INFECTION PREVENTION


“Personnel should consult the SDS (safety data sheet) and intended IFU to determine what particular chemical is safe to use and what it is comprised of,” she added. “Disinfectants have specific approvals from the EPA and contact times, so that should always be a con- sideration if looking for agents to disin- fect surfaces.”


When selecting a disinfectant, Walters


advises to pay close attention to the follow- ing attributes and/or ask related questions: • Non-abrasive or toxic product, which is safe for your team and patients


• Free rinsing product that can disinfect the inventory in suitable time


• Cost effective and fits into your bud- get, making sure to consider the dosing amounts and concentration so you can forecast how much your team will uti- lize or require


• Provides a rapid kill rate, and is approved to eliminate the types of microorganisms you are facing


• Is the product environmentally friendly, or does it require special disposal, or storage conditions? Do you have a safety spill kit for this chemical?


 Does it require specific handling instruc- tions, PPE, and respiratory ventilation?


• Does the chemical provide your depart- ment with safe, efficient and effective dis- infection or does it require a mixture of other costly tools or neutralizing agents? Pate notes the importance of align- ing the disinfectant to the device and the environment:


“To ensure the appropriate detergents are selected, determine the compatibility with the instruments to be cleaned, the type of microorganisms that potentially may be on the instruments, the exposure time to the organism, and the physical environment where the chemicals/detergents will be used. IFUs for the devices and detergents selected should be followed. Ensure there is compliance with the parameters given for water hardness, pH, and temperature for each disinfectant, and that it is appropriate for use for that particular instrument.”


Follow best practice standards HPN asked Nancy Fellows, MSN MPA RN CNOR Sr. Clinical Education Consultant, at Advanced Sterilization Products (ASP) to comment on some of the main points of disinfection concern. She emphasized adher- ence to best practice standards. “Factors that come to mind are safety and knowing best practices to minimize exposure


Mr. Spaulding and the rational approach


A microbiologist by the name of Earle Spaulding devised a rational approach to classify the methodologies for properly disinfecting or sterilizing patient-care items. The Spaulding classification system divides items and equipment according to their


likelihood of spreading infection when in use. Dependent on that likelihood (critical, semi critical, or noncritical), it can thus be determined what level of disinfection is required to remove any potential microorganisms. The Centers for Disease Control and Prevention (CDC) defines the Spaulding Classification


system as a “a strategy for sterilization or disinfection of inanimate objects and surfaces based on the degree of risk involved in their use.” The Spaulding classification system is the main reference material many standard com-


mittees as well as device manufacturers utilize when developing new devices. In accordance with the Spaulding Classification system, three levels of disinfectants


have been established to disinfect instruments based on their capabilities for containing and transferring harmful microbes. Used in response to noncritical patient care items/areas, low level disinfectants are


pretty commonplace throughout the hospital setting. These can range from floor cleaning products to surface disinfectants in patient rooms and surgical areas, and also routinely include bedpans, blood pressure cuffs, and crutches. Intermediate level disinfectants are registered with the Environmental Protection Agency (EPA) with a tuberculocidal claim (unlike low level disinfectants, which, though also registered with EPA, do not carry a tuberculocidal claim). Due to their ability to kill most bacteria and viruses, intermediate level disinfectants are often used on surfaces contaminated with blood (though are often applied on such instruments as respiratory therapy items, and sleep study devices). Lastly, high level disinfectants are used (in addition to sterilization) for items that are


considered critical or semi critical in nature, and thus require the removal of any and all microorganisms. Examples of critical items include surgical instruments, cardiac and urinary catheters, implants, and ultrasound probes; semi critical devices include, among others, anesthesia equipment, some endoscopes, esophageal manometry probes, and cystoscopes.


20 November 2022 • HEALTHCARE PURCHASING NEWS • HPNonline.com


for healthcare workers and patients. Best practices are the safest and most effective means of providing care. Implementing best practice standards and procedures ensures patient and staff safety. Performance characteristics should be considered when selecting an appropriate disinfectant solu- tion for any item, and applied it in the most efficient way.


Fellows proceeded to list the following key questions that should always be answered by the CS/SPD teams in selecting and utiliz- ing a disinfectant: • What devices are to be high level disinfected?


 Do they adhere to paulding Classification for clinical application?


• Are the devices material compatible with the HLD solution being considered?


• What are the air exchanges needed depending on the physical environment where HLD is to be performed?


• Is there manufacturer support for educa- tion of staff?


• Is it easy to use? • Is PPE required?


Close adherence to standards is not only imperative for health of the patients, but the staff as well. Improper use of disinfec- tants is often inclined to physically damage a device; likewise, the usage of disinfectants without proper ventilation for the staff can have both instantaneous and long-lasting negative side effects.”


Best means isn’t a clear-cut decision Damien Berg, BS, BA, CRCST, AAMIF, VP of Strategic Initiatives for the Healthcare Sterile Processing Association (HSPA), was adamant in his statement that the so called ‘best means’ for choosing an appropriate disinfectant is a difficult question to answer.


Damien Berg


“This question is vast because the variety of product depends on some factors that the end user must take into account.” He sug- gests asking the following questions when evaluating disinfectants: • What level of disinfection are you want- ing/needing to achieve?


• What are the disinfectants and device’s IFU and are they compatible with one another?


• What are staff safety considerations with other chemicals in the department?


•Does use of the product work with the flow of the department


• Is the product approved for use in the healthcare facility? “All of these are important factors that can determine the appropriate disinfectant and when and how to use it,” said Berg.


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