Decontamination of medical equipmentBMJ 2009; 338 doi: https://doi.org/10.1136/sbmj.b1022 (Published 01 April 2009) Cite this as: BMJ 2009;338:b1022
- Baha Al-Shaikh, consultant anaesthetist and honorary senior lecturer1,
- Radhika Jadavji, fifth year medical student2,
- Alexander Al-Shaikh, first year medical student2
- 1William Harvey Hospital, Ashford, Kent
- 2King’s College, London
Every year millions of surgical procedures and invasive medical procedures are carried out. Such procedures involve contact by a medical device or surgical instrument with a patient’s sterile tissue or mucous membranes. The introduction of infections, such as meticillin resistant Staphylococcus aureus and Clostridium difficile, is a major risk to patients. In the past decade, there have been concerns regarding iatrogenic transmission of variant Creutzfeldt-Jakob disease (vCJD) through surgical instruments.1
Failure to adequately decontaminate equipment carries the risk of person to person transmission—for example, hepatitis B virus—and transmission of environmental pathogens. Decontamination is a term that encompasses all the processes necessary to enable a reusable device to be reused. This includes cleaning, disinfection, inspection, packaging, sterilisation, storage, and use (box 1). The process makes medical devices safe for users to handle and safe for use on the patient.
Box 1: Cleaning, disinfection, and sterilisation
Cleaning—The removal of visible soil, organic material, and inorganic material from objects and surfaces, normally accomplished by manual or mechanical means, using water with detergents or enzymatic products. Cleaning does much to reduce risk of vCJD.
Disinfection—A process that eliminates many or all pathogenic micro-organisms on inanimate objects, except bacterial spores, usually accomplished using chemicals and heat (washer disinfector).
Sterilisation—The complete elimination or destruction of all forms of microbial life, accomplished by physical or chemical processes.
Healthcare associated infections are the leading cause of preventable disease. In the United Kingdom they are responsible for more than 5000 deaths a year and cost the NHS more than £1bn (€1.1bn; $1.5bn) a year. In the United States $4.5bn-6bn a year is spent on tackling these infections. Healthcare facilities must develop strategies to reduce the transmission of infection.
Clean, disinfect, or sterilise?
Because there is no need to sterilise all clinical items and some items can’t …