Cleaning and disinfecting shared patient care equipment
Shared patient equipment and the healthcare environment must undergo routine cleaning and disinfection as required as part of the standard or transmission-based precautions. The choice of products for cleaning and disinfection is an important one; effectiveness of the product, suitability for the surface and practicality must all be considered.
Shared patient equipment
Shared patient care equipment that comes into contact only with intact skin such as IV pumps, blood pressure monitors and wheelchairs is classified as non-critical under the Spaulding classification. Non-critical equipment requires cleaning, at a minimum, between patients.
Disinfection of non-critical equipment is not routinely required unless the equipment has come into contact with blood or body fluids, or patients with multi-resistant organisms (PDF, 150KB) or Clostridioides (Clostridium) difficile (PDF, 137KB).
Product requirements for cleaning or disinfection of patient care equipment
Most patient care equipment meets the definition of a medical device as per the Therapeutic Goods Act 1989. The definition of a medical device is very broad and includes a range of items from wound dressings to blood pressure monitors, and from catheters to hospital beds.
Any equipment, instrument, device, apparatus, material or other article used for the diagnosis, prevention, monitoring, treatment or alleviation of disease (among other inclusions) is classified as a medical device. The regulation of medical devices is overseen by the Therapeutic Goods Administration (TGA).
Specific requirements apply for the regulation of products intended to be used to clean and disinfect medical devices. Cleaners intended to be used on medical devices must be ‘included’ in the Australian Register of Therapeutic Goods (ARTG) before they can be supplied in Australia, and are themselves regulated as a Class I Medical Device. Disinfectants intended to be used on medical devices must also be ‘included’ in the ARTG, and are regulated as a Class IIb Medical Device.
The healthcare environment
As per the Australian guidelines for the prevention and control of infection in healthcare, local risk assessment should determine the appropriate product, method and frequency of cleaning of the healthcare environment.
Some situations require disinfection of the environment in addition to cleaning, for example:
- management of outbreaks of communicable diseases in health facilities (PDF, 195KB)
- management of multi-resistant organisms (PDF, 150KB)
- management of patients with Clostridioides difficile infection (PDF, 137KB).
Local risk assessment may identify additional situations requiring disinfection of the healthcare environment.
Hospital-grade disinfectants with specific claims including antibacterial cleaning wipes, fluids or powders must be listed on the ARTG as 'other therapeutic goods'.
Additional considerations when choosing a method for cleaning or disinfection
Items or surfaces must be clean for disinfection to be effective, sole reliance on a disinfectant without physical cleaning is not recommended. When disinfection is required, surfaces or items should always be physically cleaned with a detergent solution followed by or combined with a disinfectant.
When choosing a method for cleaning or disinfection of shared clinical equipment there are a few considerations, such asit is important to consider:
- equipment manufacturers should provide instructions for reprocessing, including the method to be used and compatible chemicals
- material compatibility of cleaning/disinfectant products with the equipment
- appropriateness of the method or disinfectant product for the target organism or local epidemiology
- potential for reduced susceptibility to chemical germicides
- cleaning and disinfection products must be used according to manufacturer’s instructions, including the required contact times for disinfectant products and any recommended rinsing process.
For further information refer to Chapter 3 of the Australian guidelines for the prevention and control of infection in healthcare.