Policy: C-08-PRO Reviewed: 7/08

Transcription

1 Written: 1979 Policy: Reviewed: 7/08 Procedure Policy Manual Revised: 81, 84, 85, 86, 87, 88, 89, 90, 92, 93, 95 Ambulatory Care Division 2/97, 7/98, 7/00, 7/02, 7/04, 7/06, 2/09, 7/10 LSU Health Sciences Center-Shreveport, LA 8/10, 5/13 Page 1 of 5 PURPOSE CIDEX (GLUTERALDEHYDE) and CIDEX OPA (ORTHOPHTHALAHYDE) HIGH LEVEL DISINFECTANT USED FOR INSTRUMENTS To provide guidelines for high level disinfection of ultrasound probes, scopes, and other instruments approved by the Infection Control Committee for processing in Ambulatory Care Clinics. POLICY 1. The following outpatient clinics are approved to use glutaraldehyde 2.4% (Cidex Activated Dialdehyde Solution) or ortho-phthalahyde 0.55% (Cidex OPA) for high level disinfection of the specified instruments: Clinics/Room Endoscopy (B3-4) Urology (3036) ENT (3086) Feist-Weiller Cancer Center (B334, B anteroom) Women & Children Health Center (2-170) Radiology ACB (1192) Usage- For High Level Disinfection of Gastric motility probes and balloons, flexible endoscopes that cannot be processed in Steris. Rectal ultrasound probes Nasopharyngeal scopes Panendoscopes, nasal scopes and laryngeal scopes Vaginal ultrasound probes Ultrasound probes 2. Only trained staff with documented competency are allowed to perform high level disinfection using glutaraldehyde or ortho-phthalahyde solutions. Annual competency is documented by the unit manager. 3. Glutaraldehyde and ortho-phthalahyde are kept in a controlled area. Containers are kept covered or closed to prevent fumes from disseminating into the air. 1

2 Cidex Activated Dialdehyde Solution/Cidex OPA High Level Disinfectant Used for Instruments Page 2 of 5 PROCEDURE Preparing Glutaraldehyde or Ortho-phthadahyde 1. Obtain a gallon bottle of solution. 2. Put on PPE (eye protection, mask, gloves, and gown). 3. Read and prepare the solution according to the manufacturer s directions on the label. (Glutaraldehyde requires mixing, ortho-phthalahyde does not.) 4. Carefully pour solution into an approved soak container. Do not splash or spill. Do not breathe the vapors. Replace the bottle cap. Place a lid on the soak container. 5. Label the soak container with the chemical solution, date of expiration, and initials. (If pouring from a previously opened bottle, check the expiration date on the original container. Solution in soak basins expires in 14 days or upon the expiration date of the original container, whichever comes first.) 6. If left over solution remains in the bottle, label the bottle with date of expiration and initials. Cidex 2.4% that remains in the bottle is good for only 14 days once activated. Cidex OPA that remains in the bottle is good for 75 days once opened. Quality Assurance for Test Strips When a new bottle of test strips is opened, perform the following quality assurance test. Ensure that the test strips you are using match the chemical (Cidex 2.4% test strips for Cidex 2.4%; Cidex OPA test strips for Cidex OPA). 1. Check the expiration date on the test strip bottle. If expired, throw away and obtain a new bottle. 2. Check the chemical solution you are using to be sure that the expiration date has not been exceeded. If it has been exceeded, do not use it, and obtain a new bottle of the chemical. 3. Prepare a control solution by diluting one part of full strength chemical solution to one part of tap water. 4. Dip 3 strips in the diluted solution and 3 strips in the full strength solution in accordance with the time specified on the bottle. Remove from the solution, stand on a paper towel, and read at the time specified on the bottle. 5. The 3 strips dipped in the full strength solution should change to the passing color on the bottle. 6. The 3 strips dipped in the diluted solution should match the fail color or not change color. 7. If your results differ from those described in number 4 and 5 above, discard the test strips, obtain a new bottle of test strips, and repeat the Quality Assurance test. 8. Document the results on the log sheet. 9. If more than one bottle fails the Quality Assurrance test, contact Infection Control. 2

3 Cidex Activated Dialdehyde Solution/Cidex OPA High Level Disinfectant Used for Instruments Page 3 of 5 Testing Glutaraldehyde/Orthophthalahyde for Efficacy 1. Glutaraldehyde/orthophthalahyde must be tested for efficacy before each use. 2. Before soaking any instrument: A. Put on a pair of unsterile gloves and eye protection. B. Check the expiration date on the soak basin to ensure that the expiration date has not been exceeded. If the expiration date has been exceeded, discard the solution. C. Check the bottle of test strips to ensure that you are using test strips that match the chemical and concentration you are testing, and to ensure that the expiration date has not been exceeded. If the test strips are expired, discard the bottle. Check the date the test strip bottle was opened. Discard any unused test strips after the bottle has been opened for 90 days. If opening the test strip bottle for the first time, place the date you opened it on the outside of the bottle and initial. Do not leave the test strip bottle open for more than 30 minutes. D. Remove a test strip from the bottle and replace the cap tightly. E. Read and follow directions on the bottle. Dip the indicating pad of the test strip into the soak solution. Follow test strip bottle directions and ensure that the strip is exposed to the chemical for the correct amount of time. F. DO NOT shake the test strip after removal from the solution. G. Remove excess solution by standing the strip upright on a paper towel. Discard the paper towel after one use. H. Read the results at the appropriate time interval according to label directions. I. If the color comparison matches the color for effective dilution of the high level disinfectant solution, record this in the log book and proceed with instructions for disinfection. J. If the color comparison does not match the results for effective dilution, record this result, and discard the solution. (Follow instructions below for discarding solution.) Cleaning and Decontaminating Instruments Prior to Disinfection Carefully measure enzyme cleaner and water, mix according to manufacturer s label instructions prior to beginning the cleaning process. 1. Instruments must be thoroughly cleaned and decontaminated prior to disinfection. 2. Thoroughly clean the instrument in accordance with the manufacturer s directions. 3. Wipe gel, blood, body fluids, or other debris off of ultrasound probes or scopes using clean 4 x 4 s or clean towel soaked in enzyme cleaner. Discard the 4 x 4 s or towel after one use. 4. If instruments have lumens or channels, they must be opened, caps removed, and thoroughly cleaned with enzyme cleaner. Channels must be brushed, and disposable channel brushes discarded after use on one instrument. 5. After cleaning with enzyme cleaner, rinse the instruments thoroughly, and dry with a clean towel or 4x4 s. Discard the towel or 4x4 s after one use. 6. Instrument lumens or channels should be blown dry with forced air. 3

4 Cidex Activated Dialdehyde Solution/Cidex OPA High Level Disinfectant Used for Instruments Page 4 of 5 Disinfection 1. Check the temperature of the solution and record on the log. If temperature is too cold, warm the room and test again. Acceptable temperatures are: Cidex 2.4% Activated Dialdehyde Solution: 68 F (20 C) or higher for a minimum soak of 20 minutes* Cidex OPA: 68 F (20 C) or higher for a minimum soak of 12 minutes* *Some departments may specify longer soak times. Check and follow your department policy. 2. Place clean, dry instrument into the soak basin. Ensure that the item is completely covered with the solution. If the instrument has inner lumens or channels, ensure that they are filled with the solution by injecting with a syringe. Replace the container lid. Remove and discard soiled gloves and gown. Wash your hands. 3. Record the time the instrument was placed in the solution as the start time or use a timer. The approved minimum soak time for glutaraldehye 2.4% is 20 minutes. Approved soak time for Cidex OPA is 12 minutes. The soak container should be labeled with the time the soak is complete or a timer should be used. 4. After the appropriate soak time has passed, prepare to rinse the instruments. Check to ensure that the soak time is complete. Wash your hands. 5. Open a sterile soak pan and sterile water. Pour sterile water into the soak pan. (Vaginal and rectal ultrasound probes may be rinsed in a clean soak pan using tap water or using copious amounts of running tap water.) 6. Put on a mask and eye protection. 7. Carefully remove the lid of the soak container and set aside. Put on a clean gown and wear sterile gloves. Remove the instrument from the soak solution, using care not to contaminate the instrument by touching contaminated surfaces or sides of the soak container. 8. Place the instrument in the basin of water. Rinse three times thoroughly to remove all traces of soak solution inside and outside of the instrument. Blot dry with sterile surgical towels or 4X4s. 9. If the instrument is lumened or channeled, use a syringe to force sterile water through the lumens, followed by purging the channels with 70% isopropyl alcohol, then dry with forced air. 10. Wrap the instrument in a clean towel for immediate use. Wrap bronchoscopes in a sterile towel. If the item is to be stored, place it in a clean container or bag, and hang long flexible scopes to dry in such a manner that the tip of the scope does not touch the bottom of the cabinet. 11. Replace the lid on the soak pan. Empty rinse basins after one use, dry, and send to CMS for cleaning and sterilization. If disposable rinse basins are used, discard after use on one instrument. 12. Remove and discard gown and gloves. 13. Keep the door to the processing room closed as much as possible. 4

5 Cidex Activated Dialdehyde Solution/Cidex OPA High Level Disinfectant Used for Instruments Page 5 of 5 Discarding Glutaraddehyde/Orthophthalahyde 1. Put on a mask, eye protection, clean gloves, and gown. 2. Place the discard bucket near the soak container. 3. Open the lid of the discard bucket and the lid of the soak container. 4. Carefully lift the soak container and pour the contents into the discard bucket, using care not to splash or spill the solution. 5. Place the lid on the discard container and, when ¾ full, call the Safety Office at extension If a spill occurs-first, contain the spill by placing cloth or paper towels to absorb it. Then, immediately call the safety office at extension Rinse the empty soak basin carefully in the sink using tap water, dry with clean towels, and send to Central Medical Supply for further cleaning and sterilization. Discard the towels after one use. 5