# Presentation: 201163

## Module 3

- DECONTAMINATION

**Notes:**
Instructor Notes 
This module contains a lot of procedural information. Emphasize the importance of following procedures and adhering to safety regulations. For some, it may have become routine and they may not recognize the consequences of poor performance. Decontamination is the “messy job” but it is critical to the sterilization and disinfection processes. 

Learning activities:
Poll the class asking “What is the most important thing to remember in Decontamination?” Use their answers as a discussion starter to emphasize personal protective equipment, safe conveyance, following procedures, etc.
There is no right answer, because everything is important...this is a way to gauge the knowledge and experience level of your audience.

Points for Discussion
Use the following questions to guide classroom discussion during the presentation of the module.
What is decontamination?
Why is it necessary? (after all most things are going to be sterilized)
How dangerous is the decontamination job?

## Identify the purpose of decontamination.
 Detail infection control procedures that are necessary in the decontamination process.
Identify Personal Protective Equipment.
Identify guidelines for safely handling sharps.
Identify hand-washing requirements.
Identify procedures for handling spills, soiled laundry, and infectious waste.
 Detail collection and transportation requirements.
 Identify decontamination equipment, procedures, and precautions.
Identify equipment.
Detail equipment purpose.
Describe equipment operating procedures.
List precautions/exclusions for each piece of equipment. 

** ****Detail infection control procedures that are necessary in the decontamination process.**
- Identify Personal Protective Equipment.
- Identify guidelines for safely handling sharps.
- Identify hand-washing requirements.
- Identify procedures for handling spills, soiled laundry, and infectious waste.
** ****Detail collection and transportation requirements.**
** ****Identify decontamination equipment, procedures, and precautions.**
- Identify equipment.
- Detail equipment purpose.
- Describe equipment operating procedures.
- List precautions/exclusions for each piece of equipment.

**Notes:**
Instructor Notes 
Review the instructional objectives
You can translate them into common language (“Today we are going to talk about how to remove soil from medical devices while keeping yourself, the staff, the patients, and the medical center environment safe, and limiting the spread of germs.”)
Explain that these objectives reflect what students will be learning in this module and that there will be a self assessment at the end, based on these objectives.
Mention the online course  (**insert URL) and that the objectives are the same.

## The Decontamination Area

**Physically separated**
**Restricted access**
**Adequate lighting and ventilation**
**Facilitate the collection and transfer of soiled supplies**

**Notes:**
Instructor Notes 
Emphasize the importance of keeping the decontamination area separated from the rest of SPD.
Depending upon the local facility, this may raise questions. Be prepared to discuss issues regarding the layout and solutions to local concerns.

Learning activities:
Present this as sort of a checklist. If you are familiar with the local facility, discuss each requirement in terms of how the local facility conforms.

Points for Discussion
Does this facility meet all the requirements?
Are there issues or areas for concern?
What is the proper procedure for addressing those concerns?

## Personal Protective Equipment

**In Decontamination Area**
**During Collection**

-  Head/hair cover
-  Glasses/Goggles/Face Shield
-  Decontamination Gloves
-  Gown
-  Shoe Cover

-  Cover Gown
-  Exam Gloves

**Notes:**
Instructor Notes 
Stress that the reason for protective gear is to protect the worker and control the spread of infection.
Acknowledge that some of the gear is uncomfortable and people sometimes feel they don’t have time to put it on or change between assignments, but it is a necessity (better safe than sorry).
Emphasize the responsibility for both the employee and the medical center.
Learning activities:
Have sample PPE on hand and demonstrate the proper method of putting them on and taking them off, you can vary the activity by doing it wrong (shake gloves around while pulling them off, handle the contaminated side with your bare hands, etc.), and asking students to point out errors and the rationale behind them.
Points for Discussion
Use the following questions to guide classroom discussion during the presentation of the module.
Who does PPE protect?
How did Universal Precaution/Standards change things?
If you wear gloves, do you still need to wash your hands?

## Cleaning Agents

- Detergents
- Disinfectants

**Notes:**
Instructor Notes 
The purpose of this section is to help the user become familiar with the characteristics and capabilities of both detergent and disinfectant in order to make wise choices when using them.

Learning activities:
Have sample MSDSs available. Read a description of a common, locally used detergent/disinfectant and ask the class to name it. 
Take a tour of the storeroom beforehand and make a list of all available cleaning agents. Have individuals volunteer examples of cleaning agents, listing them on the whiteboard or chart and asking the class to “sort” them into either the disinfectant or detergent category. For the disinfectants ask them to indicate “high”, “medium”, or “low” level. This activity will give you an indication of the class’ familiarity with their local agents. You may want to select a couple of less familiar ones and  go into detail about their characteristics and MSDS.

Points for Discussion
Use the following questions to guide classroom discussion during the presentation of the module.
What is each of these used for?
What should you do if you start to use a cleaning agent and it doesn’t look or smell right?
Is it OK to mix detergents and disinfectants together to get things even cleaner?
If you are unfamiliar with a particular product, where can you go for information?
If the medical center changes brands or types of cleaner, what should you do?

## Disinfectants

| Type | Kills: | Appropriate for: | Examples: |
| --- | --- | --- | --- |
| High 
Level | all bacteria, viruses, and fungi, but not bacterial spores |  items that have come into contact with body tissue and fluids
 disinfecting items that come in contact with mucous membranes (respiratory devices, laryngoscope blades) | chlorine dioxide, hydrogen peroxide, and peracetic acid-based formulation |
| Medium Level | most pathogenic microorganisms and some viruses, but not bacterial spores |  effectively killing organisms such as mycobacterium tuberculosis fungi, hepatitis B virus, medium and small size viruses
 use on I.V. pumps, feeding pumps, etc. | chlorine compounds, alcohols (70 percent to 90 percent ethanol or isopropyl) and some phenolic and iodophor compounds |
| Low 
Level | some types of bacteria 
generally have little effect on viruses and do not kill spores |  use in cleaning environmental surfaces, such as table tops, floors, and walls | chlorine compounds (bleach or Sodium Hypochlorite) alcohols (70 percent to 90 percent ethanol or isopropyl) and Quaternary Ammonium  Compounds |

**Notes:**
Instructor Notes
It is important for technicians to be familiar with the disinfection capabilities of the products that they use locally. Discuss specific familiar compounds and which category they fit into.

Learning Activities
If group is small enough and has access, walk through the storeroom and classify the disinfectant products by level. If this is logistically not feasible, bring some products into the classroom and ask learners to classify them and discuss their uses.

Points for Discussion
How do you choose what product to use?
If the High Level products kill more, why not just use them all the time?

## pH

**Alkaline**
**Vs.**
**Acid**

## Collection and Transport

**Notes:**
Instructor Notes
Transport varies from medical center to medical center, based on the physical layout and collection facilities. Most audiences will be familiar with at least two of the methods.

Learning activities
Talk about the characteristics and benefits of each type.
Discuss scheduling and frequency.

Points for Discussion
Use the following questions to guide classroom discussion during the presentation of the module.
What are the requirements for collection carts?
 In a pinch can I use delivery carts for collection (I mean I’m already on the floor delivering supplies, why can’t I just pick up the stuff if I wrap it really tightly?)
How often does pick-up need to be done for OR? Clinics/ other areas?
Which areas are highest use and require the most frequent pickups?
What should you do if an area is constantly calling asking you to come do a pickup? (schedule them more frequently, place more bins/containers in their area)

## The Decontamination Process

- Sort soiled instruments and equipment into groups based on how they will be cleaned
- Inspect them for damage/missing parts
- Remove visible tissue or bone (gross soil)
- Clean the device using a neutral detergent (mechanically or by hand)
-  Apply the appropriate disinfectant
-  Allow the item to dry

**Notes:**
Instructor Notes
While the basic decontamination process is the same for all equipment, certain devices will require special handling or additional care. Decontamination is a labor intensive and time consuming job, but critical to proper disinfection and sterilization.

Learning activities
Talk about working efficiently. Discuss collection schedules and ways to sort equipment that will help streamline the decontamination process.

Points for Discussion
Use the following questions to guide classroom discussion during the presentation of the module.
What do you do first when unloading soiled equipment?
What special considerations are necessary for equipment sets or loaner equipment?
Do you have to prewash items that are to be cleaned in the Sonic cleaner?

## Types of Equipment To Be Cleaned

**Electrical equipment**
**Non-electrical equipment**
**Rubber/plastic supplies**
**Metalware**
**Glassware**
**Surgical power equipment **
**Surgical instruments**
**Endoscopic equipment**
**Other**

## Using Cleaning Equipment

- Washer/Sterilizer
- Washer/Sanitizer
- Utensil Washer
- Pasteurmatic Washer
- Scope Washer

**Notes:**
Instructor Notes
These are all dishwasher like devices that use a combination of water motion and detergent to wash soil from device surfaces. 

Learning Activities
Discuss the characteristics and uses of each, distinguishing between them.
Provide examples of equipment and ask the class which device would be most appropriate for cleaning it and their rationale for making that choice.

Points for Discussion
How do you choose which equipment to use? Why is one type better than another?
What do you need to remember when loading equipment into these processors?

## Using Cleaning Equipment

- Ultrasonic Cleaner
- Cart Washer
- Steam Cleaning Device
- Tube Dryer

**Notes:**
Instructor Notes
These are devices that were designed for a specific cleaning purpose. 

Learning Activities
Discuss the characteristics and uses of each, talking about how and why they work and how to get the best service out of each.
Include a discussion of any precautions or issues students may have with using each of them.

Points for Discussion
What is cavitation? How does it work? What types of things can’t be cleaned in the Ultrasonic?What sorts of things can be cleaned in the cart washer? Is it just for carts?
What precautions are necessary when using the steam gun?

## Infection Control

- Follow Universal                                                                          Precaution/Standards
- Hand washing
- Sharps safety
- Spills
- Laundry
- Waste
- Cleanup

**Notes:**
Instructor Notes
Each of these areas contributes to good infection control. Make sure learners understand that ALL of them are necessary to ensure that the chain of infection is broken.

Learning Activities
Discuss the guidelines, walk through the procedure for each and mention any associated precautions.
If facilities are available, demonstrate hand washing procedure and ask students to observe and write down any problems or areas of concern. When you wash your hands, do several of the following:
Run the water for a long time before and after.
Use your bare hand to turn off the faucet.
Skip using soap.
Dry your hands and throw the towel away, then open the door or touch the handle on the towel dispenser – anything to recontaminate yourself.
Solicit pointers/critique from the class. After discussion, demonstrate again, following correct procedure.
Discuss any concerns with waste disposal or clean up procedures, pointing out technicians and others responsibility in each case.

Points for Discussion
Is soap necessary for hand washing? What are some side effects of constant use? How long is long enough?
Are air dryers or paper towels better? What about chemical or waterless hand cleaners?
What is your responsibility in terms of cleaning up spills?
What are the local soiled laundry procedures?
What about waste disposal?
Who is responsible for cleaning up spills?

## Safety

-  SPD Desk Guide
-  Material Safety Data Sheets
-  PPE
-  Eye Wash Stations

**Notes:**
Instructor notes
The SPD Policy and Procedures Manual provides safety related guidelines for technicians to follow. It is the technician’s responsibility to know and observe safety rules. Many workers are not familiar with the manual and don’t know where it is stored.

Learning Activities
Point out Manual Location
DO a quick walkthrough of contents
Mention update schedule
Pass around MSDS samples—discuss layout and the types of information contained—help learners become comfortable reading and using them ( you might even hand one to everyone and do a paper scavenger hunt: Who can find this type of information fastest? Chemical name, issue date, cautions, etc.)

Points for Discussion
Technician responsibility
Resources

## SPD Environmental Hazards

- Open drawers
- Sharps and needles
- Carelessly stacked washer/sterilizer baskets
- Automatic cart washer doors
- Lifting heavy objects
- Wet, slippery floors
- Automatic loaders/unloaders and doors
- Hot items
- Improper use of chemicals
- Equipment noise

**Notes:**
Instructor Notes
The technician needs to learn to recognize environmental hazards and to apply proper safety procedures to avoid injury.

Learning Activities
Discuss possible hazards and means of avoiding injury. If available, discuss local injury statistics. This is also a good place for “war stories” illustrating the hazards of the job.

Discussion Points
What is the biggest cause of injury in the SPD environment?
What factors contribute to the possibility of injury?

## The purpose of decontamination is to:
a.   Protect workers
b.  Ensure the sterility of surgical devices
c.  Reduce the bioburden on reusable devices
d.  Facilitate cross contamination

- a.   Protect workers
- b.  Ensure the sterility of surgical devices
- c.  Reduce the bioburden on reusable devices
- d.  Facilitate cross contamination

**Notes:**
Instructor Notes 
The slides are designed to display the question first and then fly in the answer on mouse click. You may want to keep track of students questions that recur in order to reinforce them in the next session.

Learning activities:
You can decide how you want to use the review questions:
 Assign them as homework
 Break the class into small groups and have them answer together (or to save time give each group a subset of the questions)
 Project them and solicit verbal answers from volunteers
Strongly recommend that the learners make notes regarding the correct answers (the questions are tied directly to the learning objectives and therefore to the certification test).

Points for Discussion
Use the questions to review and reinforce module content and correct any misconceptions.

## Match each term to its description.

- Used for cleaning environmental surfaces such as walls and floors
- Aids removal of soil such as blood, pus, and urine
- Appropriate for items that will come in contact with body tissues, fluids, or mucous membranes
- A measure of the acidity or alkalinity of a substance
- Kills most pathogenic microorganisms and some viruses

**Low-level disinfectant**
**Detergent**
**High-level disinfectant**
**pH level**
**Medium-level disinfectant**

## Carts

Solid containers

Automated Transports 

Dumbwaiters		

**Solid containers**
**Automated Transports **
**Dumbwaiters****	****	**

- Wheels require routine lubrication
- Must have a tight fitting lid
- Require programming by a technician
- Must be designated as either clean or dirty

- Match each term to its description.

## PPE consists of gloves and a head covering.
Containers must be made of disposable material.
Is done on an “as-needed” basis.
Must be done in a manner that protects the technician, the environment, and the public. 

- Containers must be made of disposable material.
- Is done on an “as-needed” basis.
- Must be done in a manner that protects the technician, the environment, and the public.

- Which statements apply to soiled equipment collection?

## PPE consists of gloves and a head covering.
Containers must be made of disposable material.
Is done on an “as-needed” basis.
Procedures must protect the technician, the environment, and the public. 

- Containers must be made of disposable material.
- Is done on an “as-needed” basis.
- Procedures must protect the technician, the environment, and the public.

- Which statements apply to soiled equipment collection?

## Which of the following can be processed in a washer/sterilizer?

-  Flexible endoscope
-  Metalware
-  Surgical power equipment
-  Glassware

## Which of the following can be processed in a washer/sterilizer?

-  Flexible endoscope
-  Metalware
-  Surgical power equipment
-  Glassware

## Order the steps for decontaminating surgical instruments.

- Place on trays or washer racks in open position.
- Remove gross soil.
- Process in ultrasonic cleaner.
- Send to prep room.

**3**
**1**
**2**
**4**

## Order the steps for decontaminating surgical instruments.

-  Remove bits or blades.
-  Wipe hand piece with water- dampened cloth.
-  Remove power source.
-  Clean hand piece with cleaning solution.

**2**
**4**
**1**
**3**

**Order the steps for decontaminating surgical instruments.**

## Hand-held device used for cleaning wheelchairs and carts. 

**Hand-held device used for cleaning wheelchairs and carts. **

- Name that equipment!

**Steam Cleaner **

## Used to dry rubber or plastic goods following cleaning, this device draws in air, heats it, and circulates it through the cabinet.

**Used to dry rubber or plastic goods following cleaning, this device draws in air, heats it, and circulates it through the cabinet.**

- Name that equipment!

**Tube Dryer**

## Uses hot water at 170 degrees F for 30 minutes to clean plastic and rubber tubing.

**Uses hot water at 170 degrees F for 30 minutes to clean plastic and rubber tubing.**

- Name that equipment!

**Pasteurmatic **

## Good for cleaning metalware, surgical instruments, and glassware. Uses steam under pressure. 

**Good for cleaning metalware, surgical instruments, and glassware. Uses steam under pressure.**

- Name that equipment!

**Washer/Sterilizer**

## Uses steam to thermally sanitize items. Considered less effective than the Washer/Sterilizer. 

**Uses steam to thermally sanitize items. Considered less effective than the Washer/Sterilizer.**

- Name that equipment!

**Washer/Sanitizer**

## Uses sound waves and a process called cavitation to remove soil particles.

**Uses sound waves and a process called cavitation to remove soil particles.**

- Name that equipment!

**Ultrasonic Cleaner **

## Requires an adapter to force cleaning solution through the channels of flexible scopes.

**Requires an adapter to force cleaning solution through the channels of flexible scopes.**

- Name that equipment!

**Scope Washer **

## Which statements are true regarding sharps?

Disposable sharps should be disposed of at the point of use.
Sharps are not a concern for SPD because they are disposed of by the user.
Sharps must be disposed of in special containers.
Sharps generally are reusable and must be reprocessed with care. 

- Disposable sharps should be disposed of at the point of use.
- Sharps are not a concern for SPD because they are disposed of by the user.
- Sharps must be disposed of in special containers.
- Sharps generally are reusable and must be reprocessed with care.