1. Patricia Pabon
February 7, 2016
Importance of Effective
Decontamination
Decontamination is a compendium, an ever-changing coming together of complex
concepts that can make or break a process that helps keep patients safe. The delicate process that
makes up decontamination is extensive, tedious and must be deliberately done. Ineffective
decontamination would prevent thorough sterilization and could leave patients, healthcare
personnel and communities at large vulnerable to a potentially dangerous situation.
According to OSHA (Occupational Safety and Health Administration) decontamination is
defined as, “the use of physical or chemical means to remove, inactivate, or destroy blood borne
pathogens on a surface or item to the point where they are no longer capable of transmitting
infectious particles and the surface or item is rendered safe for handling, use, or disposal”(2). As a
Certified Registered Central Sterile Technicians (CRCST), decontamination is one of the focal
points of our profession because without it critical reusable items would be nullified. Due to the
potentially infectious threat that soiled instruments and devices pose to human life it is imperative
that CRCSTs consider all factors that may affect the delicate chain of events that make up the
decontamination process. The CDC (Center for Disease Control) notes that there are many
elements that can influence the effective decontamination of surgical instruments in the Central
Sterile area (1). However, only a few of those factors are not intrinsically controlled. Such include:
the presence of organic and inorganic substances and concentration of disinfectants, physical/
chemical factors. All of these factors can be controlled by CRCSTs and therefore make us
responsible for doing our due diligence to prevent infection.
The presence of inorganic and organic material is an essential starting point in every
decontamination process. Matter such as serum, blood and pus can reduce the anti-microbial
activity of disinfectants by blocking the germicidal from reaching every crevice of the instrument.
In layman’s terms, “if it isn’t clean, it isn’t sterile”. This is why point of use containment is critical
!1PATRICIA PABON

2. and manual cleaning in the decontamination area must be done. The type of soil and how much
of it is left on the instruments requires the same care: soaking and manual cleaning. Assuming
that point of use cleaning has taken place then soaking and manual cleaning would be the one-
two punch that allows proper disinfection.
In addition, physical and chemical factors such as temperature, water quality, detergent
types, and detergent concentrations are influential in decontamination. In general, these factors
are the most tedious to deal with and moderation is key! For example, the higher the temperature
the more active most disinfectants will get but go too high and the excessive temperature will
actually decrease the anti-microbial activity. Water quality/hardness is another issue to consider
when cleaning because hard water will cause particulates to form and may also block the
germicidal agent from reaching all areas of the instrument or device. The types of detergent vary
and their most effective pH levels also vary. Again, balance is key- increasing the pH can
effectively inactivate certain detergents, while enhancing others. Concentration and exposure to
detergents are another important piece of the puzzle due to the fact that too high a concentration
of a detergent can produce a film protecting bioburden from the cleaning process.
In reality there are many more factors to consider when in decontam: thermal disinfection,
the use of automatic washers, relative humidity, etc. But I chose to focus on the factors that are
directly related to the human element- the CRCST. Decontamination is really a multi-step
process that relies on proper procedure, knowledge of the ones carrying out those procedures and
compliance. Generally, our challenge in decontamination is to remove all gross soil safely and
effectively in order to thoroughly sterilize items and prevent the spread of infection. But it is not
as easy as it sounds.
As CRCSTs we are human advocates first and foremost. While keeping ourselves, as
CRCSTs, safe we aim to keep others (patients and communities) safe by walking a fine line
between ignorance and hubris. I suppose that is the nature of science, especially in a relatively
new topic of interest. But what I do know for sure is: no matter how tedious and involved the
processes get in decontam they MUST BE FOLLOWED. Do it right the first time! One chink in
the chain will create an opportunity for infection to spread and it only takes one opportunity.
!2PATRICIA PABON

3. REFERENCES
1. CDC. (2008). Guideline for Disinfection and Sterilization in Healthcare Facilities.
Retrieved February 06, 2016, from http://www.cdc.gov/hicpac/
Disinfection_Sterilization/4_0efficacyDS.html
2.Case Medical Inc. (2005-2006). The Basics of Decontamination. Retrieved
February 06, 2016, from http://www.casemed.com/caseacademy/downloads/
CASDF001.pdf
3.Frieze, M. and Carlo, A., “Cleaning the Critical First Step in the
Decontamination Process”, Managing Infection Control, June 2005
!3PATRICIA PABON