Cleaning, Decontamination and Waste Management
Understand how to maintain a clean environment to prevent the spread of infection. 1. 1 State the general principals for environmental cleaning The general principals for environmental cleaning are to ensure the hospital environment is as clean as possible to reduce the risk of infection, and that all precautions are taken in accordance to legislation and Healthcare policy’s and guidelines. “To prevent the transfer of micro-organisms which may cause infection, and to prevent the transfer of foreign protein which may cause adverse reaction and pose the risk of spreading diseases e.
g. vCJD. “ Ref: class handout for Decontamination by xxxx 1. 2 Explain the purpose of cleaning schedules Cleaning schedules are put into place to give staff members a routine of when cleaning is due to take place, weekly, daily or monthly. The schedule follows the guidelines recommended by the hospital. The schedule is posted in a visible area and is completed when the cleaning has been completed. The schedule allows the management documentation to complete an audit trail and a record of usage of equipment and materials.
A cleaning schedule gives staff members specific task to be completed, it should include the cleaning materials to be used, what items are to be cleaned and how often, and a sign off sheet to be completed when task has been completed 1. 3 Describe how the correct management of the environment minimises the spread of infection To be able to minimise the spread of infection in the environment, all members of staff have to be trained in all aspects of infection control and the methods of waste management.
National standards apply to all areas of infection control and the hospital environment by providing the staff with updated training, carrying out cleaning schedules using the correct methods and materials for each task. All staff members are responsible for reducing the risk of infection and contamination of equipment and environments, by following the hospitals policies and procedures to prevent the spread of micro-organisms in the environment. The policies and procedures can be found in each department and contain all the methods of reducing the risk of infection i.
e. Endoscopy Unit Decontamination Policy for Endoscopes Decontamination of hospital equipment including medical devices Policy and procedures for Hand Hygiene in Practice Universal infection control policy (UICP) Needle-stick policy and actions to be taken after exposure to blood and bodily fluids (including HIV post exposure Prophylaxis) Management of needle-stick injuries and exposure to blood and high risk bodily fluids Personal Protective equipment policy Health and Safety Policy (safe handling) Oct 2006
1. 4 Explain the reason for the national policy for colour coding of cleaning equipment The reason for a colour coding for cleaning equipment is to prevent cross-contamination and to reduce the risk of spreading infection. “National Colour-Coding for the British Institute of Cleaning Service. Mops, buckets and aprons will be used in line with national colour codes as indicated below to prevent cross infection from equipment: RED: Sanitary appliances and wash room floors BLUE: General areas GREEN: Kitchen areas
YELLOW: Isolation rooms/areas WHITE: Protective isolation rooms” Ref: http://www. ruh. nhs. uk/ The codes are to prevent the spread of infection from one area to another all mops, buckets, cloths should be coloured coded and staff should be know the colour codes and what areas equipment can be used in. 2. Understand the principles and steps of the decontamination process 2. 1 Describe the three steps of the decontamination process 2. 2 Describe how and when cleaning agent are used 2. 3. Describe how and when disinfecting agents are used
Decontamination is a process, which destroys or removes microorganisms to prevent them from causing an infection and to prevent the transfer bodily fluids. There are three steps of the decontamination process and depending on the risk of infection and the manufactures information on how to decontaminate a specific piece of equipment. All equipment must be cleaned in between patients if it is re-usable and not for single use. There are three levels of risk High, intermediate and low, and three ways to decontaminate Cleaning, Sterilisation, and Disinfection.
Cleaning removes organic matter, and most micro-organisms it does not destroy all micro-organisms, this method also can be used prior to the sterilisation or disinfection of equipment Cleaning is a low grade form of decontamination, when a piece of equipment has not been in contact with a patient or a patient who has healthy unbroken skin. Cleaning is accomplished by using hot water with a detergent using a disposal cloth. I use this process as a social clean prior to the three-step wipe method for the flexible endoscopes we use in the department.
When I have finished with the cloth it is disposed of in the yellow clinical waste along with the gloves. When cleaning equipment I ensure they are dried properly to prevent contamination. Disinfection is used when a piece of equipment may have been contamination with a pathogenic micro-organism from mucous membranes or bodily fluids. Disinfection reduces the amount of micro-organisms but it will not destroy all bacteria or viruses. There are two methods of disinfection Heat and chemical disinfectants. Auto-claves are used in the hospital for items e. g.
bed pans, endoscopes and devices used on a patient. If a department does not have Auto-claves a liquid form of disinfection can be used i. e. chlorine, we used Clinell disposable wipes to clean beds, surface areas in the department and any spills of blood or body fluids and discard them in the clinical waste container. Sterilisation is used for high risk equipment that has been contaminated by entering the body or had contact with bodily fluids and mucous membranes, this process removes and destroys all pathogenic micro-organisms including bacteria and viruses.
The surgical instruments used in the department are place in the red striped used instrument paper bag and placed in CSSD red plastic container where they go for autoclaving in sterile services department. 2. 4 Explain the role of personal protective equipment during the decontamination process Personal Protective equipment is provided in all departments according to the “Personal Protection Policy June 2008 to prevent cross-infection and to reduce the risk of clothing and skin by patients’ blood, bodily fluids, secretions and excretions” As a healthcare assistance it is my responsibility to protect myself from infection.
When working with patients I used the necessary protection, depending on the risk of procedure, or the cleaning of equipment necessary to prevent the risk of infection or cross contamination. I am provided with a gloves, apron, mask and face goggles. The equipment is provided to reduce the risk of exposure to pathogenic microorganism when exposed to used instruments, endoscopes and contact with a patients bodily fluids or secretions they form a barrier and reduce the risk of cross infection or contamination.
During a procedure I was my hands as a cleaning, dry them and put on gloves and apron. When the procedure is finished I put them in the clinical waste container and wash my hands. When using the protective equipment to decontaminate flexi scopes it is necessary to wear eye protection to reduce the risk of splashing of chemicals into the eye along with gloves and apron preventing any cross infection on to my clothes or hands. Ref: Personal Protection Policy June 2008 2. 5 Explain the concept of risk in dealing with specific types of contamination 2.
6 Explain how the level of risk determines the type of agent that may be used to decontaminate There are three levels of risk when dealing with specific types of contamination. Level one is a low risk when in contact with healthy unbroken skin and not directly in contact with patients at this level a cleaning would be appropriate to reduce any risk of infection. The second level of risk is intermediate when in contact with bodily fluids, mucus membranes i. e. mouth and nose.
Instruments contaminated with virulent or readily transmissible organisms the process to reduce the risk at this level is high level of disinfectant followed by sterilization, this sterilisation should also be done prior to use on immune-compromised patients. The third level and the highest risk of infection or the spread of pathogenic micro-organisms is in close contact with broken skin, equipment introduced into sterile body areas e. g. nose with endoscope, open wounds removing stitches, using sterile procedures with standard precautions.
2. 7 Describe how equipment should be cleaned and stored In ENT we have equipment to perform endoscope examinations, during the procedure the scope is taken from a sterile tray the scope is wiped with a alcohol wipe to keep the camera free from smears and prepared with aqua gel to help ease through he nasal passages after completing the exam wearing gloves it is removed from patient and placed in tray with red contamination liner on top to prevent spread of infection or re-use before cleaning.
The scope is taken to the cleaning room where a sporicidel three-step process is carried out wearing gloves, apron and goggles. The scope is placed back in the tray with a green liner top to indicate it is clean. Instrument used to perform minor surgical procedures are cleaned by CSSD and are returned in a closed bag and stored in the clinic room. The equipment that is used in clinic i. e. bed, surfaces, computes, exam lights, phones and chairs are cleaned on a regular basis with Clinell wipes and they are disposed off in the clinical waste container.
3 Understand the importance of good waste management practice in the prevention of the spread of infection 3. 1 Identify the different categories of waste and the associated risks The different categories of waste generated by the hospital are segregated into categories depending on the particular risk. The hospital has different colour coded plastic waste bags, along with yellow sharps containers. Sharps are items that could cause injury and infection, i. e. needles, broken glass, syringes any other instruments or materials should be put into a sharps plastic yellow container.
Clinical waste generated by hospital wards or departments that are a potential risk of infection or spread of disease have to be disposed into yellow or orange bags depending on the department, theatre or surgical waste needs to be orange and other clinical waste yellow bags. Human tissue, limbs or other bodily waste should be placed in orange bags Non-sharps items: soiled dressing, swabs, used gloves, non-sharp disposal materials are to be placed in yellow plastic bags contained in pedal bins with lids and foot pedals. High-risk material should be doubled bagged to avoid leaks of infectious materials.
Other Waste with no potential risk of hazard or infection Catering Waste: white plastic bags, liquids in sluice Domestic/office/ General waste: black plastic bags 3. 2 Explain how to dispose of the different types of waste safely and without risk to others Sharp containers need to be put together lid and bin, dated, signed and placed in clinical area for use. When the container is three quarters full it should be sealed, signed and dated. Yellow clinical bags are securely sealed and removed by cleaning staff in the ENT department each day after clinic is finished.
It is taken to the large yellow waste bin in outpatients Non-sharps Black bags are sealed and removed by cleaning staff daily and is taken to the general waste bins located outside of the Outpatients building. 3. 3 Explain how waste should be stored prior to collection Sharps containers are stored in the Outpatients large yellow waste container for disposal, where they are collected and taken for incineration Yellow bags are stored in the Outpatients large yellow waste container located in the sluice, where they are collected and taken for incineration.
Black waste bags are taken to the waste bins outside once they are full and sealed where the appointed service waste company will collect them. 3. 4 Identify the legal responsibilities in relation to waste management The legal responsibility of the hospital is to provide a safe way of handling all the waste it generates in the appropriate way according to The Environmental Protection Act 1990, The Environment Protection (Duty of Care) Regulations, Heath and Safety Act and COSHH regulations 2002.
It is their duty of care to comply with the regulations to ensure that safe management of the waste generated is disposed of according to these guidelines and that all members of staff are trained and informed of their individual responsibilities in managing and handling any waste. Waste is managed by having it segregated in to categories of infectious, hazardous or general waste. A colour-coded system is in place to ensure all waste is identifiable by the colour it is contained in.
The hospitals policy for managing waste states the legal obligations and instructions how waste is to be managed. How the transportation and disposal of waste is managed. 3. 5 State how to reduce the risk of sharps injury To reduce the risk of a sharps injury, which can be caused when using any instrument that accidently punctures the skin, and can introduce a blood-borne virus into the blood stream.
Employee training and knowledge in how to use a sharp instrument correctly, following the policies and procedures set out by the hospital management. The needle-stick Policy and action to be taken after exposure to blood and bodily fluids (including HIV post exposure Prophylaxis), Management of Needle-stick injuries and Exposure to blood and high-risk bodily fluids, Universal Infection Control Precautions (UICP), Personal protective Equipment Policy
Performing a risk assessment prior to use, can reduce accidents, making sure the area in use has good lighting, that there is an easily accessible sharps container making sure it is not to full to allow disposal of any needles or sharp objects. Using engineering devices, i. e. Needleless connector systems – Connectors use devices other than needles to connect one IV to another. Protective sheaths – Sliding or hinged needle shields attached to disposable syringes. Retractable needles or blades – Needles of sharps, that retracts into a syringe, or back into the device.
Self-blunting- A blunt cannula seated inside a phlebotomy needle is advanced beyond the needle tip before the needle is withdrawn from the vein. Ref: https://www. rcn. org. uk/ Using these devices reduces the risk of accidental needle- stick injuries, to dispose of any sharps immediately after use, to follow standard precautions, infection control regulations and guidelines on how to dispose of any sharp materials including broken glass, blades, scalpels, or items that get into the blood system.