[{"id":44603277363,"handle":"high-level-disinfecting","title":"High-Level Disinfection","updated_at":"2020-05-28T13:35:03-07:00","body_html":"\u003cdiv class=\"coll_desc\"\u003e\n\u003ch2\u003eHigh-Level Disinfection Definition\u003c\/h2\u003e\n\u003ch3\u003e\n\u003cstrong\u003eWhat is high-level disinfection\u003c\/strong\u003e?\u003c\/h3\u003e\n\u003cp\u003e\u003cstrong\u003eHigh-level disinfection is a process that\u003c\/strong\u003e is used to treat medical and dental devices and instruments to completely kill viable microorganisms, except for a small number of bacterial spores and prions.\u003c\/p\u003e\n\u003cp\u003eThis should be followed by a cleaning process that should inhibit enough pathogens to prevent infection from being transmitted.\u003c\/p\u003e\n\u003cp\u003eThis process of disinfection also refers to the reprocessing of semi-critical dental instruments and medical devices that cannot be sterilized by traditional methods or are heat-sensitive.\u003c\/p\u003e\n\u003cp\u003eFor a better understanding of this definition, semi-critical devices refer to devices that come in contact with non-intact skin or intact mucous membranes and are not designed to penetrate tissues or other sterile areas of the human body.\u003c\/p\u003e\n\u003cp\u003eHigh-level disinfection is regarded as the common alternative in sterilizing both critical and semi-critical medical devices that are heat tolerant and meant to be used more than once.\u003c\/p\u003e\n\u003ch2\u003eHigh-Level Disinfection Methods\u003c\/h2\u003e\n\u003cp\u003eThe Association of perioperative Registered Nurses (AORN) published new guidelines, among which are the \u003ca href=\"https:\/\/www.cdc.gov\/infectioncontrol\/guidelines\/disinfection\/healthcare-equipment.html\" target=\"_blank\" rel=\"noopener noreferrer\"\u003ehigh-level disinfection guidelines\u003c\/a\u003e. High-level disinfecting should be done using these steps:\u003c\/p\u003e\n\u003cul\u003e\n\u003cli\u003eReusable semi-critical devices or instruments may be disinfected using manual methods, as recommended by the manufacturer.\u003c\/li\u003e\n\u003cli\u003eThe organization’s interdisciplinary team should decide on what high-level disinfectants (HLDs) to use and where to store them.\u003c\/li\u003e\n\u003cli\u003eThe disinfection process should be done in areas controlled and maintained with the intention of processing items in it.\u003c\/li\u003e\n\u003cli\u003eItems for processing should be prepared according to the manufacturers’ instruction for use (IFU).\u003c\/li\u003e\n\u003cli\u003eReusable semi-critical items that have been disinfected using HLDs must be protected from contamination until they are once again set to be used.\u003c\/li\u003e\n\u003cli\u003eThe organization must keep a record of the disinfection processes.\u003c\/li\u003e\n\u003cli\u003eThe personnel who handles and stores HLDs must be kept safe and protected.\u003c\/li\u003e\n\u003cli\u003eThe personnel handling HLDs must be provided ongoing education and competency activities regarding the use of the disinfecting chemicals.\u003c\/li\u003e\n\u003cli\u003eThe organization should develop and implement procedures and policies for the high-level disinfection process and review and revise them regularly.\u003c\/li\u003e\n\u003cli\u003eThe processes must be subject to regular evaluation to maintain their quality and effectivity.\u003c\/li\u003e\n\u003c\/ul\u003e\n\u003ch2\u003e\u003cstrong\u003eAre Medical Probes being Adequately Disinfected?\u003c\/strong\u003e\u003c\/h2\u003e\n\u003cp class=\"desc\"\u003eA number of alarming studies show that 3-7% of transvaginal ultrasound probes remain contaminated with \u003ca href=\"https:\/\/www.cdc.gov\/std\/hpv\/stdfact-hpv.htm\" target=\"_blank\" rel=\"noopener noreferrer\"\u003ehuman papilloma virus (HPV)\u003c\/a\u003e DNA after the routine disinfection of ultrasound and medical probes and equipment.\u003c\/p\u003e\n\u003cp class=\"desc\"\u003eThese and other reports suggest that inactivation of all microbial pathogens or high-level disinfection may not always be properly achieved, which mostly depends on the quality of used disinfectants. \u003c\/p\u003e\n\u003cp class=\"desc\"\u003eThe requirements is that semi-critical devices are high-level disinfected, which includes the inactivation all microbial pathogens except large numbers of bacterial endospores.\u003c\/p\u003e\n\u003ch2\u003eThe Reality\u003c\/h2\u003e\n\u003cp class=\"desc\"\u003eIt is important to note that the HPV disinfection researches were conducted in France, and that the routine disinfection practice in France is often only a Low Level Disinfection, typically performed with quaternary ammonium compound wipes.\u003c\/p\u003e\n\u003cp class=\"desc\"\u003eLow level disinfection would not be expected to be effective against non-enveloped viruses such as HPV as they have a higher level of resistance to disinfection.\u003c\/p\u003e\n\u003cp class=\"desc\"\u003e\u003cspan\u003e\u003cstrong\u003eNOTE\u003c\/strong\u003e\u003c\/span\u003e: The U.S. guidelines and standards recommend High-Level Disinfection of ultrasound probes, while this can vary internationally.\u003c\/p\u003e\n\u003ch2\u003eHigh-Level Disinfection and HPV\u003c\/h2\u003e\n\u003cp class=\"desc\"\u003eA recent study found that certain types of high-level disinfectants, based on glutaraldehyde and OPA, were ineffective against the HPV virus even after prolonged exposure.\u003c\/p\u003e\n\u003cp class=\"desc\"\u003eThe study concluded that oxidation-based disinfectants may be more effective at inactivating HPV. A 2015 study by Meyers confirms that hydrogen peroxide was effective in achieving a \u0026gt;4 log10 reduction of HPV16 and 186.\u003c\/p\u003e\n\u003cp class=\"desc\"\u003eSimilar results have been published for other, highly resistant non-enveloped viruses such as parvoviruses and bacteria such as aldehyderesistant bacteria.\u003c\/p\u003e\n\u003ch2\u003eNon-Enveloped Viruses\u003c\/h2\u003e\n\u003cp class=\"desc\"\u003eHPV16 and 18 are classified as non-enveloped viruses. To demonstrate effectiveness against these and other viruses, the FDA requires the use of poliovirus as the marker virus.\u003c\/p\u003e\n\u003cp class=\"desc\"\u003eThe resistance profiles of other non-enveloped viruses (human and animal pathogens) have been investigated. These include parvoviruses, coxsackieviruses, other enteroviruses, hepatitis A virus and noroviruses.\u003c\/p\u003e\n\u003cp class=\"desc\"\u003eDisinfection studies have shown that some of these viruses are distinctly more resistant than the poliovirus marker, in particular in studies with aldehyde-based disinfectants.\u003c\/p\u003e\n\u003cp class=\"desc\"\u003eThe most resistant to date are the parvoviruses. Parvoviruses are small (18-26 mm), non-enveloped, hydrophilic, single-stranded DNA viruses.\u003c\/p\u003e\n\u003ch2\u003eHigh-Level Disinfection of Ultrasound Probes\u003c\/h2\u003e\n\u003cp\u003e\u003cstrong\u003eHigh-level disinfection for ultrasound probes \u003c\/strong\u003eis necessary for the sake of the patients, your healthcare team, and your reputation, which will certainly affect your bottom line.\u003c\/p\u003e\n\u003cp\u003eThis is because transrectal, transvaginal and transesophageal probes are considered as semi-critical items that require high-level disinfected when used between patients.\u003c\/p\u003e\n\u003cp\u003eUltrasound probes are used in the vascular system or sterile body cavities, hence the need for sterilization.\u003c\/p\u003e\n\u003cp\u003eBut since they are heat sensitive, they also need to be reprocessed by soaking them in high-level disinfection products.\u003c\/p\u003e\n\u003cp\u003eOn the other hand, general surface probes that are used on the breasts or abdomen are considered low risk, so they only need low-level disinfection, not necessarily high-level disinfection \u003ca href=\"https:\/\/sonosupplies.com\/collections\/ultrasound-wipes\" title=\"Ultrasound Wipes\"\u003ewipes\u003c\/a\u003e.\u003c\/p\u003e\n\u003cp\u003eBut it’s a different story altogether if they are used in cases where biopsy is performed. The risk rises and general surface probes will need high-level disinfection solutions.\u003c\/p\u003e\n\u003cp\u003eThis level of disinfection is necessary for the probes’ built-in channels for the needle guide, for the needle guides that penetrate sterile tissue, and for the probes that are used on a non-intact skin or on high-risk patients.\u003c\/p\u003e\n\u003cp\u003eTo properly perform high-level disinfection of ultrasound probes, you also need to choose the right disinfectants.\u003c\/p\u003e\n\u003cp\u003eYou need to consider the time it would take to disinfect the probes, cost per cycle, reuse period, ventilation requirements, transducer compatibility, contraindications, and rinsing requirements.\u003c\/p\u003e\n\u003cp\u003eWhen you start using chemicals such as the Resert high-level disinfection solution, make sure to follow the FDA-cleared exposure time or the time recommended by the manufacturer.\u003c\/p\u003e\n\u003cp\u003eDon’t buy disinfectants with quaternary ammonium compounds because these are mostly used in low level disinfectants. While probe covers are recommended as part of your safety measure, they are not enough to prevent contamination, hence the need for high-level disinfection.\u003c\/p\u003e\n\u003ch2\u003eHigh-Level Disinfection Checklist\u003c\/h2\u003e\n\u003cul\u003e\n\u003cli\u003eDevices are visually inspected, cleaned again as needed before starting the \u003cstrong\u003ehigh-level disinfection process\u003c\/strong\u003e, and maintained according to manufacturer’s instructions.\u003c\/li\u003e\n\u003cli\u003eDisinfectants are prepared, tested for the minimum effective concentration (MEC) according to guidelines, manufacturer’s IFU, and infection control policy, and discarded if concentration is lower than MEC.\u003c\/li\u003e\n\u003cli\u003eDisinfectants are documented, whether prepared or replaced.\u003c\/li\u003e\n\u003cli\u003eSemi-critical devices are high-level disinfected following manufacturer’s IFU, hospital policy, and evidence-based guidelines.\u003c\/li\u003e\n\u003cli\u003eItems that have been disinfected are dried properly before reuse.\u003c\/li\u003e\n\u003cli\u003eItems are properly maintained.\u003c\/li\u003e\n\u003cli\u003eThe test strip bottle is marked with proper dates and not used beyond expiry.\u003c\/li\u003e\n\u003cli\u003ePersonnel who handle HLD have attended training or class and should know how to interpret color differences in test strips for MEC.\u003c\/li\u003e\n\u003cli\u003eFlexible endoscopes should be checked for leaks before high-level\u003c\/li\u003e\n\u003cli\u003eThe disinfectant for HLD is perfused into the channel using a syringe to ensure that that they kill microorganisms.\u003c\/li\u003e\n\u003cli\u003eEndoscopes are rinsed and channels are flushed with rinse water or tap water followed by a 70-90% alcohol.\u003c\/li\u003e\n\u003cli\u003eEndoscopes or semi-critical items are hanged or stored in areas that prevent recontamination.\u003c\/li\u003e\n\u003cli\u003eWater bottle and its connecting tube used for intraprocedural flushing should be sterilized or high-level disinfected at least once every day and filled with sterile water. An alternative would be to use sterile disposable bottles.\u003c\/li\u003e\n\u003cli\u003eDisinfection must be done in a safe environment for the personnel.\u003c\/li\u003e\n\u003cli\u003ePersonnel must wear a gown, gloves, eyeqwear, face shield, and others to protect them from exposure to chemicals.\u003c\/li\u003e\n\u003cli\u003eHigh-level disinfectants must be used at the FDA-cleared exposure time.\u003c\/li\u003e\n\u003cli\u003eHealthcare organizations should have a strategy that prevents their patients’ exposure to contaminated medical devices and instruments.\u003c\/li\u003e\n\u003c\/ul\u003e\n\u003ch2\u003eHigh Level Disinfection Policy\u003c\/h2\u003e\n\u003cp\u003eThere are several challenges that are associated with high-level disinfection, starting with its numerous steps and varying requirements for each medical instrument up to its high-risk if it is not performed properly.\u003c\/p\u003e\n\u003cp\u003eIt is usually not well-standardized across \u003ca href=\"https:\/\/www.nap.edu\/read\/9728\/chapter\/10#156\" target=\"_blank\" rel=\"noopener noreferrer\"\u003ehealthcare organizations\u003c\/a\u003e, even in the same facility that uses the same equipment. This is why it would be best to develop a policy for high-level disinfection in hospitals.\u003c\/p\u003e\n\u003cp\u003eBy adopting a hospital-wide policy, it means that you have to post the manufacturer guidelines for the medical equipment and disinfectant required by each and distribute it to the entire facility. This should help simplify the process and improve compliance with high-level disinfection requirements.\u003c\/p\u003e\n\u003ch2\u003eBest to Use For\u003c\/h2\u003e\n\u003c\/div\u003e\n\u003cdiv class=\"coll_desc\"\u003e\n\u003cp\u003eWhen it comes to disinfection of medical probes and equipment, regular disinfectants can not guarantee reliable result. That is when the risk of transmission of different viruses, fungus and bacteria is rising.\u003c\/p\u003e\n\u003cp\u003ePresented high-quality medical high-level disinfectants are the best to use for sterilization of following medical probes and equipment:\u003c\/p\u003e\n\u003cul\u003e\n\u003cli\u003eEndoscope disinfecting cleaning\u003c\/li\u003e\n\u003cli\u003eLaryngoscopes disinfecting cleaning\u003c\/li\u003e\n\u003cli\u003eArthroscope \u003cspan class=\"m_-2852983481836073098gmail-\"\u003edisinfecting cleaning\u003c\/span\u003e \u003c\/li\u003e\n\u003cli\u003eEnteroscope disinfecting cleaning \u003c\/li\u003e\n\u003cli\u003eBronchoscope disinfecting cleaning \u003c\/li\u003e\n\u003cli\u003eLaparoscope  disinfecting cleaning \u003c\/li\u003e\n\u003cli\u003eTEE disinfecting cleaning\u003c\/li\u003e\n\u003cli\u003eTransesophageal  disinfecting cleaning  \u003c\/li\u003e\n\u003cli\u003eVaginal probe  disinfecting cleaning\u003c\/li\u003e\n\u003cli\u003eRectal probe  disinfecting cleaning\u003c\/li\u003e\n\u003cli\u003eVaginal transducer  disinfecting cleaning\u003c\/li\u003e\n\u003cli\u003eRectal transducer  disinfecting cleaning\u003c\/li\u003e\n\u003c\/ul\u003e\n\u003ch2\u003e\u003c\/h2\u003e\n\u003c\/div\u003e","published_at":"2018-06-29T02:28:07-07:00","sort_order":"best-selling","template_suffix":"","published_scope":"web","image":{"created_at":"2020-04-20T15:01:03-07:00","alt":null,"width":2049,"height":2049,"src":"https:\/\/cdn.shopify.com\/s\/files\/1\/1351\/6041\/collections\/4l_bottle_of_Resert_1_-02.jpg?v=1587420064"}}]