Beyond community services: common cleanliness gaps in patient care

While making rounds within the clinic, I noticed staff cleansing the vaginal ultrasound probes between patients with a disinfectant wipe containing quaternary ammonium (a low-level disinfectant suitable to be used on devices that come into contact with intact skin). When I asked in regards to the process, the staff explained that for the reason that probe is roofed with a canopy, they assumed a disinfecting wipe can be enough. Although probe covers provide a vital layer of protection, they’ll leak or cause microscopic perforations. Because contamination can still occur, these probes should all the time be treated as in the event that they were in touch with mucous membranes and require a high-level disinfectant (suitable to be used on devices that contact mucous membranes or intact skin) fairly than a low-level disinfectant.

Gaps in knowledge and performance.

These forms of misunderstandings will not be unusual in healthcare and illustrate a broader challenge: cleansing failures are sometimes due to not lack of effort, but to gaps in knowledge and execution. Despite a few years of experience conductivityregulatory and accreditation studies proceed to cite inconsistencies in cleansing and disinfection practices.

Spaulding’s classification system.

Spaulding’s classification systemwhich categorizes medical devices in keeping with the chance of infection. Critical components enter sterile tissue or vascular systems and require sterilization. Semi-critical items come into contact with mucous membranes or intact skin and typically require high levels of disinfection. Non-critical items come into contact with intact skin and typically require low to moderate levels of cleansing and disinfection.

Other key sources of guidance.

Understanding this classification helps nursing staff prioritize cleansing requirements and avoid assumptions in regards to the level of disinfection required. Once the extent of reuse has been determined, the manufacturer’s Instructions for Use (IFU) provides detailed cleansing and disinfection steps, including compatible products and required contact times. Most healthcare facilities even have policies outlining approved processes for cleansing and disinfecting reusable equipment and eco-friendly surfaces. Accrediting agencies often ask employees in the event that they know where to seek out this information.

Appearances are deceptive.

When surfaces are freed from visible dirt, it is simple to assume that they’re secure. However, a surface that appears clean should still contain pathogens that could be transferred to patients. Some organisms, including multidrug-resistant organisms, may survive on surfaces for days and even months, contributing to infections and outbreaks of health care-associated diseases.

The role and responsibility of the nurse within the cleansing and disinfection process.

Nursing staff might also assume that environmental services staff are liable for cleansing all surfaces and equipment within the patient’s environment. While environmental services teams play a key role, not every surface or device falls under their responsibility. Often ignored items include vital sign monitors, blood glucose monitors, pulse oximeter probes, mobile workstations, keyboards, and other common equipment that’s touched multiple times throughout the day. Because nurses often have essentially the most direct contact with patients and reusable equipment, they’re uniquely positioned to use appropriate cleansing and disinfection processes.

Similar to the “5 Laws” of medication administration, there are also necessary principles to support effective cleansing and disinfection.

• Proper instructions matter. All disinfectants, cleansing tools, medical equipment and surfaces have instructions to be used that have to be followed fastidiously. Common gaps include staff not knowing where to locate the user manual or not understanding the necessities for a particular product.
• The right disinfectant matters. Not all disinfectants are interchangeable and all healthcare disinfectants needs to be approved by the Environmental Protection Agency (EPA) to be used in healthcare. Common vulnerabilities include using unapproved products, failure to scrub visibly dirty surfaces before disinfection, and assuming that every one wipes are equivalent.
• The right cleansing tool matters. Some cleansing products are incompatible with some disinfectants and should reduce their effectiveness. Common shortcomings include reusing contaminated wipes, using dried wipes, or replacing any available tool.
• The right surface matters. Different surfaces and equipment require different approaches. Some devices could also be damaged by incompatible disinfectants, while single-use items shouldn’t be reprocessed under any circumstances.
• Proper contact time matters. For disinfectants to work properly, they need to remain visibly wet on the surface. Common deficiencies include wiping the surface dry too quickly or failing to fulfill the required dwell time.

Healthcare environments may never be sterile, but they could be safer. Effective cleansing and disinfection shouldn’t be about doing more; what they care about is carrying out this process accurately and consistently. Small gaps in practice can result in significant consequences, but small improvements could make a major difference to patient safety.

Missy Travis, RN, MSN, CIC, FAPIC, is the founding father of IP&C Consulting, LLC, a consulting firm that assists infection preventionists, healthcare organizations, business owners and skilled sports teams in developing and maintaining effective infection prevention programs. Her last post was: “What’s in the air? A new approach to airflow and infection risk in healthcare.”