Multiplace Delivery System
Monthly Hyperbaric Safety Notice: December 2005
Validation of Decontamination Procedure For Amron Oxygen Hoods
In this notice we discuss the importance of validating cleaning processes for oxygen hoods.
Background
For varying reasons manufacturers of oxygen hoods will not provide a cleaning process to either allow for re-use or for routine cleaning during a patient's hyperbaric treatment course. These costly items are sold as 'one patient use only'. Most, if not all hyperbaric facilities reuse the hoods by adopting various cleaning methods after use. Our hyperbaric unit validated a cleaning process that had been in operation for some time.
Safety Issue
Cross infection is a serious concern when re-using equipment that is recommended for single patient use only. In Australia there were no relevant Standards that offer levels of cleanliness for such equipment. To minimize the risk of cross infection it was suggested by a Microbiologist to use a standard outlining a high level of cleaning. The standard suggested was Australian Standard 1162 (2000), which covers Cleaning and Sanitizing Dairy Factory Equipment. This standard is also used for food preparation surfaces. It applies to all dairy factory-cleaning operations where the equipment is cleaned by the use of circulating liquids, physically scrubbed by manual exertion or where mechanized cleaning is employed.
Key Operational Issues
The disinfectant used was Viraclean* which is a commonly used liquid cleaner available in Australia, although the process would be the same for any brand of disinfectant.
Method
As an example, our 'Major Disinfection Procedure’ is performed after a patient has completed a course of HBOT and its purpose is to decontaminate the hood. The cleaning process is carried out as follows:
- Disassemble equipment (hood, neck seal, neck ring, o-ring and rubber plug)
- Hand wash all non-disposable hood components in hot soapy water (pay particular attention to O-ring, hood base fold, tubing inlets etc)
- Rinse components with water to remove soap residue
- Dry all components including the fold in the hood base to remove excess water
- Apply disinfectant solution to all surfaces for a minimum contact time (as outlined by the manufacturer)
- Rinse all components to remove disinfectant and dry off excess water
- Place all components in clean drying area for air drying
- Once dried the hoods and neck ring should be placed into a sealable plastic bag until required for re-use.
- Once hood equipment is cleaned, disinfect pigeon hole (or the place of storage for patient hoods already in use)
A microbiological evaluation should be performed to establish that the cleaning process is effective. Swabs should be taken in areas where you would be suspicious of contamination. In our study we found the highest levels of contamination were either where the patient's hair touches the plastic or in the fold area around the bottom of the hood.
Results
The standard defines a clean surface as one which is free from residual soil or film, the surface is clean from undesirable residues of cleaning and sanitizing materials, in our case disinfectant, and after being sanitized, the surface microbial count is within acceptable levels, in our case 0.4 - 0.6 CFU/cm2 via swab method. The smallest amount of bacteria that we were able to detect was restricted to 0.4CFU/cm2 due to technological limitations. With this in mind our ideal CFU/cm2 reading is less than 0.4, however up to 0.6CFU/cm2 still meets the standard.
There may be other standards or legislated processes internationally that are more descriptive. These should be used by organizations or facilities within their jurisdiction.
Bottom Line
Oxygen hoods can be effectively decontaminated to allow for more than one patient use. Any cleaning process however should be validated by a thorough microbiological evaluation. This evaluation should be done initially, to prove the decontamination process and then periodically, to ensure cleaning processes are maintained. For any change to the cleaning process, (for example changing the disinfectant used) the validation process should be repeated.
Contributing Author: David King
Dave
resides in Brisbane, Australia, where he serves as the Wesley Centre for Hyperbaric
Medicine facility manager. Dave came into the hyperbaric field by way of the
Royal Australia Navy, where he enjoyed (mostly!) a career as a clearance diver.
In 1990, he joined Royal Darwin Hospital’s newly introduced hyperbaric
medicine service as its first hyperbaric technical officer. Four years later
he relocated to Townsville, to assume a similar position. In 1998 he journeyed
further down the coast to Brisbane, and his present position. Dave has played
a leading role in the growth and maturity of the Hyperbaric Technicians and Nurses
Association, and is presently serving a second term as its president.
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