Home Health Best practices for environmental health : environmental pollution, protection, quality and sustainability
Equipment (Medical and Surgical)
In the United States, annually there are about 46.5 million surgical and other invasive medical procedures including about 5 million gastrointestinal endoscopies. In each of these procedures, pathogenic organisms can be introduced into the body by means of the medical device or surgical instrument, thereby setting up a site of infection leading to potentially serious consequences for the patient and outbreaks of healthcare-associated infections caused by a break in procedure in the proper cleaning, disinfecting and, where necessary, sterilization of the equipment.
Sterilization is a process that destroys all forms of microbial life including spores and it may be accomplished by use of steam under pressure, dry heat, ethylene oxide gas, hydrogen peroxide gas plasma, or liquid chemicals. Disinfection is a process that eliminates all pathogenic microorganisms except bacterial spores on inanimate objects. Cleaning is the visible removal of all soil, either organic or inorganic, from objects and surfaces and can be accomplished either mechanically or by hand utilizing appropriate detergents. Decontamination results in the removal of pathogenic microorganisms from objects. The proper techniques utilized in any case include first meticulous cleaning and thorough rinsing, and then depending on the nature of the equipment, utilizing decontamination, disinfection, or sterilization techniques.
The Spalding technique which was set up as a rational approach to disinfection and sterilization of patient care items and equipment many years ago, although still being used in some areas, is considered to be an oversimplification, however the reader should understand what it is and how it works. The technique consists of dividing all patient care items and equipment into three categories including: critical items which enter sterile tissue or the vascular system and have to be sterile; semicritical items that come in contact with mucous membranes and non-intact skin including respiratory and anesthesia equipment and certain endoscopes which have to be free from all microorganisms but bacterial spores are allowed; and non-critical items that come in contact with intact skin but not mucous membranes such as bedpans, blood pressure cuffs, etc. and can be decontaminated on site without having to go to central supply for processing. One of the problems with implementing this procedure is the reprocessing of complicated medical equipment that is heat sensitive or the inactivation of certain infectious agents such as prions. Another problem is the processing of an instrument in the semi-critical category such as an endoscope that may be used with a critical instrument that comes in contact with sterile body tissues. The optimal contact time for high-level disinfection has not been defined and therefore there is no one Best Practice established for this type of procedure.
Factors that affect disinfection and sterilization include the number and location of the microorganisms and whether or not they produce spores; the resistance of the microorganisms; the concentration and potency of the disinfectants; the temperature, pH, relative humidity, and water hardness of the solution containing the disinfectants; the type and amount of organic and inorganic matter that is on the surface of medical equipment; the time of exposure of the equipment to the disinfecting solution; and the presence or absence of biofilms which are large groups of microorganisms that are tightly attached to surfaces and may be surrounded by additional materials and are difficult to remove.
Each of the major groups of instruments or pieces of equipment in use will be discussed and the most modern Best Practices will be stated as follows.
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