Maintaining a safe and hygienic environment in healthcare and community settings is essential for preventing the spread of infections. The Public Health Ontario best practices for cleaning, disinfection and sterilization provide a comprehensive framework to ensure effective infection prevention and control. Whether you’re a healthcare provider, clinic manager, or support staff, understanding and applying these guidelines will protect both clients and staff from harmful pathogens.
Why Cleaning, Disinfection, and Sterilization Matter
Proper cleaning, disinfection, and sterilization of medical equipment and environments are the backbone of infection prevention. These processes reduce the risk of healthcare-associated infections, safeguard vulnerable populations, and ensure compliance with provincial and national standards. Inadequate reprocessing can lead to outbreaks, regulatory penalties, and loss of trust.
Understanding Key Terms
- Cleaning: Removal of visible soil, organic material, and debris from surfaces or equipment.
- Disinfection: Elimination of most pathogenic microorganisms (except bacterial spores) on inanimate objects.
- Sterilization: Complete destruction of all forms of microbial life, including spores.
Public Health Ontario Best Practices for Cleaning, Disinfection and Sterilization
Overview of the Guidelines
Public Health Ontario’s best practices are based on evidence, expert opinion, and standards from the Canadian Standards Association (CSA) and the Public Health Agency of Canada. The guidelines apply to all healthcare settings, including hospitals, clinics, dental offices, long-term care, and community health centers. They also inform practices in personal service settings and home healthcare.
Core Principles of Cleaning, Disinfection, and Sterilization
The Reprocessing Cycle
The reprocessing of reusable medical devices involves several critical steps:
- Pre-cleaning: Immediate removal of gross contaminants after use.
- Cleaning: Thorough washing with detergents and mechanical action.
- Disinfection or Sterilization: Application of appropriate chemical or physical methods.
- Drying and Storage: Ensuring items are dry and stored in a manner that prevents recontamination.
Equipment and Product Assessment
- Only purchase equipment and products that can be properly cleaned, disinfected, or sterilized.
- Verify that all devices meet Health Canada licensing and CSA standards.
- Document and audit all reprocessing procedures for compliance.
Public Health Ontario Best Practices for Cleaning, Disinfection and Sterilization in Action
Cleaning – The First Step
Actionable Advice:
- Always clean items before disinfection or sterilization. Organic material can shield microbes from disinfectants.
- Use a dedicated sink and appropriate cleaning agents (detergents or enzymatic cleaners).
- Disassemble equipment as needed to ensure all surfaces are accessible.
- Wear personal protective equipment (PPE) to protect against splashes and contaminants.
Example:
After a minor surgical procedure, reusable instruments should be transported in a covered container to the reprocessing area. Staff should wear gloves and eye protection, disassemble instruments, and scrub all surfaces under running water using a brush and detergent.
Disinfection – Eliminating Most Pathogens
Types of Disinfection:
- Low-level disinfection: For non-critical items (e.g., blood pressure cuffs, stethoscopes).
- High-level disinfection: For semi-critical items (e.g., endoscopes, respiratory equipment).
Actionable Advice:
- Select disinfectants approved by Health Canada, and follow manufacturer instructions for dilution, contact time, and shelf life.
- Ensure proper ventilation when using chemical disinfectants.
- Rinse items thoroughly after disinfection if required.
Example:
A thermometer used for oral temperature checks should be cleaned and then wiped with an approved disinfectant, ensuring the surface remains wet for the recommended contact time.
Sterilization – The Gold Standard
When to Sterilize:
- All critical items (those entering sterile body sites or the vascular system) must be sterilized after each use.
Methods:
- Steam sterilization (autoclaving): Preferred for most instruments.
- Chemical sterilization: For heat-sensitive items.
- Ethylene oxide or hydrogen peroxide gas plasma: Used for complex or delicate devices.
Monitoring Sterilization:
- Use internal and external chemical indicators with every package.
- Run biological indicators (spore tests) daily or per load for implantable devices.
- Log each sterilization cycle, including date, time, temperature, pressure, and operator initials.
Example:
Dental handpieces must be cleaned, packaged in sterilization pouches with indicators, and autoclaved. The cycle is logged, and a spore test is run daily to verify effectiveness.
Environmental Cleaning and Disinfection
Routine and Targeted Cleaning
- Clean and disinfect high-touch surfaces (e.g., doorknobs, bed rails) at least daily and when visibly soiled.
- Use hospital-grade disinfectants for surfaces and non-critical equipment.
- Increase frequency during outbreaks or when caring for patients with communicable diseases.
Example:
In a clinic, waiting room chairs and door handles are wiped with a disinfectant at the end of each day and immediately if contaminated with body fluids.
Special Considerations for Community and Personal Service Settings
- Follow the same principles for cleaning, disinfection, and sterilization as in hospitals.
- Label sterilized items with date, load number, and staff initials for traceability.
- Maintain records of all reprocessing activities for inspection and quality assurance.
Example:
A tattoo studio uses single-use needles and sterilizes reusable grips and tubes in an autoclave, documenting every cycle and monitoring with chemical and biological indicators.
Public Health Ontario Best Practices for Cleaning, Disinfection and Sterilization – Quality Assurance
Auditing and Continuous Improvement
- Regularly audit reprocessing practices using checklists and logs.
- Provide ongoing staff training and competency assessments.
- Implement a recall procedure for improperly reprocessed items.
- Investigate and address any failures in the cleaning, disinfection, or sterilization process.
Occupational Health and Safety
- Ensure staff are trained in safe handling of chemicals and equipment.
- Provide appropriate PPE and vaccinations as required.
- Maintain written policies and procedures accessible to all staff.
Frequently Asked Questions
What is the difference between cleaning, disinfection, and sterilization?
- Cleaning removes visible dirt and debris.
- Disinfection kills most pathogens, but not all spores.
- Sterilization destroys all forms of microbial life.
How often should sterilization equipment be tested?
- Biological indicators (spore tests) should be run daily or with every load for implantable devices.
- Chemical and mechanical indicators should be used with every cycle.
What documentation is required?
- Log all sterilization cycles, include date, time, parameters, and staff initials.
- Maintain records of biological and chemical indicator results.
- Label all sterilized packages with date, load number, and contents.
Practical Tips for Implementing Public Health Ontario Best Practices for Cleaning, Disinfection and Sterilization
- Develop clear, written protocols for every step of reprocessing.
- Assign responsibility for monitoring and auditing compliance.
- Use visual cues (e.g., color-coded bins, checklists) to support correct practices.
- Engage staff with regular training and feedback sessions.
- Stay updated with the latest Public Health Ontario and CSA standards.
Regulatory Compliance and Legal Considerations
Meeting Provincial and National Standards
Following Public Health Ontario best practices for cleaning, disinfection and sterilization is not only about safety—it’s also a legal requirement. Healthcare facilities must comply with:
- Ontario’s Infection Prevention and Control (IPAC) standards
- Canadian Standards Association (CSA) requirements
- Health Canada regulations for medical devices and disinfectants
Actionable Advice:
- Regularly review and update your facility’s policies to align with the latest regulations.
- Maintain thorough documentation to demonstrate compliance during inspections.
- Assign a compliance officer or IPAC lead to oversee adherence and respond to regulatory changes.
Staff Training and Education
Building Competency and Accountability
Effective cleaning, disinfection, and sterilization depend on well-trained staff. Ongoing education ensures everyone is up-to-date with the latest best practices.
Actionable Advice:
- Provide initial and annual refresher training on cleaning, disinfection, and sterilization protocols.
- Use hands-on demonstrations, competency checklists, and scenario-based learning.
- Encourage staff to ask questions and report concerns without fear of reprisal.
Example:
Host quarterly workshops where staff practice proper instrument reprocessing and troubleshoot common issues together.
Common Mistakes and How to Avoid Them
Pitfalls in Cleaning, Disinfection, and Sterilization
Even experienced teams can make errors. Recognizing and addressing these mistakes is vital for safety.
Frequent Mistakes:
- Skipping the cleaning step before disinfection or sterilization
- Using expired or improperly diluted disinfectants
- Overloading sterilizers, preventing steam or chemicals from reaching all surfaces
- Inadequate drying or improper storage, leading to recontamination
How to Avoid Them:
- Implement double-check systems and visual reminders for each step.
- Assign a “buddy” system for critical tasks like loading sterilizers.
- Routinely check expiration dates and concentration of cleaning solutions.
Innovations and Emerging Trends
Staying Ahead with New Technologies
The field of infection prevention is always evolving. New tools and methods can enhance safety and efficiency.
Current Innovations:
- Automated washer-disinfectors: Reduce manual handling and improve consistency.
- UV-C disinfection robots: Supplement manual cleaning for environmental surfaces.
- Single-use, disposable medical devices: Reduce reprocessing needs for certain procedures.
- Digital tracking systems: Automate documentation and traceability of reprocessing cycles.
Actionable Advice:
- Evaluate the cost and benefits of new technologies for your setting.
- Pilot innovative tools with a small team and gather feedback before wider adoption.
Frequently Asked Questions
What is the difference between cleaning, disinfection, and sterilization?
- Cleaning removes visible dirt and debris.
- Disinfection kills most pathogens, but not all spores.
- Sterilization destroys all forms of microbial life.
How often should sterilization equipment be tested?
- Biological indicators (spore tests) should be run daily or with every load for implantable devices.
- Chemical and mechanical indicators should be used with every cycle.
What documentation is required?
- Log all sterilization cycles, include date, time, parameters, and staff initials.
- Maintain records of biological and chemical indicator results.
- Label all sterilized packages with date, load number, and contents.
Practical Tips for Implementing Public Health Ontario Best Practices for Cleaning, Disinfection and Sterilization
- Develop clear, written protocols for every step of reprocessing.
- Assign responsibility for monitoring and auditing compliance.
- Use visual cues (e.g., color-coded bins, checklists) to support correct practices.
- Engage staff with regular training and feedback sessions.
- Stay updated with the latest Public Health Ontario and CSA standards.
Resources for Further Learning
- Public Health Ontario: Official guidelines and best practice documents
- Canadian Standards Association (CSA): Standards for medical device reprocessing
- Health Canada: Lists of approved disinfectants and sterilization equipment
- Provincial Infection Control Networks: Training modules and updates
- Accreditation Canada: Accreditation standards and tools
Conclusion
Adhering to the Public Health Ontario best practices for cleaning, disinfection and sterilization is essential for infection prevention in all healthcare and community settings. By integrating these evidence-based guidelines into daily routines, organizations can ensure the safety of clients, patients, and staff, and maintain compliance with provincial regulations. Remember, effective cleaning and reprocessing are everyone’s responsibility—make it a cornerstone of your infection control program.
