December 6, 2012 — An assessment of the level of decontamination required of CPR manikins used during training classes and covered with a protective sheath is similar in a few aspects to that of the level of disinfection required of reusable probes that were covered with a protective sheath during a pulmonary, gastrointestinal or laryngeal procedure.
Any moisture or visible soil or debris (e.g., blood) that is observed on the manikin’s face and inside its mouth (whether or not a protective sheath was used) presents a manifest infection-control concern. Inadequately cleaned manikins could be a source of contamination and a vehicle of disease transmission between its uses by trainees.
Based on currently available data, it is my recommendation that the manikin’s surfaces, covered with a disposable face shield, be disinfected after each trainee’s use (not after multiple uses) and as if no face shield had been used.
The manikin would be considered a non-critical device for which low-level (or intermediate-level) disinfection of its potentially contaminated surfaces would be indicated. Several methods can be used to achieve this outcome, including vigorous wiping of the manikin’s face (and mouth) after each trainee’s use with a 4″ x 4″ gauze pad wetted with 70% isopropyl alcohol or a comparable disinfecting product. (I favor the use of a wipe that provides specific instructions on its labeling for achieving low-level or intermediate-level disinfection of surfaces.)
I am comfortable with (diluted) bleach being used to clean and disinfect the manikin’s potentially contaminated surfaces after each trainee’s use (e.g., at least 500 ppm available chlorine for 10 minutes), provided the manikin is made of materials that would not be damaged by this disinfectant. Use of an effective disinfectant that damages the manikin’s surfaces is problematic and merely robs Peter to pay Paul.
In short, I recommend, at the very least, wiping the manikin’s potentially contaminated surfaces with a 70% alcohol pad after each trainee’s use, no matter whether a face shield was used. If visible debris remains on the manikin, this process would be repeated until it is clean.
For reference, please refer to the paradigm discussed in the following article I wrote on a related topic: Muscarella LF. Recommendations to resolve inconsistent guidelines for the reprocessing of sheathed and unsheathed rigid laryngoscopes. Infect Control Hosp Epidemiol. 2007 Apr;28(4):504-7. Also refer to: New York State Department of Health. Re: Infection Control – CPR Manikins. No. 86-02; Date: 01/14/86.
Article by: Lawrence F Muscarella PhD. Posted on December 6, 2012.
What do you recommend for the cleaning of the manikin chests, hair and necks as a standard at the end of the class?
Dear Ms. Bowtle, Thank you for your inquiry. I recommend application of the same paradigm to these other surfaces as for the manikin’s face. Any moisture or visible soil or debris (e.g., blood) that is observed on the manikin’s chest or neck could pose an increased risk of exposure of trainees to potentially infectious diseases. The manikin would be considered a non-critical device for which low-level (or intermediate-level) disinfection of these surfaces would be indicated for the safety of each trainee.