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The principles of decontamination

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VOL: 96, ISSUE: 38, PAGE NO: 2

Chris Booth, RGN, is communicable diseases nurse specialist, West Pennine Health Authority

Decontamination is an important factor in preventing hospital-acquired infection in primary and secondary care settings.

Failing to decontaminate equipment or the environment may not always be obvious, but it can result in cross-infection and put patients at risk. However, the wide variety of decontamination methods in clinical use can cause confusion so the terms need to be explained.

Contamination

This refers to the soiling of living tissue or inanimate objects with organic material, usually micro-organisms.

Decontamination

This is a general term used to describe the removal of microbial contamination to make an item safe, meaning that it no longer poses a risk. It is often used to refer to equipment or the environment and does not necessarily mean that they are sterile.

Decontamination can be a combination of processes, including cleaning, disinfection and sterilisation. Washing with detergent and hot water can, in certain situations, be a satisfactory method of decontamination.

Sterilisation

This refers to the complete removal of all organic matter, including spores and viruses. In health care settings it is usually done with moist heat, such as steam in an autoclave.

Disinfection

This process is used to reduce the number of micro-organisms, but not usually spores. It does not necessarily remove or kill all bacteria, but reduces their number to a level that is not harmful to health.

The term is often applied to inanimate objects and materials, but it can also be applied to skin and mucous membranes. Disinfection can be achieved by boiling, pasteurisation, low-temperature steam cleaning or the use of chemical disinfectants.

Cleaning

This removes dust and organic matter and large numbers of micro-organisms. A prerequisite for disinfection and sterilisation, it can be done using detergent and hot water.

Disinfectants

These are chemicals which, under defined conditions, destroy bacteria and most viruses.

Antiseptics

These are chemical disinfectants that can be applied safely to skin or living tissues.

Decontamination guidelines

The choice of decontamination method is often determined by the risk of infection associated with a particular piece of equipment. The table below outlines these risk levels and recommends the appropriate means of decontamination.

The dismantling, emptying and cleaning of equipment is often done at department or ward level, or in primary care settings. Although the setting may vary, the principles of decontamination do not. All staff should be aware of the correct procedures and their limitations: some devices can be safely decontaminated only using central sterile supply departments or hospital sterilisation and decontamination units. And devices or equipment that have been designed for single use must not be reprocessed or reused.

The Department of Health’s guidelines on decontamination (1993) state: ‘Anyone who inspects, services, repairs or transports medical, dental or laboratory equipment, either on hospital premises or elsewhere, has a right to expect that medical devices and other equipment have been appropriately treated so as to remove or minimise the risk of infection or other hazards.’

Nurses are advised to obtain a copy of these guidelines so that they understand the implications of decontaminating equipment after use. They are also reminded of their obligations under The Health and Safety at Work Act 1974 and the Control of Substances Hazardous to Health Regulations 1994.

Steam sterilisers

Nurses who use steam sterilisers to decontaminate equipment should be aware of their responsibilities and the equipment’s limitations (Medical Devices Agency, 1996).

Conclusion

Decontamination is essential to ensure patient safety and maintain high standards. Your trust or health authority infection control department will be able to provide more detailed information.

The DoH recently published new guidance on infection control in hospitals. The Management and Control of Hospital Infection, HSC 2000/002, is available on the internet at: http://www.rpsgb.org.uk/infocentre/govt_circulars.htm

It has also produced a CD-ROM called Decontamination Guidance, which costs £35. Contact Rachael Carter on 0113 254 7201 for details.

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