larissa lewis, rn, bsn, cic infection preventionist
DESCRIPTION
Why is it important?TRANSCRIPT
High Level Disinfection of Clinical Equipment and
Strategies for Endoscopes
Larissa Lewis, RN, BSN, CICInfection Preventionist
UW Harborview Medical Center
WHY IS IT IMPORTANT?
Reported Outbreaks from Duodenoscopes
• Florida 2008 • Pittsburg 2012• Chicago 2013• Los Angeles 2013-2015• Seattle 2012-2015
Who’s Interested?
…And anyone else who might accredit your facility
Who Offers Guidance
THE BASICS
A Perfect World
Spaulding Classification
• Earl Spaulding was a microbiologist at Temple University
• Over 30 years ago he proposed classification of patient care items and medical equipment and appropriate level of disinfection
Non-Critical
• Equipment/ instruments that contact intact skin
Semi-Critical
• Equipment/ instruments that contact mucous membranes or nonintact skin
Critical
• Equipment/ instruments that enter sterile tissue or the vascular system
Clean
• Removal of soil
Disinfection
• elimination of most pathogenic microorganisms(not spores)
Disinfection
• Low-level disinfection – • elimination of many pathogenic
microorganisms
• High-level disinfection – • elimination of all pathogenic
microorganisms except spores
Sterilization
• elimination of all pathogenic microorganisms, including spores
Back to Earl Spaulding…Critical Items Equipment/
instruments that enter sterile tissue or the vascular system
• Surgical equipment
• ImplantsSterilization
Semi-critical Items
Equipment/ instruments that contact mucous membranes or nonintact skin
• Many endoscopes
• Vaginal US probes
• Respiratory therapy equipment
High level disinfection
Noncritical Items Equipment/ instruments that contact intact skin
• Blood pressure cuff
• Patient environment
• Ambulation aids
Low level disinfection
DON’T FORGET TO CLEAN!
Cleaning is the fundament to disinfection regardless of the level!
Why?Biofilm!
FEMS Microbiol Rev 36 (2012) 972–989
Cleaning ultrasound probes vs scopes
Vs.
These are both semi-critical items
Sterilization
• Steam• Hydrogen peroxide gas plasma• 100% Ethylene oxide (ETO)• ETO mixtures• Vaporized hydrogen peroxide• Ozone
High Level Disinfection
• Peracetic acid/hydrogen peroxide• Gluteraldehyde• Hydrogen peroxide• Ortho-phthalaldehyde (OPA)• Peracetic acid
Manual High Level Disinfection
• Active times vary by product; 7-90 minutes• Chemicals are inactive below certain
temps, vary by product; 20-30°C• Expiration dates of chemicals– Overall expiration– Expiration of the product once open– Expiration of the product in use
• May also have to test solution for quality and keep track of test strip
Lots to Track!
Automated High Level Disinfection• Completes all steps of high
level disinfection following manual cleaning
• Often device specific• Most often used with
endoscopes• Device compatibility is
essential
High Level Disinfection is EVERYWHERE!
• Outpatient clinics/procedure areas• Inpatients ancillary departments• Inpatient procedure areas• Anywhere with– Scopes–Ultrasound probes– Respiratory equipment/ anesthesia
equipment
WHY IS IT SO IMPORTANT TO KNOW WHERE HIGH LEVEL DISINFECTION IS BEING DONE?
This!All staff must be trained and competency validated
And this…
Additional Monitoring for Endoscope Procedures
• ATP? – adenosine triphosphate monitoring–Measures “cleanliness”
• Culturing? – take cultures off scopes after procedures
• Surveillance? – track patients who’ve had the procedure and monitor for infection
Most important
• Know where you have high level disinfection• Ensure device/chemical compatibility• Ensure device/automated reprocessor
compatibility• Make sure your peeps are trained• Track EVERYTHING• Follow manufacturer’s directions– The scope– The chemicals/automated reprocessor
compatibility