cn.112 Cleaning Methods – Nurses Online Discussion

Foundations of Nursing I

Subtopic:

Cleaning Methods

HAND WASHING

It includes routine and surgical hand washing

Routine

Objectives

Define the term hand washing.
Identythe requirements for hand washing.
Prepare the requirements for hand washing.
Carry out hand washing methodically.

Definition of hand washing
Hand washing is a systemic process of cleaning the hands and arms using soap or any other recommended chemical solutions, running water and friction to remove dirt, organic materials and any transient micro organism from hands and arms.

Requirements

Running water.
Soap in clean dish.
Hand towel / disposable towels.
Hand rubs such as 70% ethyl alcohol or spirit or recommended antiseptic.
Container for used towels
Peddle bin

Handwashing Procedure

Step	Action	Rationale
1	Stand in front of the hand washing equipment/sink.	For easy access to the water.
2	Turn on water; adjust force, then wet hands and wrists.	Proper adjustment prevents splashing water onto the uniform.
3	Apply soap. (If using bar soap, rinse it before returning it to the dish.)	Rinsing removes lather that may contain microorganisms.
4	Keep hands lower than elbows to allow water to flow towards the fingertips. Water should flow from the cleaner area to the more contaminated area.	Hands are more contaminated than forearms.
5	Wash hands using the following steps, each for five strokes: I. Palm to palm II. Right palm over left dorsum and vice versa III. Palm to palm with fingers interlaced IV. Backs of fingers to opposing palms with fingers interlocked V. Rotational rubbing of each thumb clasped in opposite palm VI. Rotational rubbing of fingertips and thumb tips in opposite palm	Friction loosens dirt and removes microorganisms that hide on palms, backs of hands, between fingers, and in skin crevices.
6	Once the procedure has started, avoid letting soap or detergent run down to elbows.	To avoid contaminating the clean hands.
7	Continue washing hands and wrists for at least one minute.	Ensures thorough cleansing.
8	Rinse hands. After rinsing, keep hands higher than elbows and dry thoroughly.	Maintains cleanliness of the hands.
9	Turn off the tap using your elbow or a paper towel.	Prevents recontamination of clean hands.
10	Pat hands dry from fingers to elbows using a single-use or disposable towel. Discard towel in a waste bin.	Prevents recontamination of clean skin.

Points to Remember

Communal towels should be eliminated from the clinical area.
Hand washing equipment should be clean.
Always keep nails clean and short without varnish.

HAND WASHING TECHNIQUE

Surgical hand washing

Requirements
Tray

Sterile towel for drying hands
Soap or liquid soap preferably liquid soap from dispenser.

Step	Action	Rationale
1	Prepare a sterile towel for drying hands before starting to wash.	To avoid contamination after scrubbing.
2	Stand in front of the sink, maintaining a slight distance.	To prevent contact between uniform and sink, reducing contamination risk.
3	Turn on the tap to ensure a steady stream of water.	To prevent splashing.
4	Wet hands under running water.	Prepares hands for soap application.
5	Apply a generous amount of soap, preferably liquid soap from a dispenser.	Liquid soap lathers easily and efficiently.
6	Rub vigorously in firm circular motions, keeping hands lower than wrists. Follow these six steps, each with five strokes backward and forward: 1. Palm to palm 2. Right palm over left dorsum and vice versa 3. Palm to palm with fingers interlaced 4. Back of fingers to opposing palms with fingers interlocked 5. Rotational rubbing of each thumb clasped in opposite palm 6. Rotational rubbing of fingertips and thumb tips in opposite palm	Friction loosens and removes dirt and microorganisms hiding in skin crevices, thumbs, and between fingers.
7	Continue washing hands and wrists for at least one minute.	Ensures adequate initial cleaning.
8	Rinse hands, keeping fingers pointed downward.	Removes lather effectively.
9	Reapply soap and repeat the entire procedure for three minutes for pre-operative scrubbing.	Ensures thorough decontamination before procedures.
10	After final rinse, keep hands higher than elbows.	Fingers are cleaner than elbows and must remain uncontaminated.
11	Turn off the tap using the elbow or a paper towel.	Prevents recontamination of hands.
12	Pat hands dry from fingers to elbows with a sterile towel or disposable paper. Discard towel in a waste bin.	Maintains sterility of clean hands.

DECONTAMINATION

Decontamination makes objects safer to be handled by health workers before cleaning.
It is the first step in processing soiled surgical instruments and other items.

Cleaning instruments and other items is important because:

It is the most effective way to reduce the number of microorganisms on soiled instruments and equipment. (It reduces up to 80% of contaminating micro organisms)
Cleaning with soap and water after decontamination reduces the number of microorganism.
Neither sterilization nor high-level disinfection procedures are effective without prior cleaning.

Effectiveness of Methods for Processing Instruments

Effectiveness of Cleaning, Disinfection, and Sterilization Methods

Effectiveness	Process	Items	Time	End Point
Up to 80%	Cleaning (water only)	—	Until visibly clean	—
Up to 50%	Cleaning (with agent)	—	Until visibly clean	—
Kills HBV and HIV	Decontamination	—	10-minute soak	—
Kills HBV and HIV	Decontamination of soiled instruments/articles	—	10-minute soak	—
100%	Sterilization	—	—	High-pressure steam (autoclave), dry heat, or chemical method
95% (does not inactivate some endospores)	High-level disinfection	Boiling, steaming, or chemical methods	—	—

STANDARD CONDITIONS FOR STERILISATION

Chemical Sterilization
An alternative to steam or dry-heat sterilization is chemical sterilization by soaking for 8 to 10 hours in a glutaraldehyde or at least 24 hours in an 8% formaldehyde solution.

High Level Disinfection of Instruments and Other Items
An alternative to steam or dry-heat sterilization is chemical sterilization by soaking for 8 to 10 hours in a glutaraldehyde or at least 24 hours in an 8% formaldehyde solution.

Endoscopes (Laparoscopes) and other instruments that would be damaged by heat can only be sterilized or high-level disinfected (see next section) using chemicals.

High Level Disinfection by Boiling
Items should begin once the water is at a rolling (bubbling) boil. Use instruments and other items immediately or place them in a covered, dry high-level disinfectant container. Store for up to 1 week.

Boiling Tips

Always boil for 20 minutes in a pot with a lid.
Start timing when the water begins to boil.
Items should be completely covered with water during boiling.
Do not add anything to the pot after boiling begins.
Air dry in a high-level disinfectant container before use or storage.

High-Le Disinfection by Steaming
Place or clean, dry items (e.g., surgical gloves) in the steamer pans. Start timing when steam begins to come out from between the pans and lid. Air dry high-level disinfected items in a clean area of the room. Use instruments and other items immediately or place them in a covered, dry, high-level disinfectant container. Store for up to 1 week.

Steaming Tips

Always steam for 20 minutes in a steamer with a lid.
Reduce heat so that water continues to boil at a rolling boil.
Start timing when the steam begins to come out from between the pans and lid.
Do not use more than 3 steamer pans.
Air dry in the covered steamer pans or a high-level disinfected container before use or storage.

Key Steps in Chemical HLD

Following decontamination, thoroughly clean and dry all equipment and instruments.
Cover all items completely with correct dilution of properly stored disinfectant.
Soak for 20 minutes.
Rinse well with boiled water and air dry.
Store for up to 1 week in a high-level disinfected, covered container or use promptly.
To prepare a high-level disinfectant (steamer, boil or chemical) or fill it with 0.5% chlorine solution and soak for 20 minutes. The chlorine solution can then be transferred to a plastic container and reused.) Rinse the inside thoroughly with boiled water. Air dry before use.

Decontamination of soiled instruments/articles

Objectives

Identify requirements for decontamination
Prepare a solution for decontamination.
Decontaminate soiled instruments/articles

Requirements for decontamination:

Gloves
Water
Plastic apron
Jik/other antiseptics
Container for decontaminant
Gum boots

Procedure

Step	Action	Rationale
1	Preparation of Decontaminant
	For Jik: Pour 1 part Jik into a bucket and add 6 parts water.	To make a 0.5% chlorine solution.
2	Decontamination of Instruments
	Immediately after use, place instruments in 0.5% Jik solution for 10 minutes.	To make objects safer for handling before cleaning.
	Remove instruments from Jik and place them in soapy water.	To prevent rusting.
	Place instruments and other items in 0.5% chlorine solution for 10 minutes immediately after use.	Rapidly inactivates HBV and HIV.
	Rinse all instruments immediately with cool water.	To prevent corrosion and remove visible organic material.
	Clean instruments thoroughly.	Ensures complete removal of debris and pathogens.

Removal Of Stains From Linen

Blood:

Soak immediately in a disinfectant.
If it fails to come off use hydrogen peroxide or Ammonia.
Rinse well with cold water afterwards.

Ink:

Put immediately in cold water or milk until the stain is removed.
If this falls use methylated spirit later.

Coffee and Tea:
Wash in cold water then put item in hot water.

Iodine:
Use hot water or ammonia, then rinse.

Medicines/lotions
Treat as advised.

Related Topics

• General Principles and Rules of All Nursing Procedures
• Hospital Economy
• Use of Personal Protective Equipment
• Routine and Weekly Cleaning of the Ward
• Waste Management and Disposal
• Isolation of Infectious Patients
• Causes of Infection
• Medical Waste Disposal and Management
• Cleaning Methods
• Carry out Adequate Feeding of Patients
• Perform Bladder and Bowel Care
• Passing a Flatus Tube
• Administration of Enema
• Ward Report
• Lifting/Positioning a Patient
• Tepid Sponging
• General Principles in Patient Care
• Ethics in Nursing Care
• Principles of Infection Prevention and Control
• Body Mechanics
• Bed Making
• Vital Observations
• Bed Bath
• Oral Care/Mouth Care
• Care and Treatment of Pressure Ulcers

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