Disinfect Med. Devices: Pt. 2

In Part I of “How to Properly Disinfect Reusable Medical Devices” (Novo blog 11/24/17) disinfection was defined as “The process designed to eliminate all pathogenic microorganisms, except bacterial spores, from reusable medical devices prior to sterilization." In most instances, reusable medical devices are disinfected by the use of approved liquid chemicals or by wet pasteurization. In Part II we will discuss various disinfectants that are commercially available for use in healthcare facilities along with their intended uses. When choosing disinfectants and sterilants you must first check the labeling to ensure that they are in compliance with industry standards.  It is important to also consider how sterilants and disinfectants will impact your reusable medical devices over their useful life. Medical device manufacturers indicate how their product(s) can be safely reprocessed in their instructions for use (IFU) so as to minimize potential damage to their product(s).¹ Many disinfectants are used alone or in combinations (e.g., hydrogen peroxide and peracetic acid) in the health-care setting. These include alcohols, chlorine and chlorine compounds, formaldehyde, glutaraldehyde, ortho-phthalaldehyde, hydrogen peroxide, iodophors, peracetic acid, phenolics, and quaternary ammonium compounds. Commercial formulations based on these chemicals are considered unique products and must be registered with EPA or cleared by FDA. It is important to remember that in most instances, a given product is designed for a specific purpose and is to be used in a certain manner. Accordingly, it is imperative that you always read the labels and warnings on the packaging carefully to ensure that you have selected the correct product for the intended use. You also need to ensure that it is applied properly and efficiently. “Effectiveness and compliance with standard guidelines/procedures are the most important considerations when selecting sterilants and disinfectants. By ensuring that instruments are effectively sterilized or disinfected and using appropriate effectiveness monitoring technology, SPDs play a critical role in helping to reduce the incidences of healthcare-acquired infections.”² Most disinfectants are not interchangeable. The use of incorrect concentrations and/or inappropriate disinfectants can result in damage to your reusable medical devices and incur extra time, labor and costs. Occupational diseases among reprocessing personnel have been associated with use of several commercially approved disinfectants (i.e., formaldehyde, glutaraldehyde, and chlorine). To reduce the risk to your reprocessing personnel, precautions should always be used to minimize exposure to these disinfectants. Such precautions should include approved gloves, barrier gowns, eye wear and proper ventilation.^3-5 Another risk associated with the use of chemical disinfectants is asthma and reactive airway diseases. These can occur in sensitized persons exposed to any airborne irritant that can trigger a reaction, including germicides. Asthma and reactive airway diseases can occur at levels below the levels currently regulated by OSHA. The best way to control this potential risk is through the elimination of the chemical. This can be done by switching to another disinfectant that the worker is not sensitive to or by simply relocating of the worker to another area. “More facilities are moving away from glutaraldehyde and choosing OPA or hydrogen peroxide solutions for faster disinfection times and fewer rinses, as well as to reduce staff safety concerns around glutaraldehyde exposure. Other considerations when selecting a high-level disinfectant include transducer compatibility (check your manufacturer’s IFU), contraindications, ventilation requirements and recommended re-use periods.” ⁶ When it comes to checking a manufacturer’s IFU, always make sure that the IFUs have been validated by an independent testing laboratory using AAMI and FDA recommended validation testing protocols. Without independent validation of the manufacturer’s IFUs, you have no way of knowing that the product will perform as advertised in your facility. In the absence of validated IFUs, you will not have the assurance that your medical devices won’t be damaged by the chemical disinfectant. More importantly, you won’t be able to ensure that your employees will not suffer any adverse reactions from its use. Read Part 3 here 1. Nadeau K. Connecting the dots, removing the spots. HPN November 20, 2017 2. Op cite 3. Weber DJ, Rutala WA. Occupational risks associated with the use of selected disinfectants and sterilants. In: Rutala WA, ed. Disinfection, sterilization, and antisepsis in healthcare. Champlain, New York: Polyscience Publications, 1998:211-26. 4. Hansen KS. Occupational dermatoses in hospital cleaning women. Contact Dermatitis 1983; 9:343-51 5. Melli MC, Giorgini S, Sertoli A. Sensitization from contact with ethyl alcohol. Contact Dermatitis 1986; 14:315. 6. Nadeau K. Op cite