Sterilization and infection control in the era of COVID-19

February 10, 2021
by Lauren Dubinsky, Senior Reporter
Using proper cleaning agents and procedures on medical equipment is always imperative, but it became even more important when COVID-19 hit. Early on in the pandemic, Huntington Hospital in Los Angeles dealt with a slew of challenges — one of them being disinfectant shortages.

Katie Jones, interim manager of infection prevention and control at the hospital, spoke during AAMI’s Summer Learning Series about steps the hospital took to overcome those hurdles.

Due to the pandemic, the hospital started utilizing new types of equipment including powered air purifying respirators (PAPRs) and associated PAPR hoods. Since they had to use their inventory of quaternary and alcohol-based disinfectant wipes for personal protective equipment (PPE), they needed to find another disinfectant to clean equipment and environmental surfaces near suspected or confirmed COVID-19 patients.

“Unfortunately, the most readily available item at that point would be bleach wipes, but we know that they are destructive to surfaces and equipment over time,” said Jones. “We were stuck between a rock and a hard place because that’s all we had. We couldn’t use the bleach wipes on PPE but we could use it on the equipment.”

Eventually the hospital’s Environmental Services (EVS) department was able to provide them with a wider distribution of the liquid quaternary-based disinfectant and disposable dry wipes, but not before some damage was done.

“It did lead to some damage that we were luckily able to mitigate eventually, but it was a hard decision and a really short amount of time to figure out how to control the spread of the virus and these cohort units, and to keep everything clean,” said Jones.

With ECRI’s assistance, they were able to research UV-disinfection equipment that was available on the market to find something that best met their need for additional technology to complement what their EVS staff was already doing.

Jones explained that “UV disinfection doesn’t replace your manual cleaning and disinfection procedures,” but instead functions as a supplement to that.

Using the right cleaning agent or methods is vital since medical devices exposed to unapproved methods can lead to premature deterioration and failure of the equipment, noted Izabella A. Gieras, director of clinical technology at Huntington Hospital. That can result in device performance and safety issues.

In addition, damaged equipment cannot be cleaned or disinfected effectively. Rust, degraded plastic or broken plastic on equipment is considered an infection control failure because it cannot be cleaned.

When determining how to properly clean a piece of equipment, the first place to look is the manufacturer’s recommendations, which should provide at least one effective method of disinfection and may offer guidance for use in a hospital. However, Jones cautioned that these recommendations do have some drawbacks, such as inclusion of cleaning products not available at the hospital or vague instructions.

She also emphasized that specific hospital policies and procedures must be followed. These include delegation of roles and responsibilities, specifying who cleans the equipment, how is it cleaned and when it is cleaned as well as how to train the staff to do this properly.

When this is not done right, the consequences can be dire. There are reports of multi-facility outbreaks linked to improper cleaning and disinfection of semi-critical and critical medical equipment.

In 2015, outbreaks related to duodenoscope reprocessing made national news. The FDA ordered all duodenoscope manufacturers to conduct postmarket surveillance studies in October of that year.

A systematic review found that seven distinct carbapenem-resistant Enterobacteriaceae (CRE) outbreaks were related to endoscopes — five of which were specifically related to duodenoscopes. In response, the FDA released a safety communication in April 2019 highlighting the importance of monitoring reprocessing procedures in accordance with the manufacturer’s instructions.

What’s more, 32 patient infections associated with heater-cooler devices were reported to the FDA in 2010 and 2015 as a part of their adverse event reporting system. The most recent safety communication released by the FDA in February 2020 provided updated instructions for disinfection practices to reduce microbial growth.

But as we saw with COVID-19, “not all outbreaks are related to failures in very complicated high-level disinfection or sterilization processes,” said Jones.

“As an infection preventionist, you’re usually really worried about transmission of germs or pathogens on items like portable vitals machines or telemetry monitors that require low-level disinfection,” she added.