The Provincial Infectious Diseases Advisory Committee (PIDAC) recommends that infection prevention and control (IPAC) principles be considered for every piece of equipment purchased for use in health care. Starting with the right equipment can reduce the risk of cross contamination and keep clients safe. The guiding principle is:
“If you can’t clean it, don’t buy it.” (1)
Consideration when Selecting Equipment
What level of cleaning is needed: just cleaning, disinfecting, or also sterilizing?
- This is determined by the Spaulding classification of the item. For example, birth instruments need to be sterilized and stethoscopes and blood pressure cuffs require low level disinfection.
- If the item needs to be sterilized, does the practice group have the capacity to reprocess in house, are they outsourcing their reprocessing, or using disposable items?
- If the practice is not reprocessing, do you want to purchase reusable instruments in case you move to a practice that reprocesses their own instruments?
- For items requiring disinfection between uses, can the item withstand frequent disinfection with products approved for health care use?
- Things that don’t need to be sterilized or disinfected need to be cleaned. Is this an easy to clean item? Check with the vendor or manufacturer for cleaning and maintenance instructions – many are also available online
General Principles to Consider
- Smooth surfaces are easiest to clean. Avoid crevices, seams, zippers, and Velcro to the extent feasible. For example, it may be impossible to avoid Velcro on a blood pressure cuff, and the extra attention to cleaning this item is a common problem in health care, but you have discretion to choose prenatal and birth bags with fewer Velcro and zipper fasteners.
- The item should be able to withstand repeated cleaning with health care grade cleaners and disinfectants.
- Materials that hold moisture should be avoided as they support microbial growth. Wood is an example of an organic material that retains moisture. (1)
- Microorganisms survive more easily on porous fabrics such as cotton, cotton terry, nylon and polyester and on porous plastics such as polyurethane and polypropylene. (1) Metals and hard plastics are less likely to support microbial growth than most other materials. (1)
Considerations for Specific Equipment
Pulse oximeters accessories can be purchased as disposable or reusable, though reusable ones are hard to clean appropriately. Newborn Screening Ontario provides practice groups with annual replacement probes and wraps.
Use a thermometer that is intended for shared use (i.e. hospital grade; with a sleeve) as those intended for single person use cannot be cleaned and disinfected.
- Older blood pressure cuff designs (with a removable inflation bladder inside a fabric shell) are harder to keep clean.
- Use hard sided, lockable containers (Tupperware with locking/sealing devices) to store and transport sterile equipment and separate hard sided, lockable containers to transport dirty equipment (ideally see-through containers) to help maintain sterility in transport.
- Use bags/containers that are wipeable (no mesh or fabric that can’t be wiped with health care grade cleaners, especially bags with pockets).
- Selecting a birth stool can be a challenge. Birth stools that come apart for easier transport may have more crevices that are hard to clean than stools designed as a single unit. If you decide that a birth stool with joins and crevices is the only feasible solution for transport, supply yourself with disposable brushes of appropriate size and shape to access the hard to clean areas. PIDAC recommends acrylic and plastic over wood. If you opt for a wood stool, find one which has been given multiple coats of marine grade sealant to make it less porous. Be aware that the sealant will break down over time.
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. April 2018. [cited 2018 Apr 24] Available from: https://www.publichealthontario.ca/en/eRepository/Best_Practices_Environmental_Cleaning.pdf