CLEANING AND DISINFECTION POLICY · CLEANING AND DISINFECTION POLICY First Issued by/date Issue Version Purpose of Issue/Description of Change Planned Review Date BWW/BW PCT March

CLEANING AND DISINFECTION POLICY

First Issued by/date

Issue Version

Purpose of Issue/Description of Change

Planned Review Date

BWW/BW PCT

March 01

2 Revised update. Dec 2012

Named Responsible Officer:- Approved by Date

Infection Prevention and Control Lead

Infection Control Committee

Dec 10

Policy File:- Infection Control Policy No 7

Impact Assessment Screening Complete- Yes

Full Impact Assessment

Required-

No

Key Performance Indicator

1. Infection Prevention and Control audit 2. Attendance levels at Infection Control Core Training

3. Compliance with The Health and Social Care Act 2008 Code of Practice for

health and adult social care on the prevention and control of infections and

related guidance

UNLESS THIS VERSION HAS BEEN TAKEN DIRECTLY FROM THE PCT WEB SITE THERE IS NO ASSURANCE THIS IS THE CORRECT VERSION

Cleaning and Disinfection Policy Page 2 of 21

Contents Page Introduction 3

Policy Aim 3

Policy outcome 3

Target group 4

Specific responsibilities 4 Related policies 5

Evidence to support policy 5

Background 5 Legal obligations 6

Assessment of risk 6

Cleaning - Detergents 7

Manual cleaning of equipment 8

Disinfecting - Disinfectants 9

Blood/Blood Stained Body Fluid management 11 Single Use Device 12

Equipment/Environment A-Z 13

Environmental Cleaning 17

Training 18

Audit 18

Archiving 18 Risk Assessment 18

References 18

List of those consulted in drafting process 18

Appendix 1 – Cleaning Checklist 19


NHS Wirral Cleaning and Disinfection Policy

Introduction

Decontamination of medical equipment and cleaning of the healthcare environment is essential to the effective delivery of patient care regardless of

the care environment. Guidance on the appropriate purchase, maintenance, repair and disposal of

medical equipment is incorporated in the Medical Devices Management Policy.

This policy covers cleaning and disinfection to comply with national guidance. The only service authorised to sterilise instruments within primary care or provider services is Dental Services. This is reflected within this policy. Equipment which needs to be sterile or to have been sterilised must be pre

sterilised single use or processed by an external accredited CSSD.

Policy Aim

The aim of this policy is to give general guidance on the approved cleaning and disinfection products and methods for healthcare equipment and

environment, and outline cleaning responsibilities throughout NHS Wirral, to allow staff to correctly use the appropriate product and cleaning and/or disinfection method.

Safe and correct decontamination of equipment between patients is an essential part of routine infection control practices.

Policy outcome

Equipment used throughout NHS Wirral will be decontaminated appropriate to

the level of risk to ensure risk of cross infection is minimised. For items not detailed in this policy, a risk assessment should be completed by staff for specific items. The clinical environment will be maintained to ensure safe,

clean care. General Practitioners and General Dental Practitioners are responsible for the

management of risks within their practice as part of Health and Safety responsibilities and the Code of Practice duties. To support them in this duty and to provide evidence of compliance with the Code of Practice and HTM 01-

05, this policy is available as an example of best practice.


Target group

All staff employed by NHS Wirral.

Shared as best practice with Independent General Practice staff, and

General Dental Practice staff and where relevant, Independent Pharmacists and Optometrists.

Specific responsibilities Chief Executive

The Chief Executive has overall responsibility for ensuring infection prevention and control is a core part of the Trusts governance and patient safety

programmes. Board

The Board has collective responsibility for ensuring assurance that appropriate and effective policies are in place to minimise the risks of health

care associated infections. Director of Infection Prevention and Control

It is the responsibility of the Director of Infection Prevention and Control to oversee the development and implementation of infection prevention and

control policies. Infection Prevention and Control Team

It is the responsibility of the Infection Prevention and Control Team to ensure

this policy is reviewed and amended at the review date or prior to this following new developments in decontamination research.

Service Managers

It is the responsibility of managers to ensure that staff are aware of this policy, have a suitable and adequate supply of cleaning and disinfection products

appropriate to the care environment and use appropriate dilutions effectively and safely and compatible with the manufacturers decontamination guidance.

It is the responsibility of managers to ensure that no domestic grade cleaning products are bought or used by staff in the healthcare environment.


Staff

It is the responsibility of staff to ensure they are aware of appropriate cleaning and disinfection products as detailed in this policy and that they use approved cleaning products.

Related Policies Please refer to related NHS Wirral policies and procedures.

Evidence to support policy National Resource for Infection Control. Clinical Practice. Cleaning. www.nric.org.uk

NPSA – National Patient Safety Agency

Background Decontamination Process:

This is a combination of processes, including cleaning, disinfection and sterilisation, which when used in combination make a re-usable item safe for re-use.

Cleaning

This is a process which physically removes soil e.g. dust, dirt and organic matter e.g. body fluids, from environmental surfaces and equipment.

Cleaning must precede disinfection. Disinfection

Disinfectants reduce the number of micro-organisms present but cannot be guaranteed to remove all e.g. spores. Efficiency of this process is dependant

on:

Efficient prior cleaning

Appropriate disinfectant for the micro-organisms present

Appropriate strength of the disinfectant

Compatibility of the equipment

Appropriate contact time

Sterilisation:

This is the only process which destroys all micro-organisms including spores. This can be achieved by:

http://www.nric.org.uk/


Pre sterilised single use equipment – All provider services and

Independent General Practice.

Pre Sterilised re-usable equipment decontaminated in an accredited external CSSD – NHS Wirral Podiatry services only.

Sterilised prior to re-use in an appropriately maintained benchtop steam sterilizer – NHS Wirral Dental and General Dental Services only.

Legal obligations The Health and Safety at Work etc. Act (1974). The Control of Substances Hazardous to Health Regulations 2002. The Health and Social Care Act 2008 – Code of Practice for health and adult

social care on the prevention and control of infections and related guidance.

Assessment of risk – Infection Risk to patient from contact with an item of equipment/environment

The method of decontamination selected should consider the risk of the item acting as a source or vehicle of infection and the process that it will tolerate.

Risk

Application Recommendation

High Items in close contact with a

break in the skin or mucous membrane

Items introduced into sterile

body cavities

Single use

Sterilization by

accredited CSSD (Podiatry Service

only)

(Benchtop steam

sterilization preceded by cleaning – Dental

Services only)

Medium Items in contact with intact

mucous membranes

Items/environment

contaminated with potentially virulent or readily transmissible organisms

Items prior to use on immuno-compromised patients

Thorough cleaning

followed by disinfection or

sterilisation (appropriate service only)

Single use

Low Items in contact with intact

healthy skin

Items/environment not in

contact with the patient

Cleaning


No new cleaning agent, disinfectant or sterilisation method may be introduced into NHS Wirral without the specific authorisation of the Infection Prevention

and Control Team.

Cleaning - Detergents

Healthcare grade general purpose detergent diluted according to the manufacturers instructions should be used for general cleaning in all clinical areas. The solution must be discarded on completion of each task.

It is important to dry all surfaces and items after cleaning as bacteria thrive in moist conditions.

Bowls/buckets used for the dilution of detergents must be rinsed and stored inverted to drain.

DETERGENT

USE

General purpose detergent e.g.

Hospec General environmental

cleaning

Uncontaminated equipment cleaning

General purpose detergent/and/or

disinfectant wipe

All equipment and environmental

cleaning if appropriate

NB: Detergents/Disinfectants used must be risk assessed for Control of

Substances Hazardous to Health (COSHH), included in COSHH

inventories and safety data sheets held if appropriate.

Detergents and disinfectants Dual action detergent and disinfectant wipes may be appropriate for use on

patient equipment and in healthcare environments where use of bowls of water may be hazardous e.g. baby clinics, patient’s homes and electrical equipment.


Manual cleaning of equipment Equipment may be decontaminated following the principles outlined below.

Immersion method

If debris present use sink designated for washing of equipment.(Clinical

hand basins should not be used for cleaning of equipment).

Fill the equipment washing sink or container with warm water and the appropriate amount of detergent or detergent disinfectant. Equipment

in the low risk category can be decontaminated using a detergent solution. Equipment in the medium risk category requires cleaning with a detergent and a disinfectant.

NB: It is important that the decontamination product is compatible with the equipment and is diluted to the correct strength.

Clean items under the surface of the water, were possible use a

disposable cloth and discard after use.

Allow equipment to drain then rinse in fresh warm water to remove

residues of the detergent or detergent/disinfectant.

If either the cleaning solution or the rinse water becomes obviously soiled or contaminated, it should be changed and the process

repeated.

Dry with disposable paper.

Store hollow items i.e. buckets, inverted between use.

Disinfect reusable cleaning items with the detergent/disinfectant, rinse

and dry with disposable paper.

Non-immersion method

Non immersion hand washing methods are appropriate for certain equipment where items will become compromised by soaking in aqueous solutions e.g. electrical and electronic equipment, fixed in position or are large items.

Always disconnect electrical items from the mains supply before commencing the cleaning procedure.

Immerse a disposable cloth in an appropriate solution of detergent and

warm water and wring thoroughly.


Wipe the item thoroughly ensuring that the detergent solution does not

enter electrical components where appropriate.

Rinse the disposable cloth in fresh water and repeat the above step. Discard disposable cloth after use.

Dry the equipment using disposable paper towel.

Disinfecting - Disinfectants

When a patient is known to be positive for Clostridium Difficile please refer to Policy on the Prevention and management of Clostridium Difficile infection for

guidance on specific cleaning for equipment used by patient. Sodium Dichloriosocyanurate (NaDCC) is a broad spectrum anti-microbial

agent which is effective against bacteria (including MRSA, E Coli and Pseudomonas), fungi, viruses (including HIV and Hepatitis). It is more stable and therefore more effective than liquid forms of Sodium Hypochlorite. Tablets

have a longer shelf life and are more convenient to use and correctly prepared give an accurate strength. Once made preparations will lose their strength over time,

NB: all solutions must be discarded after 24 hours.

DISINFECTANT

USE: Disinfection of previously cleaned

equipment and hard surfaces

NaDCC 1,000 ppm*

e.g. Actichlor or

Chlor-Clean (combined cleaner and disinfectant) Follow manufacturers

instructions for dilution

e.g.

Propulse Ear syringes and water chamber

Cleaning and disinfection of leg ulcer buckets and Wheelchair Service loan equipment

(NaDCC) 10,000 ppm*

e.g.

spill pack Sodium Dichloroisocyanurate

Blood and Bloodstained Body Fluid spillage (see below for guidance)

70% alcohol hard surface wipes

Disinfection of previously cleaned

hard surfaces and equipment where


facilities are not available to make up

a chlorine disinfectant or may not be safe to do so.

Faecally soiled baby changing mats Faecally soiled baby scales Electrical equipment

Within patients homes Minimal blood spills

General Dental Environment Disinfectants

Chlor clean tablets

Hospec 1 litre General purpose neural liquid detergent

Sani cloth 70 disposable disinfection wipes (contains 70% alcohol)

Sani cloth multi surface wipes (no alcohol or disinfection)

Dental Disinfectants

Dental Unit Water Lines Sterilox (electrochemically

activated water)

Ultra sonic bath Gigasept 500g (enzyme based cleaner & disinfectant)

Suction Unit Orotol 2.5 litres

Pulijet plus 1 litre

Washer disinfector detergent Dekomed detergent

AER 300 detergent

DAC Handpiece machine Nitra clean tablets

* Concentrations of NaDCC solutions are expressed as parts per million of

available chlorine.

Health and Safety considerations when using chlorine based products.

Always ensure manufacturer’s decontamination advice is compatible with the disinfectant intended to be used.

Wherever possible ensure good ventilation when using any chlorine based product.

Disinfectant is not necessary for routine cleaning.

Never mix disinfectants with other disinfectants or detergents.

Disinfectants may react causing a chemical reaction and detergents may reduce the strength of the available chlorine. Only use pre prepared combination products where this is necessary e.g disposable

single use Chlor-clean as these are manufactured to be compatible.


Always wear appropriate protective clothing i.e. gloves and aprons.

Store disinfectant products in a locked cupboard to comply with Control of Substance Hazardous to Health Regulations.

Blood/Blood stained body fluid spillage management It is the responsibility of any suitably trained member of staff to undertake the

prompt and safe removal of the hazard particularly within a general clinic environment. Spill packs are held by receptionists in multi use clinics for NHS Wirral staff use.

Always wear disposable single use gloves and apron and consider eye protection. Ensure the area is adequately ventilated and cannot be accessed

by patients/visitors.

Hard surface procedure (using spill packs): Follow manufacturers guidelines

Lightly cover small spill with chlorine releasing granules, leave for 2 minutes.

Wipe up with paper towels or disposable cloths.

Place contaminated paper towels/disposable cloths in a clinical waste

sack for incineration.

Following procedure wash area with general purpose detergent and hot

water and dry with paper towels if required. Soft surface procedure:

Spillages of blood/blood stained body fluid on furnished or carpeted surfaces may not be able to be disinfected using the above method as the granules may bleach the fabric or not adequately decontaminate interior foams.

Blood/Body fluid spills on carpets may be removed by

Covering blood/blood stained body fluid spillage with cold water to dilute blood.

Absorb the liquid with disposable paper towels.

Place contaminated paper towels/disposable cloths in a clinical waste

sack.

The area may then require cleaning with a carpet cleaner by Support

Services (NHS Wirral areas only). For advice on the decontamination of soft furniture contact the Infection

Prevention and Control Team.


Single use device:

Single use means that the medical device is intended to be used on an individual patient during a single procedure and then discarded. It is not intended to be reprocessed and used on another patient.

This is an item that is to be used only once and then discarded. The items will carry the following marking on its packaging:

Prior to purchasing new equipment

It is the responsibility of Services to ensure that equipment purchased can be effectively decontaminated in line with NHS Wirral policy.


Equipment/Environment A-Z

Equipment

Decontamination Method

Airways Single Use

Ambu bags Single Use/clean with detergent followed by

appropriate disinfectant.

Auroscope ear pieces Single use

Baby changing mat Cover with disposable paper between babies Clean with detergent at end of the session. If contaminated with blood/body fluids – clean then

disinfect before next baby in line with policy

Baby weighing scales Cover with disposable paper between babies Clean with detergent at end of the session. If contaminated with blood/body fluids – clean then

disinfect before next baby in line with policy

Bath (Bathing Centre) Clean with detergent between each client using colour coded single use disposable cloth

Bed (CES*)(patients home)

Remove body fluid contamination as it occurs using detergent/detergent wipe and disinfect if blood or

faeces

Bowls (used for cleaning purposes)

Empty, rinse with clear water and store inverted to dry

Blood pressure

equipment

Wipe cuff and monitor with detergent/detergent wipe,

pat dry with paper towel between patient use, do not immerse cuff in water.

Disposable single use cuff/cuff cover for use when a patient has a multi resistant organism

Buckets for leg ulcer washing

Clean and disinfect with 1,000pm NaDCC (Chlor-clean) between patients and at the end of the

session Store buckets inverted to drain


Commode (patients home)

Remove body fluid contamination as it occurs using detergent/detergent wipe and if contaminated with

blood or faeces – disinfect.

Dental equipment: Treatment sets

Endodontic files Reamers Aspirator tips

Sterilised

Single use Single use Single Use

Doppler ultrasound probe

Remove gel, clean with detergent/detergent wipe, do not immerse in water

Drip Stands Clean with detergent/detergent wipe between patients

Ear syringe - Propulse Follow disinfection procedure in Ear Care Procedure

ECG equipment:

Electrodes Straps/Leads/Machine

Single Use Clean with detergent/detergent wipe, do not immerse

in water

Examination couches Cover with disposable paper towel between patients Clean with detergent at the end of the session

Clean and disinfect with NaDCC if contaminated with blood/blood stained body fluid

Family planning:

Speculum Trial size caps

IUCD equipment Sub-dermal contraceptive implants

All single use

Gym equipment Clean seat and handles of equipment with detergent/

detergent wipe between patients

Hoist (CES*) (Patients home)

Frame Sling

Clean weekly with detergent/detergent wipes Slings can be laundered if contaminated – contact CES for advice


(Consider single use for patients with multi resistant

organism where appropriate and laundry facilities are not available)

Minor surgical Instruments

Disposable Single use

Nebulisers Wash mask and chamber with detergent, rinse and leave to dry on disposable paper

Do not wash tubing

Peak flow

meters/spirometry

Follow manufacturers guidance

Disposable single use mouth pieces with one way valve or filter (change filter as directed by manufacturer)

Clean machine weekly with detergent/detergent wipe

Pelvic stimulator electrodes

Single patient use Clean with detergent/detergent wipe to remove any

residues Wrap in paper roll and replace in carry case Return to patient for cleaning at home following

manufacturers instructions

Pillows All pillows should be protected with plastic (sealed) or vapour permeable cover Wipe with detergent/detergent wipe in between

patients and at end of session. Disinfect with NaDCC if contaminated with blood/blood stained body fluid

Physiotherapy

equipment

Clean weekly with detergent/detergent wipe or if

contaminated, disinfect with NaDCC if contaminated with blood/blood stained body fluid

Podiatry instruments:

Nail surgery Nail/foot treatment

packs Podiatry foot tray

Single use Cleaned and sterilized at external accredited CSSD

Cover with disposable paper between patients

Clean with detergent/detergent wipe at the end of the session Disinfect with NaDCC if contaminated with blood/

blood stained body fluid


Pressure relieving aids (patients home)

Clean with detergent/detergent wipe weekly Contact CES for advice on disinfection

Pulse oximeter Clean weekly with detergent/detergent wipe and

between patients

Scissors:

Single use

NB: Bandage/Dressing scissors – clean between patients with detergent/detergent wipe, disinfect if required

Stethoscope Clean between each patient use with detergent wipe

Sticks/frames/crutches Clean with detergent/detergent wipe between users

Stitch/staple removers Single use

Suction machines Follow manufactures guidance

Contact CES if further advice required

Syringe driver Clean with detergent wipe Do not immerse in water.

Thermometer Disposable sheath for each patient Clean handpiece weekly with detergent/detergent

wipes Do not immerse in water.

Tourniquet Wipe with detergent/detergent wipe pat dry with

paper towel between patient use or Disposable single patient use if appropriate in

specific services. If reusable tourniquet grossly contaminated – dispose of. Ensure adequate supply available.

Treatment chairs Clean daily with detergent/detergent wipes

Trolleys Clean with detergent/detergent wipe prior to/following

use

Toys: Hard

Clean weekly with detergent/detergent wipe or after

use if used as part of treatment/assessment All hard toys must be made of suitable material to withstand disinfection if required.


Soft Not suitable for healthcare facilities

Weighing scales Clean weekly with detergent/detergent wipe

Work surfaces Clean with detergent/detergent wipe at the end of each session

Vaccutainer needle holder

Single use

Vaginal speculum Disposable single use

Vaginal ultrasound probes

Cover with condom during use, clean with detergent/detergent wipes after removal

Do not immerse in water

Wheelchair Clean with detergent/detergent wipe weekly

*CES – Community Equipment Store

Environmental Cleaning Colour Coding of Cleaning Equipment

Equipment used by the contracted cleaning service is colour coded according to the area of use. This equipment is not for the use of NHS Wirral staff.

For large spills e.g. urine and vomit, initially contain with paper towels – dispose of into clinical waste bags.

Clinical staff are to use white buckets (reusable) and white single use disposable mops to decontaminate the area with the relevant cleaning

detergent/disinfectant. Mops and buckets are stored in Domestic Services cupboards. Following use, rinse out bucket and store inverted. Dispose of mop head after use in the appropriate waste stream.

NHS Wirral staff are responsible for

The cleaning and/or disinfection of all medical equipment they use.

Management of blood/blood stained body fluid and non hazardous

spills.

The general cleaning and/or disinfection of the tops of medical

couches, trolleys and worksurfaces they use.

The cleaning and/or disinfection of children’s toys.

The cleaning and/or disinfection of Patient equipment.


Patient Equipment and General Cleaning Checklist This is for use as a guide for clinic based staff to ensure that cleaning of

patient equipment is a priority. The checklist can be adapted for use by specific services and must be regularly monitored by a designated person. (available on IPC website for downloading).

Training Included in Core Infection Control Training.

Audit

As part of the Infection Prevention and Control Audit programme.

Archiving

Hard and/or electronic copies of previous versions of this document will be held by the Infection Prevention & Control Team for the retention period required under current NHS guidance.

Risk Assessment

Included in Service Risk Assessment, clinic and procedure risk assessment.

References

Medicines and Healthcare Regulatory Agency (MHRA) Sterilization - 3rd edition May 2010, Disinfection and Cleaning of Medical Equipment. Guidance on Decontamination from the Microbiological Advisory Committee to the

Department of Health (The MAC Manual) London. MHRA.

List of those consulted in drafting process Infection Control Committee

APPENDIX 1

NHS Wirral Implemented by the Infection Control Team June 2008 Review date November 2012

Patient Equipment and General Cleaning Checklist for Clinic-Based Staff (All Health Care Workers)

Depending on the function of patient equipment in use, cleaning requirements may be classified as either:

after patient contact

between patient contact

on a daily basis

on a weekly basis

All equipment should be assessed and cleaned thoroughly. The cleaning checklist should be completed after each clinic session. Equipment must be cleaned using detergent/detergent wipes. The following is the exception to this:

White buckets (reusable) and white disposable mops are available for use by clinical staff for all other spillages (please refer to Cleaning and Disinfection Policy). The clinical environment must be tidied daily and kept clutter-free. Any non-essential notices or displays on walls, windows or doors throughout the clinic should be removed in order to ensure that the general environment is maintained in a tidy and ‘de-cluttered’ fashion. Notices or posters need to be laminated if possible in order that they can be cleaned/wiped as necessary.

If any equipment is found to be in a poor state of repair, it must be taken out of use and reported, repaired or replaced as soon as possible.

N.B. This list is not exhaustive. Any specialist equipment relating to your area of practice should be added to this cleaning schedule and must be assessed,

cleaned thoroughly and monitored according to its function.

If blood or bloodstained fluids are identified, please clean area/equipment using a Spill-pak. Wear appropriate Personal Protective Equipment (PPE) i.e. disposable gloves and apron and follow manufacturers’ instructions for use.


Clinic Room……………………... Week commencing:

Mo

Any individual monitoring equipment

Wall-mounted suction units/suction apparatus

Wall-mounted oxygen points/oxygen masks

Sphygmomanometer cuffs

Portable monitoring equipment/stands

Electronic thermometer units

Stethoscopes

Patient chairs

Work surfaces

dressing trolleys examination couch

Lifting devices – Hoist

Bathroom (Oxton) inc. bath/hoist, bath chair

Monitored by Designated Person (Please print __________________________________)

Signature: __________________________ Designation: ___________ Date: __________________________

Cleaning checklist for clinic-based staff

N.B. This list is not exhaustive. Any specialist equipment relating to your area of practice should be added to this cleaning schedule and must be assessed,

cleaned thoroughly and monitored according to its function.


Clinic Room……………………... Week commencing:

Mo

Monitored by Designated Person

(Please print ______________________________________)

Signature: __________________________ Designation: ___________ Date: __________________________

Cleaning checklist for clinic-based staff

PLEASE ADD ADDITIONAL ITEMS SPECIFIC TO YOUR AREA

Documents

CLEANING AND DISINFECTION POLICY · CLEANING AND DISINFECTION POLICY First Issued by/date Issue Version Purpose of Issue/Description of Change Planned Review Date BWW/BW PCT March