The steps of processing

Proper processing involves several steps that reduce the risk of transmitting infections from used instruments and other items to health care workers and clients: 1) decontamination, 2) cleaning, 3) either sterilization or high-level disinfection, and 4) storage. For proper processing, it is essential to perform the steps in the correct order.

1. Decontamination:

The first step in processing instruments and other items for reuse, decontamination kills viruses (such as hepatitis B, other hepatitis viruses, and HIV) and many other microorganisms, making these items safer to handle by the staff who perform cleaning and further processing. Although decontamination also makes items easier to clean by preventing blood, other body fluids, and tissue from drying on them, decontamination does not remove fluids, tissue, or dirt.

2. Cleaning:

Cleaning refers to scrubbing with a brush, detergent, and water to remove blood, other body fluids, organic material, tissue, and dirt. In addition, cleaning greatly reduces the number of microorganisms (including bacterial endospores) on items and is a crucial step in processing. If items have not first been cleaned, further processing might not be effective because:

• Microorganisms trapped in organic material may be protected and survive further processing.
• Organic material and dirt can make the chemicals used in some processing techniques less effective.

3. Sterilization:

Sterilization protects clients by eliminating all microorganisms (bacteria, viruses, fungi, and parasites), including bacterial endospores, from instruments and other items. Sterilization should be performed on any items that will come in contact with the bloodstream or tissues under the skin, as well as on drapes and some surgical attire. Sterilization can be performed using steam (autoclaving), dry heat, or chemicals.

- or -

High-level disinfection
(HLD):

HLD is the process that eliminates all microorganisms (including bacteria, viruses, fungi, and parasites), but does not reliably kill all bacterial endospores, which cause diseases such as tetanus and gas gangrene. HLD is suitable for instruments and items that come in contact with broken skin or intact mucous membranes. If sterilization is not available, HLD is the only acceptable alternative. HLD can be performed by boiling, chemicals, or steaming.

4. Use or storage:

After processing, items should be used immediately or stored in such a way so that they do not become contaminated. Proper storage is as important as proper processing.

It is important to perform the steps in the appropriate order for several reasons:

1. Decontamination should always be done first to make items safer to handle.
2. Cleaning should always be done before sterilization or HLD to remove material that can interfere with these processes.
3. Sterilization or HLD should be done before use or storage to minimize the risk of infections to clients during procedures.
4. Items should be used or properly stored immediately after sterilization or HLD so that they do not become contaminated.

Sterilization is preferred over HLD for items that will come in contact with the bloodstream or tissues under the skin. In setting in which tetanus is common, all attempts should be made to sterilize these items.

©2004 EngenderHealth