OR Manager - March 2018 - 22

Sterilization & infection prevention
New guideline focuses on high-level disinfection safety
he new year brings a newly updated
Guideline for Manual
Chemical High-Level Disinfection
(formerly the Guideline for High-Level
Disinfection). This AORN guideline,
which is based on a comprehensive,
systematic review of research- and nonresearch-based
evidence, recommends
best practices for safe and effective
high-level disinfection (HLD) performed
manually when automated methods are
not possible.
T
Reusable semicritical items that have
been validated by the manufacturer for
sterilization should be sterilized if possible
because HLD poses a greater risk
of disease transmission than items processed
by sterilization. Most HLD is performed
in the preferred method of an
automated processor. Automated methods-such
as automatic endoscope reprocessors
(AERs) for HLD or sterilization
of reusable semicritical items-improve
cleaning effectiveness, increase
efficiency, and minimize personnel exposure
to hazardous chemicals.
Equipment that is sterilized using automated
methods can be better monitored
for quality and consistency than
when manual methods are used. However,
some medical devices cannot undergo
HLD in an automated processor,
and this new guideline explains ways to
safely and effectively perform manual
HLD. The purpose of this guideline is to
provide direction for:
* performing safe and effective manual
chemical HLD of reusable semicritical
items
* preventing patient and healthcare
worker injury associated with the
handling and use of liquid chemical
high-level disinfectants.
Safety considerations
When selecting a disinfection or sterilization
method, it is important to review
all available options. Sterilization provides
the greatest margin of safety. An
interdisciplinary team should perform a
risk assessment to review semicritical
22
OR Manager | March 2018
Not all high-level
disinfectants are
effective against
certain viral
pathogens.
devices that secondarily enter sterile
tissue or the vascular system for sterilization
or HLD.
There are 12 guideline recommendations
that discuss how to safely and effectively
preform manual HLD-notably
by thoroughly cleaning the device and
following manufacturer's instructions
for use (IFU).
The area where HLD is performed
should be controlled and maintained to
prevent contamination of the environment,
cross contamination, and employee
exposure while improving efficiency
and enhancing process control
and monitoring. Warning signs may be
posted at the entrance to alert staff
about the potential for exposure to hazardous
chemicals.
HLD should occur in a room that is
separate from patient care and not in
high traffic areas. There should be two
rooms, one for cleaning and one for
HLD. Having two separate rooms reduces
the chance of device contamination
after disinfection because droplets
and aerosols created during cleaning
can cause cross contamination of
nearby clean devices or surfaces.
If the two-room configuration is not
possible, and the cleaning and disinfection
are done in one room, the areas
for HLD should be separated from the
decontamination area by at least 3 feet,
and there should be a separating wall
or barrier that extends a minimum of 4
feet above the rim of the sink. To prevent
cross-contamination, there should
be a one-way flow of items undergoing
processing. Having adequate space
for staff to perform their tasks will decrease
the chance for spills.
Not all high-level disinfectants are
effective against certain types of viral
pathogens. For example, research
shows both glutaraldehyde and orthophalaldehyde
do not demonstrate
any significant reduction of infectious
human papillomavirus type 16. These
types of high-level disinfectants are
commonly used to disinfect vaginal and
rectal endocavity ultrasound probes.
In addition, inadequately disinfected
endocavity probes increase the risk for
transmission of HIV, hepatitis B virus,
hepatitis C virus, Neisseria gonorrhea,
Chlamydia trachomatis, and Trichomonas
vanginalis. Even if sheaths are
used, these probes must be thoroughly
cleaned and disinfected. A system
that uses a nebulized hydrogen peroxide
mist method is more effective than
HLD.
Interdisciplinary teams should be established
to select the type of high-level
disinfectants that will be used and decide
how to store them. Using specially
designated storage locations will reduce
the possibility of spills and personnel
exposure. Activated high-level disinfectants
should be kept in tightly closed
containers that are labeled with the contents
and re-use life dates.
Point-of-use cleaning and proper
transport must occur as medical devices
are sent to the decontamination
room for cleaning. All medical devices
must be thoroughly cleaned because
high-level disinfectants are inactivated
or are less effective in the presence of
organic material.
In addition, some high-level disinfectants
act as fixatives and may fix
organic soil and blood to the surface of
the item being disinfected.
After cleaning, rinse the item and
flush any lumens or channels with water
in accordance with the device manufacturer's
IFU. The device manufacturer
may recommend a final rinse with water
treated to remove organic and inorganic
substances, which will prevent staining
and help ensure effective HLD or sterilization.
www.ormanager.com
http://www.ormanager.com
OR Manager - March 2018

Table of Contents for the Digital Edition of OR Manager - March 2018
