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Proper device cleaning requires manufacturer guidance, internal process


July 20, 2017

Press manufacturers and vendors for details on the proper cleaning products and solutions to use on their equipment. Then make sure that employees responsible for cleaning sensitive hospital equipment have access to the right cleaning products and clear instructions on how to use them. 

The ECRI Institute recently listed device failures caused by cleaning products and practices as one of its top 10 health technology hazards heading into 2017. Specifically, the use of cleaning solutions that are incompatible with the equipment on which they’re used can cause devices to malfunction, shortening lifespan and potentially impacting patient care.

The first step to ensure proper maintenance of equipment acquired by the hospital is to check with the manufacturer for its recommendations on how to clean the equipment, specifically which products to use, says Joseph Gordon, president of Survey Resources in Manchester, New Jersey. An equipment manufacturer might specify that products be cleaned with their own brand of cleaning solutions, Gordon points out. 

However, in most cases, it will be difficult to pin a manufacturer down on which products to use when cleaning equipment, says Robert Albrecht, president of Infection Prevention Systems, LLC, in Baltimore and the former director of life safety for Medstar Washington Hospital.

Follow instructions

When manufacturers won’t tell you what to use, it’s important for them to specify what not to use, Albrecht says. These instructions will typically be based on the type of cleaning solutions and might instruct staff not to use an alcohol-based cleaning solution or one that contains hydrogen peroxide, Albrecht says.

The type of surface and the location that’s being cleaned also matter. A vinyl surface would be handled differently than one with a polyurethane finish, and cleaning done in an ICU might be different than that done in an operating room, Albrecht points out. 

When it comes to different areas of the hospital, it is important to verify that bioburden levels on products—defined as the number of bacteria living on a surface that has not been sterilized—are acceptable, he adds. Regulators don’t define acceptable bioburden limits for products and equipment, Albrecht says. This varies based on the equipment type and location and should be measured and averaged across tests for different products.

Bioburden levels can be measured using culturable plates and swabs and through use of adenosine triosphate (ATP), which is a screening agent, Albrecht says. He adds that ATP doesn’t differentiate between contaminant types, but its use in healthcare is growing as a tool to verify cleanliness. With other agents, it is important to know which media will measure which contaminants, such as bacteria versus fungi. 

EC committee should define process

Determining which cleaning products and solutions are appropriate for each piece of hospital equipment falls within the purview of the Environment of Care committee, according to Albrecht. 

The committee’s work goes beyond just selecting products—the frequency of cleaning and who is responsible for cleaning the equipment are also important considerations, he says. CMS requires the hospital to document standard operating procedures that include the process of training employees to clean different types of equipment as well as the chemical agents being used throughout the facility—things that are not always well defined, Albrecht notes.

The committee should define who is responsible for cleaning different parts of the hospital—such as the ICU, emergency department, and operating rooms—with cleaning processes based on the equipment located in those areas and the acceptable bioburden for different parts of the hospital, Albrecht says. 

Remember that cleaning frequency and the amount of contact time between the cleaning solutions and the equipment are important elements that should be defined in your policy, according to Albrecht. Additionally, any cleaning solution, even those appropriate for the equipment, will cause a certain amount of degradation of the equipment. That is an inherent part of the aging process of medical equipment, he notes.

Emphasize training on proper cleaning

A critical element of your cleaning policy is making sure the people responsible for performing the tasks are properly trained, Gordon points out. 

Include pictures of the equipment on the cleaning supplies that are appropriate for that equipment and specific instructions on the supplies about which pieces of equipment are appropriate for those supplies, Gordon suggests. The individuals who are actually cleaning the equipment are not always high-skill employees, depending upon the location in the hospital and the type of equipment, so clear guidance can help to ensure the wrong cleaning materials aren’t used, he adds. 

When looking at equipment cleaning policies and procedures, triage the equipment based on a pyramid of priority, Albrecht says. Start with the most expensive, most often used, and most fragile equipment, and prioritize the resources devoted to this equipment to ensure appropriate maintenance. 

Priority equipment likely makes up a significant amount of the items in the hospital, Albrecht warns. As an example, take monitors, which have specific instructions for care, including the type of cleaning supplies used and the frequency of cleaning. Hospitals typically have thousands of monitors, often more than one in every room, of different types and sensitivities, Albrecht says. These pieces of equipment give an idea of the risk the hospital could face without well-defined equipment cleaning practices. 

Editor’s note: This article originally appeared in Environment of Care Leader.

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