"PLANNING A SANITIZATION PROGRAM" WEBINAR

JULY 27, 2010



LINDSEY KAMPWERTH: Hello, everyone. It's

1 o'clock my time, 2 o'clock Georgia time. So I think

we're going to start.

I'd like to welcome you all to the Pass It On

Center webinar on sanitization. We want to thank you all

for participating today.

And if you have not done so already, you may wish

to download a few supporting documents for this session.

To do so, go to the www.passitoncenter.org/content and open

the article for this webinar under "New to the Knowledge

Base." The supporting documents are attached.

I myself am Lindsey Kampwerth. I am here in

St. Louis. I work for Paraquad, an independent living

center. And I also consult with the Pass It On Center.

And Trish is going to be with us too. And I'll let

her introduce herself.

TRISH REDMON: Welcome to our webinar today. I'm

Trish Redmon. I'm the consulting editor and educator for

the Pass It On Center, which means that I help create or

load content that you have donated to the Pass It On Center

knowledge base, and I help develop webinars and our

preconference at the ATIA session.

So my goal is really to either create or prepare

the content that all of the programs donate for the

knowledge base.

LINDSEY KAMPWERTH: All right. Trish, I have a

couple people saying in the public chat that you're not as

loud as I am. So I don't know if there's a way to move

your mic or just you want to try it again.

And everyone can turn the volume all the way up on

their computer and then also on the webinar room in the

bottom right corner with the little speaker.

TRISH REDMON: Is that louder now?

LINDSEY KAMPWERTH: They said it wasn't much. It's

still kind of hard to hear you. I can hear you okay, but,

yeah, you're -- I had to turn the volumes all the way up on

me.

TRISH REDMON: Okay. How about now? Is that much

better? I've got the mic volume turned all the way up.

LINDSEY KAMPWERTH: That was much better to me that

time.

TRISH REDMON: All right. I'll try speaking much

louder, Lindsey. And I have my mic volume at max. So I

hope everyone can hear me.

LINDSEY KAMPWERTH: Yeah, Trish. They're saying

it's a little better, and it sounded better to me too. So

we'll keep going.

We want to thank Caroline Van Howe in the Assistive

Technology Industry Association for providing the

technology that makes this webinar series possible.

This webinar is being recorded and will be

transcribed by Kimberly Griffin, which she's on, so thank

you, Kimberly.

The slides, audio recordings, and transcript will

be made available on the Pass It On Center website in a few

weeks.

ATIA has been a wonderful partner in this and in

providing a national venue twice yearly for a strain of

sessions on AT reuse, and starting this year, for an

all-day preconference on how to start or improve your AT

program. So that ATIA is in October, the last weekend in

October.

So if you're new to any of our webinars, let's take

a moment and just look at the right side of the screen.

This is the navigation panel, which contains the tools that

allow you to participate actively in the webinar.

You will see a list of participants at the bottom.

And if you wish to comment or ask a question, you may raise

your hand by clicking on the microphone. The moderators

will watch for you and give you the opportunity to speak.

If you prefer to type the question or comment, just

move your cursor to the blank space in the middle of the

screen on the right. And after you're done typing, when

you press "Enter," your comment or question will appear in

the public-chat area. Speakers will watch this area and

respond to your comments or questions.

And please tell us if you're having any difficulty

hearing us.

The text size can be adjusted by clicking on the

font button in the middle of your right navigational panel.

To configure screen readers, go to "Options" at the

top of your screen.

Now, I just looked at the public chat. Are you all

still having a hard time hearing me, or was that still

about Trish when she was talking? Okay. Then I'll just

keep going for the time being.

The next slide is the CEUs and CRCs are available.

So you can go ahead and follow the instructions right on

there, and it will tell you how to obtain your credits.

At the end of the program you'll be given

directions for assessing this evaluation, and we would

really appreciate any comments or suggestions to help us

improve this service that is designed to serve you.

Now let's begin.

There have been numerous webinars and ATIA sessions

devoted to various aspects of sanitization, but this one

will focus specifically on how to start a sanitization

program.

For any other presentations you can go to the Pass

It On Center site and check the list of webinars or go to

the knowledge base in "Create Sanitization" category under

"Program Options."

And just so y'all know, Trish and I are in

completely different states, and she's actually clicking

the slides for me right now. We're taking turns. So if

we're a little off, that's the reason why.

So are you all ready to begin?

So like I said before, the additional documents

related to this topic are available in the "Working

Documents" package on the Pass It On Center knowledge base,

which is on this slide. These documents will be useful in

planning or improving your sanitization program.

So a little warning -- not even a warning. This

session is about planning a sanitization program for the

cleaning and disinfection of devices. It doesn't consider

repairs or maintenance.

So there's additional tools, supplies, and

environmental accommodations that are needed for repairs

and maintenance. There are some maintenance checklists and

guidance on the Pass It On Center knowledge base for some

of the frequently donated assistive technology devices.

The next slide is about our learning objectives for

this webinar. So we want to understand the need for

sanitization. You don't want your program to be the one

that says, you know, I just got this, and so-and-so got a

staph infection from it. (Inaudible.)

Identifying what we need to know to plan a program,

the standards, the regulations, methods.

Exploring options in cleaning the equipment. Learn

how to select appropriate cleaners. Identify features of a

work area appropriate for sanitization activities. And be

prepared to document your policies and procedures to train

workers.

So the next slide is why should we sanitize

previously used AT. Number one, we want to prevent any

spread of disease to the workers or to the future users of

that donated device.

We also want to protect the program from any legal

liability resulting in negligence if the devices are not

sanitized. Like I said, someone could get a staph

infection from an inappropriately cleaned piece of

equipment.

And to make that device also as clean and

attractive for a possible next user. You know, no one

really wants something that looks like it's been dragged

behind a car for a little bit and isn't shiny. You know,

that's what they want, the new car look, per se, the shiny,

smells good. It's really their new device.

So when to sanitize your equipment. As soon as

possible. You have to protect your workers. So consider

the process when accepting donations. How can you provide

some immediate protection to those handling devices, and

how can you sanitize and maintain it in a clean state.

So those people who are sanitizing equipment right

when someone's either coming in to donate it or when they

are actually going out and picking up some equipment,

having the protective gear so that they're not actually

touching anything that could be harmful.

And then, once you get it to your building, where

should you put it? How can you keep it away from your

other cleaned inventory? Where is a safe spot?

All right. So there we go. There's the slide.

This is a beautiful slide of just that, some of the

microorganisms that can cause disease and that can live for

a long time on those devices. And, you know, it's not the

dirt and stuff that you can actually see with your eyes.

It's these little microorganisms.

So there's a ton of viruses that can be passed.

Bacteria, fungus, or the bacteria with spores are all

listed here. And just to name a couple of them:

hepatitis, mumps, chickenpox, staph infection, strep, any

molds or mildew, and tetanus.

So the language of sanitization. The definition is

removal of visible soil from objects or surfaces, including

removal of some of the harmful substances or microorganism.

So like a detergent is a chemical that aids

cleaning. A disinfectant, removal and destruction of some

harmful microorganisms. So a disinfectant actually

destroys some microorganisms.

So sanitization is actually a continuum from

cleaning to sterilization. Cleaning removes the visible

soil, like we were just talking about, and possibly some of

the harmful substances or microorganisms.

But the cleaning process may involve the use of

chemicals such as detergent that aid in dissolving some of

those different types of soils or stains.

Now, disinfection involves removal or destruction

of those harmful microorganisms, actually getting rid of

them. This often requires the use of chemicals that aid in

the removal of microorganisms. So this produced like an

anti-, meaning "working against," or an antibacterial soaps

are common.

A product that kills a microorganism is labeled as

a -cide so as germicide, bacteriacide, or pesticide. Many

of these products are regulated in their use and disposal

by the Environmental Protection Agency.

So actually removing those microorganisms.

Three-step process. Cleaning for physical removal. So the

use of some tools or detergents to remove that dirt and

debris, some other harmful substances. Then drying the

device. And then doing the actual disinfecting with

chemicals. So use of chemicals designed to act against a

specific organism to complete the sanitization process.

So why should you waste the time of drying the

device only to clean it basically again with stronger

chemicals or a whole another process? Failure to dry the

device before applying chemical disinfectant may actually

dilute the solution to the point of ineffectiveness.

So once the disinfectant is applied, it must have

sufficient service contact time to be effective. That time

varies on the product.

So typically here we use about the ten-minute rule

of it sitting on the actual device. And again, with those

chemicals, you've got to really make sure that they're

mixed to the right capacity because you don't want, as it

says, to dilute the actual chemicals, and then you're

basically wasting your time, and your things are not

completely being cleaned. So you want to follow the

directions on those.

So a method that is not necessary for AT reuse is

sterilization. And that's total destruction of

microorganisms using heat or chemical action.

It is essential for some medical environments in

which devices contact internal membranes of the patient or

facilitate the transmission of gases or fluids into the

body.

So medical and dental offices require the

application of extremely high levels of heat or steam to

completely destroy microorganisms on instruments that care

for the patients.

The used AT devices being sanitized are not or

should not be devices that have previously contacted

internal membranes or transmitted any gases or fluids into

the body. This include the respiratory equipment such as

any masks or hoses.

It is safe to sanitize an oxygen concentrator for

reuse. But all tubing, hosings, and masks must be

discarded in their appropriate manner and replaced with new

accessories before it is used by any other person.

And now that's not to say also that you might not

have a steam machine or some of this equipment at your

place. We actually have a steamer that we use. And it

just, for some of the little nooks and crannies, works a

little bit better.

So the CDC guidelines for disinfection. Most AT

devices fall into that noncritical category because they

contact intact skin and do not contact any mucus membranes.

Most AT devices can be sanitized with

intermediate-level of disinfectants. And you can review

the guidelines for disinfection and sterilization in Health

Care Facilities 2008, the Center For Disease Control. And

it is also on the Pass It On Center knowledge base for that

document.

So reuse programs are not health care facilities,

but they would do well to adhere to the standards for

health care facilities devised by the CDC.

A condensed version of the guidelines that apply to

reuse programs has been prepared by Chris Brand, the

executive director of Friends of Adult and Children Too,

FODAC in Georgia, a large reuse program located in Georgia.

Very large, by the way.

Both the complete guidelines and the condensed

versions are on the Pass It On Center. So if you guys have

been on there to the knowledge base, there's a ton on

sanitization.

So I think most of you have heard before us talk

about our indicators of quality for AT reuse. And here is

one of the indicators in reference to sanitization.

So the program has written sanitization procedures

based on sound medical or scientific practice that are

considered consistent with the manufacturer's

recommendations for the sanitization of equipment.

So this is the primary indicator that must be met

by the AT reuse program. In working our way through the

process of planning a sanitization program, we'll be

identifying what those policies and procedures that need to

be covered are.

Related indicators of quality for AT reuse are its

facilities, the safety and security of it. The facility is

safe and secure for employees, contractors, volunteers, and

customers.

And 3.3 is facilities' space and services. The

facility has adequate space and services to conduct AT

reuse activities.

So both of those have some bearing on the

sanitization program. We were talking before about your

workers touching that equipment when they pick up a

donation and their safety.

So that can be -- we'll go to the next slide.

Thank you.

And I'm going to hand it over to Trish on this one.

TRISH REDMON: I hope you can hear me well. If you

can't, please put a note in the public-chat area.

As we start planning a sanitization program, we

have to consider three major things: Our tools, our

supplies, and the work environment we'll create for the

activities.

The tools can include a variety of implements from

very small hand tools to power tools, automated cleaning

equipment, and workers' safety devices.

The supplies we use to clean -- let me stop and see

if I can make this better.

Can you hear me better now? No. Okay.

CAROLINE VAN HOWE: Hi. This is Caroline Van Howe

at ATIA just doing a sound check.

Could you indicate in the public-chat area if

you're able to hear me. Thank you.

LINDSEY KAMPWERTH: All right. I'm going to try to

take on some of Trish's slides.

And, Trish, feel free to send me any tips or notes

if I'm going to forget anything.

All right. So I sound okay. All right. Keep

going.

So Trish was talking about what you need to plan a

sanitization program. What you need (inaudible), you need

some actual tools. You need some hand tools, some power

tools, some automated equipment possibly, and some worker

safety devices.

You have to consider what supplies you're going to

need to actually clean the devices and then to protect your

workers.

And then also the environment that you have, that

space. What services do you need, such as: Do you need

plumbing? Do you need special ventilation? Do you need

power?

And then also the activity-based design. Do you

need more of a tile room for sanitization or making sure

there's a drain in the floor?

So go ahead to the next slide, Trish, if you can do

that.

I can't see it, but I will refresh my screen. Yep.

If you refresh, it will go right on to the next one. So

I'll give everyone a second to refresh, and just let me

know when y'all see the next slide. Okay. Sounds like you

guys got it. Great.

So the next slide is titled "What types of devices

will be sanitized?" So that's a big part of what you have

to consider.

Are you just going to be doing durable medical

equipment and then dividing that into manual devices and

then ones that actually have power devices? Or are you

going to be doing computers and some other digital devices?

And a little tip at the bottom is to collect the

manufacturer recommendations to begin building a procedures

manual for sanitization by device type.

So all three of these facets of the sanitization

program are determined by the types of devices, like we

just said. You know, you're going to need a lot different

tools and supplies and a different environment for working

on computers versus durable medical equipment.

All right. So the next slide.

This is a table that kind of simplifies the method

and the equipment by volume. So if you have a low volume

of equipment, you'll probably be doing some manual

cleaning. You need like a bucket or a pick or tweezers,

some brushes, plenty of cloths and towels.

And then any concerns: the adequacy, the

effectiveness, and worker safety. So for that amount of

time that you're cleaning those devices and have the

equipment that you have, is it effective?

Now, you can go ahead and compare that to all the

way on the other side where there's high volume. So you

might actually want some automative cleaning for some of

the durable medical devices such as a Hubscrub, something

like that, and then actually getting some automated

cleaning machines.

Because if you're doing a high volume of equipment

and you just need to hire someone just to clean, that might

not be very cost efficient doing all the manual cleaning.

And then but some of the concerns are those

expenses. Hubscrubs aren't cheap. And the initial cost of

what that is going to be and then actual maintenance of it.

You know, I keep using the Hubscrub as an example. But you

have to keep buying the disinfectant and the detergents and

the soap that they use for that. So considering those

costs.

So how many devices? The number of devices will

dictate what is practical and affordable for the AT reuse

program. So if you have a few devices, you may perform all

that sanitization manually. Whereas, you're moderate

volume, you might be doing it manually but then adding some

power devices. And then the large volume, consider that

automated cleaning device.

How to select cleaning equipment. So you want to

consider the volume of devices to be sanitized. You want

to analyze the time/labor implications and examine the

effectiveness and cost of alternative methods and tools.

And then you really want to compare those options to find

out what's best.

So some tools for manual cleaning for durable

medical equipment: utility buckets, industrial tweezers

and brushes.

Those manual chairs -- if y'all have a reuse

program, it never fails around them caster wheels -- hair.

The amount of hair and just randomness that gets caught up

in them casters, it really starts to slow them down and

make them rough. Those tweezers are key on that.

Also, durable medical equipment, some of the shower

chairs kind of have that (inaudible) kind of surface to

them, which little nook and crannies, having a big brush to

brush those.

And then buckets possibly for having the water and

maybe spray bottles to have some of your disinfectant put

in, if you're buying it in large quantities, to have a

little spray bottle.

And then maybe for computers or electronic

components, having an artist paintbrush. Just something

soft that you can brush the keys and use on them that's not

going to be too much wear and tear on the device.

Powered devices for cleaning. So a vacuum. That

might be useful for actually getting the dust of a surface,

especially any upholstery that there is or any cracks,

sucking some of the crumbs out of there maybe.

An air compressor for removing any of the dust from

most surfaces. Also maybe a pressure washer to assist with

removal of some contaminants. I would be careful

exactly -- make sure that the device you're cleaning can

handle a pressure washer.

And then maybe even a power spot lifter if there's

a big stain on something that you need to get that off.

That might be something you want to consider to get spots

off of equipment.

So the next slide has some automated cleaning

equipment. So there's a picture -- I hope you all can

see -- of a Hubscrub, as I was talking about before. The

automatic cleaning equipment is machines that can clean and

sanitize large devices, such as a manual chair maybe -- or

there's a tub transfer bench in there -- that are available

from several suppliers.

So the Hubscrub I mentioned. There's the

Aqua Phase and the MEDCO. And just at the bottom, some of

the different programs that have some of these devices are

FODAC, Paraquad, and Project MEND.

So the cost of automated cleaning I briefly touched

on before. Some of the initial investments. Depends on

the model, the capacity and the options that they have.

Kind of like a car, different options that you can have on

it.

And the cost for a Hubscrub and Aqua Phase models

range from approximately $9,000 to $13,000. So that's

quite an investment right at the beginning.

Then you also have the operating expenses. So you

have to consider electricity to run it. You have to have

the water supply in order to use it.

And so the Aqua Phase estimates this cost about 2

cents per cycle. So the clean, disinfectant, or dry. The

Hubscrub is about 3.5 gallons it uses per cycle.

And then you have to consider the cleaners, the

disinfectants, and drying agents, which an estimate of

about $1,500 savings versus just using spray bottles. The

comparison -- using the automated machines and mixing the

controls for chemicals can actually result in some payback

on chemicals.

The comparison of mixing to fill spray bottles

costs a program about $1,900 versus the $350 per year from

using Virex, V-i-r-e-x, with automated equipment.

So actually calculating that payback. Maybe you're

wondering: How can I do that?

So number one, you want to compute that cost of the

manual cleaning. What you have to take into consideration:

the time; the labor, so salaries; the employee benefits;

the cost of the chemicals; and then the cost of related

supplies and tools, those tweezers we were talking about,

buckets.

Step two, compute the cost of automated cleaning.

So you have to consider that initial investment to get the

actual machine and then the annual operating costs.

And then to compute the annual savings, you divide

number two -- or compute those annual savings. And then

you're going to take No. 2 and divide by No. 3 to determine

the payback.

And then in back off to the side, some of the

intangible factors are the quality of the process and the

reduction in risk. So you may be having a little more risk

having your people actually clean the device, using the

chemicals. Say that they forget to put their eye goggles

on or something along the lines of that.

And then also that quality. You know, if you

(inaudible) really dirty in that Hubscrub, is it getting as

clean if maybe you would have had the time and effort of

just one person doing it? So you have to weigh all them

factors together.

So supplies for sanitizing durable medical

equipment. The cleaners and disinfectants that we were

talking about earlier, the manual cleaning.

There's hard surface cleaners; hard surface stain

removers; leather, vinyl, plastic and glass cleaners;

intermediate-level chemical disinfectants; and car wax for

a protective coating and maybe after the cleaning; plus

washable or disposable cloths; and then manufacturer

recommended disinfectants for automated cleaning equipment.

In the absence of brand-specific recommendations

from the manufacturer, we consider the kinds of cleaners

that will be needed to clean the assistive technology. In

doing so, the basic considerations are what will

effectively remove microorganisms without harming specific

types of surface materials.

Ideally we want to identify some multipurpose

cleaners to avoid stocking a wide range of cleaners or

chemicals.

So some supplies for sanitizing computers:

compressed air cans, some alcohol wipes, and antibacterial

wipes.

The compressed air cans or soft artist paintbrushes

can be used to remove the dust from the keyboards and the

ports, anything that kind of gets caught in those keys.

To remove the contaminants from the keyboards, mice

or computer cases, alcohol or antibacterial wipes are

effective. But you always must take care to avoid any

dripping liquids onto the keyboards or computer cases. You

know, you don't want that inside the keyboard to mess it

up.

So here's a great slide Trish made. I'm giving her

all the credit for these cute slides. The actual

selecting, helping you select your chemical cleaners.

So you want to identify the chemical cleaners. We

start with a list of devices to be sanitized. And then see

the worksheet in your webinar package. We want to check

the manufacturer's recommendations.

It's reasonable to assume that we can use the same

procedures for devices made of the same material, even if

the manufacturer is different.

And Trish did post on the public chat, "Worksheet

in the webinar package to help with this." Just a reminder

that it's in there.

We also want to find the least common denominator

in tools and supplies. That is the fewest number of tools

and supplies to accomplish the task. And this process will

identify the generic types of cleaners or disinfectants

that we need but not necessarily a specific product.

So choosing cleaners. You want to follow the

manufacturer's recommendations, but these sometimes are

very vague on the topic of cleaning. So we may need to

consider the range of devices and the types of surfaces

that will need to be cleaned and identify cleaners for

each, although there are cleaners that can be used for more

than one type of device.

You want to choose cleaners though that can be

specified for either manually doing the glass or chrome, or

I know at the store sometimes they have the glass and

counter cleaners or some combination that can do more than

one type of surface.

Most AT can be sanitized with an intermediate,

high-level disinfectant. So that inactivates most of that

viruses and fungi, bacteria, TB, things that we were

talking about at the beginning of this webinar. But they

may not kill bacterial spores called tuberculocide by the

EPA.

So commercial cleaners designed for health care

settings are usually more effective and less expensive than

home formulations. Many of these products come packaged in

concentrated form. And so the convenient packaging found

in (inaudible) stores at home.

This simply means that you may need to purchase

spray bottles and actually do the measuring of the devices

to mix them together to save some money.

And then again, cluing into the fact that you don't

want to, well, if I use a little less of the concentrated

formula, it will go longer. Make sure you mix in the right

quantities so you're actually killing the things on the

devices.

So selecting cleaners and disinfectants. Some of

the factors you want to consider is effectiveness, the

convenience, the residual effects on surface materials,

human and environmental considerations, and cost.

So the effectiveness in killing or cleaning the

targeted microorganisms and how well does it work?

The convenience. How much effort is involved in

using this chemical? Does it come premixed, or do you have

to mix it together?

How long is the required contact time for

effectiveness? Does it use required protective clothing?

Does it require special storage? And does it involve

special disposal considerations that comply with the EPA

rules?

Some other questions you want to ask: Is this

product safe for use on the device surface, or does it have

a residual effect?

For example, does it clean crutch tops and rubber

tips effectively but impair the quality of the rubber over

time? Does it remove stains easily, but do you also risk

bleaching the upholstery or clothing if splashed? Does it

damage the finish of the device?

Human and environmental considerations. Is this

product toxic and pose a risk if inhaled or spilled on the

skin? Does it have fumes that may irritate the airways of

the workers?

Finally cost. How much does it cost? If all other

considerations are equal, is this product the best buy for

the money? Can I get comparable products for less

anywhere?

So shopping for disinfectants. You want to

identify the types of cleaners and disinfectants that are

needed. Shop the Internet to locate commercial products

and providers of commercial health care products that meet

the required specifications.

The Internet may be useful in locating more

information about the specific cleaners or identifying

those companies that have it. The technical sales

representative from such companies may be helpful in

analyzing your needs and recommending appropriate products.

And then if the quantity you need is too small to

qualify for good pricing, consider partnering with another

user. Most DME providers rent some equipment and must

perform sanitization tasks.

A local rehab or nursing facility might be a

potential partner. Adding to the volume may reduce their

cost also. So making those collaborations and partnerships

when buying some of this.

So here's a great chart of the disinfectants' pros

and cons. So we have three categories going down the left

side: halogens, alcohols, and then QUAT, quaternary

amines. I probably mangled that, so pardon me.

And Trish said, "We'll have a list of needed

products from the worksheet," in the public chat, she

wrote.

So going across now, those halogens, like a bleach.

The advantages of it are they're cheap; they're pretty

effective; and they're active against viruses.

But they do have some disadvantages. They can be

corrosive to metals; the disposal can be a disadvantage;

and then they're rapidly inactivated by any organic

materials.

The next line of alcohols, like ethanol. It's good

for surfaces that contact the user for skin, but it

requires water to kill bacteria and also again the disposal

of them.

And that last one, the bottom, which I'm not going

to mangle again. Some advantages are the effective surface

disinfectant at low concentrations, and they're

inexpensive. But some disadvantages are the disposals of

concentrations that are greater than 1 percent. So you're

going to have to think about that before using any of those

types of disinfectants.

An example of inexpensive, broadly effective

disinfectant and concentrated liquid is Johnson Diversey

Virex II. It comes in cases of four 64-ounce bottles to be

diluted 1 to 256. And a case price is either $75 to $85.

And I just noticed that "What about steam

cleaning?" was a question from Zachary.

And Trish said, "Steam cleaning does not

necessarily disinfect."

And he said, "Okay. Thanks."

Thank you guys for the comments.

Then Sani-Cloth, S-a-n-i-C-l-o-t-h, an

EPA-registered disinfectant in wipe format that kills

viruses and bacteria. It comes in a canister or individual

packets and is various sizes.

And then Kee, K-e-e, uses Zyme Clean, Z-y-m-e, on

hard surfaces. This product is effective against grease,

blood, food, or protein stains. It uses Power-Off, a

spray-and-wipe product for vinyl; stainless steel; or other

metals, ceramics, and other fabric. And they use carpet

spotting towels on scooters, power chairs, carpet, or

upholstery.

And then we do have a question in the public chat.

And it says, "Wouldn't sterilization be needed for

equipment that is used in nursing facilities?"

I believe that goes down to sterilization is what

we were talking about with anything touching a mucus

membrane or actually transferring fluids or gas from one

part to another.

So I would imagine that those things definitely

have to be in a nursing home. But they would have to

disinfect everything that is touching a different client to

another client.

So moving on to the next slide is cleaning

electronic equipment. The surfaces require consideration

of material. You have to be very careful again to avoid

making sure that you don't get any liquids on the

unprotected surfaces inside the computer or the electronic

devices. And workers need special training on equipment

for safe sanitization.

Computers and electronics also are sometimes

components of some of the durable medical equipment, such

as a power chair. And they require special procedures for

sanitization to ensure that the electronic components are

not damaged and that workers are not at risk of injury.

So this picture is about your space needs at your

reuse center. So you need to consider your safety

equipment. Do you have room to maybe have an eyewash

fountain?

Then your required work area. Do you have proper

setup?

Your space needs for cleaning the actual equipment.

Some of that we talked about before, such as the water and

power and what you might need.

And then actual appropriate storage of the tools,

supplies, and chemicals. Make sure that they're, you know,

not somewhere that anyone could just grab them and start

using them and think that they're just an everyday type of

cleaner and could hurt themselves possibly.

So some work area considerations. The devices to

be sanitized. Computers are a little bit more easily

sanitized on a workbench. You can have a couple more of

them maybe on a desk or on a workbench.

But then sanitizing durable medical equipment can

be facilitated by actually having a tile room with floor

drains and then easy access to water to rinse off the

equipment and use instead of having to stack everything up

on something.

So designing that work area. You want to identify

the activities and the amount of space needed to --

Hold on. I've got a question: "Does anyone have

any experience with the sanitizing wand? This slide is not

displaying properly for me, Lindsey. Lindsey is covering

the considerations."

Trish, I'm on slide "Designing the Work Area," and

it's coming up great for me.

And then I do not have any experience with the

sanitizing wand.

Does anyone here that's on the webinar have any

experience? I'll give up the mic for a second if y'all

would like to talk or just write it into the public-chat

area.

So Thom writes, "Do you mean a UV wand?"

And Zora writes, "Yes."

So (inaudible) out, Thom. So Thom says, "We looked

into getting one of those wands for Into New Hands. All my

research gives them a pretty high effectiveness rating."

So that might be something that Trish and I can

look into more and actually get some information on the

knowledge base about.

Thom also wrote, "I tend to use them on things I'd

not want to get wet."

And then Joy posted, "Verilux UV-C sanitizing wands

with Germ-X lightwave technology. The sanitizing wand is a

state-of-the-art home disinfecting tool that safely

eliminates germs, dust mites, and other microorganisms from

bedding and household surfaces without the use of harmful

chemicals. Designed to eradicate allergens, viruses,

fungus, mold spores, bacteria, and odors. The wand applies

the same technology used to disinfect drinking water and

sanitize hospitals to the invisible sources of contaminants

in your home."

Then Joy says, "It looks like there are many

kinds." So that's just one of them.

That sounds pretty cool. I hate that they brought

up the bed part. It always makes me think of all those

stories you hear about what's in your sheets.

All right. So that sounds pretty cool. Like I

said, Trish and I can probably look up more and get some

examples and put that on the knowledge base because it

sounds like it would be pretty darn useful. Thank you,

guys.

Okay. So back to designing -- yes. And Trish is

confirming with me. We'll check it out and add some

information. Thank you, Trish.

So the next is designing the work area. I think I

went through you want to identify those activities and

amounts of space needed to perform the tasks. You want to

define the flow of tasks and activities. You want to

measure the footprint of all the pieces of equipment and

workbenches and then map the dimensions of the available

work area and then start positioning work surfaces to fit

the work flow.

Identify where electrical outlets are, water

availability, drains, and ventilation are needed.

You can click the next slide, Trish. Trish says

this is the ideal scenario, but may have to adjust for

already being there. Very true. Very true.

So the next slide says "Laws and regulations

affecting workplace safety." So there's OSHA, federal

regulations, the EPA regulations, and then state and local

building codes are some of the things you might want to

look at for workplace safety.

Trish says, "The EPA is especially an issue for

chemical disposal." Thank you, Trish.

So if you've noticed, some of our graphics haven't

exactly come up in the slides. And of course this is one

of them, and the graphic is the main point.

But basically what it is is a layout of an AT

cleaning room like a tile room. And I'm 99 percent sure we

actually have this graphic in the knowledge base if you

want to see it.

Yeah, Trish. It's not showing up for us either.

But you guys can see what's in it. So it's

actually set up pretty much a rectangle. And they have an

automatic cleaning equipment. So that would be like the

Hubscrub is off to the left.

Across the room is where they actually have a tile

room with a drain. And in there they use a steamer, and so

that's in that room.

They also have -- then it would be down from the

Hubscrub, if you can picture it, a three-basin sink for

possibly cleaning it in one sink, setting it to the next

sink to completely dry, and then the third sink doing the

disinfectant on it.

Then it would kind of be under that tile room I was

just talking about. They actually have a washer and dryer.

So that comes in handy if you're getting possibly a lot of

cushions. Rip those covers right off. Or any cloth part

maybe that comes in a protection on a manual wheelchair you

can throw in the washer and dryer.

It also comes in possibly if you're going to buy

towels and not use disposable ones. You can throw them in

the washer and then just wash and dry them. Yeah.

And like I said again, that picture is on the

knowledge base on the Pass It On Center website.

So workplace safety involves the policies and

procedures that relate to overall safety, compliance with

the OSHA and EPA regulations, and specific requirements for

sanitizing assistive technology.

Worker training should include these policies and

procedures, the safe use of tools and chemicals, and the

use of appropriate personal protective equipment.

The last element that contributes to workplace

safety is a properly configured work area. This starts

with appropriate surfaces -- that is the plumbing, the

power, the ventilation -- that meets the needs of the

workers and the equipment. It takes into consideration the

space needs for the equipment, workers, functions, and

their activities that they'll be doing.

So some policies and procedures for sanitization.

The investigation of products and tools have been based on

some assumptions about the methods to be used to sanitize

assistive technology devices.

Those assumptions need to be turned into a formal

policy and very specific procedures. The policy may be a

simple statement indicating that all devices accepted into

the program for reuse will be sanitized before they are

placed in inventory for reassignment.

That one policy will require a number of procedures

to implement, from general workplace safety rules,

requiring worker trainings, types of worker personal

protective equipment required for a specific task,

procedures for their use, cleaning and storage of tools,

procedures for the use of and storage and disposal of

chemicals, and then requirements for the storage of

sanitized equipment.

This is not the subject of this webinar, but

policies and procedures underpin setting up a successful

sanitization program. The webinar package includes

guidelines for writing policies and procedures, a

recommended list, and a Mini-Guide to Sanitization.

The Mini-Guide provides even more background

information about sanitization and guides you through the

process of devising policies and procedures.

This is one of a series of proposed adapt and adopt

guides. That is it offers a model for the reuse program to

adapt to its specific needs and adopt as part of its

operating policies and procedures manual.

So Trish wrote in the public chat, "The webinar

package include a sample policy and procedures outline for

sanitization and workplace safety." Thank you, Trish.

So workers need the training. We want to review

the assistive technology program policies and procedures.

Explain the workplace safety, including those OSHA

regulations and operation of power devices, which sometimes

explaining why you're just not -- you know, you didn't make

up the rules. These are OSHA-approved regulations explains

and have people abide by them a little bit more. The use

of personal protective equipment. And then proper use,

storage, and disposal of the chemicals to avoid adding risk

to the sanitization process. These are all points you'd

like to cover.

So the next slide -- thank goodness the pictures

worked on this one because it would be a very blank slide

if we didn't have it -- is some examples of personal

protective equipment that you possibly would need: Gloves.

The pictures work, Trish, if you want to leave it.

But you want to have disposable gloves, protective

eye gear. You don't want any of those chemicals in your

eyes. Possibly even a face mask. You don't want to be

inhaling a whole bunch of dust or chemicals. Protective

footing gear. You don't want open toes that possibly a

piece of heavy equipment could come down on or possibly,

again, getting any of those chemicals onto your feet. The

girl right there has a protective apron on. Protecting

your clothes.

And, Trish, you're going to have to help me out

with that last one that's in the corner because I forgot

what that's a picture of.

And then Trish also says, "Remember that some

cleaning processes create aerosol contaminants and

chemicals."

An antistatic wristband for computer cleaning.

That's what that picture is in the bottom right.

And then Allan actually also listed possibly a back

brace for lifting heavy objects. That's a great one that

we didn't put on there. Thank you. So great point.

So the next slide is just listing those, but

they're really the essential elements of worker safety.

It's prevention here depending on the activity being

performed or the chemical or equipment being used.

So the supplies to protect workers. You want to

have plenty of disposable gloves. And I would say have

them everywhere so they're easily accessible that they

don't think, "Oh, I've got to go all the way over there to

get them."

Protective eye gear. I had mentioned something

about possibly even having an eyewash fountain if anything

were to happen. Nothing would happen if they had their eye

gear on.

A mask, depending on the activity that they're

doing.

Protective clothing again. For some of the bigger

equipment, if you're lifting it and getting it pretty close

to your body, you want that protective clothing, your

apron.

The antistatic wristband if you're working on any

computers or other power devices.

And then antiskid footwear should also be required

when doing any sanitization involving liquids. And that's

a great point. You don't want to have water on the floor

and then slip. Along with protecting your feet from

anything.

So this next slide is about our references, which I

know I've referenced many times and Trish has, too, which

Trish made a comment that says, "OSHA specifies when you

need to have eyewash stations." Thank you.

But on the Pass It On Center content in the

knowledge base, there is: The Mini-Guide to Sanitization;

Guidelines For Disinfection and Sterilization in Health

Care Facilities; Ten Ways to Find Safer and Greener

Cleaners, Toxic Use Reduction Institute; and Understanding

Sanitizers and Disinfectants, the Multi-Clean Technical

Bulletin in 2007.

And Trish says, "There's lots of checklists." We

do love our checklists at Pass It On.

And again, this is the same slide that was in the

beginning, but now we're offering CEUs and CRCs for these

webinars. So if you go ahead and go to those links, you

can get your CEUs and CRCs for this webinar.

And please, like I said in the beginning, also we

want your feedback. We want to know what you think. So

help us improve. Help us be better in serving your needs.

If you'd please complete a brief evaluation of

today's webinar at the link below. It's SurveyMonkey.com.

That would be great. We'd really appreciate it to know a

little bit more about what you thought and if we answered

those questions that you had about sanitization.

Trish says, "Thank you so much, and I'm so sorry my

sound was not better. It worked well during our precheck."

It sure did, Trish. No worries. We got it.

And the last slide is a thank you. So I'd like to

open up to any questions, comments, anything else that we

didn't cover. You guys want it in the knowledge base.

Please feel free.

I'll open up the mic. Or you can write in the

public-chat area to the right.

So George says, "Thank you for hosting this info."

And then also Trish says, "Any suggestions,

contributions to the knowledge base." Yep, we're always

looking for some more contributions to expand our knowledge

base. All right.

So Thom said that, "We're in the process of

redesigning our cleaning room. This is going to be a big

help." And that picture that didn't show up of the outline

of a sanitization room possibly might help.

Joy said that she really enjoyed this. Thanks.

Martha said, "Great job, Lindsey and Trish."

Thom said, "Thank you."

Kathe said, "Do you know of any centers that have

run into problems because of sanitization issues?"

I've heard a couple stories. One was actually here

in Missouri. And a person apparently said that there was

actually still feces on their piece of equipment. And it

did not come from Paraquad.

And so Carla and I quickly stepped in and referred

them to Pass It On Center knowledge base sanitization, very

large. It's something that I really feel some people

think, "Oh, I can wipe it down, and it's fine." But it's a

pretty serious issue.

I know -- too I've heard -- that staph infection

story that I was talking about, I've heard that happen

before. People have gotten some pretty serious illnesses

from equipment not getting cleaned properly. And that's,

you know, from your program, so the liability is coming

back on you.

B. Crosby says, "Thank you."

Paul George says, "Can you bring back the survey

page?"

Trish, can you do that, go back to the slide, I

believe it is 46.

Trish says, "Thom: We are planning to add plans

for building a cleaning room. A suggestion: Ask your

local DAL tile vendor to donate tile to you." That's a

good idea.

Vanessa says, "Thank you for the information."

Sonja says, "Good job."

Zona says, "Great job. Thanks."

Zachary, "Would something like Lysol work well for

general uses?"

We don't use any Lysol in our general uses. We

actually use the disinfectants that we buy that are

cleaners.

Trish, do you have more on that one?

Paul says "Thanks." (Audio skips) ... says thanks

(audio skips) ... Hubscrub units and this will help (audio

skips) ... of our training.

I'm sure it will. Five Hubscrubs that's great.

Then Trish says, "Use the commercial health care

version not the home version of Lysol products." Thank

you.

And before y'all get off, thank you so much. We

appreciate you listening and enjoying this webinar. Trish

and I had a great time doing it together. She put together

all the key slides.

And Trish says, "Thanks to all of you too."

And Zachary would like to know where he could get

that, the commercial health care version, so not the home

version?

Trish says check with a commercial products

provider online.

And Zach says, "Thank you."

Barclay is saying, "To tag along with Zachary's

question, any thoughts about presanitizing equipment that

has been donated before it gets fully cleaned in the

cleaning room? What products should we use or a car kit

when picking up equipment? Anyone have this?"

I would definitely say, when you're picking up

equipment, definitely having gloves and protective clothing

on when you're picking up any durable medical equipment.

We currently don't do any precleaning before it

gets a full cleaning in the cleaning room. We actually

just make sure it's in a designated spot where it's with

other dirty equipment and staff members are not around it

or other staff in our building that's not reuse staff can

access it.

Does anyone else out there do any precleaning?

And to get back on that, Barclay, also in the car

we do have like an emergency kit. He does have like an

apron and the eye guards, a mask, most of that equipment we

were talking about. They just don't suit up every single

time, but they do use the gloves every single time.

And Vanessa asks, "Could you find it at Home Depot

or Lowe's?"

And Trish said, "Yes. Some programs use

antibacterial wipes at donation events."

Oh, so she must have been saying yes to Vanessa.

And then some programs use the antibacterial wipes for

donation events and pickups.

That was a good idea for definitely an event.

Trish said, "Protective gear is important too."

Thom said, "We don't preclean, but we're getting a

kit together with gloves, plastic sheets, duct tape, maybe

one of the handheld UV wands."

I like those UV wands now. I've got to do a little

research on them.

Barclay said, "On the last webinar Kansas talked

about precleaning during donation drives. Just didn't know

if anyone had a kit."

I see.

And Thom says, "A willingness to say 'no thank you'

if the item is just too dirty."

Isn't that the truth?

Does anyone else have any questions or comments?

Paul says, "Plastic trash bags might work as a

protective barrier until items can be cleaned."

And Trish said, "That kit that you guys were

talking about is another good idea that we can put on the

knowledge base. And we'll pull the info together."

And Zachary says, "That's kind of why I was asking.

I don't want to offend the people by wearing aprons and

gloves when I'm picking up donated wheelchairs, but I want

to be safe about it."

You know, if people get a little offended about it,

I would say just explain it. Saying this is your practice

and procedures that you have created and your training that

you went through. This is the training. This is how we

handle each situation.

Because, yes, possibly they think their equipment

is possibly clean, but this is the precautions they take

with every person's equipment when they pick it up. They

don't want to risk one time possibly something happening.

It seems like usually a simple explanation sometimes works

out for people.

"How do you know if someone doesn't have intact

skin?"

I would say if they mention that they have a

pressure sore. And you're probably going to say -- you

know, you don't ask that, obviously, every time you're

picking up donated equipment, if someone had a pressure

sore. That would be the only way that I would know to ask.

I don't know if anyone else has any suggestions.

So Trish says, "You don't know if the donor did not

have intact skin. You just need to follow the procedures

to truly disinfect and guard against any disease

transmission."

Does anyone else have any questions or comments?

You guys have got great questions and are bringing up some

good points.

Zachary says, "Is there any sort of additive you

can put in a steam cleaner?"

And then Trish said, "If we do not cover an area of

concern, please e-mail us."

Trish's e-mail is trish@passitoncenter.org, and

mine is lindsey@passitoncenter.org.

Zachary, we use a steam cleaner in here. We don't

add an additive to it. Now, that's not to say that there

isn't one out there. I don't know of one out there right

now. Possibly anyone else on the webinar might.

Yeah, Trish says she's not familiar with the

additives for steam cleaners.

But I think it's the heat that's doing the actual

cleaning.

And then Joy just commented, "I think you could say

to donors ahead of time that your staff always uses

protective gloves as a procedure for everyone."

Yeah. That's kind of what I was saying. It's your

policy and procedure, and that's how you pick up equipment,

taking all precautions.

Does anyone else have any comments or questions?

Trish says, "I wonder if all programs have

workplace safety training orientation."

And Zachary said, "Thanks. It's been helpful."

We don't here at Paraquad have training

orientation, but I do know that we have certain rules we

have to follow if we're going to be in the sanitization

room.

We also have an accessible gym, and that's another

place where the biggest one there is wearing the closed-toe

shoes with gripping soles. But we don't have an actual

orientation on it.

Trish says, "I wonder if a general workplace safety

presentation that could be customized to the program would

be a useful addition to the knowledge base."

Any comments? My vote on that one is "yes" right

away. What does anyone else say about that, creating a

customizable presentation about safety that programs could

pull off the knowledge base and use?

So Kathe says, "I think it would be helpful."

I agree completely.

Joy asks, "Would it be a video? That would be very

helpful."

We could almost do a little bit of each, have a

video and then also have a PowerPoint with some of those

slides that we just had in here.

Trish is on the same page. We could do a

PowerPoint and video with some support.

Joy says, "You could have posters that could be

customized."

Yeah, to just keep up there and remind people of

the process and how to do it.

Kathe says, "Do you have any idea or comments that

various centers may be placing on their websites regarding

the sanitization of equipment?"

I don't off the top of my head.

And Trish just said, "I've not seen any comments,

and I scanned a lot of program sites a few months ago."

Trish says, "That might be a good addition to the

site to explain what you do to sanitize."

Yep. And I think, Trish, too, we have different

programs that have submitted some of their sanitization

information, like Kansas and a couple other places.

Then Kathe writes, "And to make certain that people

who are receiving equipment do not interpret sanitization

as sterilization."

Trish wrote, "We have lots of information from

programs. Kansas, Paraquad, Project MEND, and the entire

STAR manual is in the knowledge base."

Yeah, that interpreting sanitization not as

sterilization is a good point. But I've -- in just over

experience with our program, some people just seem to want

to get the equipment. Sometimes they don't care if it's

been through a mud pit. They just want it. They don't

care.

And I've noticed myself actually having to explain

to people the importance of making sure it's clean, making

sure a repair technician has looked at it, making sure it's

back to the manufacturer's standards and all that. But

yeah, that's for sure.

Naomi put, "It's important, though, to know when

one is needed over the other."

Yes, this is true.

Trish wrote, "Sterilization is not possible without

highly sophisticated equipment."

So I have -- it's 2:25 my time, and here's a couple

of questions coming in or comments.

"Perhaps a step-by-step video example might be good

to have."

And then Joy put, "I understood earlier that

sterilization is only needed for items that contain mucus

membranes (audio skipped) ... or transferring any fluids or

gases, any of those tubes also."

And Trish wrote, "If we use the appropriate

disinfectants (inaudible) ... I think we will have safe

equipment."

Trish put, "We are working on a step-by-step video

to supplement our knowledge base content."

Does anyone else have any comments or questions?

Definitely appreciate all your suggestions. And that's

what we're here for, to do what you guys want and what you

need to know.

And Trish wrote, "Thanks so much to all the

participants. We hope you join us at our next webinar on

August 31st."

I agree. It was my pleasure. And thank you all

for bearing with us and going through this PowerPoint with

us. And if there's no more questions or comments, we can

call it a day.

Kathe says, "Thank you."

Naomi says, "Thanks."

Caroline Van Howe says, "Great job, Lindsey and

Trish."

Thank you, Caroline, for being on, too, and helping

us out. We appreciate it.

Vanessa says, "Thank you, and have a good evening."

Yes. You all too. I hope y'all have good weather.

Thank you, and have a good evening also.