Managing Reusable Instruments and Devices in Ambulatory Care
Ambulatory healthcare facilities — such as clinics, surgery centers, medical offices, and dental offices — must make concerted efforts to prevent and control the spread of infectious diseases and outbreaks. As more patient care services have shifted from inpatient to outpatient settings, the importance of infection prevention and control (IPC) has become more pronounced.
Various methods can help practitioners and staff members in ambulatory healthcare facilities prevent and control infection-related adverse events. One area to target as part of IPC initiatives is the appropriate and thorough decontamination of reusable medical/dental instruments and devices. Examples of these items include thermometers, otoscopes, stethoscopes, forceps, ultrasound equipment, blood glucose meters, blood pressure cuffs, dental handpieces, and periodontal scalers.
Healthcare providers and staff members should consider the following risk management strategies related to instruments and devices as part of their overall IPC plan.1
Strategies for Reprocessing Reusable Instruments and Devices
- Make sure that reusable instruments and devices are clearly differentiated from single-use disposable devices. Reinforce to providers and staff members that single-use disposable devices should not be reused under any circumstances.
- For each reusable instrument or device, determine the level of disinfection or sterilization needed. The level will depend on how the item is used.2
- Critical instruments/devices are those that penetrate sterile tissue, bone, or the vascular system; they require thorough cleaning and sterilization.
- Semi-critical instruments/devices are those that contact mucous membranes or skin that is not intact; they require thorough cleaning and high-level disinfection.
- Noncritical instruments/devices are those that contact only intact skin; they require low-level disinfection.
- Develop written policies and procedures for reprocessing reusable devices, and make sure providers and staff members have read and understand these policies and procedures.
- Keep policies, procedures, and manufacturers’ reprocessing instructions for reusable devices in reprocessing areas.
- Provide training and validate competency for employees who process reusable devices. Training should occur at least annually and when new equipment is introduced.
- Provide thorough guidance for the appropriate use of personal protective equipment during reprocessing procedures.
Strategies for Sterilizing Reusable Instruments and Devices
- Ensure that the facility’s IPC policies require appropriate cleaning, decontamination, and sterilization of critical reusable instruments and devices.
- Establish standards for routine maintenance of sterilization equipment according to manufacturers’ instructions.
- Implement biological monitoring of the sterilization process.
- Develop written policies and procedures for managing reprocessing errors or failures.
Strategies for High-Level Disinfection of Reusable Instruments and Devices
- Ensure that the facility’s IPC policies require at least thorough cleaning and high-level disinfection for reusable semi-critical instruments and devices.
- Make sure that disinfection procedures require use of high-level disinfectants (cleared by the U.S. Food and Drug Administration) and manufacturers’ recommended exposure conditions. Ensure adequate supplies of product(s).
- Develop a system for identifying which instrument was used on which patient.
- Perform routine maintenance on high-level disinfection equipment according to manufacturers’ guidelines.
Strategies for Low-Level Disinfection of Reusable Instruments and Devices
- Implement a policy for low-level disinfection of noncritical instruments and devices. Disinfection should occur periodically or when the items are visibly soiled.
- Ensure that adequate supplies of disinfectants or germicides approved for use in healthcare facilities are available and accessible to staff.
For more detailed information about reprocessing reusable instruments and devices, see the various resources from the Centers for Disease Control and Prevention’s Healthcare Infection Control Practices Advisory Committee as well as the Association for Professionals in Infection Control and Epidemiology’s disinfection and sterilization resources.
Endnotes
1 Note: The types of instruments and devices used in ambulatory healthcare facilities vary. Not all guidance in this document applies to all facilities. Healthcare leaders, providers, and staff should determine appropriate IPC efforts based on their facilities and patient populations.
2 Centers for Disease Control and Prevention. (2016, September). Guide to infection prevention for outpatient settings: Minimum expectations for safe care (Version 2.3). Retrieved from www.cdc.gov/healthcare-associated-infections/hcp/prevention-healthcare/outpatient-expectations.html; Centers for Disease Control and Prevention. (2016, October). Summary of infection prevention practices in dental settings: Basic expectations for safe care. Retrieved from www.cdc.gov/dental-infection-control/hcp/summary/index.html
