12 Tips For Safety Considerations in The Sleep Lab
What are some safety considerations in the sleep center for infection control?
This article originally appeared in the A2Zzz Magazine's June 2015 issue. Click here to access the original article.
To help reduce the possibility of acquiring and transmitting an infection it is an expectation that sleep centers establish an infection prevention and control program. The protocols put in place must be applicable to all infections or potential sources of infection that a sleep center might encounter, a recent example of that would be last year’s outbreak of Ebola.
An infection control program plays a major role in efforts to improve patient safety and quality of care. Everyone who works in the organization has responsibilities for preventing and controlling infection.
Be sure to follow the manufacturer’s recommendations for proper cleaning as some of the equipment and supplies used in the sleep center require low-level disinfection while others require a high level disinfection. It is important to reference national standards when setting the standards in your program. nA good resource is The Centers for Disease Control and Prevention (CDC). This site offers options to receive email updates and that is helpful to see if there are any concerns for infection outbreaks.
What to keep in mind
The use of High Level Disinfectants (HLD) in the sleep center is under much review. Some hospital centers are using other options such as pasteurization or single use products to avoid use of HLD. CPAP masks and tubing are an example of items requiring HLD protocols.
Effective tips on controlling infection
1. All reusable CPAP equipment (hoses, masks, mask frames, valves, humidifiers and headgear) must be soaked in a hospital approved enzymatic cleaning solution for the amount of time specified in the cleaning solution manufacturer instructions, rinsed thoroughly, and disinfected using a hospital approved disinfectant or pasteurization.
2. Clean equipment must be dried in an area designated as a clean utility room, then individually re-packaged and placed in the appropriate storage area. The disinfectant/germicide must be able to kill a broad range of pathogens such as:
- Pseudomonas aeuginosa
- Staphylococcus aureus (MRSA)
- Salmonella choleraesuis
- E. Coli
- Herpes Simplex virus type 1
- Herpes Simplex virus type 2
- Influenza virus type A
- Influenza A2 virus
- Vaccinia viruses
- Adenovirus type 5
3. If your program is using chemicals it is important that protocols are put in place to use them properly.
4. The disinfectant straight from the bottle is a primary skin and eye irritant. Care must be taken to avoid contact with the concentrate on skin and in eyes.
5. Personal protective equipment is required when using HLD products.
6. An eye wash station is recommended in the work area. Make sure to reference the product guide for recommendations on the ratio of solution to water.
7. Solution should be stored in an air tight covered container to avoid evaporation.
8. Test strips are designed to be an indicator of the germicidal activity level of the disinfectant. The color of the test strip after it has been dipped into the solution indicates how much germicide is still in the solution. As the solution is used over a period of time, the level of germicidal activity decreases and the weaker the solution becomes, the lighter (yellow) the strip will be.
9. The test strips should be used daily and testing logged with a designated staff person’s initials and date.
10. Always label the container with the date the solution was changed.
11. Employees need to be careful and use gloves and protective eyewear (goggles) when cleaning equipment.
12. The PAP masks need to unassembled (cushion and frame) prior to soaking. The tubing does take some working to make sure is properly submerged. The technologist will need to hold tubing down until the tubing fills with solution and no air is in the tubing. Once the equipment has been soaked long enough care must be taken to properly rinse equipment. Tubing must be rinsed inside and out and take care to assure that cushions are properly rinsed with attention given to the folds. Allow the mask components to air dry out of direct sunlight.
Other things to consider
Manufacturers do have mask cleaning guides that you can reference. Make sure you look for recommendations such as how many times you can process a mask. If that kind of standard is put in a cleaning guide you will need to log that.
Perform a visual inspection of each mask component. If any visible deterioration of a mask component is apparent (cracking, crazing, tears etc), the mask component should be discarded and replaced. Slight discoloration of the silicone components may occur and is acceptable.
Employees need policies that specify the requirements for, and frequency of, education and training. Competency assessment is essential for all personnel involved in the reprocessing of medical equipment/devices.
Here is an example:
- Any individual involved in the cleaning, disinfection and/or sterilization of medical equipment/devices must be properly trained and their practice must be audited on a regular basis to verify that standards are met.
- Training must include information on cleaning, disinfection and sterilization, occupational health and safety issues, and infection prevention and control.
- Orientation and continuing education for all personnel involved in reprocessing of medical equipment/devices will be provided and documented.
- Feedback should be provided to personnel in a timely manner.
The AAST has published competencies on Maintenance, Cleaning and Safety Precautions in Polysomnographic Technology.
The Fundamentals of Sleep Technology, Second Edition is also a great resource.
Sleep technologists, what are some ways you keep your lab infection-free?