Use of disinfectants and antiseptics policy Responsible Directorate:
Dr Judith Hooper
20 January 2010
NICE GUIDANCE Once NICE guidance is published, health professionals are expected to take it fully into account when exercising their clinical judgment. However, NICE guidance does not override the individual responsibility of health professionals to make appropriate decisions according to the circumstances of the individual patient in consultation with the patient and/or their guardian or carer.
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Version Control Document Title: Document number: Author: Contributors: Version: Date of Production: Review date: Postholder responsible for revision: Primary Circulation List: Web address: Restrictions:
Use of disinfectants and antiseptics Sue Ross NHS Kirklees Infection Prevention and Control Team 1 September 2009 September 2011 Lead Infection Prevention and Control Nurse
Performance Indicators Performance Indicators:
Safe use of antiseptics and disinfectants
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Section 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11
Introduction Associated policies and procedures Aims and objectives Scope of the policy Accountabilities and responsibilities Disinfectants and antiseptics Environmental disinfection Equality impact assessment Training needs analysis Monitoring compliance with this policy References
Page 4 4 4 5 5 6 8 10 10 10 11
Appendices A B C D
Definitions Key Stakeholders consulted/involved in the development of the policy/procedure Equality Impact Assessment Tool Choice of disinfectants
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12 13 14 15
Policy Statement NHS Kirklees will ensure the safe and effective use of disinfectants and antiseptics to ensure the safety of patients and staff.
Introduction NHS Kirklees has a duty of care to keep patients, staff and visitors safe by having systems to ensure that equipment is properly decontaminated this includes using appropriate cleaning materials for the environment for skin cleansing.
Associated policies and procedures This policy should be read in accordance with the following Trust policies, procedures and guidance.
Hand Decontamination Policy
Standard Universal Precautions Policy
Health and Safety Policies
Incident Reporting Policy
Waste Management Guidelines
Records Management Policy
Medical Devices Policy
Aims and objectives The key aims of this policy are: ●
To ensure high standards of decontamination of reusable medical devices occurs using the cleaning agents recommended by the manufacturer.
To ensure staff are aware of which disinfectant to use for the environment and equipment.
To reduce the associated risks to patients, and healthcare workers from the transmission of healthcare associated infections (HCAI).
To ensure compliance with the Health and Social Care Act (2008).
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Scope of the policy This policy must be followed by all NHS Kirklees employees who are developing policy and procedural documents or developing guidance for colleagues. It must be followed by all staff who work for NHS Kirklees (the PCT), including those on temporary or honorary contracts, bank staff and students. Breaches of this policy may lead to disciplinary action being taken against the individual. Independent contractors are responsible for the development and management of their own procedural documents and for ensuring compliance with relevant legislation and best practice guidelines. Independent contractors are encouraged to seek advice and support as required.
Accountabilities and Responsibilities The Chief Executive (CE) is accountable for ensuring that effective arrangements for the use of disinfectants and antiseptics are in place within NHS Kirklees. The Director of Infection Prevention and Control (DIPC) has responsibility to provide assurance to the Board and to have direct accountability for the appropriate use of cleaning agents, antiseptics and disinfectants. The Infection Prevention and Control team will: ●
Ensure this policy is reviewed as required and work with Heads of Services to implement necessary changes in practice.
Act as a resource for the purchase, monitoring and cleaning of equipment.
Act as a link between NHS Kirklees and specialist agencies and networks.
Take a role in investigating incidents related to decontamination and managing associated hazards.
Heads of Service are responsible for ensuring that healthcare professionals using antiseptics and disinfectants adhere to the policy. Employees will: ●
Co-operate and assist with the implementation of the Policy, and its associated procedures.
Bring to the notice of management, any problems of failings associated with the use of antiseptics and disinfectants.
Attend training as required.
Make themselves aware of, and follow safe systems of work and control methods (including personal protective equipment) provided for their safety and the safety of Page 5 of 16
Always follow the instructions within the product information regarding dilution and handling.
Promptly report all incidents concerning the use of cleaning agents, antiseptics and disinfectants in accordance with the Trust’s Policy and Procedure on reporting incidents.
Report any adverse ill health effects arising from the use of cleaning agents, antiseptics and disinfectants to both the Health & Safety Department and the relevant Occupational Health Department.
Seek specialist advice as necessary.
Disinfectants and Antiseptics Disinfection Disinfection is a process used to reduce the number of viable infectious agents but which may not necessarily inactivate certain viruses and bacterial spores. Disinfection does not achieve the same reduction in microbial counts as sterilisation. Many disinfectants are inactivated by organic matter such as blood, pus, food and faeces. Instruments and other articles must, therefore, be thoroughly cleaned before disinfection. Disinfectants - are chemicals that destroy micro-organisms (not prions). However, they are not suitable for use on skin or tissue. Antiseptics - are usually non-toxic chemicals that destroy or inhibit the growth of microorganisms on the skin or tissues. Dilution:
chemical disinfectants/antiseptics must be used at the recommended strength. Too high a concentration is wasteful; too low a concentration is ineffective.
check the shelf life of the disinfectant/antiseptic and ensure correct storage many disinfectants deteriorate after dilution. Solutions should always be freshly prepared, used once then thrown away.
no disinfectant/ antiseptic acts instantly. It is, therefore, essential that the correct time is observed.
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COSSH Regulations The Control of Substances Hazardous to Health (COSHH) regulations 2002 requires that an assessment is made of any health risk that may arise from exposure to hazardous substances and that appropriate control measures must be provided to avoid the risk. Most disinfectants are hazardous to some degree and are, therefore, subject to COSHH regulations. A full assessment of the risks should be available and should be consulted if required. Accidental spillage of irritant disinfectants onto skin or into eyes must be removed immediately with plenty of cold water. Please refer to individual COSHH risk assessment sheets available
COSHH Hazards Aldehydes
Extremely irritant and toxic. Not recommended for use in Primary Care.
Highly inflammable: irritant to eyes, nose and throat; prolonged skin contact may cause drowsiness.
Generally of low toxicity. If concentrated may cause irritation to the eyes and skin. In normal use is non-irritant, but prolonged contact can occasionally cause hypersensitivity.
Irritant to nose, eyes and lungs; contact with acid (eg, urine) gives off chlorine gas therefore avoid applying directly onto urine spills.
Iodine and Iodophors
May cause skin reactions
Appendix 1 details the disinfectants and antiseptics currently available.
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Environmental Disinfection Hypochlorite 0.1% solution Equivalent to 1,000 parts per million of available chlorine
For general clinical and environmental use where no body fluid is present
Hypochlorite 1% solution Equivalent to 10,000 parts per million of available chlorine
For spillage of blood and body fluids
Hard surface detergent wipes
To clean hard surfaces
The general environment ie, the walls, floors, ceilings and furniture do not require disinfection unless contaminated with blood and body fluids. Warm water and a neutral detergent/detergent wipes are generally sufficient. Disinfectants must never be poured down drains in an attempt to disinfect them.
National Colour Coding Scheme of Safer Hospital Cleaning
SANITARY APPLIANCES AND WASHROOM FLOOR
GENERAL AREAS (inc wards, depts, office and communication areas)
KITCHENS (dept and ward)
WASHBASINS AND WASHROOM SURFACES
OPERATING THEATRES AND ANTE ROOMS
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Professional concentrated neutral detergent for environmental cleaning and washing up The manufacturer’s recommendation for dilution must always be followed. For general cleaning duties, the usual strength is 0.1% (5 mls of neutral detergent per 5 litres of warm water); for washing up crockery and general kitchen utensils, the usual strength is 5 mls of neutral detergent in 10 litres of warm water. Alternatively detergent wipes can be used (AZO plus wipes). Chlor-Clean Chlor-clean is a product used for terminal cleaning and disinfection of patient surfaces during and following outbreaks of infection. Chlor-clean should be used at 1,000 parts per million available chlorine for “terminal cleans” of areas or rooms / wards after use by infected patients. During outbreaks of infection areas / wards must be cleaned twice daily with Chlor-clean solution, and commodes after each and every use.
Equality Impact Assessment Page 9 of 16
In order to meet these requirements, a single equality impact assessment is used to assess all its policies/guidelines and practices. This Policy was found to be compliant with this philosophy (see Appendix C). 9.
Training Needs Analysis In order to ensure that policies, guidelines and protocols are introduced and work effectively, there is a need to provide adequate training and instruction. As a result, the author of this document has carried out a training needs analysis which has identified that clinical staff require training. The contents of this policy will be highlighted within the infection prevention and control mandatory training sessions. NHS Kirklees is committed to the training and continuing development of all staff including independent contractors on all relevant issues surrounding the safe use of disinfectants and antiseptics.
Monitoring Compliance with this policy NHS Kirklees will monitor compliance with this policy using: â—?
Environmental audit results.
Essential Steps assessments
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References ● Winning Ways: Working Together to Reduce Healthcare Associated Infection in England, Chief Medical Officer, 2003 ● Getting Ahead of the Curve: A Strategy for Combating Infectious Diseases, Department of Health, 2002 ● The Health Act 2006. Code of Practice for the Prevention and Control of Health Care Associated Infections. Department of Health. (Revised January 2008.) ● National Decontamination Project. A process for commercial involvement in improving NHS Decontamination. NHS Estates June 2003. ● About the Healthcare Commission. Inspecting, Informing, Improving. Commission for Healthcare Audit and Inspection 2005. ● Standards for Better Health. Legislative Basis Section 46 of the Health and Social Care (Community Health and Standards) Act 2003. ● Department of Health 2007 – Decontamination Health Technical Memorandum 01-01 Decontamination of Reusable Medical Devices ● Saving Lives / Essential Steps to Safe, Clean Care (DH 2006). ● Health and Social Care Act (2008) DH ● Clostridium difficile infection: How to deal with the problem – DH and HPA, January 2009 ● Aycliffe G., Hugo W. Russell A. (1992) Principles and Practice of Disinfection. Preservation and Sterilisation. Blackwell. London ● Control of Substances Hazardous to Health Regulations 2002. Statutory Instrument 2002 No 2677. ISBN 0 11 042919 2, ● Health and Safety at Work Act (1974) HMSO. London. ● Management of Health and Safety at Work Regulations 1999. Statutory Instrument 1999 No. 3242. ISBN 0 11 085625 2. http://www.opsi.gov.uk/SI/si/1999/19993242.htm ● MHRA DB 2006 (04) Single Use Medical Devices: Implications and Consequences of Reuse. DOH London ● Personal Protective Equipment (PPE) at Work. Health and Safety Executive (HSE) 1992. ● The Environmental Protection Act 1990. The Stationery Office, London. Page 11 of 16
Definitions Infection Control Infection control is the use of evidence based practice, training and education, policies and procedures to prevent or minimise the risk of cross infection, through a managed environment, which minimises the risk of infection to patients, staff and visitors. Disinfectant Chemicals that destroy micro-organisms (not prions). They are not suitable for use on skin or tissues. Antiseptic Usually non toxic chemicals that destroy or inhibit the growth of micro-organisms on skin or tissue.
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Key stakeholders consulted/involved in the development of the policy Stakeholders name and designation NHS Kirklees Infection Control Committee KCHS SOP Group
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Key Participant Yes/No Y
Feedback requested Yes/No Y
Feedback accepted Yes/No
Equality Impact Assessment Tool
Insert Name of Policy / Procedure Yes/No 1.
Does the policy/guidance affect one group less or more favourably than another on the basis of: • Race
• Ethnic origins (including gypsies and travellers)
• Religion or belief
• Sexual orientation including lesbian, gay and bisexual people
• Disability - learning disabilities, physical disability, sensory impairment and mental health problems
Is there any evidence that some groups are affected differently?
If you have identified potential discrimination, are any exceptions valid, legal and/or justifiable?
Is the impact of the policy/guidance likely to be negative?
If so can the impact be avoided?
What alternatives are there to achieving the policy/guidance without the impact?
Can we reduce the impact by taking different action?
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Appendix D Choice of Disinfectants Generic Classification Phenolics
Brand Name Black fluids – Jeyes fluid White fluids – Izal Clear soluble – Stercol, Hycolin, Clearsil
Applications General environmental disinfection Environmental particularly in presence of sputum/faeces
Gram positive, Gram negative, fungi, some viruses bacterial spores-resistant
Cuts and abrasions
Gram positive Gram negative – poor
A wide range of environmental applications.
Gram positive Gram negative, AFB – moderate, bacterial spores, fungi-moderate
Domestos, Milton, other Chlorinereleasing products, eg, Haz Tabs, Presept, Chlor-clean
Iodine and iodophors
Povidone iodines Betadene, Disadene
Broad spectrum Sporicidal
Chlorhexidine Hibitane Hibiscrub Hibisol Chloroprep
Gram positive Gram negative – moderate, some viruses, fungi
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Efficiency factors Good general purpose disinfectants. Corrosive. Poisonous. Cannot be used where they can contaminate food. May stain wool, cotton and synthetic fabrics. Damages copper nickel and zinc. Inactivated by hard water and organic matter. Good cheap effective disinfectants. Odour can be irritant. May corrode fabric and metals. Not compatible with detergents. Should not be mixed with acids, eg, urine. Inactivated by organic materials. Undiluted liquid hypochlorite has a limited shelf life; always check ‘use by date’. May cause skin reactions. Only antiseptic to have sporicidal action on skin Non-toxic. Has residual and cumulative effect on skin. Inactivated by soap. Alcohol solution should not be used with diathermy. Too expensive for environmental use.
Dilution % Black fluids – follow manufacturer’s instructions. Stercol 1% Hycolin 1% Clearsil 0.625%
2.5-5-% Available chlorine (ppm) required Blood spill – 10,000 ppm Environment – 1000 ppm Instruments – 500 ppm Infant bottles, teats – 125 ppm (undiluted chlorine contains 100,000 ppm available chlorine) Hand disinfection – 0.75% povidone iodine 1 in 10 (0.5%) with alcohol 70% for pre-op 1 in 100 (0.05%) for general skin use 2% Chlorhexidine for skin cleansing
Skin disinfection Trolley tops Thermometers
Gram positive Gram negative AFB some viruses
Heat sensitive equipment
Gram positive Gram negative Bacterial spores, HIV and HBV, Fungi, AFB – moderate
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Efficiency factors Evaporation diminishes concentrations. Can only be used effectively on clean surfaces. Causes rubber to swell and plastic to harden. Flammable. Non-damaging to plastic, metal and rubber. Extremely toxic
Dilution % Ethanol – 70% (90% for viruses) Isopropanol – 60-70%
These chemicals are irritant and strictly controlled under COSHH. Their use cannot be recommended in primary care.