The Principles of Medical Device Decontamination

Flexible teams should be brought together to accomplish this; the composition of the team may need to vary as the situation develops. The following is a very general summary of categories of failures and the possible significance of those failures. It is a guide and cannot be definitive.

An item being used without any decontamination This is usually an isolated inadvertent occurrence involving a single patient, who would normally be easily traced. It could occur on a wider scale due to grossly inadequate systems or negligence. In this case, patients affected may be very difficult to trace. An item being used with inadequate cleaning prior to disinfection or sterilisation Heat based disinfection and sterilisation are resilient processes where microbicidal action is very unlikely to be compromised significantly by a pre-cleaning failure. Cleaning failures preceding heat based processes do pose risks to patients in other contexts, such as the introduction of extraneous particulates in delicate situations such as those involving lenses in the eye, but these are not infection risks. Effective cleaning before chemical disinfection is more critical and failures here can compromise disinfection significantly. Chemical sterilisation processes such as those using hydrogen peroxide are comparatively new technology and there is less experience on their resilience, but they are likely to be compromised significantly by pre-cleaning failures. The degree of failure here would be important. Chemical disinfection can be severely compromised by failures in adequate pre-cleaning, both in terms of inactivation of the disinfectant by the presence of organic matter, and in terms of the disinfectant failing to penetrate a mass of organic matter. Examples of minor cleaning failure would be using an unvalidated detergent, using too low a detergent concentration, inadequate exposure time or sub-optimal temperature. An example of a major cleaning failure would be complete failure to irrigate a medical device lumen.

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