Decontamination

Decontamination
This section is broken down into several sections and includes cleaning and disinfection of
healthcare equipment and the healthcare environment.
Definitions and application of processes
The term ‘decontamination’ refers to the combination of processes by which pathogenic
microorganisms, including bacterial spores, are removed from an item, making it safe
to handle, use or discard. Decontamination is a three-step process that involves cleaning,
disinfection and sterilisation (in that order).
CLEANING Cleaning is a process that uses detergent and water to remove visible
contamination.
It does not necessarily destroy microbes. Effective cleaning is essential
before disinfection or sterilisation. It is imperative that detergent is used to clean, not
disinfectant.
Detergent is crucial in cleaning as it breaks up dirt and grease, making it easier for the
water to remove any contamination. The combination of detergent and water removes
around 80% of microorganisms from surfaces.
Drying after cleaning is as important as cleaning itself in order to prevent growth of
microorganisms not removed during the cleaning process; this is true for hands and
surfaces.
DI S I N F E C T I O N Disinfection is a process that uses chemical agents or heat to eliminate
many or all pathogenic microorganisms on inanimate objects, with the exception of bacterial
spores.
Disinfectants should only be used when there is a risk of transmission of infection, e.g.
when a patient has an infection. They are not required routinely; cleaning with detergent
alone is adequate.
Disinfectants should be used to disinfect. They should be applied to clean surfaces – they
must not be used to clean (with the exception of products used for blood/body fluid
spillage management).
Alcohol is a disinfectant (not a cleanser) and should not be used for cleaning. Alcohol
acts as a fixative to proteins (which are present in blood and tissue) and makes them stick
to surfaces.
S T E R I L I S AT I O N This is the complete elimination or destruction of all forms of microbial
life, including bacterial spores.
I N F E C T I O N R I S K S A ND DECONTAMINATION REQUIREMENTS It is important
when buying equipment to check with the manufacturer how it should be decontaminated
and that the recommended method is achievable, as to deviate from manufacturer’s guidance
may invalidate the product warranty and transfer liability for the product (should it fail
or cause harm) to you as the user.
Decontamination of reusable medical devices should be undertaken in a dedicated facility
that ensures segregation of dirty and clean items, has a defined workflow, moving from
dirty to clean, and supports tracking and tracing of individual items, with documentation
that supports this, e.g. a sterile services department (SSD). Local decontamination at ward
level should be avoided.
The level of decontamination an item requires is dependent on how it is used – noninvasive
items require a lower level of decontamination than invasive items (see Table 2).
Table 2 Infection risks and decontamination requirements
Level of risk Application
Level of decontamination
required Examples
High Invasive items
Items in close contact with a
break in the skin or mucous
membrane
Items introduced into a sterile
body area
Sterilisation
High-level disinfection may
be adequate for some items
Surgical instruments
Dressings
Catheters
Prosthetic devices
Intermediate Items in contact with intact
mucous membranes, body fluids
Items contaminated with
particularly virulent or readily
transmissible organisms
Items for use on highly
susceptible patients or sites
Disinfection Endoscopes
Respiratory equipment
Low Items in contact with normal/
intact skin
Cleaning and drying
Disinfection is required if
there is a known risk of
infection
Washbowls
Toilets
Bedding
Minimal Items not in contact with the
patient/their immediate
surroundings
Cleaning and drying Floors
Sinks
Walls
S I N G L E U S E O N LY Items designated ‘single use only’ by the manufacturer must not be
reused under any circumstances, despite any cost concerns. Figure 2 shows the ‘single use
only’ symbol

When the ‘single use only’ symbol is seen on a medical device or its packaging the item
must be used once only and discarded. This is different from single-patient use items that
can be reused with the same patient.
If single-use items are reprocessed (decontaminated) and reused, the product liability is
transferred from the manufacturer to the reprocessor, who becomes responsible for the
item’s performance. This means that if a product fails to operate properly or causes harm or
injury it is the responsibility of the reprocessor.
Decontamination of healthcare equipment
• All items of equipment should be cleaned after each use/between patients.
• Manufacturer’s guidance must be adhered to when cleaning healthcare equipment.

Table 3 Healthcare equipment and decontamination methods
Item
Decontamination method – all items require
decontamination after each use
Beds Wash bed frame with detergent and water
If disinfection is required use a chlorine-releasing agent at 1000 parts per
million available chlorine strength
Bed cradles Wash with detergent and water
If disinfection is required use a chlorine-releasing agent at 1000 parts per
million available chlorine strength
Commode frame Clean with detergent wipes
If disinfection is required use a chlorine-releasing agent at 1000 parts per
million available chlorine strength
Commodes should be disassembled for cleaning and disinfection
Commode pan Wash with detergent and water
If disinfection is required use a chlorine-releasing agent at 1000 parts per
million available chlorine strength
Reusable bedpans Wash in an automated washer–disinfector with a heat disinfection cycle that
reaches 90 °C, or reaches 80 °C and maintains the temperature for 1 minute
OR
Wash in detergent and water then disinfect with a chlorine-releasing agent at
1000 parts per million available chlorine strength
Bedpan holder (used
with disposable liners)
Wash with detergent and water
If disinfection is required use a chlorine-releasing agent at 1000 parts per
million available chlorine strength
Blood pressure cuffs Wipe with a detergent wipe
If disinfection is required use a chlorine-releasing agent at 1000 parts per
million available chlorine strength
Dressings trolleys Wash with detergent and water
To disinfect wipe with 70% alcohol after cleaning
Incubator Wash with detergent and water
If disinfection is required use a chlorine-releasing agent at 125 parts per
million available chlorine strength or wipe surfaces with 70% alcohol
Mattresses Wash with detergent and water avoiding excess wetting
If disinfection is required use a chlorine-releasing agent at 1000 parts per
million available chlorine strength
Nailbrushes Sterilised by heat disinfection in SSD
Pillows Wash with detergent and water avoiding excess wetting
If disinfection is required use a chlorine-releasing agent at 1000 parts per
million available chlorine strength
Portable suction unit Wash bottle in detergent and water after emptying, after each use
If contents were blood stained, disinfect after washing with a
chlorine-releasing agent at 10 000 parts per million available chlorine
Sheets Send for laundering at patient discharge/when soiled/stained/contaminated/
creased, at least twice a week
Thermometers After removal of protective sleeve disinfect with an alcohol wipe
Toys Wash hard toys with detergent and water
If disinfection is required use a chlorine-releasing agent at 1000 parts per
million available chlorine strength and rinse or wipe with 70% alcohol
Urine bottles Wash in an automated washer–disinfector with a heat disinfection cycle that
reaches 90 °C, or reaches 80 °C and maintains the temperature for 1 minute
OR
Wash in detergent and water and then disinfect with a chlorine-releasing
agent at 1000 parts per million available chlorine strength
Wash bowls (plastic) Wash with detergent and water and dry thoroughly

• General purpose detergent and water/detergent wipes should be suitable for cleaning
the majority of items. Consult your infection control team and decontamination manager
for further advice and always follow manufacturer’s guidance when cleaning equipment
in order to avoid causing damage.
• Wear an apron and gloves when cleaning.
Table 3 sets out the cleaning and disinfection methods for items of healthcare equipment
commonly used at ward level. This guidance may differ from local policy – please refer to
infection control guidance in your place of work.
Note that disinfection is required if an item was used with an infectious patient. If contamination
with high-risk blood or body fluid occurs, a chlorine-releasing agent at 10 000
parts per million available chlorine strength should be used to disinfect. Check manufacturer’s
guidance beforehand for compatibility and refer to the subsection on management
of blood and body fluid spillages and splashes.
Decontamination of the healthcare environment
GENERAL S TANDARDS
• All areas must be kept free of unnecessary equipment and clutter to facilitate cleaning.
• The healthcare environment and all patient equipment must be visibly clean and free
from dust, dirt, debris and blood/body fluid contamination/ stains.
• The floor should not be used for storage – floors must be kept clear to facilitate cleaning.
• The fabric of the environment should be maintained and any damage or defects should
be repaired/replaced.
• Every bed space/single room should be cleaned with detergent and water when a patient
leaves before the next patient is admitted.
• Cleaning schedules should be displayed publicly.
I S O LATION ROOMS
• Isolation rooms should be cleaned last after all other areas in the ward to prevent the
spread of microorganisms and transmission of infection.
• The domestic should wear disposable gloves and an apron when cleaning in an isolation
room. These should be removed in the room immediately before leaving, discarded into
the clinical waste bag and hands should be washed.
• On a daily basis the room should be cleaned with detergent and water and then disinfected
using a chlorine-releasing agent at 1000 parts per million available chlorine
strength or cleaned and disinfected in one step with a chlorine-based detergent at 1000
parts per million available chlorine strength.
• After discharge of an infectious patient the room should be cleaned with detergent and
water and then disinfected using a chlorine-releasing agent at 1000 parts per million
available chlorine strength or cleaned and disinfected in one step with a chlorine-based
detergent at 1000 parts per million available chlorine strength.
• Curtains should be changed after the patient is discharged/transferred from the ward.
CURTA I N S
• Curtains should be changed when soiled/contaminated, after outbreaks of infection, after
discharge of an isolated patient and otherwise every three months as a minimum.
• Fabric curtains should be laundered every three months and disposable curtains should
be changed every three months as a matter of routine.
• If curtains become stained, contaminated or soiled they must be changed immediately.
• No curtain should be stained – curtains with old stains that are set into the fabric should
not be used.
E Q U I P M E N T U S ED F O R C LEANING
• The domestic should wear heavy-duty gloves for cleaning, not disposable clinical gloves,
unless working in an isolation room.
• Mops and buckets should be stored clean, dry and upside down to allow drying and to
avoid dust and debris from accumulating inside. Buckets should be stacked in a pyramid
style, not inside one another.
• Cleaning materials used by the ward domestic should be stored in the domestic service
room and not in any other area of the ward.
• Cloths used to clean and disinfect isolation rooms should be disposable or laundered immediately
after cleaning the isolation room. They must not be used to clean another area.
• All mop heads and cloths should be laundered daily.
COLOUR CODI N G F O R H Y G I E N E The following colour-coding scheme should be
applied to all cleaning materials (gloves, mop handles, buckets, cloths):
Red: bathrooms, washrooms, showers, toilets, basins and bathroom floors
Blue: general areas including wards, departments, offices and basins in public areas
Green: catering departments, ward kitchen areas and patient food service at ward level
Yellow: isolation areas
DO M E S T I C S E RVI C E R O O M ( C L E A N E R ’ S C U P B O A RD) The domestic service room
should be used solely to prepare and clean equipment used for cleaning; there should be no
personal belongings stored and food should not be consumed there. The domestic service
room is regarded as a dirty environment in the same way that the sluice room is, and to
consume food there presents a risk of infection to the member of staff.
CL E A N I N G F R E Q U E N C I E S
Blinds and curtains
In a hospital setting, curtains and blinds should be changed every three months and immediately
upon soiling, staining or contamination.
Floors
Floors should be washed daily with detergent and water. Spillages should be cleaned (and
disinfected if necessary) immediately.
Horizontal surfaces
All horizontal surfaces should be cleaned daily with detergent and water.
Lockers, bed tables
Lockers and bed tables should be washed daily with detergent and water. Spillages should
be cleaned (and disinfected if necessary) immediately.
Showers
Shower curtains should be cleaned daily with detergent and water and changed every three
months – sooner if contaminated.
Toilets
Toilets should be cleaned daily as a minimum and more frequently during outbreaks of
diarrhoeal illness, when they should be disinfected with a chlorine-releasing agent at 1000

parts per million available chlorine strength. Toilets should be cleaned at any time that
they are soiled.
Walls
In theatres walls should be cleaned every 6 months. In other areas there is no requirement
to wash walls with any specified frequency other than to spot-clean any areas that become
dirty using detergent and water.
Wash hand basins
Wash hand basins should be cleaned daily as a minimum and more frequently during outbreaks
of diarrhoeal illness, when they should be disinfected with a chlorine-releasing
agent at 1000 parts per million available chlorine strength.
Windows
Window cleaning is usually done by an external contractor and there is no recommended
frequency.
Managing blood and body fluid spillages and splashes
Blood and body fluids have different levels of risk in terms of their infectivity – see the
subsection on infectivity of body fluids.
In the event of a blood/body fluid spillage it is essential to disinfect the affected area as
described here in order to avoid transmission of bloodborne viruses. Hepatitis B can survive
on surfaces for at least seven days and it is possible to pick it up from inanimate objects;
therefore careful disinfection of spillages and contamination is essential.
HAND H Y G I E N E , G LOVE S , A P R O N S , VI S O R S A ND MASKS
• When disinfecting spillages gloves and an apron should be worn.
• If there is any risk of splashing to the face a surgical mask and eye protection should also
be worn.
• After dealing with the spillage the gloves, apron, etc., should be removed and hands
should be washed.
DI S I N F E C T I N G T H E S P I LLAGE Hypochlorite preparations should be used to disinfect
spillages, at the following concentrations:
• 1000 parts per million available chlorine for urine, vomit or faeces.
• 10 000 parts per million available chlorine for blood/body fluid spillages.
• If hypochlorite solution at 10 000 parts per million available chlorine has already been
prepared and the weaker solution has not, it is acceptable to use the stronger solution to
disinfect following spillage of urine, vomit or faeces – preparation of a separate solution
is not strictly necessary.
Hypochlorite granules should be used for fresh blood/body fluid spillages; these absorb the
spillage whilst disinfecting with 10 000 parts per million available chlorine.
• Do not apply hypochlorite granules to urine or vomit spillages, as the chemical reaction
that occurs causes chlorine gas to be released.
A wide range of products are available for managing blood and body fluid spillages,
including biohazard kits, impregnated wipes – make sure you are familiar
with the products available in your organisation and how to use them

20 DECONTAMINATION
BLOOD/ B LOOD- S TA I N ED B ODY F L U IDS
Fresh spillages
1. Apply hypochlorite granules to the affected area and leave for two minutes.
2. Clear up the spillage and granules with paper products, i.e. disposable items, and
discard into clinical waste.
3. Wash the affected area using general purpose detergent and water or detergent wipes
to remove residual hypochlorite.
4. Dry the affected area thoroughly.
Dried blood/blood-stained body fluids/splashes/
environmental contamination
1. Apply hypochlorite solution at 10 000 parts per million available chlorine strength to the
affected area using paper products. Allow two minutes contact time for disinfection
to take place. Where this is not practicable, e.g. splashes on equipment, hypochlorite
solution should be used to wipe the equipment to remove the contamination.
2. Discard all paper products used to clear up the spillage into a clinical waste bag.
3. Wash the affected area using general purpose detergent and water or detergent wipes
to remove residual hypochlorite.
4. Dry the affected area thoroughly.
U R I N E , VOMIT AND FAECES
1. Clear up the urine/vomit/faeces with paper products and discard into a clinical waste bag.
2. Disinfect the affected area using paper products and hypochlorite solution at 1000 parts
per million available chlorine strength.
3. Wash the affected area using detergent and water or detergent wipes to remove residual
hypochlorite and then dry thoroughly.
4. A chlorine-based detergent at 1000 parts per million available chlorine strength can be
used instead of steps 2 and 3.
I N F E C T IVI T Y O F B ODY F L U IDS Body fluids are regarded as being ‘high risk’ or
‘low risk’ in terms of infectivity. Urine, vomit and faeces are low risk; the following are
high risk:
• Blood/blood-stained body fluids
• Semen
• Vaginal secretions
• Synovial fluid
• Cerebrospinal fluid
• Amniotic fluid (liquor)
• Peritoneal fluid
• Pleural fluid
• Breast milk.
CARE WITH HYPOCHL O R I T E P R E PARAT I O N S
• Always prepare hypochlorite solution(s) in the container(s) provided by the manufacturer.
There should be two available to you – one for 10 000 parts per million available chlorine
concentration and another for 1000 parts per million available chlorine concentration.
• Follow manufacturer’s guidance on preparation of the solution(s).
• Prepare with cold water.

• Do not decant the solution into another vessel.
• Do not shake the container whilst waiting for the tablets to dissolve as to do so may lead
to the contents spraying out when the lid is removed.
• Hypochlorite solutions lose their strength after 24 hours – discard any unused solution(s)
after 24 hours and prepare a fresh batch the next time it is needed.
• Keep the lid of the container – the container should not be used without a lid.
• Hypochlorite solutions are COSHH substances and should be stored securely.
• Hypochlorite is corrosive to metal and therefore prolonged contact with metal should be
avoided.
• Manufacturer’s guidance should be consulted before applying hypochlorite solution to
any item of equipment.
• Do not apply hypochlorite to carpets and soft furnishings as it will strip out the colour;
instead clean with general purpose detergent and water and use steam to disinfect.
• Heavily soiled/contaminated items that cannot be cleaned and disinfected must be
discarded.
• The products used to clear up spillages must all be disposable – mops and buckets should
not be used.