INF ECTION P R EVENTION
Reprocessing of laboratory or medical equipment
Whether by hand or by machine, generally all healthcare environments will have an in-house reprocessing area to handle the cleaning of reusable items – anything from sample dishes to surgical instruments – which must have a strict level of sanitisation. Automated reprocessing has advantages for decontamination and infection control, as machines can reach or hold higher temperatures than washing by hand and can provide validation through records of individual cycle statistics. Washer disinfectors provide the critical cleaning of medical devices. Since the start of the pandemic, many healthcare providers are adding more reprocessing capacity to their premises to keep up with the demand. When planning a new reprocessing area, we recommend taking care to ensure this can be in a controlled zone, only accessed by a limited number of staff and ideally not passed through by other people. This will minimise any risk of contamination to the equipment or to the cleaned items. If your reprocessing area is in a less than ideal location and you are unable to move it, consider how it could be protected in another way, for example by installing partitions around it. When loading machines, for best practice, ideally you should use two (or more) colour coded trolleys. One to bring in dirty items for loading or washing, and one to transfer clean items back to where they are needed. If this is not possible, ensure that trolleys are thoroughly cleaned and disinfected between loading and unloading to avoid cross-contamination. If your workplace has a drying or unloading area, again designate a clean area and dirty area with colour coding if possible and ensure they are kept clean.
Clean and disinfect all touch points of the machines after use. Handles and touch screens in particular are important, but the
There is always a risk of infection spreading in any clinical environment, and co-infection or secondary infection of patients in care can cause complications with potentially lethal consequences. This risk factor is heightened by the coronavirus pandemic. Cox et al (2020) described how 50% of patients dying of COVID-19 had secondary bacterial infections.
entire exterior of the machine should be disinfected at least daily. This is an important routine so that all operatives can be sure a machine is free of contaminants when they go to use it. Disinfectant wipes can be used for this task. Keep hand sanitiser next to the machines for added protection.
When cleaning the floors of reprocessing areas, zone the area from clean to dirty and brush or mop in that direction, so that dirt is moved away from the cleanest area of the room, towards the outside. Ideally, your reprocessing zone will not have common areas which are used by staff for other tasks. If it does, these areas need treating with great care in order to minimise risk of contamination reaching the cleaned items. In particular, ensure there is no eating, drinking or general conversations held around this area. Reprocessing operatives should wear gloves, a mask and, ideally, an apron when unloading clean items from the machines. When it comes to the machines themselves, it is down to the needs of your organisation as to what functionality is needed and the size, type and volume of items which need to be cleaned or disinfected. Check on the Government guidelines relevant to your organisation as to
the need for or usage of protein residue kits and their pass protocols.
Such a kit can be used to swab any joins or areas of cleaned items which may have held residue of contaminants in the wash. After applying the solution, wait a few minutes, rinse and check whether a coloured dye is visible to alert you to any protein residue remaining which could not otherwise be seen. If discolouration occurs, it is recommended the full load should be washed again. Remember that hand-drying or air-drying items leads to a risk of contamination from a cloth or airborne dust or droplets. Therefore, the faster you can transfer cleaned items from the machines to their storage area, the lower the risk of contamination. A dry item is also at lower risk of attracting airborne particles than one which is wet. Consider using a drying function or make this a priority if you are investing in a new machine.
Storage of cleaned items is also critical. Of course, the interiors of storage cabinets should be kept clean and ideally avoid storage on open shelving, to minimise risk of dust or airborne contaminants. Make sure to clean handles of drawers or cabinets after each time you touch them.
Laundering of PPE
In a healthcare environment most PPE is single use and, if this is the case, it must be disposed of after use, even if it appears clean or undamaged. Even a hole the size of a pin prick can let in a multitude of bacteria. Some items, however, can be laundered. It is recommended that laboratory coats and scrubs are laundered on site to reduce risk of contamination from an outside source where cleanliness is not so closely regulated as in a clinical environment. Workwear should be laundered every day
after the end of a shift, so it is important that appropriate changing areas are available with clear locations for staff to deposit soiled garments. Make sure it is clear that reusing worn clothing after a shift is not acceptable. It is important to ensure that bags used for contaminated laundry are non-permeable
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