UNCONTROLLED WHEN PRINTED

To maintain equipment and surfaces 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 staff.

Process

  • Cleaning is a process of physically removing all visible and non-visible contamination from a surface using soap or detergent and water or TGA approved disinfecting wipes.
  • Cleaning includes the removal of blood, body fluids, and other biological material from a surface.
  • Cleaning should always be performed from the “cleanest” (least contaminated) area to the “dirtiest” (most contaminated) area to prevent the spread of contaminants.
  • Disinfection is a process which kills pathogenic microorganisms (with the exception of bacterial spores) on a surface. Three levels of disinfection are recognized; high, medium, and low.
  • The level of disinfection required for reusable equipment is determined by the degree of contact with the patient and the contamination risk to the patient. 

    Categories of items for patient care

    Level of RiskApplicationProcessStorageSJA WA
    Critical Entry or penetration into sterile tissue, cavity or bloodstreamSterilization by steam under pressure (autoclaving), or a minimum of an automated low-temperature chemical sterilant system, other liquid chemical sterilant or ethylene oxide sterilization.

    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 sterilized by the manufacturer, and must be disposed of appropriately after use.

    Non-disposable critical items, including ultrasound transducers and laryngoscope blades, have specific chemical cleaning products and guidelines provided.

    Semi-critical Contact with intact mucous membranes or non-intact skinSterilization by steam or at least minimum of high level thermal disinfection.Store to protect from environmental contamination.

    Most semi-critical devices used are single use and are sterilized by the manufacturer, and must be disposed of appropriately after use.

    Non-disposable semi-critical items, including ultrasound transducers and laryngoscope blades, have specific chemical cleaning products and guidelines provided.

    Non-critical Contact with intact skin but not mucous membranesCleaning with approved disposable impregnated neutral detergent/low or mid level disinfectant wipes.Store in clean, dry place.

    All non-critical reusable devices are cleaned and disinfected after each individual patient use:

    • Sphygmomanometers
    • BP cuffs
    • Oral thermometers
    • Stethoscopes
    • Cardiac monitors
    • Suction units
    • Stretchers and compartment surfaces

    Daily Clinical Cleaning and Disinfection of the Ambulance

    • The ambulance units and all patient care equipment should be cleaned and disinfected on a daily basis.
    • Emphasis should be placed on the patient care area of the ambulance and the areas/surfaces that come in contact with patients and paramedics.
    • Hand hygiene must be performed following cleaning and disinfection procedures.
    • New nitrile gloves must be worn when performing general cleaning and disinfection procedures.
    • Appropriate PPE, including a facemask and eye protection should be risk assessed and worn when cleaning the ambulance following a call when the patient may have had a febrile respiratory illness (FRI).
    • Coveralls, face shields and/or eye protection should be worn while cleaning if there is the possibility of splashing of blood or body fluids.

    At End of Each Call (including Last Call)

    • The cleaning and disinfection of surfaces and equipment between calls protects clinical staff and their patients.
    • Remove and dispose of PPE used during patient care and perform hand hygiene.
    • Clean and disinfect reusable eye protection worn during the call with approved detergent/disinfectant wipes.
    • Put on new gloves before beginning cleaning.
    • Remove soiled/used linen and discard in linen receptacle at the hospital.
    • Dispose of all single use and single patient use equipment in the appropriate general or clinical waste bin at the hospital.
    • Clean and disinfect reusable equipment used to treat the patient with approved detergent/disinfectant wipes and allow contact time recommended by the manufacturer. This may include but is not limited to:
      • Cardiac monitor
      • Suction unit
      • Stethoscope
      • BP cuff<
      • Pulse oximeter
      • Oxygen regulator and tank
      • Spinal and extrication equipment
      • Equipment bags (external surfaces).
    • Inform Area Manager of heavily soiled equipment and follow their direction.
    • Clean and disinfect all compartment surfaces including stretcher, mattress and straps, in contact with the patient with approved detergent/disinfectant wipes and allow contact time recommended by the manufacturer. 
    • If patient had signs and symptoms of a febrile respiratory illness (FRI), clean and disinfect all compartment surfaces that may have been contaminated by respiratory droplets within two (2) metres of the patient.
    • Dispose of all waste in the appropriate general or clinical waste bins. Clinical and sharps waste is to be disposed of in the designated clinical waste bins at hospital.
    • Remove and dispose of PPE in appropriate waste bin, and perform hand hygiene.
    • Put clean linen on the stretcher.

    At End of a Shift

    • Clean and disinfect all exposed surfaces of patient compartment with approved detergent/disinfectant wipes and allow contact time recommended by the manufacturer. 
    • Replace full sharps containers when 3/4 full with empty containers, ensuring the sharps container is well sealed and appropriately discarded in designated clinical waste/sharps bin at hospital.
    • Dispose of other non-clinical waste in general waste bin.
    • Clean and disinfect all common/high touch surfaces of driver compartment (i.e. steering wheel, seat belts, door handles, radios, etc) with approved detergent/disinfectant wipes and allow contact time recommended by the manufacturer. 
    • Wipe down personal equipment such as pens, iPads, pagers, stethoscopes, pen-lights, shears with approved detergent//disinfectant wipes and allow contact time recommended by the manufacturer. 
    • Sweep and mop the ambulance floor with cleaning equipment designated for this purpose.
    • Manually wash mop head in detergent, rinse and hang to dry. Discard if in poor state and replace. 
    • Remove and dispose of gloves and other PPE in general waste bin, and perform hand hygiene.

    Following a Blood or Body Substance Spill

    • Consideration should be made to remove the vehicle from service, contact Manager to discuss this.
    • If cleaning is applicable:
      • Select and put on appropriate PPE.
      • Remove necessary equipment from the vehicle to prevent further contamination
      • Manage the blood and body fluids spill by:
        • Containment (cover spill with absorbent material, towel, sheet etc., to absorb the bulk of the blood or body substance) 
        • Confinement (prevent spread of contamination).
        • Disposal (treat as clinical waste).
      • Use cleaning methods that reduce the chance of splashing or contamination of clothing, or the environment, to remove the gross spillage.
      • When the gross spillage has been removed, use the routine cleaning of vehicles procedure to complete the task, paying special attention to the cleaning of all equipment, stretcher, fittings and surfaces. 
      • It is illegal to allow contaminates to enter into public storm-water drains etc. However, separate soak wells at Stations which are not connected to public storm-water drains may be used. Officers must contact the Property and Supply department to confirm suitability before use. 
      • When cleaning is complete, Remove PPE and perform hand hygiene.
      • Restock and prepare the vehicle for operational use. A full vehicle inventory check is recommended at this point. 

    Linen Handling

    • Handle used/soiled linen as little as possible in order to minimise agitation when removing it from the stretcher
    • Wear gloves when handling used linen, especially when it is soiled with blood or body fluids. After every transport where the patient was placed on the stretcher, remove used linen from the stretcher and immediately place it in the designated linen receptacle at the hospital.
    • When linen receptacle is not available, place used/soiled linen in waste bag for containment and transportation to the hospital.
    • Carefully handle and store all clean linen to maintain its cleanliness and minimise contamination.

    Laundering of Uniforms

    • Safe handling of used/soiled uniforms and good hygiene practice will help prevent transmission of infection.
    • Used/soiled uniforms are changed daily and home laundered. Laundering must involve the use of an appropriate laundry detergent and warm/hot water (≥50C). If hot water is not available, uniforms should be washed separately from other household linen and a clothes dryer should be used for drying.
    • If a uniform becomes visibly soiled with blood or body substances:
      • Return to the Station/Depot and remove contaminated uniform. 
      • Place in a designated leak-proof clear plastic bag or clinical waste bag and tie securely.
      • If the skin is soiled, irrespective of whether cuts or abrasions are present, wash area well with soap and water. Alternatively, shower.
      • Put on a clean uniform.
      • Extensive skin soiling requires immediate assessment of the skin for areas that are non-intact. 
      • If non-intact skin has been in contact with blood or body substances, clinical staff should undergo medical assessment in accordance with Management of Occupational Exposure Procedure 12.8.
      • Heavily soiled uniforms may be considered too contaminated for home laundering and will be disposed of or professionally cleaned by agreement with the Manager.

    References

    National Health & Medical Research Council and the Australian Commission on Safety and Quality in Healthcare. (2010). Australian guidelines for the prevention and control of infection on healthcare.  Canberra, Australia:  Commonwealth of Australia.

    National Occupational Health and Safety Commission.  (2011). National Code of Practice for the preparation of material safety data sheet (2nd ed.). [NOHSC: 2011(2003)].  Canberra, Australia:  Australian Government Publishing Services.

    Royal College of Nursing.  (2011). The selection and use of disinfectant wipes.  RCN guidance.  London, United Kingdom:  Royal College of Nursing.

    Standards Australia/Standards New Zealand.  AS/NZS 4815:2006.  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 4146:2000. Laundry practice.  Strathfield, Australia:  Standards Australia International Ltd.

    Key Terms & Links

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    Directorate
    Clinical Services

    Responsible Manager
    Head of Clinical Services

    Date

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