Cleaning and Disinfection

Download Complete Policy

	JHH Official Cidex OPA Solution Log Sheet (PDF)

Decontaminate 10 minutes - Clean - Disinfect. Let Dry

Cleaning is the physical removal of organic material or soil from objects. It must be accomplished with water, mechanical action, and detergents. One must visually inspect an object after the process to assure that cleaning has been accomplished.

Disinfection (low, intermediate, high level) is the killing or inactivation of all microorganisms, except for some spore forms, on inanimate objects. The efficacy of disinfection is affected by a number of factors, including the type and level of microbial contamination, the activity of the disinfectant, and the disinfectant contact time. Organic material and soil can block disinfectant contact and may inhibit disinfectant activity. Therefore, cleaning must precede all disinfection processes.

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Cleaning

General purpose powdered detergent concentrate
Scouring powder
General purpose liquid detergent

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Low Level Disinfection

Kill most bacteria and some fungi, and inactivate some viruses. Does not reliably kill Mycobacterium tuberculosis or bacterial spores.

Quaternary ammonium compounds: AirX 109 ®
For designated areas: AirX 44 HBV ®

Non-Critical Items, Environmental Surfaces, Items in contact with intact skin - but not mucous membranes: blood pressure cuffs, floors, walls, table tops, beds, medical equipment.

Procedure

Disinfect - Operative Suites, Certain procedure areas, blood spills with AirX 44 HBV®
All other areas with AirX 109®

For AirX 109 ®

1. Dilute 1:256, 1/2 oz to 1 gallon of water - Label & Discard after 24 hours
2. It takes 10 minutes to disinfect a surface. Use enough solution so that it will take 10 minutes to air dry.
3. Wipe off with a clean cloth or mop
4. Change solution between patient rooms
5. Change cleaning cloths when you change the solution
6. Discard solution in hoppers, toilets or mop sinks.

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Kill most bacteria including Mycobacterium tuberculosis and most fungi.
They inactivate most viruses and kill some bacterial spores.

Best Choices:	Bleach 1:50 dilution	expires after 1 month	opaque container
	Bleach 3:64 dilution	expires after 1 month	opaque container
	Bleach 1:10 dilution	expires after 1 month	opaque container
	Ethyl or Isopropyl alcohol - 70%
Also Approved:	Hydrogen peroxide
	HTH (calcium hypochlorite solution) - Rehabilitation Medicine Dept. Only
	Lysol® (Phenolic) - written approval required from HEIC

Select Semi-Critical Items

Hydrotherapy tanks
thermometers
medical equipment

Clean first
Disinfect

1. Check expiration date of solution!
2. It takes 10 minutes to disinfect a surface. Use enough solution so that it will take 10 minutes to air dry.
3. Wipe off with a clean cloth or mop
4. Change solution between patient rooms
5. Change cleaning cloths when you change the solution
6. Discard solution in hoppers, toilets or mop sinks.

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Bleach 1:50 dilution	expires after 1 month	opaque container
Bleach 3:64 dilution	expires after 1 month	opaque container
Bleach 1:10 dilution	expires after 1 month	opaque container
AIRX 44 HBV®

Don't get stuck: If broken glass or other sharp material may be present, use a dust pan forceps or other device for clean-up. Discard waste in biohazard boxes lined with red bags.

Procedure

1. Put on gloves, gown and additional personal protective equipment as indicated. Anticipate splashing.
2. Cover spill with absorbant drape or paper towel
3. Flood with appropriate bleach dilution or AirX 44 HBV ®
4. Wait 10 minutes
5. Wipe up spill and discard in red bags.
6. Perform a final wipe with an intermediate-level disinfection. Use sufficient solution so that it takes 10 minutes to dry.
7. Let dry

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Ortho-phthaldehyde Cidex OPA®

Health Safety & Environment (HSE) must be contacted before an area uses Ortho-phthaldehyde Cidex OPA®. In most settings, Cidex OPA® must be used in a fume hood. Not for environmental surfaces. Only trained staff may use Cidex OPA®. Gluteraldehyde (Cidex®) is no longer used at Johns Hopkins Hospital.

Semi-Critical Items, Selected Critical Items

Semi-Critical items are those which come into contact with mucous membranes or non-intact skin:

respiratory therapy equipments, endoscopes.

Procedure
Only trained staff may use Cidex OPA®

JHH Official Cidex OPA Solution Log Sheet (PDF)

Wear gloves, goggles, and an apron or gown. Avoid skin contact. Caustic and can cause skin irritation.

1. Test solution when first placed into use using approved test strips.
2. In- use solution expires 14 days. Unused solution in capped bottle expires 70 days after opening.
3. Solution must be marked with the date it was placed in use and the expiration date.
4. Test orth-phthaldehyde concentration daily with test strips. Report test strip failures to HEIC.
5. Wash items thoroughly in detergent and water then rinse prior to immersion in Cidex OPA®.
6. Immerse in Cidex OPA® for 12 minutes.
7. Remove from Cidex OPA® using aseptic technique and rinse thoroughly with sterile water. flush interior aspects vigorously with three times using a minimum of 500 cc of sterile, tap, or filtered water for each rinse.
8. If filtered or tap water is used for rinsing, a final rinse using 70% isopropyl alcohol is required.
9. Insertion tubes and channels must be thoroughly dried.
10. Discard Cidex OPA® only after it has been neutralized. Contact the Department of Health, Safety and Environment 5-5918.

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JHH/JHU Staff Employees	Follow the policy Use appropriate agents from the approved list of cleaners and disinfectants
Supervisor/Department Management	Ensure employee compliance with this policy Contact HEIC to seek approval of new products
Dept of Hospital Epi and Inf Control (HEIC)	Maintain up to date, effective policies
Health Safety and Environment	consult on spill cleanup, Cidex OPA® use dermatologic reactions to cleaning & disinfection products
Environmental Services	Maintain adequate supply of approved agents. Assist with large blood spills.

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Block SS, ed. Disinfection, sterilization, and preservation. 4th ed. Philadelphia: Lea and Febiger, 1991.

CDC Hospital Infection Control Practices Advisory Committee, “Guideline for Prevention of Nosocomial Pneumonia - Part I and II”, AJIC Am J Infect Control, 1994; 22: 247-292.

Rutala WA. Guideline for selection and use of disinfectants. Am J Infect Control 1996;24: 313-342.

Martin, MA, Reichelderfer, M. APIC Guideline for Infection Prevention and Control in Flexible Endoscopy. Am J Infect Control 1994;22:19-38.

Hospital Infection Control Practices Advisory Committee. Guideline for Prevention of Nosocomial Pneumonia. Part I and II. Am J Infect Control 1994;22:247-292.

Hanson, PJV et al. A study if glutaraldehyde disinfection of fiberoptic bronchoscopes experimentally contaminated with MTB. Journal of Hospital Infection (1992) 22, 137-142

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