Revised Guideline for Manual High-Level Disinfection

Key Takeaways: Guideline on HLD

What You Need to Know to Improve Patient & Staff Safety

The updated 2024 AORN Guideline for Manual High-level Disinfection includes recommendations for performing manual high-level disinfection (HLD) of reusable semi-critical items. It also provides guidance on avoiding injuries to patients and personnel from high-level disinfectants.

The goal of this updated guideline is to improve the consistency of manual HLD, says Amber Wood, MSN, RN, CNOR, CIC, FAPIC. Wood serves as an AORN senior perioperative practice specialist and lead author of the guideline.

“There is a lot of room for error in the manual HLD process. We hope facilities are able to move toward automated processes,” she said. “We understand not all devices can be processed by automated methods. This guideline provides a safe way to use a manual process.”

What’s New?

Ergonomic Improvements & Protective Gear

New Recommendation: Staff discomfort can lead to mistakes and non-adherence to processing guidelines. AORN recommends the sterile processing area have ergonomic features to reduce staff discomfort. Ergonomic features can include work surfaces and sinks at a comfortable height. Also, there should be space to perform cleaning with sufficient lighting. It's also important the space be at a comfortable room temperature with minimal noise.

Personal Protective Equipment

Revised Recommendation: personnel performing manual HLD should wear personal protective equipment (PPE) that corresponds with the degree of anticipated exposure. New studies show cleaning and processing devices during HLD creates splashing.

“It is important to have PPE with as much fluid resistance as possible. This helps keep staff safe when they are performing processing,” she said. “The updates offer guidance, so facilities know what to look for on labels when comparing PPE.”

Recommended PPE:

• Fluid-resistant surgical mask, gown, and shoe covers or boots
• Face shield or eye protection (e.g., goggles)
• Gloves recommended by the glove and disinfectant manufacturers for use with the high-level disinfectant
• Additional PPE as recommended on the chemical safety data sheet (e.g., respirators, aprons).
• Read the full guideline for PPE requirements (e.g., fitted cuffs on gloves, gowns with thumb loops)

Point-of-Use Treatment, Transport & Handover Communication

Revised Recommendation: performing point-of-use treatment should be done immediately after device use. Immediate post-use treatment of medical devices and swift transportation to decontamination areas are crucial. This prevents delays that necessitate intensive cleaning protocols.

Enhanced communication to sterile processing team members related to the device’s exposure to contaminants during surgical procedures is vital for effective decontamination. Sterile processing team members need to know what happened with a device during the case to clean it properly.

Hand-over communication to decontamination personnel should include:

• Time point-of-use treatment was completed
• Whether point-of-use treatment began immediately after use of the device or the time the device was done being used and if it was kept moist until point-of-use treatment
• If reusable accessories are with the device
• Patient identification
• Notes on whether the device was exposed to a large amount of contamination (e.g., blood) or difficult-to-clean products (e.g., simethicone, radiographic medium)

Inspection & Verification

New Recommendations: staff should use a clean borescope to visually inspect accessible channels of the device before HLD. This allows for visual inspection of internal channels. It also may identify damage or debris that would otherwise be undetected.

Additionally, cleaning verification tests performed at established intervals (e.g., after each use, daily) verify manual cleaning of the device before HLD. Cleaning verification testing (e.g., ATP, protein, carbohydrate, hemoglobin) provides an objective method for verifying cleanliness.

Rinse After HLD

New Recommendations: The high-level disinfectant manufacturer’s IFU may recommend a large volume of fresh rinse water to facilitate removal of chemical residues. The basin used should be large enough to contain the volume of rinse water recommended in the high-level disinfectant manufacturer’s IFU.

Also, changing the rinse water after each use can help prevent contamination of the item after processing.

Drying Procedures

New Recommendations: Because moisture on device surfaces facilitate microbial growth and biofilm formation, devices that undergo HLD should be dried in accordance with the manufacturer’s IFU.

The updated guideline also specifies all accessible device channels should be dried with pressure regulated instrument air or high-efficiency particulate air filtered air in accordance with the manufacturer’s IFU to prevent introducing contaminants that may be present in lower-quality air.

Webinar: Watch What's New

Manual High-Level Disinfection Guideline Update 2024 (1.0 CH)

Periop nurses can also stay up to date on the updated Guideline for HLD by watching AORN’s webinar. It covers enhanced handover communication, cleaning verification testing, and drying techniques to ensure the safety of patients and healthcare workers. Watch anytime on demand.

This updated guideline is available in AORN eGuidelines Plus (available to subscribers). 

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