Cleaning, Disinfection and Sterilization of Medical Devices
Medical Devices save lives, when one combats various diseases and health problems such as Covid-19, COPD, Intrapulmonary shunting, obstructive sleep apnea, ARDS, and Refractory hypoxemia.
It is also useful for regular and medical emergency patient care at home, institutions, Airports, bus stands, Railway Stations, and factories.
The disinfection and Sterilization are a major parts of the medical device usage, care, and functioning as it can be life-threatening to patients when skipped.
These are some guided steps that will help Clean, Disinfect and Sterilise medical devices such as Ventilator and other Respiratory care equipment.
We should know enough about these three terms Cleaning, Disinfection, and Sterilizing before getting started in this Guide,
1.) What Cleaning stands for?
It is a procedure of Removing Dirt, and Organic and inorganic material from the Device’s Surface. The cleaning procedure prevents the growth of microorganisms on the device’s surface.
This is mainly done using a wet cloth soaked in Soap or detergent with different PH levels to wipe out the surface. After that, it should be cleaned properly and carefully to remove residuals from the surface.
2.) What does Disinfection stand for?
The disinfection procedure is all about removing pathogenic microorganisms on the Device’s Surface. This step ensures all organic material and pathogenic microorganisms have been removed.
This procedure can be done with Heating or chemical, It depends on the equipment type, disinfectant, and processes. The Disinfectant chemical should be sanitary registered for hospitals, clinics, and other medical environments and must be recommended by the Manufacturer. This approach should be selected on the basis of its Documented Effectiveness over all kinds of microorganisms (Viruses, bacteria, and fungi).
3.) What does Sterilize stand for?
Sterilization removes all living microorganisms consisting of surface spores. The sterilization procedure should be done just after cleaning and disinfection. It ensures that Organic material and most pathogenic microorganisms have been removed.
This sterilization procedure can be done with steam sterilization or Chemical activity. As per World Health Organisation (WHO), This Guide is helpful for Oxygen Concentrators, High Flow Nasal Cannulas, Bipap, Cpap, Pulse Oximeters, vital sign monitors, Invasive Mechanical Ventilators, etc.
Note: Before starting the procedure with electrical/electronic Medical Equipment, Please Disconnect Power Supply. The hygiene activities must not be performed in the Medical ward, biomedical workshops are preferred. The Disinfection or sterilization process has to be followed as guided in the instruction manual specific to the device.
Cleaning, Disinfection and Sterilization Of Oxygen Concentrators Devices
When the Device is used over the same patient
Humidifier
Oxygen Bubble Humidifier (Non-Heated Bottle) must be cleaned and disinfected Daily. It must be disposed of after single use.
Humidifier Cleaning and Disinfection Steps, Empty the Humidifier Bottle’s Water and Rinse the humidifier Flask under running water. The humidifier must be filled with Pure Distilled water or Cold Boiled Water between the top scale line and the lowest one.Kindly Please, Do not use tap water and bottle distilled water to fill into a humidifier.
Air Intake filter
Gently Pull the Filter and replace it with a spare Filter. Put it into Cold soapy water, and swirl it gently to remove detritus. Put Out of cold water and make it completely dry for the Next use.
Bacterial Filter
It should change weekly. The maintenance department has to take care of it as per the manufacturer’s instructions.
When Device is used between patients
After it is used over one patient it should be Cleaned, Disinfected, and sterilized appropriately for safe use for the next one. Before Starting the process, perform safety steps, like hand hygiene, and don the PPE Suit Properly.
- Always Disconnect the Device From the Power supply before disinfection or cleaning.
- Always Dispose of the single-user Patient Interface in a biohazardous waste Container.
- Shift Oxygen Concentrators away from the patient to the Ventilated area for cleaning.
- Discard hand gloves in appropriate biohazardous waste containers; perform hand hygiene procedure and Don New hand gloves.
- Then, Wash the humidifier in mild detergent with warm water. Rinse it and allow it completely air dry.
- Wipe the Oxygen Concentrator Device surface from top to bottom including the flow meter, controls, and LED. It can be performed with a Damp cloth or disposable wipes soaked in detergent and clean water. Then, wipe with a dry lint-free cloth.
- Wipe it with compatible disinfectant solutions it should wipe from top to bottom with the surfaces of sensors and cables. Disinfectant Sodium hypochlorite 0.1% (1000 ppm) should be used as per the device manufacturer’s Advice. Please note that you must not use Different disinfectants during the process. It may produce Toxic fumes.
- Last but not least Doff PPE and Discard it properly and then perform hand hygiene and ensure that the Oxygen Concentrator is stored properly in a place where there is a lower risk of contamination between uses. Most Importantly, When Device is not in use The Cleaning and Disinfection process should be performed twice a month.
Cleaning, Disinfection and Sterilization Of High-flow nasal cannula
Non-invasive ventilation of the same patient
Humidifier
- Oxygen Bubble Humidifier Must be washed, rinsed, and disinfected on a regular basis. humidifier should be disposed of after single use.
- Empty the Humidifier and rinse its flask under running water. Please be careful while filling up the humidifier with distilled water or cold-boiled water. Do not use Tap water, distilled bottled water, and drinkable water.
- Air and Dust Filters, If the manufacturer manually Advices, Air and dust filters can be rinsed once a week under running water.
When it is used in Between patients
- First, Perform hand hygiene and don a PPE Suit properly then turn off and disconnect the device from the patient, oxygen, and power supply.
- Dispose of the Single-use Patient Interface, Such as Nasal cannula tubing, water bag, and water chamber after draining to the biohazardous waste container.
- Shift the High Flow Nasal Cannula to the ventilated area for cleaning. Change the gloves appropriately.
- Wipe the external surface of the device including all parts and top-to-bottom with Detergent.
- Prepare disinfectant solutions and wipe them with compatible disinfectant (As per WHO, Hydrogen peroxide>0.5% OR Ethanol 70-90%; OR as Manufacturer’s Advice) When the Manufacturer advises using high-level disinfection. It must be performed properly.
- Now, Remove PPE and Hand wash properly and then High Flow Nasal Cannula Should be stored at a place where high ventilation is available.
Cleaning, Disinfection and Sterilization of Invasive Mechanical Ventilators
During the Ventilation on Same Patient
- Single-use breathing circuits should not be routinely changed for the same patient.
- When using a disposable inspiratory and expiratory filter, it should be changed when the resistance is increased. The Disposable filter can be used for up to 48 hours whichever comes first as per the manufacturer’s manual.
- The gas supply inlet filter should drain water on a daily basis. Check the amount of liquid in the expiratory module daily. It shouldn’t be more than half of the bottle.
During the Ventilation Between Patients
- Please be careful about Patients’ care tasks while disconnecting the device.
- Now, start with hand hygiene then Don hand gloves and PPE properly and disconnect the device from the patient and power supply.
- Disposed of single-use breathing circuits and exhalation valve filters to the biohazardous waste container.
- Prepare a closed container for Components(i.e. Respiratory valve, active humidifier, flow sensor, expiratory tubing, or other connectors/ components) that need high-level disinfection. it transports to the sterile services department.
- Shift the Ventilator to the Ventilated area for Cleaning and disinfection, Discard gloves, perform hand hygiene, and Don new gloves.
- Wipe the Ventilator and its components such as the controls, housing, trolley, support, touch screen, power cord, and gas supply hose with a damp cloth or disposable wipe soaked in detergent. then Wipe off with a dry lint-free cloth
- Prepared with disinfectant Solutions (it should always perform before use and away from patients). It can be performed with Fresh cloth or Disposable cloth to be soaked into a disinfectant Solution.
- Wipe the Device From top to bottom and its surfaces, sensors, and cables. (avoid electrical connectors).
- Remove PPE and Perform Hand hygiene.
- Store the Cleaned Ventilator in a well-ventilated area and Disinfect it before the new use.
Care, cleaned, and disinfect respiratory equipment in the sterile services department.
- Perform hand hygiene and Don Appropriate PPE (As per protocol, ppe worn during the disinfection process should be with a surgical mask/ respirator, goggles or face shield, long sleeve fluid resistant gown and apron, boots, and rubber gloves )
- Wipe the Device’s external surface with a disposable or damp cloth soaked in detergent. and then rinse it with clean water or wipe it off with a cloth soaked in clean water.
Now, disinfect with physical methods For heat-resistant components.
- Steam sterilization is an effective and inexpensive method for high-level disinfection. It should be done with steam which is autoclaving at a lower temperature or hot water disinfection at least at 121 °C
- Dry the equipment; physical equipment like Washer, pasteurizer, and autoclave machines have a drying feature.
- After the pasteurization procedure, it needs hot air or an air drying cabinet before storage.
Disinfect chemicals For Plastic and other parts that can be damaged by heat.
- Prepare a well-ventilated room and chemical disinfectant for this procedure. Now wipe the device surface with a fresh cloth or disposable wipe soaked in compatible disinfectant(such as hydrogen peroxide >0.5% OR ethanol 70-90%; ).
- When using the chemical disinfection method, Rinse it with sterile or clean water(i.e. boil for 5 minutes and cooled). Sterile water is preferable to rinse the residual chemical disinfectant from the device. avoid tap water and filtered water for rinsing because it may nurture the microorganisms that can cause pneumonia.
- Please make sure sterile water is not feasible for the process then you need to do water passed through a 0.2 μ filter followed by an alcohol rinse and forced-air drying. Store the Equipment in a dry close package.
Note: The Disinfection or sterilization process has to be followed as guided in the Instruction manual specific to the device by the manufacturer.