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Hello everyone,
Please find the questions and answers from the Dec 25 COP webinar from presenter Terry McAuley below.
How can we confirm someone doesn’t have an infection and therefore cleaning is enough? Aren’t we better off disinfecting non-critical devices to keep our residents safe?
As stated during the presentation, preadmission screening (risk assessment) of incoming patients can provide information that would lead to suspicion of whether someone may have the risk of being infected or colonised with an multi-resistant organism (requiring contact precautions) or is incubating another illness transmitted by the droplet or airborne route. Patients requiring transmission-based precautions should have dedicated equipment, or when this equipment needs to be shared, this would be cleaned and disinfected according to the local policy for transmission-based precautions.Routine use of disinfectants for all cleaning, both environmental and shared patient equipment can be considered, however there is a risk of contributing to emergence of resistance to disinfectant products and potentially also contributing to antimicrobial resistance. Whilst this topic remains controversial, routine use of disinfectants is discouraged where there is a lack of evidence supporting their use.
The section titled Common mechanisms associated with increased resistance to disinfectants and the co-occurrence of resistance to disinfectants and antibiotics in this article may be of some assistance to understand current concerns over inappropriate use of disinfectants, where there is a lack of evidence supporting their use – https://pmc.ncbi.nlm.nih.gov/articles/PMC12628408/
The NHMRC Guidelines have this statement on page 74, so it is important to keep this in mind.
” Its good practice for shared clinical equipment to be cleaned with a detergent solution between patients and disinfection where indicated. Exceptions to this should be justified by risk assessment.”
Lastly, thorough cleaning of equipment will reduce the microbial load on items and is essential prior to the use of any disinfectant product. Therefore, adherence to proper cleaning technique is our first and best defence against spreading organisms between patients via shared patient equipment.
If we assign equipment to a person that is never shared, do you have to clean after each use?
The answer to this you would need to review the manufacturer’s instructions for use for specialised equipment, for example face masks and tubing used with oxygen therapy equipment. For equipment that may become soiled with blood or body substances during use, think commodes etc then cleaning after use may be warranted when likely to have been soiled, even if used only by that one patient. With other items, such as blood pressure cuffs being applied to clean, intact skin you could possibly conduct a risk assessment and determine a reduced frequency.Where does the responsibility lie with external service providers (e.g. podiatry, dental) to ensure they are complying with AS 5369:2023.
The responsibility for compliance rests with the services provider, however as the organisation has engaged them to provide services, there is an expectation that some form of due diligence has been undertaken to establish that they are registered, work from a suitable practice setting (i.e. don’t reprocess their RMDs in their home kitchen or laundry), have suitable policies for transport and reprocessing of RMDs that reference requirements in AS5369, have some sort of evidence that they or their staff have suitable qualifications / undergone some form of training and have experience in RMD reprocessing and preferably, have undergone accreditation or an independent audit by a suitable IPC Consultant. All of these requirements should be clearly stated in the service agreement that outlines roles and responsibilities.HI Terry. Is there a requirement to use specific grades of detergent in a washer-disinfector for non-critical devices, or can household detergents or tablets like Sun or Finish be used?
Detergents used in these machines should be intended for use on medical devices. I have recently been surprised / horrified to see pot and pan detergent (highly alkaline product used in commercial kitchens) being used, and also found dishwashing powder being used in this equipment. Typically, the detergents used are neutral or mildly alkaline. Companies like Whiteley and Ecolab may have a suitable product for this purpose, as would the supplier / distributor of the machine you are using.What evidence is there that resistance is caused by disinfectants in the real world? I know of 1 in a lab that hasn’t been replicated.
There is some limited evidence that the mechanisms that bacteria use for antimicrobial resistance can also be applied by the organisms to develop resistance to disinfectants and vice versa.The section titled Common mechanisms associated with increased resistance to disinfectants and the co-occurrence of resistance to disinfectants and antibiotics in this article may be of some assistance to highlight other published studies that have identified disinfectant resistance in a variety of organisms and how this resistance may also contribute to resistance to other antimicrobial agents – https://pmc.ncbi.nlm.nih.gov/articles/PMC12628408/
