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Mannequin Cleaning - Recommendations
Purchases of training mannequins should thoroughly examine the manufacturers’ recommendations and provisions for sanitary practices. Students should be told in advance that the training sessions will involve "close physical contact" with their fellow students. Students should not actively participate in training sessions (hands-on training with mannequins) if they have dermatological lesions on hands or in oral or circumoral areas, if they are known to be seropositive for hepatitis B surface antigen (HbsAq), if they have upper respiratory tract infections, if they have Acquired Immunodeficiency Syndrome (AIDS), or if the student has reason to believe that he or she has been exposed to or is in the active stage of an infectious process. If more one mannequin is used in a particular training class, students should preferably be assigned in pairs, with each pair having contact with only one mannequin. This would lessen the possible contamination of several mannequins by one individual and therefore limit possible exposures or other class members. All persons responsible for CPR training should be thoroughly familiar with hygienic concepts (e.g. thorough hand washing prior to mannequin contact, not eating during class to avoid contamination of mannequins with food particles, etc.) as well as the procedures for cleaning and maintaining mannequins and accessories (e.g. face shield). Mannequins should be inspected routinely for signs of physical deterioration, such as cracks or tears in plastic surfaces, which make thorough cleaning difficult or impossible. The clothes and hair of mannequins should be washed periodically e.g. monthly or whenever visibly soiled. During the training of two-rescuer CPR, there is no opportunity to disinfect the mannequin between students when "switching procedure" is practiced. In order to limit the potential for disease transmission during this exercise, the second student taking over ventilation on the mannequin should simulate ventilation instead of blowing into the mannequin. This recommendation is consistent with current training recommendations of the American Red Cross and the American Heart Association. Training of the “obstructed airway procedure” involves the student using his or her finger to sweep foreign matter out of mannequin’s mouth. This action could contaminate the student’s finger with exhaled moisture and saliva from previous students in the same class and/or contaminate the mannequin with material from the student’s finger. When practicing this procedure, the finger sweep should either be simulated or done on a mannequin whose airway was decontaminated after the procedure. At the end of each class, the procedures listed below should be followed as soon as possible to avoid drying of contamination on mannequin surfaces:
Each time a different student uses the mannequin in a training class, the individual protective face shield, if used, should be changed. Between students or after the instructor demonstrates a procedure such as clearing any obstruction from the airway, the mannequin face and inside the mouth should be wiped vigorously with clean absorbent material (e.g. 4” x 4” gauze pad) wet with either the hypochlorite solution described in recommendation #8 above or with 7% alcohol (isopropanol or ethanol). The surfaces should remain wet for at least 30 seconds before they are wiped dry with a second piece of clean absorbent material. We are somewhat reluctant to recommend use of alcohols in this instance and to do so only as an alternative, since some persons find the odor of hypochlorite objectionable. Although highly bactericidal, alcohols are not considered primarily as an aid in mechanical cleaning; also, in a short contact period alcohols may not be effective against bacteria or other pathogens. Nonetheless, in the context of vigorous cleaning with alcohol and absorbent material, little viable microbial contamination of any kind is likely after the cleaning procedure. People responsible for the use and maintenance of CPR mannequins should be encouraged not to rely totally on the mere presence of a disinfectant to protect them and their students from cross-infection during training programs. Emphasis should be placed on the necessity of thorough physical cleaning (scrubbing, wiping) as the first step in an effective decontamination protocol. Microbial contamination is easily removed from smooth, non-porous surfaces by using disposable cleaning cloths moistened with a detergent solution, and there is no evidence that a soaking procedure alone in any liquid is as effective as the same procedure accompanied by a vigorous scrubbing. With specific regard to recent concerns about potential for hepatitis B and AIDS transmission in CPR training, it has recently been shown that the hepatitis B virus is not as resistant to disinfectant chemicals as it was once thought to be. Current recommendations for strategies dealing with AIDS contamination are the same as those for viral hepatitis B. These guidelines for mannequin decontamination appear with permission from the Heart & Stroke Foundation of Canada. This information appears in the "HSFS BLS Instructors Handbook - 1996." |
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