Decontamination

Decontamination is broadly defined as the removal of vegetative forms of micro-organisms from surfaces. This aims to reduce the number of viable microorganisms to a level which presents a reduced risk to patients and staff. This differs from cleaning, which is the removal of organic matter from surfaces or sterilisation, which involves removing or destroying all micro-organisms, including spores (Wilson, 2019).

Environmental surfaces play an important role in the transmission of infectious organisms. Examples of organisms which can be transmitted via surfaces include Acinebacter baumannii, Clostridium difficile, Methicillin resistant Staphylococcus aureus (MRSA) in addition to many viruses associated with diarrheal infections, such as norovirus (Kramer and Assadian, 2014).

The process of decontamination requires two key steps:

1. Cleaning removes contaminants and any other unwanted substances. Typically, cleaning is performed using detergent
2. Disinfection is the removal of microbes on surfaces and objects using chlorine-based products (Han et al, 2021)

Decontamination of surfaces should occur routinely in clinical areas as part of universal infection prevention and control precautions, and routine decontamination of surfaces should ideally performed at least once daily. However, there are situations where decontamination is indicated more frequently, or immediately (Table 1). 

Enhanced levels of environmental decontamination is

The equipment used to decontaminate a surface will depend on the approach being taken in addition to consideration of risks such as the likelihood of exposure to bodily fluids. Equipment may include:

• Personal protective equipment - this should be selected based on manufacturers guidance for chemical products (eg gloves, eye protection), in addition to the risk of exposure to bodily fluids
• Water and detergent for cleaning prior to disinfection
• An appropriate chemical solution selected based on local policy and risk assessment
• An appropriate container to store and transport any chemicals used

Procedure for decontamination using a chemical product:

1. Collect relevant equipment and review any relevant manufacturers guidance and local policies on decontamination
2. Don personal protective equipment
3. Prepare any chemical products as per manufacturers guidance
4. Ensure that any chemical products are placed into a secure container prior to transporting to the surface and/or equipment requiring decontamination
5. Remove any visible organic material from the surface by cleaning using detergent (soap) and water. This requires physical effort as much of the removal of organic material is dependent on the mechanical cleaning process. Surfaces with visible contamination with organic material cannot be decontaminated until the visible contamination is removed
6. Apply disinfectant chemical on to the surface. Typically, chemical disinfectants need to be left on a surface for a period of time (contact time) to allow deactivation of the microorganisms. This period of time should be specified in the manufacturer's guidance
7. Following disinfection, all chemicals should

There are several risks involved in the decontamination process including:

• Damage to equipment, incorrect decontamination processes may damage or destroy equipment
• Chemical burns caused by exposure to disinfectants – nurses must adhere to manufacturers guidance or seek guidance from an infection control specialist, if necessary, prior to handling chemicals
• Nurses must be aware of the Control of Substances Hazardous to Health (COSHH) regulations (Health and Safety Executive, 2021), which provide guidance on chemicals used for decontamination
• Chemicals should not be mixed contrary to manufacturers guidance. This may result in the release of dangerous fumes which could cause respiratory problems
• Human factors must be considered, given the laborious nature of the decontamination process surfaces are often not decontaminated correctly. This is often a result of insufficient wipe-off during cleaning, inadequate contact times between the surface and the disinfectant or inadequate concentration of the disinfectant (Hung et al, 2020). Regular training in

Nurses must remain aware of the risks posed by ineffective decontamination. Namely, the transmission of infectious organisms which may result in infection leading to increased length of inpatient stays, potential fatality, increased costs to healthcare services and staff sickness. To prevent this, nurses must maintain their knowledge of the decontamination process including knowledge of the available products and target organisms to allow robust risk assessments to be conducted and inform the choice of products used. Effective leadership and oversight is required to ensure that decontamination is performed correctly. This can be achieved by robust auditing processes and commercial products to test efficacy.

There are currently technologies emerging that are designed to assist with decontamination which are considered non-touch and do not require nurses to carry out traditional decontamination procedures. These technologies include devices which released aerosolised hydrogen peroxide, ultraviolet light and gaseous ozone among others (Boyce, 2016). However, these still

Nursing and Midwifery Council: standards of proficiency for registered nurses

Part 2: Procedures for the planning, provision and management of person-centred nursing care

9. Use evidence-based, best practice approaches for meeting needs for care and support with the prevention and management of infection, accurately assessing the person’s capacity for independence and self-care and initiating appropriate interventions

9.4 use appropriate personal protection equipment

9.6 use evidence-based hand hygiene techniques

Boyce JM. Modern technologies for improving cleaning and disinfection of environmental surfaces in hospitals. Antimicrob Resist Infect Control. 2016; 5, 10. https://doi.org/10.1186/s13756-016-0111-x 

Centers for Disease Control and Prevention. Cleaning & disinfecting environmental surfaces. 2016. https://www.cdc.gov/oralhealth/infectioncontrol/faqs/cleaning-disinfecting-environmental-surfaces.html (accessed 25 January 2024)

Han Z, Pappas E, Simmons A et al. Environmental cleaning and disinfection of hospital rooms: A nationwide survey. Am J Infect Control. 2021;49(1):34-39. https://doi.org/10.1016/j.ajic.2020.08.008 

Health and Safety Executive. EH40/2005 workplace exposure limits. 2020. https://www.hse.gov.uk/pubns/priced/eh40.pdf (accessed 25 January 2024)

Health and Safety Executive. Methods of decontamination. 2021 https://www.hse.gov.uk/biosafety/blood-borne-viruses/methods-of-decontamination.htm (accessed 25 January 2024)

Hung IC, Chang H-Y, Cheng A et al. Implementation of human factors engineering approach to improve environmental cleaning and disinfection in a medical center. Antimicrob Resist Infect Control. 2020;9(1):17. https://doi.org/10.1186/s13756-020-0677-1 

Kramer A, Assadian O. Survival of microorganisms on inanimate surfaces. use of biocidal surfaces for reduction of healthcare acquired infections. 2014;7-26. https://doi.org/10.1007/978-3-319-08057-4_2 

Wilson J. Infection control in clinical practice. 3rd