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El procesamiento del lugar de uso incluye todas Los procedimientos realizados en lugar de uso antes del transporte de un Dispositivo médico reutilizable (DMR) a la sala de reprocesamiento o al departamento de esterilización.
Los lugares de uso y los servicios de reprocesamiento pueden estar en diferentes ubicaciones (en el mismo edificio o distantes). Los operadores de reprocesamiento pueden no ser funcionarios del centro de salud (por ejemplo, en caso de subcontratación)
El procesamiento en el lugar de uso es realizado por empleados que recibieron formación adecuada en DMR y precauciones de salud laboral y seguridad ocupacional relacionadas con el manejo de DMR contaminados
Los operadores que ejecutan procedimientos en el lugar de uso, visten equipos de protección individual y son conscientes del riesgo de lesiones con objetos cortantes y conocen las medidas que deben tomarse en caso de accidente, verifican que todos los dispositivos y piezas estén presentes, identifican los DMR dañados e inician el proceso de reparación / mantenimiento o eliminación. manejan los DMR con cuidado y conocen el proceso que se aplicará en caso de caída, manipulan el DMR de una manera que evite la dispersión de contaminantes en la atmósfera y las superficies ambientales. |
Los principales objetivos del procesamiento en el lugar de uso son:
Si se deja secar, la suciedad se adhiere al dispositivo y se vuelve difícil de eliminar, lo que hace más díficil su limpieza. Los lúmenes pueden obstruirse con material orgánico. Debe evitarse dejar el DMR durante la noche o durante el fin de semana. Las largas demoras en el procesamiento contribuyen a la formación de biopelículas que protegerán a los microorganismos de los procedimientos de limpieza de rutina. La sangre, otros fluidos corporales y la solución salina son altamente corrosivos y pueden causar picaduras en los instrumentos. |
Los DMR se instalan de forma segura en contenedores de transporte para evitar cambios y daños durante el transporte. Se presta especial atención a los artículos frágiles. Los componentes afilados son separados Los contenedores de transporte están cerrados. Los contenedores llevan una indicación clara que el contenido posee riesgo biológico. Las indicaciones de riesgo biológico pueden estar definidas por la normativa local. Cuando el exterior de un contenedor de transporte está visiblemente sucio, se descontamina cuidadosamente antes del transporte. |
Las operaciones de procesamiento en el lugar de uso se realizan de acuerdo con las instrucciones de uso del fabricante del DMR.
El tubo de inserción del endoscopio se limpia con un paño que no suelte pelusa. El paño está saturado con una solución limpiadora de instrumentos, o una solución limpiadora y desinfectante de instrumentos que no tenga efecto fijador de proteínas. Los canales se lavan con la misma solución. Para el canal de aire / agua, se puede utilizar agua de la botella de enjuague de canales. Se lleva a cabo una prueba de fugas de acuerdo con las instrucciones del fabricante de DMR. Esto asegura la detección temprana de fugas y perforaciones y la prevención de daños más graves por la penetración de líquidos a sus fibras ópticas. |
Las formulaciones de limpieza y desinfección cumplen con las regulaciones y normas internacionales. Se evitan procesos de fijación como el calor seco o los aldehídos. Los baños de remojo se preparan en lavabos destinados para este uso. |
Los DMR frágiles están adecuadamente protegidos durante el transporte. Es posible que se requieran retenedores para instrumentos microquirúrgicos y endoscopios. Las ópticas se colocan en contenedores especiales. Los instrumentos afilados se separan dentro del contenedor Los instrumentos pesados deben ser colocados en la parte inferior y los instrumentos más livianos y delicados en la parte superior. Las bandejas de instrumentos no deben ser sobrecargadas. El tamaño de los contenedores evita que los artículos flexibles se doblen excesivamente. |
Se preparan procedimientos operativos estándar (POES) del procesamiento en el lugar de uso en asociación con usuarios quirúrgicos y médicos, de acuerdo con los pincipios de gestión de la calidad.
La Validación del proceso de controles de procesamiento en el lugar de uso que:
El proceso se implementa de acuerdo con los principios de gestión de la calidad.
Used on patient or withdrawn from packaging
Go to Preparation for cleaning – Key principles →
1 of 7 Preparación para la limpieza en el lugar de usoAccording to SOP’s Gross soil removal, soaking, careful installation of RMD in closed container
Go to Preparation for cleaning – process →
2 of 7 Preparación para la limpieza en unidad de reprocesamientoAccording to SOP’s
Go to Preparation for cleaning – process →
3 of 7 DMR preparado para limpieza y desinfecciónRMD prepared for cleaning
Go to Storage – Key principles →
4 of 7SOP’s prepared in partnership with medical or surgical users
Occupational health and safety measures
Go to WFHSS recommendation for preparation for cleaning →
Transfer to sterilization department or reprocessing room
Go to Preparation for cleaning – process →
6 of 7Controls
Go to Preparation for cleaning and quality →
7 of 7“The WFHSS executive committee is pleased to put the WFHSS Guidelines at your disposal.
They have been written for all the professionals working directly or indirectly in the field of the reprocessing of Reusable Medical Devices (RMD) used in Health Care facilities.
They are the result of a consensus from a review of national practices, standards, regulations.
They are intended to provide guidance and the state of the art recommendations from an academic world society focused on science but their purpose is not to supersede local regulation, standards or guidelines.
They will be updated regularly to follow the evolution of the science and the evolution of the RMD and the technologies.
Your feedback is essential to contribute to the improvement of the Guidelines , feel free to use the form to send your comments or suggestions.
We wish you interesting reading!
On behalf of the Executive Committee
Dr Christine DENIS, President”
Combination of all technical and associated administrative actions intended to keep equipment at a state in which it can perform its required function, or restore it to such a state (ISO 11139 : 2018)
Packaging is intended to preserve the sterility of teh reusable medical device (RMD) until its use.
Rigid sterile barrier system designed to be repeatedly used (ISO 11607-1 2018)
For the puropose of these guidelines, International Standard means standardsor guidance published by international standardization organizations such as ISO or CEN.
Go to the international standards paragraph or Regulation and standards chapter
Prion is a small proteinaceous infectious unit that appear in a variety of neurodegenerative diseases, including bovine spongiform encephalopathy, Creutzfeldt-Jakob disease, and scrapie. They derive from a normal body protein that becomes irreversibly misfolded and proliferates primarily in the central nervous system.
Prions are highly resistant to disinfection and sterilization
Some sterilizing, cleaning and disinfecting formulations are known to favor the adherence and resistance of proteins, including prion on RMD surfaces.
Levels of purity of ambient air and compressed air used for drying.
Chemical, physical, biological, and radiological characteristics of water used for cleaning, disinfection, rinsing and steam sterilization of RMD.
Processing operation performed at point of use of the Reusable Medical Device (i.e. operating theatre or care unit)
Quality management includes all the activities that organizations use to direct, control, and coordinate quality. These activities include formulating a quality policy and setting quality objectives. They also include quality planning, quality control, quality assurance, and quality improvement.
In the present guide the quality management chapter includes a description of the processus approach, performance evaluation, risk and non-conformity management, documentation management and traceability
Go to quality management chapter →
The Spaulding classification qualify the RMD as non critical when they touch intact skin, semi-critical when they are brought in contact with mucous membranes and critical when they enter sterile body cavities. Processing requirements increase with level of risk involved in their use.
OHS deals with all aspects of health and safety in the workplace and has a strong focus on primary prevention of hazards (WHO : 2016)
For the present guidlelines reusable medical device (RMD) means:
The reprocessing of single use medical device is outside the scope of theses guidelines.
Medical device regulations vary between regions. Some items may not be registered as medical devices in some regions.
Sterilization is intended to renders the reusable medical device free from viable microorganisms. Sterilization is implemented on a clean RMD. Most common Sterilization process is steam. Low temperature sterilization processes are available for heat sensitive RMD
Disinfection :
Process to reduce the number of viable microorganisms to a level previously specified as being appropriate for a defined purpose (ISO 11139 : 2018)
Cleaning :
Removal of contaminants to the extent necessary for its further processing or for intended use (ISO 11139 : 2018)
Other definition: The first step required to physically remove contamination by foreign material, e.g. dust soil. It will also remove organic material such as blood, secretion, excretion and microorganisms, to prepare a medical device for sterilization or disinfection (WHO : 2016)
Cleaning may be combined to disinfection in cleaning & disinfections processes (for instance in automated washer-disinfectors)
Sterilization :
Process used to render product free from viable microorganisms (ISO 11139 : 2018)
SOP’s are written, step-by-step instructions that describe how to perform a routine activity. SOP’s aim to achieve efficiency, quality output and uniformity of performance, while reducing miscommunication and failure to comply with industry regulations.
technical operation conducted periodically to establish that the operational performance of the equipment or process remains within the limits established during validation (ISO 11139 : 2018)
Some sterilizing, cleaning and disinfecting formulations are known to favor the anchorage of proteins, including prion on RMD surfaces. For instance, dry heat, ethylene oxide, aldehyde based sterilizing and disinfecting agent such formaldehyde or glutaraldehyde, alcohol used to accelerate drying of some RMD. For this reasons, some national guidelines recommend to avoid use of this subtances or require specific precautions (for instance thorough cleaning)
“The WFHSS executive committee is pleased to put the WFHSS Guidelines at your disposal.
They have been written for all the professionals working directly or indirectly in the field of the reprocessing of Reusable Medical Devices (RMD) used in Health Care facilities.
They are the result of a consensus from a review of national practices, standards, regulations.
They are intended to provide guidance and the state of the art recommendations from an academic world society focused on science but their purpose is not to supersede local regulation, standards or guidelines.
They will be updated regularly to follow the evolution of the science and the evolution of the RMD and the technologies.
Your feedback is essential to contribute to the improvement of the Guidelines , feel free to use the form to send your comments or suggestions.
We wish you interesting reading!
On behalf of the Executive Committee
Dr Christine DENIS, President”
Non terminal sterilization is a process whereby product is not sterilized in a sterile barrier system and hence not protected from environmental and handling contamination after the sterilization cycle.
Go to Sterilization chapter →
Process whereby product is sterilized within its sterile barrier system (ISO 11139 : 2018)
Go to Sterilization chapter →
SOP’s are written, step-by-step instructions that describe how to perform a routine activity. SOP’s aim to achieve efficiency, quality output and uniformity of performance, while reducing miscommunication and failure to comply with industry regulations.
For the needs of the present guidelines outsourcing means a process in which a healthcare facility employs another organization to perform some or all reusable medical device reprocessing tasks. The organization can be another healthcare facility, a shared reprocessing unit or a private service company. The services can be perfomed within the healthcare facility or externalized.
Pyrogen are substances that induces fever. Endogenous pyrogen are low-molecular weight protein produced by phagocytic leukocytes in response to stimulation by exogenous pyrogens. Exogenous pyrogens are produced by bacterial endotoxins and other microbial product such as antigen, antibody complexes, virus
Endotoxins are lipopolysaccharide components of the cell wall of Gram-negative bacteria that are heat stable and elicits a variety of inflammatory responses in animals and humans (ISO 11139: 2018)
Ability to trace the history, application, use and location of an item (products, parts, materials, and services) or its characteristics through recorded identification data.
For the purpose of theses guidelines, training means the certified acquisition of the theoricital, practical skills and behavior adapted to the assignment. Skills are periodically controlled and updated as needed.
Routine control check that performances of process or equipment are maintained over time between 2 process validations. Routine controls can be systematic (at each cycle) or at predefined periodicities. For instance, for the sterilization process, at end of each cycle, it is checked that process parameterare are within the validated tolerances, leak tests are performed daily or at periodicity defined by local recommandations.
Go to process validation chapter →
Written indication provided by the manufacturer to ensure correct and safe use of a products (including but not limited to reusable medical device, reprocessing equipment and consumables). IFU of RMD include the instruction for reprocessing. IFU are also available for reprocessing equipment and consumables.
Identification and analyzis of potential issues that could negatively impact a given process. Risk analysis includes an evaluation of the consequence and likelihood. The issues with the more severe consequences and higher likelihood of occurence are addressed in priority. As needed measure are then to minimize the occurence or consequence. Methods are available to improve the reliability of the risk analysis.
Storage concerns mainly sterile medical device. Storage of disinfected devices may be allowed by local regulation in defined conditions.
Transport includes:
Process validation means establising, by objective evidence that a process consistently produces a results or product meeting its predeternined objective. Process validation applies to all steps of RMD reprocessing from point of use processing to storage. When equipments are used validation include their installation qualification (IQ), operational qualification (OQ) and performance qualification (PQ).
Process validation is perfomed before implementation of a new process or equipment (initial validation). Revalidation takes place periodically (usually each year) or after event justifying total or partial revalidation (change in the process, maintenance of equipments).
Waste management groups all activities and actions required to manage waste including the collection, transport, treatment and disposal of waste together with monitoring of the waste management process. Instrument reprocessing waste are are solid (i.e., single use packaging, detergent or disinfectant empty bottles, cleaning brushes, possibly sharp devices), liquid (i.e., cleaning, disinfecting, rinsing solutions) or gazeous (i.e., sterilization, cleaning or disinfection effluent). Waste might be non hazardous, infectious, or toxic. Waste management regulation limits impact on environment and protects staff. Waste management rules are country dependent.
Traceability is the ability to trace the history, application, use and location of an item (products, parts, materials, and services) or its characteristics through recorded identification data.
Reusable Medical device (RMD)
Medical devices wich are not single use i.e. which can be reused under appropriate reprocessing conditions, for an undelimited number of time or for a predetermined number of use.