Equipment Purchasing Guide: Think IPAC

There are many factors to consider when purchasing new equipment. Thinking about how easy or difficult it will be to comply with provincial standards for cleaning, disinfection or sterilization before purchasing each item will save time, trouble and money in the long run.

“If you can’t clean it, don’t buy it.”

- Provincial Infectious Diseases Advisory Council (PIDAC)

The Provincial Infectious Diseases Advisory Committee (PIDAC) provides simple guidance on equipment purchasing: “If you can’t clean it, don’t buy it.” (1) But having an infection prevention and control (IPAC) plan for every piece of midwifery equipment requires critical thinking. Despite the urgency of reducing health-care-acquired infections, manufacturers of health-care equipment lag behind in designing their products with IPAC in mind. Midwives, like all other health-care professionals, need to think strategically when purchasing equipment to meet IPAC standards.

Primary Considerations: Spaulding and Manufacturers’ Instructions

In Ontario and internationally, the Spaulding Classification System (Spaulding) is used to determine the level of processing needed for health-care equipment and instruments before they can be reused. The system is based on the risk of transmission of pathogens. For example, birth instruments which enter sterile tissue must be sterile, while equipment for taking blood pressure, which comes into contact with intact skin, requires low-level disinfection. The Spaulding classifications applied to midwifery equipment are described in Midwifery Equipment Disinfecting Tips.

PIDAC also requires that health-care professionals consider equipment manufacturers’ instructions for use (MIFU). When there is a discrepancy between the Spaulding classification and the manufacturer’s cleaning recommendations, the higher level process must be applied.

Even a piece of equipment as basic as a stethoscope presents IPAC challenges. According to Spaulding, a stethoscope is classified as non-critical, so low-level disinfection (LLD) is required. Research has shown that stethoscopes can be as heavily colonized with pathogens as the hands of the clinician. Manufacturers of stethoscopes (e.g. Litmann) recommend wiping the instrument with 70% alcohol, but alcohol can only achieve LLD if the surface remains wet for a highly impractical 10 minutes. Other wipes approved for health-care use can achieve LLD with shorter wet contact times, but these products risk damaging the stethoscope, reducing its life and/or voiding the warranty. Ultimately, midwives must accept that the risk to instruments and equipment is necessary to avoid exposing clients to pathogens.  

The decision guide, Four Questions to Ask Before You Purchase Equipment, is a good place to start when considering what to buy. Details about specific pieces of equipment can be found in the guide, including:

Four Questions to Ask Before You Purchase Equipment
 

  Question
                  Considerations

 1
What are the cleaning requirements?
  • If there is a discrepancy between PIDAC standards and the manufacturer’s instructions for use (MIFU), the higher level of disinfection must be used.

 2
Can I clean it?
  • Check whether the process required is feasible in the practice group. For more information, see Products for Disinfecting Midwifery Equipment.
  • If the manufacturer’s instructions do not explicitly permit the use of disinfectants approved for health care in Ontario, consider the risk based on the type of equipment. If an approved disinfectant would actually cause the equipment to stop functioning or give unreliable readings, its purchase would be a safety concern. If an approved disinfectant would void the product warranty or reduce its useful life, its purchase would be a practical concern.

3
Are there better or easier-to-clean alternatives?
  • Consider whether other brands would be easier to clean while serving the same function equally well.

 4
What is the IPAC plan for this item?
  • Making a plan may involve problem-solving. Sometimes meeting PIDAC standards requires using disposable equipment, treating items the manufacturer classifies as multi-use as single-use, and using cleaning products and processes not recommended by the manufacturer.

 

References

(1) Ontario Agency for Health Protection and Promotion (Public Health Ontario), Provincial Infectious Diseases Advisory Committee. Best practices for environmental cleaning for prevention and control of infections in all health-care settings. 3rd ed. Toronto, ON: Queen’s Printer for Ontario; 2018. (19-21)