Decontamination,You, and

Biofilms

Presented by SPSmedical

• Largest sterilizer testing Lab in North America with over 50 sterilizers

• Develop and market sterility assurance products that offer advanced technologies

• Provide full day sterilization Seminars and on-site Facility audits for compliance with best practices

• Corporate member: CSA and AAMI, serving on numerous sterilization working groups

Objectives

At the end of this program, participants will be able to…

• describe general decontamination recommendations,• list OSHA’s Bloodborne Pathogen requirements,• identify CS/SPD personnel attire requirements.• practice the methods for proper transporting and

decontamination of soiled items.

Traffic ControlDecontamination should be restricted to authorized personnel only.

Staff and visitors can carrymicroorganisms into decontaminationareas, increasing the potential for environmental contaminants in these areas.

It also protects them from exposure to contaminated items.

Example of Floor Plan

Biohazard Area

Universal symbol for

biohazard area and

should be prominently

displayed.

Facility Design

Separate functional work

areas with walls or

partitions to:

• control traffic flow,• contain contaminants

generated during processing.

Ventilation

Minimum Air Exhausted

Functional Area Air Flow Air Exchanges to Outdoors

Decontamination Negative (in) 10 per hour Yes

AAMI Table 3, ST-46

Separate from other areas with floor, walls, ceiling and work surfaces made of nonporous materials to withstand frequent cleanings and wet conditions.

Air should be flow into the decontamination area and exhausted to the outdoors via a nonrecirculating system.

Facility Design

• Pass thru window to prep area.• 3 section sink is recommended.• Ideal sink size is 36” high, 8-10” deep and wide

enough to allow instrument trays to lay flat.• Staff safety, proper cleaning and comfort are

the priorities.• Eyewash station.

Facility Design

Here’s an example of an

inexpensive eye wash system

that attaches to the existing

cold water faucet. The hot and

cold water should be blended

that meets OSHA standards.

Available from most Lab Supply Dealers

Personnel

Technicians should be:• competent in standard

precautions• knowledgeable in all

aspects of sterilization • knowledgeable in worker

safety • knowledgeable in the operation of their facility’s

decontamination equipment

Personnel

In accordance with OSHA’s Bloodborne Pathogens

Standard, written policies should be in place and communicated to all employees covering:

• hand washing procedures• clean hair, body and nails at all times• no nail polish or artificial nails permitted• change wet or soiled attire immediately

Personnel

BLOODBORNE PATHOGENS FINAL STANDARD:

SUMMARY OF KEY PROVISIONS

PURPOSE: Limits occupational exposure to blood and other potentially infectious materials since any exposure could result in transmission of bloodborne pathogens which could lead to disease or death.

SCOPE: Covers all employees who could be "reasonably anticipated" as the result of performing their job duties to face contact with blood and other potentially infectious materials.

Fact Sheet No. OSHA 92-46

Bloodborne Pathogens

• EXPOSURE CONTROL PLAN• METHODS OF COMPLIANCE• HEPATITIS B VACCINATION• POST-EXPOSURE EVALUATION AND

FOLLOW-UP• HAZARD COMMUNICATION• INFORMATION AND TRAINING• RECORDKEEPING

EXPOSURE CONTROL PLANRequires employers to identify, in writing, tasks and procedures as well as job classifications where occupational exposure to blood occurs--without regard to personal protective clothing and equipment.

METHODS OF COMPLIANCEMandates standard precautions, (treating body fluids / materials as if infectious) emphasizing engineering and work practice controls.

Bloodborne Pathogens

Hand Washing

Facilities should be located in the

Decontamination area as well as

personnel support areas.

Staff should wash their hands before the beginning

and at completion of work activities. Also wash; after

handling contaminated items, after removing gloves,

after touching the face, before leaving the decontam

area, and after using the toilet.

Hand Washing

According to the CDC… hand washing is the single most important act in the prevention and spread of disease and infections.

Be sure to wash often and feel free to use waterless systems if no soil is present.

Decontamination Attire

Per OSHA’s bloodborne pathogen regulations:• General purpose, utility gloves• Liquid resistant covering with sleeves - Level 4 barrier

performance per AAMI PB70 standard• Eye protection and high filtration mask if risk

of splash or aerosols is present

Reusable gloves, aprons and eye protection should be cleaned at least daily. Before leaving the area, remove all protective attire, being careful not to contaminate skin or clothing, and wash hands.

Decontamination Attire

• Hair covering

• Face mask with shield

• Waterproof disposable gown

• Gloves

• Scrubs

• Shoe covers

Transporting Soiled Items

Think confinement: point of use

to the decontamination area.

Select containers that prevent

spillage:• bins w/lids• impermeable bags• enclosed or covered carts • closed sterilization

containers

What about Biofilms?

Most of the bacteria in the world, live in micro-ecosystems filled with hundreds of different other microorganisms.

And most of the microorganisms are not free-floating (as we may imagine in a culture tube) but instead grow attached to surfaces in complex communities called biofilms.

Biofilms

Biofilms

Biofilms are tenacious

polysaccharide structures

formed by bacteria that cling

to surfaces. Once formed, it

takes direct friction or

oxidizing chemicals to

remove them. Prompt cleaning

reduces or eliminates bio-films.

Bacteria become attracted to surfaces for a number of reasons. One is gravity, as organisms may just settle out and end up resting on a surface. Bacteria (who often have a negative charge associated with their outer envelop) may also be attracted to the positive charges on some inorganic surfaces.

Why and how do these biofilms form?

Biofilms

But there is evidence that biofilm formation is much more than random physical forces. Many surfaces attract and concentrate nutrients, and many bacteria have the capacity to detect and move toward high concentrations of nutrients (an ability called chemotaxis).

Biofilms may form.. - on solid substrates in contact with moisture, - on soft tissue surfaces in living organisms,

- at liquid air interfaces.

Ways to reduce bioburden and formation of biofilms:

• Clean at point of use (POU), e.g. wipe instruments as needed with sterile surgical sponges moistened with sterile water during the procedure to remove gross soil.

• Irrigate instruments with lumens with sterile water as needed throughout the surgical procedure.

• Treat instruments with an enzymatic solution prior to transport.

• Avoid leaving instruments to dry. • Clean ASAP as time is a factor.

Ways to reduce bioburden and formation of Biofilms:

• The more that can be done on the front end, the better the results.

• If blood, protein and fats are left to dry on surgical instruments, the greater the bioburden, the greater the difficulty in cleaning the instrument. If you can not clean, you can not sterilize!

Decontamination

Cleaning and rinsing are considered the first and most important steps in decontamination.

Always follow the device mfg.’s instructions

whether using manual or mechanical means.

Decontamination

Mechanical cleaning: • is recommended because

it provides a high level of cleaning that is difficult to replicate using manual methods.

• Ultrasonic cleaners should be used only after gross soil has been removed.

Decontamination

Mechanical cleaners are available as: • Ultrasonic• Washer-sanitizers• Utensil washers• Cart washers• Pasteurization• Washer-disinfectors / decontaminators• Washer sterilizers

Ultrasonic Washer/Disinfector

Cart washerWasher/Decontaminator

Decontamination

Manual cleaning may be

needed for certain devices:• Temperature sensitive• Solution sensitive• Size limitation• Mixed metals• Power equipment

Three section sinks are recommended for manual cleaning of instruments

(soaking, cleaning and rinsing)

Decontamination

When manual cleaning isneeded, wash below the water line surface to reduce aerosols.

Brushes and other cleaning implements should be disinfected or sterilized daily.

Aerosols are a cloud of solid or liquid particles in a gas

form, created by the scrubbing motion.

Be sure to select and use a Level 4 class of barrier protection apparel per AAMI

standard PB70

Decontamination

Be sure to use lukewarm water

(80°F-110°F) and detergent

solutions. To prevent coagulation,

do not exceed 140°F.

The temperature of the soaking

solution should be monitored

and documented.

Decontamination

Do not use abrasive cleaning compounds, and/or

implements such as metal scouring pads, as they

can damage devices. When cleaning lumens, be

sure to consult with the device

manufacturer for information

regarding the proper brush size

and brush type.

THANK YOU!!

SPSmedical Supply Corp.

Sterilization Products & Services6789 W. Henrietta RoadRush, NY 14543 USAFax: (585) 359-0167Ph: (800) 722-1529

Website: www.spsmedical.com

© 2009, SPSmedical Supply Corp.

Certificate is available after viewing by calling SPSmedical

or e-mailing education@spsmedical.com

Decontamination, You & Biofilms

Purchasing AAMI Standards

If your organization is not a member of AAMI, you may purchase the Standards directly from SPSmedical at our member discount. The member discount saves you 40-50% depending on the document.

For example:

ORDER CODE: AAMI ST:79List Price: $220 Member Price: $110

References & Resources

Association for the Advancement of Medical Instrumentation 1110 North Glebe Road, Suite 220, Arlington, VA 22201-4795703-525-4890 Fax: 703-276-0793 www.aami.org

Association of periOperative Registered Nurses 2170 South Parker Road, Suite 300 Denver, CO 80231-5711800-755-2676 www.aorn.org

Canadian Standards Association5060 Spectrum Way Mississauga, Ontario L4W 5N6 CANADA800-463-6727 Fax: (416) 747-2510 www.csa.ca

Certification Board for Sterile Processing & Distribution2 Industrial Park, Suite 3 Alpha, NJ 08865 908-454-9555 www.sterileprocessing.org

International Assoc. of Healthcare Central Service Materiel Management 213 W. Institute Place, Suite 307 Chicago, IL 60610312-440-0078 Fax: 312-440-9474 www.iahcsmm.org