UNIVERSITY OF ARKANSAS FOR MEDICAL SCIENCES

MEDICAL CENTER

PROCEDURE

PROCEDURE:

207

EFFECTIVE:

8/05

REVISION:

 

APPROVED:

1/08

PROCEDURE FOR DISINFECTION OF MEDICAL EQUIPMENT USING GLUTARALDEHYDE

 

PURPOSE:   To provide guidelines to assist personnel in the care, cleaning, decontamination, maintenance, handling, storage, and disinfection of medical equipment and related accessories.  Use of this procedure will assist personnel in providing a safe environment for patients and healthcare workers. 

 

EQUIPMENT: 

  1. Glultaraldehyde 14 day solution and activator

  2. Glutaraldehyde solution test strips

  3. A hard plastic container with tightly fitting lid

  4. Enzymatic detergent

  5. Timer or other device for determining soaking period

  6. Soft cloth or sponge

  7. Brush

  8. 70% to 90 % ethyl or isopropyl alcohol

  9. Syringes

  10. Personal Protective Equipment (PPE):

  • Face shield or safety glasses

  • Gowns

  • Gloves

    • Nitril gloves (the blue ones) or,

    • Latex exam gloves (double) or,

    • Sterile latex gloves                                                

 

NURSING ACTION:

 

PROCEDURE STEPS: 

 

Activation of Glutaraldehyde solution

Dress in PPE prior to handling of glutaraldehyde solution.

  1. Activate glutaraldehyde solution by adding the entire contents of the activator vial that is attached to the glutaraldehyde gallon bottle.
  2. Shake well.  Activated solution immediately changes color to green, thereby indicating solution is ready to use.
  3. Test glutaraldehyde solution as noted in Quality Control section below.
  4. Record the date of activation (mixing date) and expiration date on the glutaraldehyde solution container.

Cleaning/Decomtamination

  1. Inspect equipment and related accessories for any damage, loss of function, and gross soil.

  2. Blood and body fluids must be removed from surfaces, lumens, and objects with a neutral detergent soap before the object is disinfected with glutaraldehyde.

  3. Any organic material on the object will diminish the disinfection capacity of the glutaraldehyde.

  4. Thoroughly clean, rinse and rough dry objects before immersing in glutaraldehyde solution.

  5. Cleaning procedure for endoscopes:

  • Wash the insertion tube of the endoscope with an enzymatic solution using a soft cloth or sponge.

  • Remove all detachable parts and soak in the enzymatic detergent solution.

  • Open all ports during the cleaning process.

  • Irrigate internal suction/biopsy channels of flexible endoscopes with large amounts of enzymatic detergent and tap water to soften, moisten, dilute, and remove organic soils (e.g., blood, respirator secretions).

  • Brush accessible channels to remove particulate matter.  Reusable cleaning brushes require thorough cleaning and disinfection after each use.

  • Clear the air-water channel with forced air.

  • Gently wipe/brush the tip of the endoscope to remove any debris or tissue that might be lodged around the air-water outlet.

  • Clean detached parts in enzymatic solution.  Brush irregular surfaces to remove all organic debris.

Disinfection

  1. Test the glutaraldehyde solution as noted in Quality Control below.

  2. Completely immerse medical equipment and related accessories/equipment in glutaraldehyde solution for a minimum of 20 minutes (use timer) to achieve high level disinfection.

  3. Remove devices and equipment from the solution and rinse thoroughly by immersing it completely in three separate large baths of water.  Each rinse should be a minimum of one minute in duration.

  4. For Endoscopes:  after high-level disinfection and before storage, rinse endoscopes, including internal channels, with sterile water followed by a rinse with 70% or 90% ethyl or isopropyl alcohol and dry with forced air.  This process reduces the potential for recontamination by waterborne microorganisms.

  • Use a fresh change of water for each rinse.

  • Discard the water following each rinse.

  • Do not reuse water for rinsing or any other purposes as it will be contaminated with glutaraldehyde.

  • After processing, hang endoscopes in a vertical position to facilitate drying.  Store in a manner that discourages contamination.  In case of scopes, hang so that there are no coils or kinks.  Never store scopes in their cases.

  • Endoscope accessories (e.g., biopsy forceps, cytology brushes) that enter sterile tissue or the vascular system should be sterile.

  1. Change gloves every 15 minutes, if wearing doubled latex exam gloves, during the disinfection process.

Reuse

The glutaraldehyde solution may be reused within the limitations indicated in the Quality Control section below and the expiration date of the solution.

 

Disposal

Discard used solution down sink drain; flush well with a large quantity of water.  Rinse container well with water and discard in regular trash.

 

Quality Control (QC)

The 14 day solution is good for up to 14 days after reconstitution if an adequate concentration is confirmed with the daily test strip reading as described below.  Dispose of solution in 14 days if effectiveness has been confirmed up to 14 days.

  1. Perform QC as outlined below every day before using glutaraldehyde for high level disinfection.  If glutaraldehyde solution is used more than 10 times during a day, the solution should be tested again prior to the 10th use.  Make sure that the test strips match the type of glutaraldehyde solution your clinic uses.

  2. Immerse the indicated pad of the test strip in the solution for 3 seconds, and then remove.  Do not shake strip.

  3. Remove excess solution by standing the strip upright on a paper towel.

  4. Read results at 75 seconds and record.  Do not read past 75 seconds.

    1. If strip pad is completely purple it indicates effective solution.

    2. If any portion of the reagent area remains orange, this indicates ineffective solution.  Discard the solution.

    3. Tightly recap test strip bottle after each use.

    4. Discard any unused test strips 90 days after bottle is originally opened.

  5. Mix and test a new bottle of glutaraldehyde solution.

Documentation

Record test results in glutaraldehyde testing log.

 

Spill Clean-Up

Wear appropriate PPE.

Contain spill by using absorbent material to pick up the liquid.  Carefully scoop up and place in bio-hazard container for disposal.  Wash contaminated surfaces with soap and water.

 

Splashes in Eyes

Immediately flush eyes at the eyewash station and then seek medical assistance.  Fill out a variance report and contact your supervisor.

REFERENCES:

Advanced Sterilization Products, Johnson & Johnson, Division of Ethicon, 33 Technology Drive, Irvine, CA  92618, Material Safety Data Sheet, CIDEX Activated Dialdehyde Solution, Issue date: 9/22/03.

The University of Arkansas for Medical Sciences, Infection Control Manual, Policy 6.15, Disinfection and

     Sterilization, Review date 4/01.

APIC Guideline for infection prevention and control in flexible endoscopy, Alvarado, Carla J.; Reichelderfer, Mark; The 1997, 1998, 1999 APIC guidelines committees, AJIC American Journal of Infection Control, Vol. 28(1), April 2000,

     pp. 138-155.

Recommended Practices for Cleaning and Processing Endoscopes and Endoscope Accessories, AORN Journal, Vol

     77(2) February 2003, pp. 434-435, 438, 441-442.

RESOURCE PERSON(S):   Tonie Durrett, RN, MNSc