6 Environmental Cleaning and Equipment Safety

The stages of reprocessing

Reprocessing reduces the spread of microorganisms and helps protect patients and workers. The appropriate method depends on what an item contacts, how it is used, the type of contamination, and the instructions from the product or device manufacturer. Cleaning must come before disinfection or sterilization.

Cleaning, disinfection, and sterilization

Cleaning physically removes soil and organic material, usually with water and detergent or an enzymatic cleaner. It lowers the number of microorganisms and prepares an item for later processing. Dried blood and tissue can be difficult to remove and can interfere with disinfection or sterilization.

Disinfection inactivates many or most disease-causing microorganisms on inanimate objects, but ordinary disinfection does not reliably destroy bacterial spores. The level of disinfection—low, intermediate, or high—is selected according to the item’s intended use.

Sterilization destroys all forms of microbial life, including bacterial spores. It is required for critical devices. Disinfectants are intended for inanimate surfaces and equipment; antiseptics are formulated for living tissue.

Choose processing by intended use

The Spaulding classification connects an item’s infection risk to the minimum reprocessing needed. Classify an item by what it contacts in its intended use:

• Critical: Contacts normally sterile tissue or the vascular system. Examples include surgical instruments and implants; these require sterilization before use.

• Semicritical: Contacts mucous membranes or nonintact skin. Many endoscopes and respiratory devices fit this category; they require at least high-level disinfection. Use heat sterilization when the device and its instructions permit or require it.

• Noncritical: Contacts intact skin only. Examples include blood-pressure cuffs and stethoscopes; these require cleaning and, when indicated, low-level disinfection.

Follow the device manufacturer’s reprocessing instructions and facility policy. Intended use matters: an item contacting nonintact skin may need a higher level of processing than the same item used only on intact skin. Do not use high-level disinfectants or chemical sterilants on ordinary noncritical surfaces.

Reprocess reusable equipment safely

Treat used equipment as contaminated until it has completed the required reprocessing. At the point of use, remove gross soil and prevent it from drying when the device instructions call for this. Transport contaminated instruments in a closed, appropriately leak-resistant container. Use puncture-resistant containment when sharps could puncture the container. Wear task-appropriate PPE, and do not reach by hand into containers holding contaminated reusable sharps.

In the designated reprocessing area, follow the required steps:

1. Clean the device thoroughly, including hinges, joints, channels, and other hard-to-reach areas, using the specified method and detergent or enzymatic cleaner.

2. Rinse and inspect as directed. If soil remains, repeat cleaning; do not proceed as though the item is clean.

3. Disinfect or sterilize according to the item’s classification and the manufacturer’s instructions. Observe the required concentration, temperature, exposure time, and other process conditions.

4. Rinse, dry, package, and store as required for the device and process. Protect processed items from recontamination.

5. Monitor sterilization. Use mechanical and chemical monitoring for each load as applicable, and biological indicators at the frequency required by guidance, regulation, and facility policy. Document results and follow the facility’s response procedure if a cycle or indicator fails. Do not release a load that does not meet release criteria.

Clean and disinfect the environment

Use a written, risk-based schedule that specifies who cleans each area, what is cleaned, how often, and which products and methods are used. Clean high-touch surfaces more frequently than low-touch surfaces. Examples of high-touch surfaces include bed rails, call buttons, bedside tables, IV-pole handles, switches, and shared equipment. Clean and disinfect shared noncritical patient-care equipment between patients as required by facility policy and its instructions. Perform terminal cleaning after patient transfer or discharge according to facility procedure.

Use a systematic approach to limit the spread of contamination: work from clean to dirty, high to low, and in an orderly pattern. Use a fresh cloth surface as it becomes soiled. Do not double-dip a cloth into a clean solution or shake cloths and mop heads. Prevent cleaning equipment and solutions from carrying contamination between rooms, and reprocess reusable cleaning tools after use according to policy.

Choose a product approved for the surface, equipment, and intended pathogen. Follow the product label and device manufacturer’s instructions, including dilution, application method, ventilation, PPE, and wet contact time. Do not mix cleaning chemicals. Consult the safety data sheet (SDS) for hazards and protective measures. Disinfectant fogging does not replace routine manual cleaning and disinfection.

Manage blood and body-fluid spills

Respond promptly to blood and body-fluid spills using the facility’s procedure. Restrict access as needed, put on PPE appropriate to the spill and splash risk, and use absorbent material to remove visible contamination. Dispose of cleanup material in the correct waste container. Clean the surface, then apply an appropriate disinfectant according to its label and allow the required contact time.

Never pick up potentially contaminated broken glass with bare hands. Use tools such as forceps, tongs, or a brush and dustpan. Report spills or exposures through the facility’s required channels.

Handle contaminated waste and laundry

Place contaminated sharps immediately, or as soon as feasible, in a closable, puncture-resistant, leak-resistant sharps container. Do not recap, bend, or break a used sharp by hand. Place other regulated waste in closable, leak-resistant containers labeled or color-coded as required, and close them before transport. Follow applicable federal, state, and local disposal rules; not every item that has contacted a patient is automatically OSHA-regulated waste.

Handle contaminated laundry as little as possible and with minimal agitation. Bag or containerize it where it was used, and do not sort or rinse it at the point of use. Use leak-resistant containment when wet laundry could leak or soak through, and wear appropriate PPE.

Meet workplace and facility requirements

The Bloodborne Pathogens Standard, 29 CFR 1910.1030, requires employers to maintain a clean and sanitary worksite and establish a written cleaning schedule and decontamination methods based on the location, surface, soil, and work performed. Work surfaces contaminated with blood or other potentially infectious materials must be decontaminated after procedures, promptly when visibly contaminated or after a spill, and at the end of the shift if contamination may have occurred since the last cleaning.

Protective coverings must be replaced when visibly contaminated or, when potentially contaminated, at the end of the shift. Employers must provide appropriate PPE and safe procedures for handling contaminated equipment, waste, and laundry.

Facility infection-prevention policies may require additional patient-care cleaning, such as disinfecting equipment between patients. Follow facility policies as well as OSHA requirements, product labels, device instructions, and applicable local regulations.