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Infection Control and Cleanliness: Autoclaves in Care Homes Policy

Policy Statement

This policy provides guidance on the use and maintenance of autoclaves in line with statutory requirements for care services to maintain high standards of cleanliness of facilities and equipment and health and safety laws.

Background

Autoclaves are instruments that produce superheated steam under very high pressure to sterilize instruments and other media, making it safe to handle and re-use. The home understands that an autoclave is a complex and potentially dangerous piece of equipment and that use of an autoclave must meet the requirements of the Provision and Use of Work Equipment Regulations 1998 and the Pressure Systems Safety Regulations 2000

The home also understands that certain autoclaves need to comply with relevant British Standards, notably:

• BS EN 285:2015 Sterilization. Steam Sterilizers. Large Sterilizers
• BS 3970-1:1990 Sterilizing and Disinfecting Equipment for Medical Products. Specification for General Requirements.

In {{org_field_name}}, the rules below should be followed.

1. Only those staff trained in the use of the autoclave should operate it.
2. When using an autoclave, it is important that staff wear the proper Personal Protective Equipment. This includes wearing fluid resistant gloves, a plastic apron and splash goggles when a splash hazard is present.
3. Staff using the autoclave should always follow the set operating procedure for the autoclave as set out in the manufacturer’s instructions.
4. Staff operating the autoclave should ensure that they enter full details in the Autoclave Log.
5. Staff should never attempt to autoclave and re-use equipment that is intended for single use only.
6. Managers should ensure that the autoclave is properly and regularly maintained and serviced and that full-service documentation is kept.
7. Staff using the autoclave should record and report any faults or problems with the autoclave immediately.
8. Staff using the autoclave should always employ the highest standards of infection control knowledge and techniques at all times.

Record Keeping

In {{org_field_name}}, all autoclave users prior to autoclaving must fill out all information requested in the Autoclave Log. This includes recording the operator’s name, location, phone number, date, temperature and type and amount of material cleaned. A record of each cycle should also be made in the Autoclave Log.

Maintenance

In {{org_field_name}}, the following maintenance schedule will be followed.

Daily Checks:

• visual checks for steam and water leaks and checking, for example, that the steam pressure from supply is correct
• checking for cleanliness of autoclave parts, for example, internal chamber, fittings, door seal etc. and cleaning where necessary
• inspecting chart recordings for unusual traces and reporting any abnormalities.

Weekly Checks:

• operation of indicator lamps
• temperature and pressure gauges and correlation of temperature gauge against pressure gauge during a cycle
• inspection of chart recordings for abnormalities.

The autoclave should be regularly tested and serviced as recommended by the autoclave manufacturer by a qualified service engineer. All checks and servicing checks should be recorded in the Autoclave Maintenance Log.

If it is determined that an autoclave is not working either during use or testing, staff should contact the qualified service engineer immediately so that repairs can be scheduled. Use of the autoclave is prohibited until repairs are made. An appropriate warning sign must be posted on the autoclave by care home management to warn other people to not use the autoclave.

All repairs and servicing should be completed by appropriately qualified and experienced service engineers and in accordance with the manufacturer’s instructions. Where an autoclave cannot be repaired or is condemned by the service engineers, then it should be replaced.

Training

All users of the autoclave must be fully trained in its use. All approved autoclave users will be encouraged to read the autoclave manufacturers instruction manual and Safety of Pressure Systems — Pressure Systems Safety Regulations 2000 — Approved Code of Practice L122 (HSE Books).

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Responsible Person: {{org_field_registered_manager_first_name}} {{org_field_registered_manager_last_name}}

Reviewed on: {{last_update_date}}

Next Review Date: {{next_review_date}}

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