Donald Armstrong: Help Your Hospital in the Fight Against HAIs

It is a regulatory requirement to clean and disinfect medical equipment before being used on a patient. Such a practice is also simply the right thing to do. We need to keep our patients and hospital personnel safe.

While that outlook is a no-brainer, the cleaning and disinfection of medical equipment is a complicated responsibility that relies on a thorough understanding of the equipment, its use, workflows, and effective cleaning practices.

Without that knowledge, even the best of intentions can result in troubling consequences. In fact, medical devices can be damaged because of inappropriate cleaning products or practices. The ECRI Institute named that problem as one of its selections for the top health technology hazards of 2017. The damage could be the result of fluid intrusion or chemicals eating away at the cases and parts of the devices. Plastic parts on pumps, scopes, and even robots are not meant to be soaked with liquid so powerful that it will start to break down the plastic.

Responsibility for the cleaning and disinfection of medical devices and equipment typically rests with a hospital’s sterile processing department (SPD). But as the professionals who service and maintain medical devices, we’re in a position to see problems (perhaps the corrosive effects of a cleaning agent), and we have a crucial role to play in the fight against healthcare-associated infections or HAIs.

Our role can manifest itself in two ways. First, when we see equipment that we believe has been damaged by corrosive cleaning products or improper procedures, we must speak up. In my department, we take pictures of the device, open a work order, and make note of the damage and the steps we took to remediate the damage. We will then report the issue to the department that uses the equipment to make sure cleaning is done correctly (this is often hard to find out). An example of this would be if several infusion pumps were delivered to our shop with damage related to cleaning or transport. We would report the problem to the user department and our delivery department.

Second, our partnership role with our sterile processing colleagues also comes into play when we come across contaminated equipment. We have all seen equipment that is filthy when it comes to our shops to repair. In my department, when we see such equipment, we note it through our intradepartmental reporting process as a “non-safe” issue. The report would make its way to the individuals who could act on such matters (again not the easiest process).

I’d like to hear about your experiences. Have you come across equipment damaged during cleaning? What do you do about that? Who keeps track of damaged devices by cleaning products and/or processes? What’s your relationship with your hospital’s SPD?

Second, what is your department’s policy when dirty equipment comes to your shop? How is it handled?

My colleague Rich Fechter and I will speak about infection control and damaged equipment at June’s AAMI Annual Conference & Expo in Austin, TX. I look forward to seeing you. Also, if you’d like to exchange ideas before then, please email me at  Let’s start a fruitful and spirited discussion about the major role that the HTM community can play in keeping HAIs down in our facilities.

Donald Armstrong, CBET, CHTM, works in the Clinical Technology and Biomedical Engineering Department at Stanford Health Care in California. He is a member of AAMI’s Technology Management Council.

5 thoughts on “Donald Armstrong: Help Your Hospital in the Fight Against HAIs

  1. Years ago I worked at a medical equipment rental company. Once per month, we randomly selected 20 rental items that were in our post-cleaning holding room to swab and send to a lab for results. Our results had always come back with no trace of pathogen growth. After watching the process, I noticed that the swabbing was only being done on easy to clean flat surfaces. I took it upon myself at the next months testing to swab surfaces that would were likely to be touched but were more difficult to clean: ribbed Knobs, touch panels, clamp handles, etc. Two weeks later, I received a call from the CDC wanting information because the lab found pathogens that were not normally found in our neck of the woods, and it was reported to the CDC. I agree with your premise that equipment should be routinely checked for cleanliness by “someone” and processes set up to deal with the findings. Some contamination is inevitable but the type, quantity, and potential to infect patients is the critical piece.

  2. Everyone seems to think the cleaning agents utilized in the facility kill off all bacteria. Ideally, yes, they have high percentage kill rates if left on the surface for a certain amount of time. But the fact that we are missing the point here and not actually validating its true cleanliness tells us how traditional we really are. The biomedical trade should be stepping up to the plate here and addressing the concepts of how we operate. With the amount of test equipment we utilize in the industry, I feel we can shine hear and begin monitoring and surveillance almost in the same manner as we operate a Volt meter. Worthwhile Performance Improvements (PI) projects can and will spring up because everyone will learn and awareness level in order to make sure the cleaning agents are working, and also the staff responsible for the cleaning are doing this properly. It will be then when you realize how dirty your facilities really are. You will find some testing noncompliant. I guarantee it. You will find recurring problems. Your EOC should find the resolutions needed for each specific hazard, if reported properly. Infection Control Departments need everyone’s help. They can not do this on their own. I believe in shared responsibilities in order for better outcomes in communication and collaboration at your facilities. IF you get into this more, you will eventually figure out how simple it is to track your outbreaks and find your own bacterial threats that pop up every now and then. Some devices are more critical than others and I believe different validation programs are needed in place, especially with the GI scopes. I believe patient safety needs a good facelift in this arena and our trade has the knowhow to kindle the fire, so to speak, in a much needed science. (Yes, it is a science!).

  3. Hospitals need to use the cleaning process that successfully eliminates the potential infectious agent. And clearly this has changed over time to be more aggressive. If that is a bleach wipe or UV light or a silver spray and the manufacturer does not support it, well then the equipment will be damaged over time. We understand that and manage the situation that causes, other than sloppy cleaning practices. I have seen imaging systems sold for use in operating room suites which have control components that can be only cleaned with soap and water — and that is almost being negligent in design for the application environment. I understand that from the manufacturing side (and their partners), the development of materials to meet the current (and future?) disinfection practices takes research, funding and time, but it cannot be ignored. So it is a complex, challenging and changing disinfection environment, and we need to do what is safe for the patient.

  4. How are devices processed when they are leaving the shop and going back into clinical use? Do they go through sterile processing or does biomed perform the final cleaning? And what happens between whatever the final steps are and the device reaching the area of use? The problem isn’t just coming in dirty; it can also be going out dirty.

    • William Hyman the questions you ask are beyond the knowledge of the industry. Maybe a pilot study can performed on incoming equipment for repair or PM or whatever. Equipment that was not supposed to be cleaned by SPD usually received a wipe down and back to the floor. But I only began wiping down 100% of equipment in the last 5 years after becoming aware that unsafe levels of ATP measurements were giving the facility wide PI project score of 50% surface compliance. Our CNO in the EOC meeting was furious and directed everyone to pick up a bleach wipe and clean ourselves if we have to. It took us time to bring the monthly surface compliance up. We learned alot in 5 years and the overall score came up to almost 80% in those 5 years. By that time we had an outbreak task force developed that provided knockdown and containment facility wide. The biggest obstacle was the Infection Control department not wanting us to gain knowledge that a patient to patient Infection transmission occurred. So the charge nurses began calling our task force instead of the IC Department. This was probably done for liability reasons but the IC Department was on the edge regardless. It was difficult to work with the IC department at times as a result of this great breakthrough in proactive HAI work we were doing.

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