical items after each individual use, although either intermediate or
low-level disinfection may be appropriate in specific circumstances.
The process as follows;
·
Clean
as necessary with detergent solution
·
If
decontamination necessary, use disinfectant
·
Stethoscopes,
sphygmomanometers, blood pressure cuffs, mercury thermometers,
non-invasive ultrasound probes, intravenous pumps and
ventilators
Storage:
·
Store
in a clean dry place to prevent environmental contamination
Methods of cleaning:
Automated cleaners (ultrasonic cleaners and
washer-disinfectors) reduce the handling of instruments and are recommended for
cleaning basic instruments that can withstand the process.
• Ultrasonic cleaners work by subjecting instruments to high frequency, high-energy sound
waves, thereby loosening and dislodging dirt.
• Washer-disinfectors use detergent solutions at high temperatures to wash instruments. When a
washer-disinfector is used, care should be taken in loading instruments: hinged
instruments should be opened fully to allow adequate contact with the detergent
solution; stacking of instruments in washers should be avoided; and instruments
should be disassembled as much as possible.
b) 2. Manual
Cleaning is done manually for fragile
or difficult-to-clean instruments and in areas without automatic units.
The two essential components of
manual cleaning are:
·
Friction:
rubbing/scrubbing the soiled area with a soft brush
·
Fluidics
- use of fluids to remove soil and debris from internal channels after brushing
and when the design does not allow passage of a brush through a channel.
Cleaning agents
The cleaning solution and style must
be appropriate for each instrument and equipment. Cleaning solutions are
usually neutral pH or mildly alkaline as such solutions generally provide the
best material compatibility profile and good soil removal and mildly acidic
solutions may damage instruments.
6. Respiratory hygiene
and cough etiquette
Respiratory hygiene and cough etiquette should be applied as
a standard infection control precaution at all times. Covering sneezes and
coughs prevents infected persons from dispersing respiratory secretions into
the air. Hands should be washed with soap and water after coughing, sneezing,
using tissues, or after contact with respiratory secretions or objects
contaminated by these secretions.
Steps in respiratory hygiene and cough etiquette
Anyone with signs and symptoms of a respiratory infection,
regardless of the cause, should follow or be instructed to follow respiratory
hygiene and cough etiquette as follows:
·
Cover
the nose/mouth with disposable single-use tissues when coughing, sneezing,
wiping and blowing noses
·
Use
tissues to contain respiratory secretions
·
Dispose
of tissues in the nearest waste receptacle or bin after use
·
If
no tissues are available, cough or sneeze into the inner elbow rather than the
hand
·
Practice
hand hygiene after contact with respiratory secretions and contaminated
objects/materials
Keep contaminated hands
away from the mucous membranes of the eyes and nose
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