Best Way of Standardize Cleaning of Automated Dispensing Cabinets to Prevent Infections

Acta Scientific NUTRITIONAL HEALTH (ISSN:2582-1423) Volume 6 Issue 6 June 2022 Review Article Best Way of Standardize Cleaning of Automated Dispensing Cabinets to Prevent Infections Saleh Alanazi1,2*, Fawziah Almutairi1, Asma Altoub1, Thamer Alotaibi1, Saad Alobaidi1,2, Saad Alnofaie1, Khalil Almajed1,2, Meshal Alshakrah1, Hind Albadali1, Abdullah AlRomi1, Nourah Shuraym1 and Haya Almufrij1 1 Pharmaceutical Care Services, King Abdulaziz Medical City, Ministry of National Received: May 06, 2022 Published: May 30, 2022 © All rights are reserved by Saleh Alanazi., et al. Guard Health Affairs, King Abdullah International, Saudi Arabia 2 King Saud bin Abdulaziz University for Health Science Collage of Pharmacy and Abdullah International Medical Research Center, Riyadh, Saudi Arabia *Corresponding Author: Saleh Alanazi, Pharmaceutical Care Services, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, King Abdullah International, Saudi Arabia. DOI: 10.31080/ASNH.2022.06.1067 Abstract Background: King Abdulaziz Medical City -KAMC is tertiary hospital in Riyadh, with a bed capacity of 1501. Commenced implemen- tation of Automated Dispensing Cabinets (ADCs) technology. However, despite variety of benefits of ADCs, as is the case with many medical equipment handled by multiple users in the daily workflow it can be a risk for transmission of pathogens from user to user or from user to patient. Furthermore, Additional considerations regarding cleaning ADCs is essential during COVID-19 pandemic. This guidance preformed to provide best practice advice on defining responsibilities and standardize effective cleaning and disinfection ADC machine. Method: we start with cleaning after that do disinfection using appropriate substance for remove all organic substance to make the pathogen capacity a smaller amount were infection transmission impossible. Result: provide a standardized guideless for effective cleaning process. As will implement measurements tool to meantime infection control. Conclusion: Many hospital staff use the same medical equipment every day in their work, as it may become more likely that infection can be transmitted from staff to staff or from staff to patient. Moreover, to avoid many kinds of contamination and infections we having such a cleaning guideline is essential. Keywords: Cleaning; Cabinets; Automated Dispensing; Pathogens Introduction King Abdulaziz Medical City central region KAMC-CR is tertiary hospital in Riyadh under umbrella of ministry of National Guard, with 1850 beds. Commenced implementation of automated dis- pensing cabinets (ADCs) technology, which is automated drug stor- age machines or cabinets that permit medications to be saved and dispensed close to the patient care area, though controlling and tracking drug distribution [1]. ADCs is allowing all user in patient Citation: Saleh Alanazi., et al. “Best Way of Standardize Cleaning of Automated Dispensing Cabinets to Prevent Infections". Acta Scientific Nutritional Health 6.6 (2022): 86-90. Best Way of Standardize Cleaning of Automated Dispensing Cabinets to Prevent Infections 87 care to approach the medications necessary in overall hospital like ficiently washed with hot water and neutral detergent- products time of medications delivery from the pharmacy to the patient care. Disinfectants product (wards, operating room emergency room and in all patient care areas), which has been described as good approach to reduction the Moreover, ADCs can minimize the medication errors, give more security and control of the medications and drugs, and help safety with a pH near to 7- as per the manufacturer’s directions for difficult surfaces [5]. Disinfectant is a chemical agent that rapidly destroys or deac- protections [1]. Now around 200 devices housed in variety medical tivates most infectious agents [5]. However, choosing appropriate ers in the course of daily workflow it can be a risk for transmission equipment. and surgical units. However, despite variety of benefits of ADCs, as is the case with many medical equipment handled by multiple usof pathogens from user to user or from user to patient. Furthermore, Additional considerations regarding cleaning ADCs is essen- tial during COVID-19 pandemic. Furthermore, many researchers did estimation the determination of the COVID-19 virus on various disinfectant depends on the level of disinfection required which is also based on degree of risk for infection involved in use of the The following classification is the levels of disinfectant • (except tubercle bacilli), lipid viruses, some non-lipid virus- surfaces. Observed that the COVID-19 virus lived 4 hours, 24 hours, and up to 72 hours on copper, cardboard, and plastic with stainless steel, respectively [2]. However, until now in previous studies transmission of the COVID-19 virus had not been finally linked to es, and some fungi, however, not bacterial spores. For items • contaminated environmental surfaces [3]. Even though, it is neces- For objects, that link with mucous membranes or not un- ized effective cleaning to reduce any role that fomites might play Materials Cleaning equipment There is cleaning solution in cleaning cloths are the main re- sources that are utilize for cleaning of surfaces in healthcare ser- ILD (Intermediate Level Disinfectant) - kills all vegetative viruses, and fungus spores, however not bacterial spores. which to outline some considerations for ADC usage and standardsubsequent infection transmission. that touch intact skin (non-critical items) [6]. bacteria, lipid enveloped and some non-lipid enveloped sitating to establishment of roles and responsibilities system by in the transmission of COVID-19 and other coronaviruses linked to LLD (Low Level Disinfectant) - kills all vegetative bacteria damaged skin should obtain intermediate level disinfection • (semi- critical items) [6]. HLD (High Level Disinfectant) - kills all vegetative bacte- ria, viruses and other microorganisms, and some bacterial spores. It is special for some for crucial devices because that enter sterile tissue or the vascular system [6]. In general, the products available in market are evaluated ei- vices; established system is necessary to that ensures that a clean ther by Food and Drug Administration -FDA for liquid chemical be cleaned after each day’s use. Nevertheless, organizations may non-critical surfaces and gaseous sterilants [7]. Furthermore, the cloth(s) is used for each area. Do it in improper way this could compromise the efficacy of the cleaning process. The cloths must also depend on using disposable cloths instead, especially for moist areas where the contamination may be higher. To avoid contamination, disinfect mop heads and cleaning cloths frequently (e.g., launder and dry at least daily [4]. Cleaning product Cleaning is a process, which proposes to remove foreign mate- rial from a surface. The purpose of using a detergent is a surfactant that help the elimination of dust and organic substance. Can be suf- sterilants used on critical and semi-critical equipment or by Envi- ronmental Protection Agency EPA regulates disinfectants used on commonly used disinfectant classes are described below [8]. Alcohols Ethanol aqueous solution of ethanol can be utilized direct on work surfaces of laboratory benches, skin, [8], and ADCs. Chlorine (sodium hypochlorite): Chlorine, is one of the rapid- acting oxidant, and is broad-spectrum chemical germicide and a commonly accessible. It is usually an aqueous solution of sodium Citation: Saleh Alanazi., et al. “Best Way of Standardize Cleaning of Automated Dispensing Cabinets to Prevent Infections". Acta Scientific Nutritional Health 6.6 (2022): 86-90. Best Way of Standardize Cleaning of Automated Dispensing Cabinets to Prevent Infections hypochlorite, sold as bleach, to give different concentrations from • 88 chlorine by diluted with water. Stored and used in well-ventilated areas because chlorine gas is extremely toxic [8]. • Must be from high to low catch surfaces in dusting technique. oxide in the health-care setting because it is contains numerous Hydrogen Peroxide: Possible uses for stabilized hydrogen per- • way by either using a clockwise or counterclockwise [10]. area must be visually checked. oxide considered as high-level disinfectants [9]. novative work on disinfectant surgery so it is has taken a major place in the area of hospital disinfection [9]. However, it used for intermediate to low disinfectant level noncritical medical devices. Disinfection To reduce the number of microorganisms by apply- ing EPA-registered antimicrobial products that are effective against certain pathogens and this is the goal of this process. Disinfection technique Quaternary Ammonium Compounds: It is commonly used in • Automated dispensing cabinets (ADC) is clearly placed on low- • noncritical surfaces, like floors, furniture, and walls. It is considered of low-level disinfected level product. level disinfectant according to this classification. As well, the risk of infection involved in using ADCs is non- critical. Thus, Disinfectant Wipes (70% alcohol) is appropriate product for disinfectant ADCs process. Method The goal of Cleaning and disinfection are reduce the pathogen capacity significantly to a position where disease transmission does not happen. Cleaning and disinfection are important principle to maintain infection control. Cleaning Anticipates eliminating foreign material (e.g., dust, soil, blood, secretions, excretions, and microorganisms) from a surface or an item using water, detergent, and mechanical action/friction is cleaning process [10]. However, since organic and inorganic materials that stay on the surface of instrument interfere with effectiveness of this process cleaning is required before disinfection. Cleaning techniques • The cleaning flow should be from low-touch or slightly soiled areas to areas/items, which are considered high-touch or heavily soiled. Upon achievement, to guarantee the area is thoroughly cleaned and that essentials have not been missed the entire accounts of the properties, germicidal efficacy, and. Hydrogen perPhenolic: Phenol initial use as a germicide by Lister in his in- Then we can clean the area by accomplished in a methodical A disinfectant-detergent solution with disinfect (damp wipe) all horizontal, vertical, and contact surfaces with a cotton cloth saturated (or microfiber). Various scientific studies have shown the efficacy of hospital disinfectants against pathogens with a contact time of at least 1 minute although highly EPA-registered hospital disinfectants have a contact time of 10 minutes on the label [7]. Roles and responsibilities Collaboration is an important component to maintain ADCs clean. Also defining cleaning responsibility to assigned staff ensure accuracy and accountability in cleaning. This guidance suggests the following responsibilities distribution see table 1. Commonly accessed surfaces such as (keyboards, mice, Bar Code Scanner, and touchscreens) need more regular cleaning from users before use. Other ADCs inside component like (drawers/Bins, flex Lock, external Return Bin, Acrylic Doors, and frame) which are responsibility of pharmacy technicians need less frequent cleaning semiannually, Additional cleaning could be required in certain circumstances. The internal component which is known as CPU fan air filter should be also considered in routine cleaning, Annual cleaning to prevent dust accumulation is important, it suggested to done regularly during Planned Preventive maintenance (PPM). For the outer door and frame scheduled to be cleaned every two weeks or when visibly soiled Citation: Saleh Alanazi., et al. “Best Way of Standardize Cleaning of Automated Dispensing Cabinets to Prevent Infections". Acta Scientific Nutritional Health 6.6 (2022): 86-90. Best Way of Standardize Cleaning of Automated Dispensing Cabinets to Prevent Infections ADC -Component Cleaning Method Exterior Painted Metal Cleaning and Keyboard/ Mouse Wipe surfaces Surfaces Touchscreen Fingerprint Reader Drawers/Bins Flex Lock External Return Bin Frame (inside) Frame (Outside) Disinfectant spray (70% alcohol) Commercial glass cleaner Mild Commercial glass cleaner Mild Cleaning and disinfecting spray and Wipe spray and Wipe Outcomes and Measures Disinfectant wipes (70% alcohol) Disinfectant wipes Cleaning and surfaces detergent and water Disinfectant spray (70% alcohol) Disinfectant spray (70% alcohol) Before Use/when Conclusion Important to daily infection control to help reduce transmission of pathogens, regular cleaning and disinfection of pharmacy prod- ucts is the use of readily available cleaners and disinfectants with EPA approvals. There can be a risk of pathogen transmission due to medical devices operated by multiple users in the daily workflow from staff to staff or staff to patient. Moreover, having such a cleaning guideline is mandatory to avoid many types of contamination Responsible Person Housekeeper USER visibly soiled Before Use/when USER visibly soiled Before Use/when visibly soiled Every 6month/when visibly soiled Before Use/when visibly soiled Every 2 weeks/when visibly soiled Every 6month/when visibly soiled Every 6month/when visibly soiled Every 2 weeks/when visibly soiled Table 1: Guidance for Roles and Responsibilities. ATP bioluminescence assays. and infection visibly soiled Disinfectant Wipes (70% alcohol) surfaces surfaces Every 2 weeks/when Disinfectant Wipes (70% alcohol) spray and Wipe disinfecting Acrylic Doors (inside) For Disinfecting: Disinfectant spray Wipe surfaces side) Acrylic Doors (Out- cloth or equivalent with water Wipe surfaces Wipe surfaces Frequency For Cleaning: damp lint-free cotton disinfecting Bar Code Scanner Product use 89 USER Pharmacy Technician USER Housekeeper Housekeeper under supervision of Pharmacy Technician Pharmacy Technician Housekeeper Author Contributions Supervision, project administration, saleh alanazi and Haya Mu- frij and data collection Asma Altoub, Fawziah Mutairi and Hind Al Badali, writing, original draft preparation, Thamer Alotaibi1, Saad Alobaidi, Saad Alnofaie, Khalil Almajed formal analysis, writing-re- view and editing, Meshal Alshakrah, Abdullah Alroumi and Norah AlShrim All authors have read and agreed to the published version of the manuscript. Acknowledgments Authors would like to extend their sincere appreciation to the Infection control department in KAMC-RD and automation section in pharmaceutical care services for their support Citation: Saleh Alanazi., et al. “Best Way of Standardize Cleaning of Automated Dispensing Cabinets to Prevent Infections". Acta Scientific Nutritional Health 6.6 (2022): 86-90. Best Way of Standardize Cleaning of Automated Dispensing Cabinets to Prevent Infections 90 Conflicts of Interest The authors declare no conflict of interest. Bibliography 1. Guidance on the Interdisciplinary Safe Use of Automated 2. Neeltje van Doremalen., et al. “Aerosol and Surface Stability of 3. 4. 5. Dispensing Cabinets. Institute for Safe Medication Practices (2008). SARS-CoV-2 as Compared with SARS-CoV-1”. The New England Journal of Medicine 382 (2020): 1564-1567. Cleaning and disinfection of environmental surfaces in the context of COVID-19: interim guidance (2020). https://www.cdc.gov/infectioncontrol/guidelines/disinfection/ https://www.sahealth.sa.gov.au/wps/wcm/connect/18 741180499970f0891e8faa8650257d/SA-Health-clean- ing-standard-2014_%28v1.1%29-cdcb-ics-20180301. pdf ?MOD=AJPERES&CACHEID=ROOTWORKSPACE- 6. 7. 8. 9. 18741180499970f0891e8faa8650257d-niReMMM Cleaning environment patient equipment and medical devices Guideline for Disinfection and Sterilization in Healthcare Facilities (2008). https://www.oakland.edu/Assets/upload/docs/LabSafety/ disinfectantsFinaLAug2009.pdf https://www.cdc.gov/infectioncontrol/guidelines/disinfection/disinfection-methods/chemical.html 10. https://www.sahealth.sa.gov.au/wps/wcm/connect/18 741180499970f0891e8faa865 257d/SA-Health-clean- ing-standard-2014_%28v1.1%29-cdcb-ics 20180301. pdf ?MOD=AJPERES&CACHEID=ROOTWORKSPACE 18741180499970f0891e8faa8650257d-niReMMM Citation: Saleh Alanazi., et al. “Best Way of Standardize Cleaning of Automated Dispensing Cabinets to Prevent Infections". Acta Scientific Nutritional Health 6.6 (2022): 86-90.