LLD is performed after the equipment/device is thoroughly cleaned and rinsed. The container used for disinfection must be washed, rinsed and dried when the solution is changed. Refer to Appendix A for chemical products that may be used to achieve low level disinfection. High Level Disinfection (HLD) High level disinfection eliminates vegetative bacteria, enveloped viruses, fungi, mycobacteria (e.g. Tuberculosis) and non-enveloped viruses. HLD is used for semicritical medical equipment/devices. High level disinfectants include 2% glutaraldehyde, 6% hydrogen peroxide, 0.2% peracetic acid, 7% accelerated hydrogen peroxide and 0.55% ortho-phthalaldehyde (OPA). Pasteurization also achieves high level disinfection. HLD is performed after the equipment/device is thoroughly cleaned and rinsed. Refer to Appendix A and Appendix F for chemical products that may be used to achieve high level disinfection. 11.1 Noncritical medical equipment/devices are to be decontaminated using a Low Level Disinfectant. 11.2 Semicritical medical equipment/devices must be decontaminated using, at a minimum, High Level Disinfection. Sterilization is the preferred method of decontamination. 11.3 Noncritical and semicritical medical equipment/devices that are owned by the client and reused by a single client in their home do not require disinfection between uses provided that they are adequately cleaned prior to reuse.
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26 Canadian Standards Association. CAN/CSA Z314.3-01. Effective Sterilization in Health Care Facilities by the Steam Process. Toronto, Ont.: Canadian Standards Association; 2001. 27 Health Canada. Hand washing, cleaning, disinfection and sterilization in health care. Can Commun Dis Rep. 1998; 24 Suppl 8: i-xi, 1-55. Best Practices for Cleaning, Disinfection and Sterilization in Health Authorities March 2007 24 See Section 10, “Disassembling and Cleaning Reusable Medical Equipment/Devices” for cleaning requirements. 11.4 All disinfectants must have a Drug Identification Number (DIN) from Health Canada.28 11.5 The chemical disinfectant used for disinfecting medical equipment/devices must be compatible with both the equipment/device manufacturer’s instructions for disinfection and the cleaning products involved in the reprocessing of the equipment/device. The following items should be considered when selecting a disinfectant for use in the health care setting: a) Compatibility with equipment/device and surfaces to be disinfected; b) Compatibility with detergents, cleaning agents, and disinfection and/or sterilization processes; c) The intended end use of the equipment/devices to be disinfected; d) Personal and environmental safety. 11.6 Disinfectant manufacturers must supply recommended usage for the disinfectant to ensure that it is compatible with the medical equipment/devices on which it will be used. a) Manufacturer’s recommendations for chemical disinfectants must be followed pertaining to: i) Use ii) Contact time (NOTE: Where the manufacturer recommends a shorter contact time with a particular product than is required to achieve the desired level of disinfection/sterilization, an infection prevention and control specialist must be consulted for advice) iii) Shelf life iv) Storage v) Appropriate dilution vi) Required PPE b) If a disinfectant manufacturer is unable to provide compatibility information specific to a piece of medical equipment/device, information may be obtained from Health Canada’s drug information website: [www.hc-sc.gc.ca/dhp-mps/prodpharma/databasdon/dpd_index_e.html]. 11.7 The process of high level disinfection requires monitoring and auditing. If a chemical product is used, the concentration of the active ingredient(s) must be verified and a logbook of daily concentration test results is to be maintained. a) Chemical test strips should be used to determine whether an effective concentration of active ingredients is present despite repeated use and dilution. b) The frequency of testing should be based on how frequently the solutions are used (i.e. test daily if used daily). c) Chemical test strips must be checked each time a new package/bottle is opened to verify they are accurate, using positive (e.g. full strength disinfectant solution) and negative (e.g. tap water) controls.