Aim
To maintain reusable medical devices (RMDs) and equipment in a manner that eliminates or minimises colonisation of microorganisms, thereby reducing the risk of infection and promoting a safe environment for patients and clinical personnel.
Key points
Any infectious agents introduced into the body can establish infection. In all healthcare settings, reusable medical devices should be handled in a manner that will prevent patient, healthcare worker and environmental contact with potentially infectious material.
Any medical device or equipment that is to be reused requires reprocessing—cleaning, disinfection and/or sterilisation. The minimum level of reprocessing required depends on the is determined by the degree of contact with the patient, the contamination risk to the patient and manufacturers instructions.
Definitions
- Reprocessing - the activities required to ensure a RMD is safe for its intended use.
- Cleaning - the removal of foreign material (e.g. soil and organic material) from objects and is normally carried out using detergent, water and physical action. If an item cannot be cleaned, it cannot be disinfected or sterilised. Cleaning should always be performed from the “cleanest” (least contaminated) area to the “dirtiest” (most contaminated) area to prevent the spread of contaminants.
- Disinfection - the process that inactivates non-sporing infectious agents, using either thermal (moist or dry heat) or chemical means. Items need to be cleaned before being disinfected. There are three levels of disinfection; high, medium, and low.
- The majority of items used in the pre-hospital setting are classed as low risk where low level decontamination is sufficient.
- Sterilisation - destroys all microorganisms on the surface of an instrument or device, to prevent disease transmission associated with the use of that item.
Categories of items for patient care
| Level of Risk | Application | Process | Storage | SJA WA |
|---|---|---|---|---|
| Critical | Entry or penetration into sterile tissue, cavity or bloodstream | Clean thoroughly as soon as possible after use. Sterilise after cleaning by steam under pressure. If heat or moisture sensitive, sterilise through an automated low temperature chemical sterilant system, other liquid chemical sterilants or ethylene oxide sterilisation. | Sterility must be maintained. Integrity of the package must be maintained. Store to protect from environmental contamination. | All critical devices used are single use and are sterilised by the manufacturer, and must be disposed of appropriately after use:
|
| Semi-critical | Contact with intact mucous membranes or non-intact skin | Clean thoroughly as soon as possible after using. Steam sterilisation is preferable. If the equipment will not tolerate steam use a high level TGA-included chemical or thermal sterilant or medical device disinfectant. | Store to protect from environmental contamination. | Most semi-critical devices used are single use and are sterilised by the manufacturer, and must be disposed of appropriately after use. Non-disposable semi-critical items have specific chemical cleaning products and guidelines provided:
|
| Non-critical | Contact with intact skin but not mucous membranes | Cleaning with approved disposable impregnated low or mid level TGA-included disinfectant wipes | Store in clean, dry place. | All non-critical reusable devices are cleaned and disinfected after each individual patient use:
|
Single Use Items
To avoid cross-contamination between patients and avoid material degradation, bio-compatibility reactions or endotoxic reactions caused by residues from reprocessing and device failure the following principles are adhered to:
- Single-use medications, solutions, injectables, equipment and other medical devices are used wherever the clinical situation dictates such practice.
- Single-use labelled devices are discarded after each single use.
- Single patient use labelled equipment and other medical devices are reprocessed in accordance with the manufacturer’s instructions and reused on the same patient only, not put into general supply.
- Any single-use item or instrument that has penetrated the skin, mucous membrane or other tissue must be discarded after use or at the end of the procedure, whichever is more appropriate.
Key Terms & Links
Workplace Instruction (WIEM10) Tristel Trio System
Workplace Instruction (WIEM08) Cleaning of Reusable Equipment Emergency Rescue Helicopter
Guidelines for Reprocessing Ultrasound Transducers (2017) Guidelines for Reprocessing Ultrasound Transducers - - 2017 - Australasian Journal of Ultrasound in Medicine - Wiley Online Library
National Health & Medical Research Council and the Australian Commission on Safety and Quality in Healthcare. (2021). Australian guidelines for the prevention and control of infection on healthcare. Canberra, Australia: Commonwealth of
Australia.
Standards Australia/Standards New Zealand. AS/NZS 4815. Office-based health care facilities. Reprocessing of reusable medical and surgical instruments and equipment, and maintenance of the associated environment. Sydney, Australia: Standards Australia International Ltd and Standards New Zealand.
Standards Australia/Standards New Zealand. AS/NZS 4817. Reprocessing of reusable medical devices in health service organisations. Sydney, Australia: Standards Australia International Ltd and Standards New Zealand.
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