When someone says “infection control,” lifts and slings probably aren’t the first two potential carriers that come to mind. That’s because they aren’t major contributors to nosocomial infection. But they can contribute, so you need to take effective infection-control measures.
What exactly should you do? Wash your hands after each patient contact and after handling slings and other patient equipment that have come into contact with the patient’s skin, body fluids, and bed linens, whether the equipment appears to be contaminated or not. When handling apparently contaminated equipment, wear disposable gloves to prevent the spread of infection or cross-contamination. And to keep the lifts and slings infection-free, follow the manufacturer’s directions, which should be based on the principles and guidelines below.
Using the Spaulding hierarchy
The Spaulding hierarchy—an approach to cleaning, decontaminating, disinfecting, and sterilizing medical equipment—sorts equipment into three categories: critical, semicritical, and noncritical. These terms refer to the intended use of the device, not the degree of contamination. A device designated as noncritical can still carry contaminants. Even an I.V. pole can be splashed with blood or body fluids and become a vehicle of infection.
• Critical devices come in contact with sterile body tissue and include surgical instruments, cardiac and vascular catheters, implants, and needles. These devices need sterilization.
• Semicritical devices come in contact with skin or mucous membranes that are not intact and include respiratory therapy equipment, anesthesia equipment, and flexible endoscopes. These items usually require high-level disinfection.
• Noncritical devices touch only intact skin and include crutches, bed boards, and blood pressure cuffs. The intact skin acts as an effective barrier to most microorganisms, so using a basic cleaning and low-level decontamination is sufficient. Low-level disinfectants include 70% to 90% alcohol, a 1:100 dilution of bleach, and quaternary ammonium germicidal detergents. Lifts and slings fall into this noncritical category.
A hierarchy of sanitation
Think of sterilization, disinfection, decontamination, and cleaning as a hierarchy, with sterilization as the most stringent and cleaning as the most basic. Sterilization uses physical or chemical procedures to destroy all microbial life, including bacterial endospores.
Disinfection inactivates all pathogens but not all microbes. High-level disinfection kills all organisms except high levels of bacterial spores via a germicide cleared by the Food and Drug Administration as a sterilant. Intermediate-level disinfection kills mycobacteria, most viruses, and bacteria via a chemical germicide registered by the Environmental Protection Agency (EPA) as a tuberculocide. And low-level disinfection kills some viruses and bacteria with a chemical germicide registered by the EPA as a hospital disinfectant.
Decontamination removes pathogens from objects, rendering the objects safe to handle. Cleaning removes all matter that microorganisms may find favorable conditions for continued life and growth, usually by scrubbing with hot water and detergent. For lifts and slings, cleaning is the appropriate level of sanitation.
Cleaning lift hardware
When a lift has fixed overhead rails and a nonportable motor, the track and motor casing should be cleaned the way similar equipment—such as fixed I.V. pole overhead track and room divider curtain track—is cleaned. Maintain the equipment both during and between patient stays or according to the manufacturer’s instructions.
Mobile lifts should be cleaned regularly or according to the manufacturer’s instructions. Normally, this means cleaning all external surfaces, using your institution’s procedures for wiping down moveable medical equipment. A mobile lift should be cleaned before each patient uses it, particularly if the previous patient had a communicable disease or an infection, or if there’s a risk of gross contamination.
At a minimum, all surfaces that could have been touched by the previous patient— including the boom and mast, strap, sling bar, and hand control—should be wiped down with a chemical germicide registered by the EPA as a hospital disinfectant. Leave the solution in place for the prescribed time. Then, before the next patient uses the equipment, clean the disinfected surfaces a second time to remove traces of the disinfecting solution.
If a nonportable overhead motor is moved from room to room, it may become contaminated by contact with ambient surfaces and by the person carrying the motor. Treat the motor casing, strap, sling bar, and hand control as you would treat a mobile lift.
Cleaning soft goods
Consider nondisposable slings and other porous textile fabric items, even if they don’t come in contact with nonintact skin or mucous membranes, to be contaminated after use by a patient. Don’t allow these items to be shared by patients. An exception may be made for a nonporous protective barrier or liner used between the sling and the patient’s skin. Each patient needing a mechanical lift device should be assigned a sling that’s stored in his or her room. Examine both nondisposable and disposable slings and other porous textile fabric items before every use to make sure they are clean and safe for use.
Most nondisposable, absorbent (nylon, polyester, and cotton) slings and sheets are machine washable, per the manufacturer’s recommendations. Based on the hot-water laundry cycle guidelines of the Centers for Disease Control and Prevention, these items should be washed in water that is at least 160º F (71º C) for at least 25 minutes. The water may be as hot as 200º F (93.3º C) if the sling has no reinforcements and is not made of a plastic-coated net fabric. Chlorine bleach of over 100 parts per million (ppm) may cause premature aging from fabric degradation. Avoid pure phenol-based disinfectants. Phenolic salts of 500 ppm or less are acceptable. Tumble drying increases wear and isn’t recommended. Use a drying cabinet or hang the sling. When used and laundered properly, slings can last up to 15 years.
Nonabsorbent, plastic-coated net and plastic-coated fabric slings, slide sheets, and repositioning sheets can be laundered in the way just described. Or you can disinfect them between patients and use them again. To do so, mist spray an EPA-approved, wipe-down disinfectant on all skin contact areas from a distance of 12 inches, based on the manufacturer’s instructions. Allow disinfected areas to air dry completely before use with another patient.
When disposable slings and repositioning sheets are soiled or when the patient using them is discharged, properly dispose of them so they won’t be used for another patient.
Infection-free lifts and slings
Lifts and slings may not pose the most obvious threat of nosocomial infection, but they can spread infection, and you must take appropriate measures. Wash your hands. Wear gloves. And keep lifts and slings clean and infection-free.
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Spaulding EH. Chemical disinfection of medical and surgical materials. In: Lawrence C, Block SS, eds. Disinfection, Sterilization, and Preservation. Philadelphia, Pa: Lea & Febiger; 1968:517-531.
Wright L, Evitt CP, Baptiste A. Protocol for safe use of patient handling slings—does one size fit all? AOHP Journal. Fall 2005:28-32.
Robert M. Scherer, RN, BA, is Regional Vice President Midwest at Liko North America in Franklin, Massachusetts.