The equipment

All clinical equipment coming into contact with the patient must be clean or sterile. Care must be taken to ensure that no equipment becomes a reservoir of potentially pathogenic organisms. The reliability of bench-top sterilization is questionable unless the user is conversant with the time and temperature requirements and the load characteristics, and is sure that the necessary checks and maintenance are being carried out. Bench-top downward-displacement sterilizers (or gravity sterilizers) as set up in the United Kingdom are unsuitable for wrapped instruments, and must not be used for this purpose. The time and temperature relationships for steam sterilizers are different in the United States, the United Kingdom, and continental Europe. The recommended temperatures for such an autoclave in the United Kingdom are a minimum of 134 °C for a holding time of 3 min and a maximum of 137 °C. The cycle time for such a process is about 20 min. In contrast, the United States equivalent for a gravity-feed ('bench-top') autoclave is either 121 °C for a holding time of 20 min (standard gravity) or a 132 °C for a holding time of 10 min (high-speed or flash process). Machines are generally designed to conform with national guidelines. Therefore it is vital that the user checks that the recommended sterilization cycle for an article can be achieved by the sterilizers available. Further advice concerning United Kingdom practice is given in Health Technical Memorandum 2010 (NHS Estates 1994).

The role of disinfectants must be carefully assessed. The hospital should have a formal disinfection policy which lays down the broad guidelines for supply and use of these agents. It is important that the legal aspects of the use of these agents is appreciated (such as complying with the Control of Substances Hazardous to Health (COSHH) legislation in the United Kingdom). Most disinfectants will support the growth of bacteria, and therefore can become an inadvertent source of infection. This is particularly true for chloroxylenols, diguanides (e.g. chlorhexidine), and quaternary ammonium compounds (e.g. cetrimide), all of which may become contaminated with environmental Gram-negative bacilli.

In general, surfaces should be kept clean with a detergent wash, and if necessary wiped over with a proprietary alcohol-impregnated cloth which is then discarded. Items must not be left to soak in containers of disinfectant unless a high-level disinfection process is being used for equipment that cannot be sterilized by any other technique (e.g. fiber-optic endoscopes). In such circumstances, a mechanical washer should be used to ensure optimal cleaning and disinfection. The use of chemical agents to sterilize equipment is not reliable.

Equipment labeled 'for single use only' must be discarded after single use. Attempts to reprocess such items may result in failure to sterilize or degradation of the material. If an adverse incident occurred in a patient, the user could be liable for damages in law. Some products may be for single-patient use or be recommended for a limited number of uses. It is important that the manufacturer's recommendations are followed.

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