SESLHD PROCEDURE COVER SHEET NAME OF DOCUMENT Antiseptics and Disinfectants TYPE OF DOCUMENT Procedure DOCUMENT NUMBER SESLHDPR/354 DATE OF PUBLICATION June 2014 RISK RATING Medium LEVEL OF EVIDENCE NSW Ministry of Health Policy Directives; Commonwealth of Australia Department of Health and Aging Guidelines NSW Work Health and Safety Act NSW Work Health and Safety Regulations National Standards 3.1, 3.3, 3.5, 3.10 REVIEW DATE June 2017 FORMER REFERENCE(S) Former SESLHNPD/126 ‘Antiseptic and Disinfectants’ EXECUTIVE SPONSOR or Director Clinical Governance EXECUTIVE CLINICAL SPONSOR AUTHOR Infection Control Manual Working Party [email protected] POSITION RESPONSIBLE FOR THE DOCUMENT Infection Prevention & Control Working Party KEY TERMS Antiseptic, disinfectant, sterilant SUMMARY To outline how to use, apply, manage and store antiseptics and disinfectants as per guidelines and policy [email protected] COMPLIANCE WITH THIS DOCUMENT IS MANDATORY This Procedure is intellectual property of South Eastern Sydney Local Health District. Procedure content cannot be duplicated. Feedback about this document can be sent to [email protected] SESLHD PROCEDURE Antiseptics and Disinfectants PR 354 1. POLICY STATEMENT To outline the principles for the safe management and use of antiseptics and disinfectants for all staff The procedure has been developed in line with the NSW Ministry of Health Infection Control Policy Directive and National Safety and Quality Health Service Standard No. 3 ‘Preventing and Controlling Healthcare Associated Infections, specifically Criterion 3.5. 2. BACKGROUND Antiseptic: a chemical for disinfection of the skin, mucous membranes or other living tissue to decrease the number of microorganisms present Disinfectant: any substance used on inanimate objects such as instruments and environmental surfaces to kill or inhibit growth of microorganisms Microorganism: a tiny form of life which can be bacterial, viral or fungal that may be capable of causing infection or disease Sterilant: a chemical agent, other than a gas, which is used to sterilise medical devices. A sterilant kills all microorganisms 3. RESPONSIBILITIES 3.1 Employees will: Comply with management procedures for each Antiseptic and Disinfectant Ensure risk assessment is done and appropriate PPE worn while cleaning spills Comply with the procedure outlined for each Antiseptic and Disinfectant in line with local Infection Control policies and procedures. 3.2 Line Managers will: Ensure that antiseptics and disinfectants are available, stored safely and that HCW’s are educated in the procedure for use. 4. PROCEDURE 4.1 Antiseptics Use only antiseptics supplied by the Pharmacy Department Select the correct antiseptic for the use required (refer to Table: Antiseptic Guide) Read label carefully before use, especially contact time recommendations Check the tamper proof seal is intact Check the use by date Measure correctly Wear gloves to avoid chemical contact Revision 1 Trim No. T14/19749 Date: June 2014 Page 1 of 4 COMPLIANCE WITH THIS DOCUMENT IS MANDATORY This Procedure is intellectual property of South Eastern Sydney Local Health District. Procedure content cannot be duplicated. SESLHD PROCEDURE Antiseptics and Disinfectants PR 354 Avoid splashes to prevent harm to skin and eyes Do not create an aerosol (fine mist) with solution Do not combine antiseptics Do not add detergent or any other substance to an antiseptic. This may inhibit the antimicrobial effect Use a clean, dry container for each solution Do not contaminate the solution Record date when opened and discard by designated use-by date (as indicated on the manufacturer's label) Do not "top up" antiseptic solutions Discard single use containers immediately after use Do not return decanted antiseptic solution to its original container. Discard the unused solution Discard antiseptic solution carefully after use Close the lid after use (if applicable) Antiseptics will not make dirt safe. The area may need to be cleaned first Do not use an antiseptic for cleaning Do not use an antiseptic as a disinfectant or a sterilant Anaphylactic reactions can occur with antiseptics applied topically 4.2 Disinfectants Chemical disinfection may only be used for items for which thermal methods are unsuitable Before use, check the manufacturer’s instructions for compatibility of the instrument or equipment with the disinfectant Relevant MSDS (Material Safety Data Sheet) must be consulted before use Appropriate PPE as specified in the MSDS must be used Only use disinfectants specified in the Australian Register of Therapeutic Goods (ARTG) and these should only be used for the approved purpose Follow the manufacturer’s instructions Use only disinfectants supplied by the facility Select the correct disinfectant for the use required (refer to Table: Disinfectant Guide) Read label carefully before use Check the tamper proof seal is intact (if applicable) Check the use by date Record date when opened and discard by designated use-by date (as indicated on the manufacturer's label) Measure correctly Use the correct concentration/dilution Instruments and equipment must be cleaned with a neutral detergent or enzymatic solution prior to chemical disinfection Avoid splashes to prevent harm to skin and eyes Do not create an aerosol (fine mist) with solutions Do not combine disinfectants Do not add detergent to a disinfectant. This may inhibit the antimicrobial effect Revision 1 Trim No. T14/19749 Date: June 2014 Page 2 of 4 COMPLIANCE WITH THIS DOCUMENT IS MANDATORY This Procedure is intellectual property of South Eastern Sydney Local Health District. Procedure content cannot be duplicated. SESLHD PROCEDURE Antiseptics and Disinfectants PR 354 Do not contaminate the solution Use a clean, dry container for each solution Ensure ventilation is adequate Do not return a decanted disinfectant solution to its original container. Discard the unused solution Do not "top up" disinfectant solutions Discard disinfectant solution carefully after use Close the lid after use (if applicable) Discard single use containers immediately after use Do not use as an antiseptic or a sterilant Do not use a disinfectant for cleaning Disinfectants will not make dirt safe. The area will need to be cleaned first Do not store instruments or cleaning tools in disinfectants before or after use 5. DOCUMENTATION Nil 6. AUDIT Central Line Catheter Insertion Checklist Aseptic technique audits 7. REFERENCES NSW Ministry of Health ‘Infection Control Policy Directive’ PD 2007_036 Australian Commission on Safety and Quality in Healthcare: Australian Guidelines for the Prevention and Control of Infection in Health Care. 2010 http://www.nhmrc.gov.au/node/30290 Tortora, G., Funke, B. and Case, C.(2010) Microbiology. An Introduction. 10th Ed. The Benjamin Cummins Publishing Company Inc, USA. Australian College of Operating Room Nurses Ltd. ACORN Standards, Guidelines and Policy Statements. 2013 National Standard 3 Prevention of Healthcare Associated Infections NSW Health Department. Skin Penetration Code of Best Practice. 2001 Marscall, J. et al. Strategies to Prevent Central Line-Associated Bloodstream Infections in Acute Care Hospitals. Infection Control and Hospital Epidemiology. 2008; 29: S22-S30 Revision 1 Trim No. T14/19749 Date: June 2014 Page 3 of 4 COMPLIANCE WITH THIS DOCUMENT IS MANDATORY This Procedure is intellectual property of South Eastern Sydney Local Health District. Procedure content cannot be duplicated. SESLHD PROCEDURE Antiseptics and Disinfectants 8. PR 354 REVISION AND APPROVAL HISTORY Date Revision No. Author and Approval May 2003 0 IAHS Infection Control Coordinators Feb 2005 1 Approved by Area Policy and Procedure Committee on 10 Feb 2005 and ratified by Area Executive 21 Feb 2005 for a six month period – review August 05 May 2006 Draft Former IAHS policy reviewed and merged for SESIH in collaboration with SESIH Infection Control Manual Working Party July 2010 Draft Presented to SESIH Area Infection Prevention and Control Committee R. Bourke – Sutherland Hospital Apr 2011 2 May-Jun 2014 2.5 Minor amendments made by Infection Prevention Control Working Party. Re-formatted by District Policy Officer Jun 2014 2.5 Approved by Executive Clinical Sponsor, Prof. George Rubin Revision 1 Amended to reflect change to Local Health Network Trim No. T14/19749 Date: June 2014 Page 4 of 4 COMPLIANCE WITH THIS DOCUMENT IS MANDATORY This Procedure is intellectual property of South Eastern Sydney Local Health District. Procedure content cannot be duplicated. SESLHD PROCEDURE Antiseptics and Disinfectants PRODUCT H CHLORHEXIDINE 0.5% in A 70% Alcohol handrub N with emollients D C L E A N S CHLORHEXIDINE 2% E R S TRICLOSAN 1% Revision 1 PR 354 RECOMMENDED USES Hand disinfection when hands are not visibly soiled Hand wash prior to an aseptic procedure INSTRUCTIONS If hands are visibly soiled, running water must be used Vigorously rub hands for a minimum 15 seconds with enough solution to completely wet hands Prior to aseptic procedures minimum 30 seconds rub required Refer to Infection Control Manual: Hand Washing, Hand Cleansing and Hand Care policy NOTES FLAMMABLE Not suitable if hands are visibly soiled Should not be relied on to be effective against C. difficile and some viruses Refer to C.diff procedure Not to be used for environmental cleaning Hand wash in areas as determined by the local Infection Control Committee Trim No. T14/19749 Date: June 2014 Page 1 of 6 COMPLIANCE WITH THIS DOCUMENT IS MANDATORY This Procedure is intellectual property of South Eastern Sydney Local Health District. Procedure content cannot be duplicated. SESLHD PROCEDURE Antiseptics and Disinfectants PR 354 PRODUCT RECOMMENDED USES H Hand gel 66% w/w ethanol Hand disinfection when A hands are not visibly soiled N D C L E A N Hand foam ethanol S absolute 60% with E propan-1-ol 10% R S S ALCOHOL 70% tinted K I N Revision 1 Hand disinfection when hands are not visibly soiled Skin preparation prior to procedures Trim No. T14/19749 INSTRUCTIONS If hands are visibly soiled, running water must be used Vigorously rub hands for a minimum 15 seconds with enough solution to completely wet hands Prior to aseptic procedures minimum 30 seconds rub required If hands are visibly soiled, running water must be used Vigorously rub hands for a minimum 15 seconds with enough solution to completely wet hands Prior to aseptic procedures minimum 30 seconds rub required Ensure skin is clean Swab site carefully CONTACT TIME - allow site to air dry prior to procedure (DO NOT WIPE DRY) Date: June 2014 NOTES FLAMMABLE Not suitable if hands are visibly soiled Should not be relied on to be effective against C. difficile and some viruses Refer to C.diff procedure Not to be used for environmental cleaning FLAMMABLE Not suitable if hands are visibly soiled Should not be relied on to be effective against C. difficile and some viruses Refer to C.diff procedure Not to be used for environmental cleaning FLAMMABLE Do not use prior to electric cautery Page 2 of 6 COMPLIANCE WITH THIS DOCUMENT IS MANDATORY This Procedure is intellectual property of South Eastern Sydney Local Health District. Procedure content cannot be duplicated. SESLHD PROCEDURE Antiseptics and Disinfectants PRODUCT CHLORHEXIDINE 0.015% with CETRIMIDE 0.155% Aqueous (Sterile) P R E P A R A T I O N CHLORHEXIDINE 0.05% Aqueous (Sterile) CHLORHEXIDINE 0.5% Aqueous (Sterile) CHLORHEXIDINE 0.5% in 70% Alcohol Revision 1 PR 354 RECOMMENDED USES Initial cleaning of dirty wounds in Emergency Department Soaking off adhered dressings Perineal swabbing For use as skin antisepsis in neonates less than 28 weeks gestation and less than 1500 grams until 7 days old Pre-operative skin preparation of hypersensitive areas and patients allergic to povidone iodine For use as skin antisepsis in infants less than 2 months Skin preparation prior to insertion of intravascular devices for neonates greater than 28 weeks gestation Trim No. T14/19749 INSTRUCTIONS Ensure skin is clean Use undiluted. Single use container CONTACT TIME - allow site to air dry prior to procedure (DO NOT WIPE DRY) Ensure skin is clean Use undiluted. Single use container CONTACT TIME - allow site to air dry prior to procedure (DO NOT WIPE DRY) Ensure skin is clean Use undiluted. Single use container CONTACT TIME - allow site to air dry prior to procedure (DO NOT WIPE DRY) Ensure skin is clean Do not apply to broken skin CONTACT TIME - allow site to air dry prior to procedure (DO NOT WIPE DRY) Date: June 2014 NOTES Good detergent / cleaning action. Avoid contact with meninges or middle ear. Keep out of eyes Avoid contact with meninges or middle ear. Keep out of eyes Avoid contact with meninges or middle ear. Keep out of eyes FLAMMABLE Use chlohexidine 2% in 70% alcohol for adults Page 3 of 6 COMPLIANCE WITH THIS DOCUMENT IS MANDATORY This Procedure is intellectual property of South Eastern Sydney Local Health District. Procedure content cannot be duplicated. SESLHD PROCEDURE Antiseptics and Disinfectants PRODUCT S CHLORHEXIDINE 2% in K 70% Alcohol I N P R E P A R A CHLORHEXIDINE 2% and T 70% Isopropyl Alcohol I (Solu I.V. MAXI swabstick) O N CHLORHEXIDINEGlucona te2% swab stick (alcohol free) PR 354 RECOMMENDED USES Skin preparation prior to procedures Skin preparation prior to insertion of intravascular devices Skin antisepsis prior to insertion of intravascular devices Skin antisepsis in infants Cleaning of bungs in infants CHLORHEXIDINE 4% in Ethanol 70% IV prep (Persist Plus) Revision 1 Skin preparation prior to insertion of intravascular device Trim No. T14/19749 INSTRUCTIONS Ensure skin is clean Do not apply to broken skin or mucous membranes CONTACT TIME - allow site to air dry prior to procedure (DO NOT WIPE DRY) Ensure skin is clean Do not apply to broken skin CONTACT TIME - allow site to air dry prior to procedure (DO NOT WIPE DRY) Ensure skin is clean Disinfect insertion site for one minute, turn swab over and apply antiseptic to site for further one minute Allow site to air dry Ensure skin is clean Disinfect insertion site for one minute, turn swab over and apply antiseptic to site for further one minute Allow site to air dry Ensure skin is clean Do not apply to broken skin CONTACT TIME - allow site to air dry prior to procedure (DO NOT WIPE DRY) Date: June 2014 NOTES FLAMMABLE FLAMMABLE FLAMMABLE Do not use if child is less than 2 months FLAMMABLE Page 4 of 6 COMPLIANCE WITH THIS DOCUMENT IS MANDATORY This Procedure is intellectual property of South Eastern Sydney Local Health District. Procedure content cannot be duplicated. SESLHD PROCEDURE Antiseptics and Disinfectants PRODUCT S CHLORHEXIDINE 2 or 4% K I N POVIDONE IODINE 5% P (1/2 R E strength Betadine) P (Biodene) A POVIDONE IODINE 10% R Solution (Betadine, A Novadine S) T This may be packaged as I a swab, swab stick, O steritube or bottle N TRICLOSAN 1% S CHLORHEXIDINE 4% U R G I C A L Revision 1 PR 354 RECOMMENDED USES Pre-operative body wash Skin preparation prior to specific surgical procedures e.g. eye lids (Operating Theatre use only) Skin preparation prior to surgical procedures/blood culture collection/skin puncture INSTRUCTIONS Can be provided as individual patient use sachets, disposable cloths or liquid wash Apply to clean skin, mucous membranes CONTACT TIME - refer to manufacturer's instructions Apply to clean skin, mucous membranes CONTACT TIME 3 - 5 minutes - refer to manufacturer's instructions NOTES DO NOT USE FOR NEONATES If patient allergic to iodine, Chlorhexidine 0.5% to be used Avoid regular use in patients on lithium or with thyroid disorders Pre-operative body wash Surgical hand wash before entering normally sterile tissue Trim No. T14/19749 Refer to SESIH Infection Control Manual: Hand Washing, Hand Cleansing and Hand Care policy Date: June 2014 Page 5 of 6 COMPLIANCE WITH THIS DOCUMENT IS MANDATORY This Procedure is intellectual property of South Eastern Sydney Local Health District. Procedure content cannot be duplicated. SESLHD PROCEDURE Antiseptics and Disinfectants PRODUCT PR 354 RECOMMENDED USES INSTRUCTIONS NOTES S C R U B Revision 1 Trim No. T14/19749 Date: June 2014 Page 6 of 6 COMPLIANCE WITH THIS DOCUMENT IS MANDATORY This Procedure is intellectual property of South Eastern Sydney Local Health District. Procedure content cannot be duplicated.