Understanding the Three Levels of Decontamination

Home 5 News 5 Understanding the Three Levels of Decontamination

Understanding the disinfection requirements and procedures is key for maintaining standards across the medical industry. Across the entire spectrum of appliances, devices and instruments, maintaining a rigorous decontamination schedule helps alleviate the transfer of potentially harmful micro-organisms to patients and staff. An understanding of the cycle of usage is a foundation for a broader understanding of decontamination.

Decontamination is defined as a single process or combination of processes that result in the equipment being safe to be used again on the same or another person.

There are three levels of decontamination; 1, general cleaning, 2, disinfection and 3, sterilisation.

Equipment used in healthcare may be designated as single use, single patient use or reusable multi-patient use. Any equipment not designated as a single use item must be made safe following use by Sterile Services Staff, or Decontamination Engineers to prevent micro-organisms being transferred from equipment to patients and potentially resulting in infection.

The Department of Health defines the medical device life cycle as acquisition; cleaning; disinfection; inspection; packaging; sterilization; tracking; transportation and storage before use.

In terms of reusable medical devices the approach is exactly the same with an extended life cycle that follows a use, transport, wash, disinfect, dry, inspect, pack, label, sterilise, storage, tracking, re-use process.

To ensure that the decontamination of reusable medical devices is undertaken correctly, it is vital for Sterile Services Technicians and Decontamination Engineers to conduct appropriate risk assessments and follow schedules that allocate risk levels to specific pieces of equipment.

The table below is taken from the Microbiological Advisory Committee (MAC) issued & updated by the MHRA in 2020 & is based upon the Spaulding Classification published in 1957, it’s principles remain relevant today.

Low risk: These items either contact only intact skin or do not come into contact with the patient e.g. IV pumps, furniture, floors. Low risk items should be kept both clean and dry & subjected to localised decontamination schedules between patient use.

Intermediate risk: These items: come into contact with intact mucous membranes; or may be contaminated with particularly virulent or readily transmissible organisms e.g. commode chair; or used on immunocompromised patients. Items require disinfection or sterilisation after cleaning.

High risk: These items penetrate skin or mucous membrane; enter the vascular system or sterile spaces. These items go through the complete decontamination process of cleaning, disinfection and sterilization.

Cleaning and/or disinfection of medical equipment must:

  • Take place after and between uses on individual service users.
  • Once cleaned/disinfected, pieces of equipment should be labelled, including being dated and signed to identify that it has been cleaned.
  • Audits should be carried out regularly on cleanliness of equipment in each area.
  • Equipment requiring service or repair must be thoroughly cleaned and decontaminated prior to inspection, and a label attached identifying method of decontamination.

In line with the above, the process across all risk levels involves cleaning, with lower risk items often requiring no more than a detergent wipe or wash with hot water, and thorough drying.

As the risk levels increase, so too does the requirement for comprehensive cleaning ahead of a heat disinfection process using steam under pressure, ethylene oxide, gamma irradiation and other sterilisation processes. See the table below:

Microbiocidal activity of decontamination methods:

 

SporesMycobacteriaBacteriaViruses
Thermal Washer-DisinfectorX✔✔✔✔✔✔✔✔
Low Temperature SteamX✔✔✔✔✔✔✔✔
Chemical DisinfectantEfficacy Dependent on Exact ChemicalEfficacy Dependent on Exact ChemicalEfficacy Dependent on Exact ChemicalEfficacy Dependent on Exact Chemical
Steam✔✔✔✔✔✔✔✔✔✔✔✔
Dry Heat
Gas Plasma / Activated Hydrogen Peroxide✔✔✔✔✔✔✔✔✔✔✔✔

 

Key: X None, ✔ Poor, ✔✔ Moderate, ✔✔✔ Good

 

To find out more about our services relating to the three levels of decontamination of reusable medical devices we offer at AVM Services, contact us today on 01223 254499 or email info@avm-addenbrookes.org.uk.

 

About our Sterile Services Technician Training

About our Decontamination Engineer Training

About our Decontamination Manager Training

Recent Articles

AP(D) Authorised Person Course – Glasgow

We are pleased to announce that our Authorised Person (Decontamination) Training Course (APD01) will be available between  14 to 17 May 2024 at NHS Greater Glasgow & Clyde.

This is a 4-day course to teach staff the skills and expertise needed to perform day-to-day tasks and duties to effectively manage aspects of decontamination.

read more

Quality Management Systems Course Showcased at IDSc

Cambridge University Hospitals-AVM attended the 17th Annual Institute of Decontamination Sciences (IDSc) conference on 28 and 29 November 2023 to showcase our newly-released online training course, Quality Management Systems 1 (QMS1). 

To ensure ease of use and broad-based accessibility, the course is video-based with interactive elements and is designed to be highly informative and beneficial to staff involved in the decontamination of reusable medical instruments such as surgical instruments or endoscopes.

read more

AVM Services – Decontamination Specialists

Professional training, consultancy and specialist services for decontamination testing and validation