Cleaning and
Decontamination
Chapter 9
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Objectives
As a result of successfully completing this chapter,
students will be able to:
 Discuss basic factors that impact cleaning and
decontamination:
Design and location of decontamination area.
Environmental design and controls.
Housekeeping concerns.
Staff safety and personal attire.
Staff education and training.
 Describe important selection and usage concerns
for cleaning agents (water, detergents, enzymes, and
enzymatic detergents) and for lubricants.
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Objectives
 Explain details about cleaning and decontamination,
and review manual procedures and mechanical methods
to complete both processes.
 Discuss procedures to clean basic types of
instruments:
General cleaning protocols.
Delicate and hard-to-clean instruments.
Instrument containers and basins.
Power equipment.
Mobile patient care equipment.
Verification and quality control tactics.

Review procedures to manage infectious waste.
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Important Facts
Cleaning is the first step in device
reprocessing after use.
You can clean without sterilizing, but
you can never sterilize without
cleaning.
Cleaning is the cornerstone of the
sterilization process.
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Terminology
Cleaning – The removal
of all visible and nonvisible soil and any other
foreign material from the
medical device being
reprocessed.
Decontamination –
Removing or reducing
contamination by
infectious organisms or
other harmful substances.
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Design of the Decontamination Area
Floors and walls
should be
constructed of
materials that can
tolerate harsh
chemicals.
Traffic should be
restricted and PPE
is required.
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The Decontamination Area
Emergency
Eyewash/shower
equipment should
be available within
10 seconds or 30
meters of a potential
chemical exposure.
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Housekeeping
Horizontal work surfaces should
be cleaned and disinfected at the
beginning and end of each shift.
Spills should be cleaned
immediately.
Floors should be cleaned and
disinfected daily.
Biohazardous waste should be
removed at frequent intervals.
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Personal Protective Equipment
PPE is required at all
times.
Discard PPE that is
soaked with blood or
infectious materials.
Discard torn, punctured
or nicked gloves.
Jewelry and acrylic
fingernails are not
permitted.
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Food or Drink is not permitted in the
Decontamination area.
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Training
No employee should
work in the
decontamination area
without training on:
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Standard Precautions
PPE
Safety
Handwashing
Proper handling of
contaminated items
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Water
The primary vehicle in
the cleaning process.
Water quality can
impact cleaning
outcomes.
pH, hardness, and
temperature must be
monitored
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pH Scale
0
1
2
3
4
5
6
7
8
9 10 11 12 13 14
• pH is used to measure acidity or alkalinity.
• Acids turn litmus paper RED.
• Alkalies (sometimes called bases) turn litmus paper
BLUE.
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Chelating Agents
–
Chemicals that hold
hard water minerals in
solution, and prevent
soaps or detergents
from reacting with
minerals.
Sequestering Agents
– Chemicals that remove
or inactivate hard water
minerals.
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An Overview of Effective
Cleaning Agents
Are non-abrasive
Are low-foaming
Are free-rinsing
Allow for rapid soil dispersion
Are non-toxic
Are effective on all types of soil
Have a long shelf life
Are cost-effective
Can be monitored for effective concentration
and useful life.
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Detergents
Substances that
dislodge, remove,
and disperse solid
and liquid soils from
the surface being
cleaned.
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Detergents
Detergents are
specially formulated
for the specific uses.
For example, manual
cleaning or
mechanical cleaning.
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Enzymes
Breakdown or “digest” large organic
molecules to facilitate their removal.
Are very specific in their actions.
Different enzymes work on different
soils.
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Enzymes
Protease – Breaks down blood, mucous,
feces, and albumin.
Lipase – Breaks down fatty deposits such
as bone marrow and adipose tissue.
Amylase – Catalyzes (changes) starch.
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Enzymes and Temperature
Temperatures above
400C (1400F) can affect
chemical reactions.
Cool temperatures may
not activate the enzyme.
Monitor water
temperature and check
manufacturer instructions
for specific temperature
requirements.
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Selecting an Enzymatic Detergent
Consider the following factors:
– Water temperatures in the decontamination area
– Room temperature in the decontamination area
– Useful life and stability of the product
– Expiration date of the product
– The material used to construct the device to be cleaned
– Whether it is approved and registered by the EPA
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Detergents for Ultrasonic Cleaners
Must be low-foaming
to prevent
interference with the
cleaning process.
Are usually
formulated with
Surfactants and
Chelating agents.
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Surfactant – A surface-acting agent that lowers
the surface tension of a liquid so it can penetrate
deeper. Surfactants also prevent debris from
being re-deposited on items.
Chelating Agent – A chemical that holds hard
water minerals in solution and prevents soaps or
detergents from reacting with minerals.
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Instrument Lubricants
Prolong the life and function of instruments.
Instrument lubricants must be water-soluble.
Should be applied after cleaning.
Instrument lubricants cay be applied
manually in the clean assembly area or
mechanically as one of the final steps in a
mechanical wash cycle.
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Cleaning
The removal; (usually with detergent and
water) of both visible and invisible soil
from the surfaces, crevices, serrations,
joints and lumens of instruments, devices
and equipment.
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Remove Gross Soil As Soon As
Possible to:
Reduce the number of
microorganisms on the item.
Reduce the nutrient material
that can support microbial
growth.
Reduce the potential for
environmental contamination,
aerosolization, or spillage.
Minimize damage to devices
from blood and other
substances.
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The Importance of Cleaning
Cleaning is the
foundation of
disinfection
and
sterilization.
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Decontamination
The use of physical or chemical
procedures to remove, inactivate,
or destroy bloodborne pathogens.
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Decontamination
How an item was,
or will be used
determines the
level of
decontamination
required.
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Technology Creates
Cleaning Challenges
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Manual Cleaning
May be done:
– Prior to mechanical cleaning
– When the decontamination area
does not have mechanical
cleaners
– For delicate or complex
instruments
– For powered-surgical
instruments
– For instruments with lumens
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Facilitate Cleaning By:
Monitoring water
temperature and
hardness.
Measuring detergents
accurately.
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Facilitate Cleaning By:
Opening hinged
instruments to
expose hinges,
jaws, and
box-locks.
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Cleaning
Use a 3-Sink Set-up
– Wash sink
– Intermediate Rinse
sink
– Final Rinse sink
*Brush instruments
under the surface of
the water to prevent
aerosols.
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Cleaning Brushes
Use the correct size brush for the item being
cleaned.
Clean and disinfect/sterilize routinely or discard
and replace.
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Mechanical Cleaning
Washers
– Automated equipment
used to clean,
decontaminate, or
disinfect and dry
medical devices.
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Ultrasonic Cleaners
Use Cavitation
Process
Superior to manual
scrubbing/cleaning
Require non-foaming
detergents
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Cavitation:
Ultrasonic vibrations create tiny air bubbles that grow larger until
they implode (collapse). That implosion dislodges soil from the
instrument’s surface, as well as crevices, hinges, and other hard
to reach areas within the instrument.
Implosion
Implosion
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Ultrasonic Cleaner Tips
Rinsing is necessary to remove residue
that remains on instruments.
The tank must be routinely cleaned.
Instruments must be precleaned to
remove gross soil.
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Ultrasonic Cleaner Tips
Must be degassed each time they are filled.
The cleaner’s lid should remain closed during
operation.
All lumens should be completely filled with
cleaning solution.
All instruments should be completely open and
submerged.
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Ultrasonic Cleaners
Do not place these items in the ultrasonic
cleaner:
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Chrome-plated instruments
Ebonized Instruments
Plastic
Cork
Glass
Wood
Chrome
Rubber
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Automated Mechanical Washing
Impingement
– The spray-force
action of
pressurized water
against
instruments being
processed to
physically remove
bioburden.
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Mechanical Washers
Use several
successive steps
in their cycles to
clean medical
devices.
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Mechanical Washer Tips
Expose all surfaces.
Do not stack trays on top of one another.
Remove lids or covers from trays.
Check detergent levels frequently.
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Washers Need Direct Contact
Multi-level
organizing trays
may impede
mechanical cleaning
processes by
shielding the
instruments from
the wash spray.
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Protect Instruments from Damage
during Mechanical Cleaning
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Mechanical Washers
Choose the correct
cycle for the items
being processed.
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Automated Cart Washers
Automated Cart
Washers use
detergent and hot
water to clean large
carts.
With special racks,
they may also be
used to clean basins,
pans, etc.
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Basic Instrument
Cleaning Procedures
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Instrument Decontamination
The most important
step in the
sterilization
process.
Instruments that
have not been
properly cleaned
cannot be sterilized.
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Instrument Cleaning
Every instrument or
device that enters the
decontamination area
must be treated as if it
is potentially
hazardous.
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Instrument Cleaning
Should begin within
15 minutes to 1 hour
after use.
Prolonged delays in
instrument cleaning
can have negative
impacts on
instruments.
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Blood should never be allowed
to dry on instruments.
Process instruments
immediately, or:
– Cover with a moist
towel
– If they can be
immersed, place in a
soak basin with the
appropriate solution.
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Instrument Cleaning
Disassemble multipart instruments
Open boxlocks and
hinges for cleaning
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Instruments with Lumens
Place under water to
prevent aerosols when
brushing
Brush lumens using an
appropriate size brush
Force water and
detergent through them
using a syringe or
cleaning nozzle
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Defective Instruments
When Instruments
come back from
Surgery tagged for
repair they must be
decontaminated
before they are sent
for repair.
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Clean All Items in Accordance with
Manufacturers’ Instructions.
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Power Equipment
Must be manually
cleaned.
Do Not Immerse.
Clean cannulations
(lumens) thoroughly.
Follow Manufacturer’s
instructions
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Mobile Patient Care Equipment
Follow OEM (Original
Equipment
Manufacturer’s)
instructions.
Pay attention to
details such as
access doors,
latches, etc.
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Cleaning Quality Control
Instruments are
visually inspected for
cleanliness in the
clean assembly area.
There are some
commercial
monitoring products
available to test the
effectiveness of
mechanical washers.
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Infectious Waste
Not all healthcare facility trash is “Medical
Waste”.
Healthcare facilities separate their waste.
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Waste Categories
General Trash – garbage disposed of as municipal solid
waste.
Regulated Medical Waste or Infectious Waste –
waste capable of transmitting infectious disease.
Hazardous Waste – May cause serious illness or death.
Must be red-bagged.
Low-level Radioactive Waste – exhibits radioactive
characteristics such as radioactive decay.
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Cleaning Summary
Follow established
standards and
manufacturers’
instructions.
Pay attention to detail.
Cleaning is the most
important step in
medical device
processing.
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Questions?
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