Decontamination, Disinfection and Sterilisation Policy

{{org_field_name}} believes that infection control is a critical element in the running and management of any residential care facility as serious infections can easily be spread if inadequate controls are in place.

The protection of people who use the service from such diseases is a key aim of {{org_field_name}}, which expects all of its staff and volunteers to adhere strictly to a range of policies relating to the control of infection, including this one, which is designed to ensure the adequate disinfection or decontamination of medical devices and environmental surroundings.

Legal Considerations

This care service will adhere to all relevant legislation, including:

the Health and Safety at Work, etc Act 1974
the Public Health Infectious Diseases Regulations 1988
the Control of Substances Hazardous to Health Regulations 2002 (COSHH).

Under the above legislation, and associated codes of practice, {{org_field_name}} understands its legal and moral duty to ensure the health and safety of both staff and people who use the service and to protect them, wherever practicable, from dangerous substances in the workplace, including the risk of transmission of infections.

Guidance

{{org_field_name}} seeks at all times to comply with evidence-based best practice in infection control, particularly with the Health and Social Care Act 2008 Code of Practice on the Prevention and Control of Infection and Related Guidance published by the Department of Health and Social Care (the Hygiene Code). The home understands that in England compliance with this guidance is an effective way to help it to meet its regulatory requirements with the Care Quality Commission under the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

The home understands that the regulations require premises and equipment used for the provision of health or social care to be “clean” and for providers to maintain standards of hygiene “appropriate” for the purposes for which they are being used.

In addition, the home will comply with all other relevant best practice infection control guidance.

For instance, applicable guidance from the National Institute for Health and Care Excellence (NICE) includes:

CG139: Healthcare-associated Infections: Prevention and Control in Primary and Community Care (updated February 2017)
PH36: Healthcare-associated Infections: Prevention and Control (November 2011).

Guidance is also available from the Department of Health and Social Care (DHSC) and from the Health and Safety Executive (HSE) in the form of:

Infection Prevention and Control (IPC): Resource for Adult Social Care, DHSC
Prevention and Control of Infection in Care Homes: An Information Resource (2013), DHSC
HSG220 Health and Safety in Care Homes (2nd edition) (2014), HSE.

Specialist advice and support will be obtained from the local public health protection team and from relevant primary healthcare teams.

Regulation

{{org_field_name}} recognises that it must comply with the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in order to meet its legal requirement for registration with the Care Quality Commission (CQC).

With respect to infection control, the home understands that a range of regulations may apply, including:

Regulation 12: Safe Care and Treatment — this requires providers to assess the risk of, and prevent, detect and control the spread of, infections, including those that are healthcare associated
Regulation 15: Premises and Equipment — this states that premises and equipment must be clean, suitable for the purpose for which they are being used, properly used and properly maintained.

Guidance for Providers on Meeting the Regulations, published by the CQC in March 2015, provides guidance on how this service should comply with the regulations.

The guidance specifies that:

where applicable, premises must be cleaned or decontaminated in line with current legislation and guidance, and equipment must be cleaned, decontaminated and/or sterilised in line with current legislation and guidance and manufacturers’ instructions
equipment must be cleaned or decontaminated after each use and between use by different people who use the service
multiple-use equipment and devices must be cleaned or decontaminated between use
single-use and single-person devices must not be reused or shared
all staff must understand the risk to people who use services if they do not adhere to these requirements.

Definitions and Theory

{{org_field_name}} understands the term “decontamination” to refer to a range of processes which remove or destroy contamination, preventing micro-organisms or other contaminants reaching a susceptible site in sufficient quantities to cause infection or other harmful response. The processes include effective cleaning, disinfection and/or sterilisation, used to render reusable medical devices and equipment safe for further use.

“Cleaning” refers to a basic level of washing and cleansing, such as with ordinary soap and hot water. This may be all that is required for certain low-risk items such as reusable bowls or basins and is an essential pre-requisite for higher level disinfection, decontamination or sterilisation as the presence of any organic matter might render higher levels of decontamination ineffective.

“Disinfection” refers to a process which cleans an item or a surface and reduces the number of viable micro-organisms but is not necessarily effective against all bacterial spores or some viruses. Chemicals that achieve this result are known as “disinfectants” and are intended to reduce contamination to reasonably safe levels.

This level of decontamination is appropriate for medium-risk items, which are items that come into contact with intact mucous membranes, such as reusable bedpans/urinals, reusable face masks, cutlery/crockery, bed linen, oral thermometers, etc.

Where the complete removal of micro-organisms or other contaminants is needed, as is the case in the use of reusable medical devices and equipment, then “sterilisation” is required: a process which removes or destroys contamination by all micro-organisms, including spores. High-risk equipment or materials which come into contact with broken skin or mucous membranes should always be sterile, eg medical instruments, urinary catheters or dressings.

In the context of the sterilisation of reusable medical devices, the home understands “reuse” to apply to medical devices that are not single-use and which can safely be used again following some form of reprocessing between use, ranging from a simple washing of the item to a full cleaning and sterilisation process.

Medical devices that can be sterilised should not be confused with “single-use equipment”, which refers to devices that are intended to be used on an individual person during a single procedure and then discarded. The use of single-use equipment is covered by guidelines issued by the Medicines and Healthcare Products Regulatory Authority (MHRA), which state that devices designated for single use must not be reused under any circumstances.

Procedure

To fully protect people who use the service from the risks associated with infection, in {{org_field_name}} the following guidance from Infection Prevention and Control (IPC): Resource for Adult Social Care (2022, DHSC) applies.

Low-risk equipment (items that come into contact with intact skin or items that do not come into contact with people) or environmental surroundings, such as floors, surfaces, drip stands, washbowls, etc will be cleaned and dried using soap and water or other appropriate cleaning agents.
Medium-risk equipment (items that come into contact with intact mucous membranes or items contaminated with particularly virulent or readily transmissible pathogens), such as respiratory equipment, reusable bedpans/urinals, reusable face masks, cutlery/crockery, bed linen, oral thermometers, etc will be cleaned using soap and water followed by disinfection with an appropriate disinfectant.
High-risk medical devices or equipment (all reusable medical devices that are used in close contact with a break in the skin or mucous membranes, and devices that enter a sterile area of the body) must be sterile, which means that either single-use sterile equipment should be used or reusable equipment must be sterilised before reuse.
The choice of decontamination method centres around the infection risk associated with the intended use of the equipment and should be assessed in each case. Chemical disinfection is not a substitute for sterilisation.
Sterilisation of high-risk equipment will be achieved by the use of a benchtop autoclave or by a suitable provision from a local sterile services provider.
All items requiring decontamination must first be adequately cleaned to remove organic matter.
Only staff who are trained and competent in the use of the autoclave should attempt to sterilise reusable medical equipment or devices.
All staff using disinfectants or other cleaning chemicals should wear the appropriate personal protective equipment and should use the substances with reference to the appropriate COSHH risk assessments.
Staff should only ever attempt to decontaminate reusable medical devices or equipment. Single-use devices should be managed according to the home’s Single-use Medical Devices Policy — they should be discarded after use and no attempt should be made to resterilise or decontaminate them.

{{org_field_name}} requires staff at all times to comply fully with The Health and Social Care Act 2008: Code of Practice for Health and Adult Social Care on the Prevention and Control of Infections and Related Guidance.

Implementation

All staff are responsible for the implementation of this policy and for ensuring that the home, and its equipment, is always kept in a clean and hygienic condition.

Overall responsibility for ensuring the policy is implemented, monitored and reviewed rests with the Infection Control Lead for the home.

The Infection Control Lead will work closely with the manager of the home to ensure that all infection control policies are effectively implemented and that the home has adequate supplies of handwashing materials and facilities, personal protective equipment and sterile clinical equipment, including reusable and single-use medical devices.

The procurement strategy for these products will be led by the Infection Control Lead and will be based upon sound best practice principles. It is vital that decontamination methods, safety and infection risk are considered before any piece of equipment is purchased.

Individual staff practitioners are responsible for ensuring that they implement this policy wherever necessary and exercise adequate infection control precautions at all times, seeking further advice from the Infection Control Lead as required.

Information on the policy will be:

circulated to all staff
provided to all new employees
included in the Infection Control Policy, the Clinical Waste Policy, the Autoclave Policy and the Single-use Medical Devices Policy.

Training

All new staff should be encouraged to read this policy as part of their induction process. Those staff who are required to work with medical devices will be expected to be appropriately trained, qualified and competent to do so. The home will ensure that appropriate access to ongoing infection control refresher training is provided to all persons with clinical or cleaning roles.

Audit

The use of reusable and single-use medical devices within the organisation will be subject to regular audit to monitor compliance with this policy.

The Infection Control Lead for the home is responsible for ensuring that evidence-based policies and procedures in relation to the control of infection are developed and their implementation is monitored.

The Infection Control Lead for the home will monitor carefully any incident reports relating to infection control matters in order to identify any trends or patterns.

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}}

WCH67. Decontamination, Disinfection and Sterilisation