Cleaning, Disinfecting, and Sterilising

Policy

Our practice follows cleaning procedures that meet the requirements of:

• NZS 8134:2021 Ngā paerewa Health and disability services standard
• AS/NZS 4815:2006 Office-based Health Care Facilities

We make sure that all reusable medical equipment and instruments are thoroughly decontaminated to prevent patient-to-patient transmission of infection.

Staff who are responsible for any, or all, parts of the decontamination process are appropriately trained. During their induction, clinical staff are trained on the principles of sterilisation.

Cleaning reusable items

Cleaning is the most important step in reprocessing reusable equipment, and must always be done before items are disinfected or sterilised.

All reusable equipment is cleaned and decontaminated according to how the item is used, and the level of risk.

Follow the manufacturers' instructions for the use of cleaning products. For non-critical items, a combined cleaning and disinfecting wipe may be used.

Single-use items must not be cleaned and reprocessed for use on other patients.

Autoclave sterilisation

Q40

Who is trained to operate the steriliser?

In our team the following staff are trained to use the autoclave:

• All nurses

Maintenance is carried out annually – sooner if needed – and includes:

• servicing
• calibration

  The autoclave should be calibrated on site:

  • when installed
  • when serviced or repaired
  • annually.
• validation.

Autoclave log

How do you keep a log of successful sterilising?

All sterilisation cycles are recorded and show the:

• time and date each article was sterilised
• duration of the sterilising cycle
• temperature and pressure levels of the autoclave.

Cycles are logged as follows:

Q41

• The practice nurse records the daily batch number and any indicators used during the cycle on the autoclave printout.
• All log sheets are filed in the autoclave folder.

All records of maintenance and sterilisation cycles are kept for at least 12 months.

See also Cleaning Specific Items for information about cleaning the autoclave.

Sterilisation procedure

1. Cleaning, rinsing, and drying instruments
   1. In "dirty" sink, flush items in warm running water to remove debris.

      NZS4185:2006, 2.9.2.2 recommends that two sinks should be available for manual cleaning of equipment. However, if a second sink is not yet available, a bowl may be used in its place.

   2. In "clean" sink, immerse open instruments in a low-foam enzymatic detergent.

      Soak instruments for 5–60 minutes only. Consider using a timer to ensure maximum soaking time is not exceeded.

   3. Scrub items in soaking solution:
      • Keep items below the water.
      • Use a brush that can be autoclaved.
   4. Rinse items under warm-to-hot running water.
   5. Dry using lint-free towels or cloths immediately after rinsing. Do not air dry.

      Soaking solution should be changed regularly throughout the day, especially if it is visibly dirty.

2. Preparing the load
   1. Visually check that items are functioning, and look clean and free from debris.
   2. Make sure all forceps and scissors are open – use protective covers for tips if necessary.
   3. Package in the approved bags and seal according to the manufacturer's instructions. Make sure there are no gaps in the seal.
   4. Make sure each package has a Class 1 chemical indicator incorporated into its surface.
   5. Label the exterior of the package with a non-toxic, water-resistant marker.

      Include date, load number and, if required, a description of the contents.

3. Loading and running the steriliser
   1. Load items onto the autoclave racks according to the manufacturer's instructions.
   2. Separate packages to allow air removal, steam penetration, and drying.
   3. Make sure that no packs touch the chamber wall.
   4. Check and run the correct steriliser cycle.
   5. Enter details into the steriliser log.

   Do not attempt to open the steriliser door while the cycle is in operation.

4. Unloading the steriliser
   1. Remove items from the steriliser while hot, and place on a rack in the cooling area. Use protective gloves or the manufacturer's approved grip handle.
   2. Check that sterilisation has been successfully completed. Complete the autoclave log.
   3. Once cool, inspect each item. Ensure it is correctly:
      • packaged
      • labelled
      • sealed (no gaps).

5. Storing sterile items
   • When cool, store sterilised packs in a clean, enclosed storage area.
   • Rotate stock so that items sterilised earlier are used first.

Refer to the manufacturer's instructions for full details of operating the autoclave. These are kept in the nurses' office.

Monitoring successful sterilisation

Are these bullet points correct for your practice? It is best practice is to use at least two different methods to monitor sterilisation.

Successful sterilisation is monitored with different indicators:

Q42

• Physical checks are done at the end of each cycle, e.g. checking displays, gauges, or printouts.
• Chemical indicators are included in every cycle to check that the correct temperature has been reached.
• Biological indicators are used annually during servicing to identify any spores that are resistant to sterilisation. 

If indicators show that sterilisation has not been successful:

First failed test:

Check for errors, repack, and repeat sterilisation.

Second failed test:

1. Advise the practice manager, who may need to arrange servicing.
2. Place DO NOT USE label on front of autoclave, and the date.

Use disposable items only until autoclave is serviced and validated.

This policy was reviewed with input from Ruth Barratt, Infection Prevention & Control and Quality Advisor (PhD, MAdvPrac (Hons), RN, CICP-E).