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contamination in areas in which “clean” activities take place.
Examples of
areas where “clean” activities take place are operating theaters, procedure
rooms, and working areas for sterilizing, high-level disinfecting, and storing
instruments and other items. Areas in which “dirty” activities take place include
rooms where soiled instruments and other items are washed. 86 It is ideal to have
separate rooms – one for receiving and cleaning instruments and other items and
another room for final processing (sterilization or high-level disinfection) and
storage. However, in many settings in Egypt this is not possible. When only one
room is available, it should be arranged so that activities and objects flow in an
organized way. It is necessary to have at least one sink (two are preferable),
sufficient counter top space for receiving dirty items and for drying and packaging
clean items, and for storage space (preferably closed cabinets).
It is key to
have good spatial separation between soiled handling area and the clean,
packaging area.
Establishing an SSD
Soiled, used, and recyclable equipment should be collected from the wards and
then should be transferred to the SSD where it is washed, inspected, disinfected
or packaged and sterilized, and dispatched back to the wards.
Fig. 27: Flow diagram of items processed in SSD
Delivery of
items to
Ward/Operating
Theater
Storage of
clean items
165
Receiving dirty
instruments
Processing:
Cleaning, Disinfection,
Sterilization, Packing
86
86
Receive instruments in the dirty area.
Wash all instruments in water and detergent or enzymatic presoak
either mechanically or manually using appropriate protective barriers.
Inspect all equipment for cleanliness and damage.
•
•
•
•
•
•
•
•
•
Send
damaged
instruments
for
repair
decontamination or discard them if necessary.
after
appropriate
Pack cleaned instruments on a tray.
Autoclave trays at recommended temperature and/or disinfect as
required.
Ensure that the packaged trays are dry – inspect tapes.
Sort the packaged trays for ward collection.
Return equipment to the ward or store in the clean treatment room.
Cleaning, Disinfection, and Sterilization of Medical Equipment
In the ward:
•
Collect instruments that are to be re-used in a clearly labeled
container.
•
Arrange for dirty instruments to be delivered to the SSD – DO NOT
ATTEMPT TO WASH THEM ON THE WARD.
•
Discard cotton wool balls and dressings into regular waste disposal
containers (for more details see chapter on Waste Disposal I).
In the SSD:
The layout of the SSD
Ideally, physical barriers should separate dirty and clean areas in the
reprocessing room. However, if this is not possible (perhaps because of shortage
of space or of funds) the same room can be used, provided that:
• The air moves from the clean area to the dirty area.
• Both areas have separate storage facilities.
• There are adequate hand disinfection facilities.
• Activity patterns are established in which soiled objects never cross
paths with clean, sterilized, or high-level disinfected instruments and
other items.
• The doors are kept closed in the reprocessing rooms in order to
minimize dust contamination and to eliminate flies.
• There is separate equipment for each area.
• The staff work in either area– never in both.
166
Cleaning, Disinfection, and Sterilization of Medical Equipment
Storage in the SSD
After items have been reprocessed, the sterile packs should be stored in well-
ventilated, clean stores ready for dispatch to the wards. Collection should be
regular and there should be a written record of receipt and delivery. This helps to
monitor the use and the loss of instruments.
Note!
Do not store instruments or other items such as scalpel blades and suture
needles in solutions-always store them in a dry container. Microorganisms can
live and multiply in both antiseptic and disinfectant solutions which can
contaminate instruments and other items and which can lead to infections.
SSD staff facilities
•
All SSD staff should be provided with adequate protective clothing (e.g.
heavy duty gloves, plastic aprons, and eye protection if manual
cleaning is undertaken). Overshoes are not necessary.
•
SSD staff should be immunized against hepatitis B. (See chapter
“Occupational Safety and Employee Health”
Fig. 28: Single room for processing instruments and other items
Receiving
Sink
Auto-
clave
Waste
Door
Work area
Waste
Cleaned
Instruments
Work area
Boiler
Sterile pack work area
Sterile storage cabinet
The flow of work in a single room for reprocessing of instruments should be
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