With the infection rate of COVID-19 increasing in nearly every state, sterilizing and cleaning are on the minds of many. Of course cleaning and disinfecting has existed since before the pandemic — dating back to at least 150 years ago, with Joseph Lister.

The level of cleaning, the efficacy, the methods and process can differ, and certainly do, depending on the medical device being cleaned, what the device is used for, what materials are used in its construction, and guidelines put out by the CDC and other organizations.

With so much to cover, it’s important that hospitals look to experts for staff training and to implement procedures and protocols. Michael Heusser, clinical engineering manager at Middlesex Health, in Middletown, Connecticut is one of those experts.

At Middlesex, Heusser says different individuals are in charge of cleaning different devices dependent on the use case for the device. For instance, if it was something at a fixed site in a patient’s room, environmental services would be tasked with cleaning it upon discharge of the patient. If the device was mobile and traveled with staff between patient rooms, it’s cleaned by the clinical staff. In terms of surgical instruments, the cleaning for those devices is done through the central sterile processing department, with appropriate cleaning, sterilization and high-level disinfection taking place.

Cleaning is important, but cleaning with the right chemicals or methods is nearly as important.

“There’s really two thresholds,” Heusser said. “Lack of cleaning can be a health risk for patients or staff. It may also impact how well a device functions. But there’s also cleaning with the wrong chemicals, whether it’s because that’s all you have on hand or it’s what staff prefers to use.”

According to Heusser, ECRI has had inappropriate cleaning chemical use on their top 10 health technology hazards list for years, and for good reason. The wrong cleaning chemicals may not actually get a device as clean as it should be or may threaten the integrity of the device. Harsh chemicals can react with materials in undesirable ways — plastics may become brittle and cause potential harm to patients or equipment if pieces break off, or pitting or cracking of surfaces can occur and ultimately harbor more germs in harder to clean areas of a device. There have even been documented cases of fires occurring after fluids have come in contact with the electronics of a device. Of course, that’s getting back to the first threshold — if cleaning is done at all.

A white paper Heusser referenced, “Methods for assessing the adequacy of practice and improving room disinfection” by Philip Carling M.D., said that only about 32 percent of objects are cleaned within institutions — which means some locales would exceed that percentage, but others would fall even further below. “This also raises the question of whether or not it was cleaned correctly,” Heusser said.

For his part, Heusser makes sure staff is trained to clean and disinfect devices using the proper cleaning agents while doing their day-to-day jobs. However, with so many different types of cleaning solutions it can be difficult to keep track of what’s used on what device. So they’ve devised a visual cue to keep things straight. “We came up with stickers placed on devices that are color-coded to the chemical type that we’re using. And it’s shaped to the individual. So squares are for users, circles are for EVS, and we educate on what each sticker means. There’s also writing on them to identify. This way, when the individuals are using the devices in the rooms, there’s a reminder about who is responsible and what chemical to ultimately use.”

As far as having the proper cleaning solutions on hand, the COVID-19 pandemic has made that a particular challenge.

Heusser has seen some price gouging, but more typical is just the shortage of cleaning supplies. “We’ve had to go and buy various products that are equivalent of what we’re used to from different vendors. It’s been a constant search, we might order 10 cases, but we’re only allocated to receive two. Fortunately, we’ve been able to make the solutions we need based on bulk supplies and things of that nature, but other places probably aren’t as lucky,” Heusser says.

He’s also noticed some changes in how staff carries out the cleaning tasks. “I wouldn’t say they’re cleaning more thoroughly, they were already doing that well. It’s more that they’re being more cautious — wiping over the same spot they already cleaned for instance, just because.”

If Lister were alive today, it’s hard to say how he’d react. While a global rate of only 32 percent seems low. Prior to the pioneering work he did to educate about the importance of disinfecting and cleaning, that rate was even lower. And in facilities fortunate enough to have professionals like Heusser on staff, the number is significantly higher.