This appendix supplements Physiotherapy Alberta’s IPC position statement and broadly outlines parameters around equipment cleaning, disinfection and sterilization. For further infection control information, physiotherapists are advised to refer to information published by Alberta Health and Wellness, Health Canada or other resources as referenced.
Most cleaners, disinfectants and sterilants used in health care are regulated and should have a drug identification number (DIN). An exception is the domestic product hypochlorites (i.e., household bleach). Follow the manufacturer’s instructions and/or guidelines when cleaning, disinfecting and sterilizing equipment and instruments. The classification system (Table 1) for cleaning, disinfecting or sterilizing equipment, used in health care, is based on the use of the item and potential risk of infection.
Table 1 - Cleaning, disinfecting and sterilizing classification guidelines
Adapted from Cleaning, Disinfecting and Sterilizing Office Instruments and Health Canada Infection Control Guidelines.
||Decontamination after cleaning
||No contact with skin/patient (e.g., weight scales, furnishings)
||Low levels of disinfection
|Contact with intact skin (e.g., cups, beds, blood pressure cuff)
||Intermediate level of disinfection
||Contact with mucous membranes or non-intact skin but ordinarily does not penetrate tissues (e.g., inter-mediate level - thermometers, high level - vaginal probes, reusable peak flow meters)
||Intermediate or high level disinfection
||Enters vascular system or body tissue or houses an instrument that will be entering the blood stream/body tissue (e.g., IMS plungers)
|Presents high risk of infection if item is contaminated with microorganisms
All instruments undergoing disinfection or sterilization must first be thoroughly cleaned to remove organic material and/or foreign debris. Failure to adequately clean items may interfere with the disinfection and sterilization process.
When cleaning instruments:
- Use stainless steel utility sink dedicated to cleaning and handling dirty instruments.
- Ensure process is carried out using appropriate apparel – gloves, masks and gowns.
- Wash articles in warm, sudsy detergent water using friction (rubbing/scrubbing) to clean surfaces, cracks and crevices.
- Rinse thoroughly in clean warm water.
- Air dry or dry with lint free towel.
The disinfection process eliminates many disease producing pathogens or microorganisms from inanimate objects with the exception of bacterial spores. Disinfection levels are based on the healthcare instrument’s use and the risk of infection. Submersion time varies and should be checked against the manufacturer’s guidelines.
Technology related to chemical disinfectants continually evolves. Physiotherapists must keep current on the variables that change most frequently including submission times and hazards related to the chemical compound. Many products for disinfection are available and Table 2 includes the names of a few products as examples.
Table 2 - Disinfection Guidelines
Adapted from: Health Canada Infection Control Guidelines13, 15, Infection Control for Regulated Health Professionals9
||Detergent - disinfection combination:
- Quaternary ammonium compounds 'quats' (e.g., 1492, Dimension III)
- 3% hydrogen peroxide (e.g., Perdiem, Hydrox)
- Hypochiorites (e.g., 5.25 % household bleach 1:500 dilution-14 ml per 4 litres)
|Good for non-critical items (e.g., smooth surfaces, cups, patient beds)
- Accelerated hydrogen peroxide 0.5% (e.g., Percept, Virox 5)
- Alcohols 60-90% (e.g., 70% isopropyl alcohol, Rubbing Alcohol)
- Hyprochiorites (e.g., 5.25% household bleach solution 1:10 prepared daialy 100 ml per litre)
- Glutareldeyhyde 2%
- Accelerated hydrogen peroxide 7% (e.g., Chemo 20)
|Semi-critical and critical items (e.g., vaginal probes) that cannot be subject to sterilization processes (i.e., cold sterilization)
Sterilization destroys all microbial life. When performing sterilization, ensure compatibility between the instruments and sterilization equipment used. Ensure the sterilization equipment has been validated for the medical device being sterilized. Then, follow the manufacturer’s instructions for cleaning, disinfecting and sterilizing the device. The following are common methods for achieving sterilization.
Steam and pressure
Autoclaves use steam under pressure to kill microorganisms. The common steam temperature is 121° C (250° F). Monitoring methods should be used to ensure critical parameters have been reached. Packaged items require the following settings:
- 133 °C (271°F); 15 minutes
- 121° C (250°F); 30 minutes
Dry Heat Sterilizer uses heat alone to kill micro-organisms. Only equipment approved by the Canadian Standards Association for dry heat sterilization should be used.1 This method takes much longer than autoclave to produce sterility. Monitoring methods should be used to ensure critical parameters have been reached.
Chemicals used for high level disinfection can also be used to achieve sterilization if the instruments are exposed for a longer time period. There are risks to those working with chemical sterilants and therefore dry heat or steam and pressure are the recommended methods.
Sterilized instruments should be handled and stored in a manner that promotes the integrity of the sterile state.