Baron cockroach spray — reviews, instructions, recommendations


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Spring Cleaning

Apr 24, 2020 | 0 Comments

Spring showers bring May flowers, and weeds. This is an ideal time to spruce up the yard and perhaps, with the help of the professionals at Baron Services transform it into a showpiece. Imagine your yard as a desert oasis. During a consultation Baron Services will.

A Social Distancing Oasis

Mar 28, 2020 | 0 Comments

Spring is here and summer temperatures are not far behind. This is the perfect time to call the professionals at Baron Services and transform your swimming pool into the perfect social distancing oasis. And if you don’t have a swimming pool, well, Baron Services can.

The Stuff of Nightmares

Feb 27, 2020 | 0 Comments

There is just something otherworldly about the spider that sends an involuntary shudder down the spine. There is even a term for a fear of spiders — arachnophobia. And the fear factor associated with these multi-legged critters has been exploited in countless movies.

I tried the cult-favorite hair dryer with 33,000+ rave reviews—here’s what happened

This thing has thousands upon thousands of rave reviews. Too good to be true?

Updated March 4, 2020

Recommendations are independently chosen by Reviewed’s editors. Purchases you make through our links may earn us a commission.

This isn’t a product review. It’s a save-the-date to the wedding of my dreams. I’m marrying the Revlon One-Step Hair Dryer and Volumizer and I don’t care what the town clerk has to say.

This whole relationship began when Reviewed’s social media manager, Kate McCarthy, told me about a magical brush that dries your hair and styles it perfectly at the same time. Much like someone who is single and sick of being set up on fruitless blind dates, I was curious but didn’t immediately make plans to try it out. Then the internet blew up with testimonials of the Revlon dryer and I couldn’t ignore it anymore. Our first date was a Saturday and I had dinner plans with friends after, so I was prepared to either talk crap or profess my infatuation, as one does after that first IRL rendezvous. As you now know, it was love.

OK, the hair dryer personification ends now. Let’s talk about why this tool is magic, and how it cut my hair styling routine in half.

What is the Revlon One-Step Hair Dryer and Volumizer and what does it claim?

The Revlon One-Step Hair Dryer and Volumizer uses nylon pins and tufted bristles that grasp the hair while the hot air flow dries and smooths it.

As its name suggests, this tool from Revlon is designed to be a one-and-done solution for hair styling, meaning you don’t need to break out the hair dryer, round brush, and flat iron to get a professional-looking blowout at home. Every aspect of the One-Step’s design is deliberate and serves a purpose, according to Revlon. Using nylon pins and tufted bristles, the company claims the dryer helps detangle locks as you use it. With an oval-shaped barrel instead of round, the brush smooths the hair on the longer, flat side of the oval and volumizes it on the shorter, round side. It also claims that it has “Ionic Technology” that conditions, smooths, adds shine, and reduces frizz and static.

These are lofty claims, and after reading them, I expected a fast, sleek, and voluminous blowout—a tall order without going to the salon. It always seems like something has to give: You can give yourself a great blowout at home but it takes longer, or you can get your locks from soaking to dry quickly, but forfeit the smooth-yet-voluminous style you hoped for. But this dryer is a unicorn and the 30,000 (and counting) Amazon reviews and a 4.4-star rating is a great reassurance of that.

How does the Revlon One-Step Hair Dryer and Volumizer work?

To achieve the best style, the instructions say to grab “manageable” sections of damp, detangled hair. I pinned my freshly washed and combed-through hair into a clip at the top of my head, then let down the first layer and applied my Redken heat protectant from mid-shaft to end. I repeated this same process each time before going in with the One-Step on the high setting—the instructions say to use high for coarse hair and low for fine hair, but I always use high on my medium-textured, wavy-curly hair. I ran the brush under or over each small section of hair, starting at the root and slowly gliding it down through the ends. For best results, you want to hold the brush at the roots for a few seconds to make sure they are completely dry before you continue working downward. Focusing on the root, in my experience, is the key to achieving great volume and avoiding any greasiness caused by the roots not fully drying.

How does the Revlon One-Step Hair Dryer and Volumizer compare to a typical hair dryer?

The Revlon One-Step Hair Dryer and Volumizer eliminates the need for a round brush.

When I use a hair dryer, I have two options: 1. Blow air at my head to get my hair dry but know that it’s going to end up a poofy mess and I’ll have to go in with a flat iron after. Or 2. Use a round brush and work section by section to dry my hair into smooth strands, but still go in with a straightener to fix errant kinks and flyaways. It feels like a lose-lose ordeal and I often dread the styling process, but I do it a couple times a week because I (sadly) don’t feel very confident with my air-dried hair.

The Revlon doesn’t require holding a hair dryer in one hand and a brush in the other, but it achieves the same results as using those two tools because it is a round brush and a steady stream of air in one. With this tool, I skipped the poofy stage of the drying process and went right from wet, limp hair to dry, straight strands. Not having to take out a flat iron after saved me at least 15 minutes, and the drying process itself only took me about 30 minutes, or about how long it usually takes to get my hair straightener-ready with a normal dryer.

Is the Revlon One-Step Hair Dryer and Volumizer damaging to hair?

We tested the Revlon One-Step Hair Dryer and Volumizer in our lab to see how hot it gets after 30 minutes of use.

One of my concerns was that the Revlon’s metal barrel, which comes into direct contact with your hair, got burning hot to the touch and I theorized that the air stream had to also be very hot in order for me to see such great results. As someone with damaged (read: bleached and often heat-styled) hair, I worried that the Revlon would be worse for my hair than a typical dryer.

To ease my concerns and give you, the reader, a better idea of how hot the Revlon gets, we placed a heat sensor among the bristles (where your hair rests as you’re using the dryer) and ran it for 30 minutes (about how long it takes to dry my hair). We recorded a maximum temperature range of 165°F to 175°F. Because our heat sensor is metal, the heat transfers faster and holds longer to it than it would to your hair, so your hair likely wouldn’t actually heat up that high. While it’s not a perfect correlation because you’d use them differently, for the sake of comparison, we ought to mention that our Best Overall hairdryer, the Bio Ionic, reached a high temperature of 153°F in a 30-minute air flow test. The conclusion we can draw from this is that the Revlon is in the same ballpark as a typical hair dryer in terms of hot air flow.

As your hair lies directly against the surface of the Revlon’s barrel, we also took temps of the metal itself during a 30-minute run. We recorded a maximum heat range of 160°F to 165°F, which is significantly lower than even the minimum temperature on most flat irons and curling irons, both of which can heat up from 300°F to 400°F or more. This further set me at ease, knowing I could skip my flat iron entirely (and that extra 15 minutes of even hotter heat exposure) and still get the style I wanted from the Revlon alone.

Still, as with any hot tools, using the Revlon in excess is not healthy for your hair, especially if you’re not using a heat-protectant spray or cream to act as a barrier between your hair and the heat. So do yourself and your locks a favor and use one, no matter which hot appliance you use.

Does the Revlon One-Step Hair Dryer and Volumizer do what it claims?

My hair during and after using the Revlon One-Step Hair Dryer and Volumizer.

Absolutely. With this tool, you don’t need a straightener or curling iron to leave the house with a sleek, finished-looking style. With minimal effort, you can dry your hair from root to tip and customize your ‘do to have more or less volume and curls inward or outward at the ends. The tool feels a bit bulky to hold, as it is longer than a typical hair dryer and requires two hands to balance well, but it eliminates the juggling act of holding a dryer with a brush, which makes it overall easier to manage.

Is the Revlon One-Step Hair Dryer and Volumizer worth it?

We all need a Revlon One-Step Hair Dryer and Volumizer.

Yes, yes, yes. Well, unless shiny, straight, soft, bouncy locks are not your thing. But for everyone else, it’s totally worth it. I’m planning to buy my own now that testing is done and I also want to buy one for my mom, who currently uses the Revlon One-Step Hair Dryer and Styler, which has a similar build but features a square paddle brush at the end. Spoiler: That one doesn’t work nearly as well.

Get the Revlon One-Step Hair Dryer and Volumizer on Amazon for $58

The product experts at Reviewed have all your shopping needs covered. Follow Reviewed on Facebook, Twitter, and Instagram for the latest deals, product reviews, and more.

Prices were accurate at the time this article was published but may change over time.

Recommendations for Disinfection and Sterilization in Healthcare Facilities

Guideline for Disinfection and Sterilization in Healthcare Facilities (2008)

A. Rationale

The ultimate goal of the Recommendations for Disinfection and Sterilization in Health-Care Facilities, 2008, is to reduce rates of health-care associated infections through appropriate use of both disinfection and sterilization. Each recommendation is categorized according to scientific evidence, theoretical rationale, applicability, and federal regulations. Examples are included in some recommendations to aid the reader; however, these examples are not intended to define the only method of implementing the recommendation. The CDC system for categorizing recommendations is defined in the following (Rankings) section.

B. Rankings

Category IA. Strongly recommended for implementation and strongly supported by well-designed experimental, clinical, or epidemiologic studies.

Category IB. Strongly recommended for implementation and supported by some experimental, clinical, or epidemiologic studies, and by a strong theoretical rationale.

Category IC. Required by state or federal regulations. Because of state differences, readers should not assume that the absence of an IC recommendation implies the absence of state regulations.

Category II. Suggested for implementation and supported by suggestive clinical or epidemiologic studies or by a theoretical rationale.

No recommendation. Unresolved issue. These include practices for which insufficient evidence or no consensus exists regarding efficacy.

C. Recommendations

1. Occupational Health and Exposure
  1. Inform each worker of the possible health effects of his or her exposure to infectious agents (e.g., hepatitis B virus [HBV], hepatitis C virus, human immunodeficiency virus [HIV]), and/or chemicals (e.g., EtO, formaldehyde). The information should be consistent with Occupational Safety and Health Administration (OSHA) requirements and identify the areas and tasks in which potential exists for exposure. Category II, IC. 214, 320, 959, 997, 998
  2. Educate health-care workers in the selection and proper use of personal protective equipment (PPE). Category II, IC.
  3. Ensure that workers wear appropriate PPE to preclude exposure to infectious agents or chemicals through the respiratory system, skin, or mucous membranes of the eyes, nose, or mouth. PPE can include gloves, gowns, masks, and eye protection. The exact type of PPE depends on the infectious or chemical agent and the anticipated duration of exposure. The employer is responsible for making such equipment and training available. Category II, IC. 214, 997-999
  4. Establish a program for monitoring occupational exposure to regulated chemicals (e.g., formaldehyde, EtO) that adheres to state and federal regulations. Category II, IC. 997, 1000, 1001
  5. Exclude healthcare workers with weeping dermatitis of hands from direct contact with patient-care equipment. Category IB. 1002, 1003
2. Cleaning of Patient-Care Devices
  1. In hospitals, perform most cleaning, disinfection, and sterilization of patient-care devices in a central processing department in order to more easily control quality. Category II. 454, 836, 959
  2. Meticulously clean patient-care items with water and detergent, or with water and enzymatic cleaners before high-level disinfection or sterilization procedures. Category IB. 6, 83, 101, 104-106, 124, 179, 424-426, 436, 465, 471, 911-913, 1004
    1. Remove visible organic residue (e.g., residue of blood and tissue) and inorganic salts with cleaning. Use cleaning agents that are capable of removing visible organic and inorganic residues. Category IB. 424-426, 466, 468, 469, 471, 908, 910
    2. Clean medical devices as soon as practical after use (e.g., at the point of use) because soiled materials become dried onto the instruments. Dried or baked materials on the instrument make the removal process more difficult and the disinfection or sterilization process less effective or ineffective. Category IB. 55, 56, 59, 291, 465, 1005, 1006
  3. Perform either manual cleaning (i.e., using friction) or mechanical cleaning (e.g., with ultrasonic cleaners, washer-disinfector, washer-sterilizers). Category IB. 426, 456, 471, 999
  4. If using an automatic washer/disinfector, ensure that the unit is used in accordance with the manufacturer’s recommendations. Category IB. 7, 133, 155, 725
  5. Ensure that the detergents or enzymatic cleaners selected are compatible with the metals and other materials used in medical instruments. Ensure that the rinse step is adequate for removing cleaning residues to levels that will not interfere with subsequent disinfection/sterilization processes. Category II. 836, 1004
  6. Inspect equipment surfaces for breaks in integrity that would impair either cleaning or disinfection/sterilization. Discard or repair equipment that no longer functions as intended or cannot be properly cleaned, and disinfected or sterilized. Category II. 888
3. Indications for Sterilization, High-Level Disinfection, and Low-Level Disinfection
  1. Before use on each patient, sterilize critical medical and surgical devices and instruments that enter normally sterile tissue or the vascular system or through which a sterile body fluid flows (e.g., blood). See recommendation 7g for exceptions. Category IA. 179, 497, 821, 822, 907, 911, 912
  2. Provide, at a minimum, high-level disinfection for semicritical patient-care equipment (e.g., gastrointestinal endoscopes, endotracheal tubes, anesthesia breathing circuits, and respiratory therapy equipment) that touches either mucous membranes or nonintact skin. Category IA. 6-8, 17, 20, 99, 101, 108, 113-115, 129, 138, 139, 147, 152-154, 471, 1007
  3. Perform low-level disinfection for noncritical patient-care surfaces (e.g., bedrails, over-the-bed table) and equipment (e.g., blood pressure cuff) that touch intact skin (see Recommendation 5g). Category II. 17, 46-48, 50-52, 67, 68, 372, 373, 378, 382, 401
4. Selection and Use of Low-Level Disinfectants for Noncritical Patient-Care Devices
  1. Process noncritical patient-care devices using a disinfectant and the concentration of germicide listed in Table 1. Category IB. 17, 46-48, 50-52, 67, 68, 378, 382, 401
  2. Disinfect noncritical medical devices (e.g., blood pressure cuff) with an EPA-registered hospital disinfectant using the label’s safety precautions and use directions. Most EPA-registered hospital disinfectants have a label contact time of 10 minutes. However, multiple scientific studies have demonstrated the efficacy of hospital disinfectants against pathogens with a contact time of at least 1 minute. By law, all applicable label instructions on EPA-registered products must be followed. If the user selects exposure conditions that differ from those on the EPA-registered product label, the user assumes liability from any injuries resulting from off-label use and is potentially subject to enforcement action under FIFRA. Category IB. 17, 47, 48, 50, 51, 53-57, 59, 60, 62-64, 355, 378, 382
  3. Ensure that, at a minimum, noncritical patient-care devices are disinfected when visibly soiled and on a regular basis (such as after use on each patient or once daily or once weekly). Category II. 378, 380, 1008
  4. If dedicated, disposable devices are not available, disinfect noncritical patient-care equipment after using it on a patient who is on contact precautions before using this equipment on another patient. Category IB. 47, 67, 391, 1009
5. Cleaning and Disinfecting Environmental Surfaces in Healthcare Facilities
    1. Clean housekeeping surfaces (e.g., floors, tabletops) on a regular basis, when spills occur, and when these surfaces are visibly soiled. Category II. 23, 378, 380, 382, 1008, 1010
    2. Disinfect (or clean) environmental surfaces on a regular basis (e.g., daily, three times per week) and when surfaces are visibly soiled. Category II. 378, 380, 402, 1008
    3. Follow manufacturers’ instructions for proper use of disinfecting (or detergent) products — such as recommended use-dilution, material compatibility, storage, shelf-life, and safe use and disposal. Category II. 327, 365, 404
    4. Clean walls, blinds, and window curtains in patient-care areas when these surfaces are visibly contaminated or soiled. Category II. 1011
    5. Prepare disinfecting (or detergent) solutions as needed and replace these with fresh solution frequently (e.g., replace floor mopping solution every three patient rooms, change no less often than at 60-minute intervals), according to the facility’s policy. Category IB. 68, 379
    6. Decontaminate mop heads and cleaning cloths regularly to prevent contamination (e.g., launder and dry at least daily). Category II. 68, 402, 403
    7. Use a one-step process and an EPA-registered hospital disinfectant designed for housekeeping purposes in patient care areas where
      1. uncertainty exists about the nature of the soil on the surfaces (e.g., blood or body fluid contamination versus routine dust or dirt); or
      2. uncertainty exists about the presence of multidrug resistant organisms on such surfaces. See Recommendation 5n for recommendations requiring cleaning and disinfecting blood-contaminated surfaces.

      Category II. 23, 47, 48, 51, 214, 378, 379, 382, 416, 1012

    8. Detergent and water are adequate for cleaning surfaces in nonpatient-care areas (e.g., administrative offices). Category II. 23
    9. Do not use high-level disinfectants/liquid chemical sterilants for disinfection of non-critical surfaces. Category IB. 23, 69, 318
    10. Wet-dust horizontal surfaces regularly (e.g., daily, three times per week) using clean cloths moistened with an EPA-registered hospital disinfectant (or detergent). Prepare the disinfectant (or detergent) as recommended by the manufacturer. Category II. 68, 378, 380, 402, 403, 1008
    11. Disinfect noncritical surfaces with an EPA-registered hospital disinfectant according to the label’s safety precautions and use directions. Most EPA-registered hospital disinfectants have a label contact time of 10 minutes. However, many scientific studies have demonstrated the efficacy of hospital disinfectants against pathogens with a contact time of at least 1 minute. By law, the user must follow all applicable label instructions on EPA-registered products. If the user selects exposure conditions that differ from those on the EPA-registered product label, the user assumes liability for any injuries resulting from off-label use and is potentially subject to enforcement action under FIFRA. Category II, IC. 17, 47, 48, 50, 51, 53-57, 59, 60, 62-64, 355, 378, 382
    12. Do not use disinfectants to clean infant bassinets and incubators while these items are occupied. If disinfectants (e.g., phenolics) are used for the terminal cleaning of infant bassinets and incubators, thoroughly rinse the surfaces of these items with water and dry them before these items are reused. Category IB. 17, 739, 740
    13. Promptly clean and decontaminate spills of blood and other potentially infectious materials. Discard blood-contaminated items in compliance with federal regulations. Category IB, IC. 214
    14. For site decontamination of spills of blood or other potentially infectious materials (OPIM), implement the following procedures. Use protective gloves and other PPE (e.g., when sharps are involved use forceps to pick up sharps, and discard these items in a puncture-resistant container) appropriate for this task. Disinfect areas contaminated with blood spills using an EPA-registered tuberculocidal agent, a registered germicide on the EPA Lists D and E (i.e., products with specific label claims for HIV or HBV or freshly diluted hypochlorite solution. Category II, IC. 214, 215, 557, 1013
      1. * If sodium hypochlorite solutions are selected use a 1:100 dilution (e.g., 1:100 dilution of a 5.25-6.15% sodium hypochlorite provides 525-615 ppm available chlorine) to decontaminate nonporous surfaces after a small spill (e.g., 10 mL) of blood or OPIM, or involves a culture spill in the laboratory, use a 1:10 dilution for the first application of hypochlorite solution before cleaning in order to reduce the risk of infection during the cleaning process in the event of a sharp injury. Follow this decontamination process with a terminal disinfection, using a 1:100 dilution of sodium hypochlorite. Category IB, IC. 63, 215, 557
    15. If the spill contains large amounts of blood or body fluids, clean the visible matter with disposable absorbent material, and discard the contaminated materials in appropriate, labeled containment. Category II, IC. 44, 214
    16. Use protective gloves and other PPE appropriate for this task. Category II, IC. 44, 214

      Update: Recommendation 5.q. was updated to reflect changes in Federal regulatory approvals: LIST K: EPA’s Registered Antimicrobial Products Effective against Clostridium difficile Spores external icon

      6. Disinfectant Fogging
      1. Do not perform disinfectant fogging for routine purposes in patient-care areas. Category II. 23, 228

      Clarification Statement: CDC and HICPAC have recommendations in both 2003 Guidelines for Environmental Infection Control in Health-Care Facilities and the 2008 Guideline for Disinfection and Sterilization in Healthcare Facilities that state that the CDC does not support disinfectant fogging. Specifically, the 2003 and 2008 Guidelines state:

      • 2003: “Do not perform disinfectant fogging for routine purposes in patient-care areas. Category IB”
      • 2008: “Do not perform disinfectant fogging in patient-care areas. Category II”

      These recommendations refer to the spraying or fogging of chemicals (e.g., formaldehyde, phenol-based agents, or quaternary ammonium compounds) as a way to decontaminate environmental surfaces or disinfect the air in patient rooms. The recommendation against fogging was based on studies in the 1970’s that reported a lack of microbicidal efficacy (e.g., use of quaternary ammonium compounds in mist applications) but also adverse effects on healthcare workers and others in facilities where these methods were utilized. Furthermore, some of these chemicals are not EPA-registered for use in fogging-type applications.

      These recommendations do not apply to newer technologies involving fogging for room decontamination (e.g., ozone mists, vaporized hydrogen peroxide) that have become available since the 2003 and 2008 recommendations were made. These newer technologies were assessed by CDC and HICPAC in the 2011 Guideline for the Prevention and Control of Norovirus Gastroenteritis Outbreaks in Healthcare Settings, which makes the recommendation:

      “More research is required to clarify the effectiveness and reliability of fogging, UV irradiation, and ozone mists to reduce norovirus environmental contamination. (No recommendation/unresolved issue)”

      The 2003 and 2008 recommendations still apply; however, CDC does not yet make a recommendation regarding these newer technologies. This issue will be revisited as additional evidence becomes available.

      7. High-Level Disinfection of Endoscopes
      1. To detect damaged endoscopes, test each flexible endoscope for leaks as part of each reprocessing cycle. Remove from clinical use any instrument that fails the leak test, and repair this instrument. Category II. 113, 115, 116
      2. Immediately after use, meticulously clean the endoscope with an enzymatic cleaner that is compatible with the endoscope. Cleaning is necessary before both automated and manual disinfection. Category IA. 83, 101, 104-106, 113, 115, 116, 124, 126, 456, 465, 466, 471, 1015
      3. Disconnect and disassemble endoscopic components (e.g., suction valves) as completely as possible and completely immerse all components in the enzymatic cleaner. Steam sterilize these components if they are heat stable. Category IB. 115, 116, 139, 465, 466
      4. Flush and brush all accessible channels to remove all organic (e.g., blood, tissue) and other residue. Clean the external surfaces and accessories of the devices by using a soft cloth or sponge or brushes. Continue brushing until no debris appears on the brush. Category IA. 6, 17, 108, 113, 115, 116, 137, 145, 147, 725, 856, 903
      5. Use cleaning brushes appropriate for the size of the endoscope channel or port (e.g., bristles should contact surfaces). Cleaning items (e.g., brushes, cloth) should be disposable or, if they are not disposable, they should be thoroughly cleaned and either high-level disinfected or sterilized after each use. Category II. 113, 115, 116, 1016
      6. Discard enzymatic cleaners (or detergents) after each use because they are not microbicidal and, therefore, will not retard microbial growth. Category IB. 38, 113, 115, 116, 466
      7. Process endoscopes (e.g., arthroscopes, cystoscope, laparoscopes) that pass through normally sterile tissues using a sterilization procedure before each use; if this is not feasible, provide at least high-level disinfection. High-level disinfection of arthroscopes, laparoscopes, and cystoscopes should be followed by a sterile water rinse. Category IB. 1, 17, 31, 32, 35, 89, 90, 113, 554
      8. Phase out endoscopes that are critical items (e.g., arthroscopes, laparoscopes) but cannot be steam sterilized. Replace these endoscopes with steam sterilizable instruments when feasible. Category II.
      9. Mechanically clean reusable accessories inserted into endoscopes (e.g., biopsy forceps or other cutting instruments) that break the mucosal barrier (e.g., ultrasonically clean biopsy forceps) and then sterilize these items between each patient. Category IA. 1, 6, 8, 17, 108, 113, 115, 116, 138, 145, 147, 153, 278
      10. Use ultrasonic cleaning of reusable endoscopic accessories to remove soil and organic material from hard-to-clean areas. Category II. 116, 145, 148
      11. Process endoscopes and accessories that contact mucous membranes as semicritical items, and use at least high-level disinfection after use on each patient. Category IA. 1, 6, 8, 17, 108, 113, 115, 116, 129, 138, 145-148, 152-154, 278
      12. Use an FDA-cleared sterilant or high-level disinfectant for sterilization or high-level disinfection (Table 1). Category IA. 1, 6-8, 17, 85, 108, 113, 115, 116, 147
      13. After cleaning, use formulations containing glutaraldehyde, glutaraldehyde with phenol/phenate, ortho-phthalaldehyde, hydrogen peroxide, and both hydrogen peroxide and peracetic acid to achieve high-level disinfection followed by rinsing and drying (see Table 1 for recommended concentrations). Category IB. 1, 6-8, 17, 38, 85, 108, 113, 145-148
      14. Extend exposure times beyond the minimum effective time for disinfecting semicritical patient-care equipment cautiously and conservatively because extended exposure to a high-level disinfectant is more likely to damage delicate and intricate instruments such as flexible endoscopes. The exposure times vary among the Food and Drug Administration (FDA)-cleared high-level disinfectants (Table 2). Category IB. 17, 69, 73, 76, 78, 83
      15. Federal regulations are to follow the FDA-cleared label claim for high-level disinfectants. The FDA-cleared labels for high-level disinfection with >2% glutaraldehyde at 25°C range from 20-90 minutes, depending upon the product based on three tier testing which includes AOAC sporicidal tests, simulated use testing with mycobacterial and in-use testing. Category IC.
      16. Several scientific studies and professional organizations support the efficacy of >2% glutaraldehyde for 20 minutes at 20ºC; that efficacy assumes adequate cleaning prior to disinfection, whereas the FDA-cleared label claim incorporates an added margin of safety to accommodate possible lapses in cleaning practices. Facilities that have chosen to apply the 20 minute duration at 20ºC have done so based on the IA recommendation in the July 2003 SHEA position paper, “Multi-society Guideline for Reprocessing Flexible Gastrointestinal Endoscopes.” 12, 17, 19, 26, 27, 49, 55, 57, 58, 60, 73, 76, 79-81, 83-85, 93, 94, 104-106, 110, 111, 115-121, 124, 125, 233, 235, 236, 243, 265, 266, 609

      Update: Multisociety guideline on reprocessing flexible gastrointestinal endoscopes: 2011 pdf icon [PDF – 547KB] external icon

      8. Management of Equipment and Surfaces in Dentistry
      1. Dental instruments that penetrate soft tissue or bone (e.g., extraction forceps, scalpel blades, bone chisels, periodontal scalers, and surgical burs) are classified as critical and should be sterilized after each use or discarded. In addition, after each use, sterilize dental instruments that are not intended to penetrate oral soft tissue or bone (e.g., amalgam condensers, air-water syringes) but that might contact oral tissues and are heat-tolerant, although classified as semicritical. Clean and, at a minimum, high-level disinfect heat-sensitive semicritical items. Category IA. 43, 209-211
      2. Noncritical clinical contact surfaces, such as uncovered operatory surfaces (e.g., countertops, switches, light handles), should be barrier-protected or disinfected between patients with an intermediate-disinfectant (i.e., EPA-registered hospital disinfectant with a tuberculocidal claim) or low-level disinfectant (i.e., EPA-registered hospital disinfectant with HIV and HBV claim). Category IB. 43, 209-211
      3. Barrier protective coverings can be used for noncritical clinical contact surfaces that are touched frequently with gloved hands during the delivery of patient care, that are likely to become contaminated with blood or body substances, or that are difficult to clean. Change these coverings when they are visibly soiled, when they become damaged, and on a routine basis (e.g., between patients). Disinfect protected surfaces at the end of the day or if visibly soiled. Category II. 43, 210
      9. Processing Patient-Care Equipment Contaminated with Bloodborne Pathogens (HBV, Hepatitis C Virus, HIV), Antibiotic-Resistant Bacteria (e.g., Vancomycin-Resistant Enterococci, Methicillin-Resistant Staphylococcus aureus, Multidrug Resistant Tuberculosis), or Emerging Pathogens (e.g., Cryptosporidium, Helicobacter pylori, Escherichia coli O157:H7, Clostridium difficile, Mycobacterium tuberculosis, Severe Acute Respiratory Syndrome Coronavirus), or Bioterrorist Agents
      1. Use standard sterilization and disinfection procedures for patient-care equipment (as recommended in this guideline), because these procedures are adequate to sterilize or disinfect instruments or devices contaminated with blood or other body fluids from persons infected with bloodborne pathogens or emerging pathogens, with the exception of prions. No changes in these procedures for cleaning, disinfecting, or sterilizing are necessary for removing bloodborne and emerging pathogens other than prions. Category IA. 22, 53, 60-62, 73, 79-81, 105, 118-121, 125, 126, 221, 224-234, 236, 244, 265, 266, 271-273, 279, 282, 283, 354-357, 666
      10. Disinfection Strategies for Other Semicritical Devices
      1. Even if probe covers have been used, clean and high-level disinfect other semicritical devices such as rectal probes, vaginal probes, and cryosurgical probes with a product that is not toxic to staff, patients, probes, and retrieved germ cells (if applicable). Use a high-level disinfectant at the FDA-cleared exposure time. (See Recommendation 7p for exceptions.) Category IB. 6-8, 17, 69
      2. When probe covers are available, use a probe cover or condom to reduce the level of microbial contamination. Category II. 197-201
        Do not use a lower category of disinfection or cease to follow the appropriate disinfectant recommendations when using probe covers because these sheaths and condoms can fail. Category IB. 197-201
      3. After high-level disinfection, rinse all items. Use sterile water, filtered water or tapwater followed by an alcohol rinse for semicritical equipment that will have contact with mucous membranes of the upper respiratory tract (e.g., nose, pharynx, esophagus). Category II. 10, 31-35, 1017
      4. There is no recommendation to use sterile or filtered water rather than tapwater for rinsing semicritical equipment that contact the mucous membranes of the rectum (e.g., rectal probes, anoscope) or vagina (e.g., vaginal probes). Unresolved Issue. 11
      5. Wipe clean tonometer tips and then disinfect them by immersing for 5-10 minutes in either 5000 ppm chlorine or 70% ethyl alcohol. None of these listed disinfectant products are FDA-cleared high-level disinfectants. Category II. 49, 95, 185, 188, 293
      11. Disinfection by Healthcare Personnel in Ambulatory Care and Home Care
      1. Follow the same classification scheme described above (i.e., that critical devices require sterilization, semicritical devices require high-level disinfection, and noncritical equipment requires low-level disinfection) in the ambulatory-care (outpatient medical/surgical facilities) setting because risk for infection in this setting is similar to that in the hospital setting (see Table 1). Category IB. 6-8, 17, 330
      2. When performing care in the home, clean and disinfect reusable objects that touch mucous membranes (e.g., tracheostomy tubes) by immersing these objects in a 1:50 dilution of 5.25%-6.15% sodium hypochlorite (household bleach) (3 minutes), 70% isopropyl alcohol (5 minutes), or 3% hydrogen peroxide (30 minutes) because the home environment is, in most instances, safer than either hospital or ambulatory care settings because person-to-person transmission is less likely. Category II. 327, 328, 330, 331
      3. Clean noncritical items that would not be shared between patients (e.g., crutches, blood pressure cuffs) in the home setting with a detergent or commercial household disinfectant. Category II. 53, 330
      12. Microbial Contamination of Disinfectants
      1. Institute the following control measures to reduce the occurrence of contaminated disinfectants:
        1. prepare the disinfectant correctly to achieve the manufacturer’s recommended use-dilution; and
        2. prevent common sources of extrinsic contamination of germicides (e.g., container contamination or surface contamination of the healthcare environment where the germicide are prepared and/or used).

        Category IB. 404, 406, 1024

        13. Flash Sterilization
        1. Do not flash sterilize implanted surgical devices unless doing so is unavoidable. Category IB. 849, 850
        2. Do not use flash sterilization for convenience, as an alternative to purchasing additional instrument sets, or to save time. Category II. 817, 962
        3. When using flash sterilization, make sure the following parameters are met:
          1. clean the item before placing it in the sterilizing container (that are FDA cleared for use with flash sterilization) or tray;
          2. prevent exogenous contamination of the item during transport from the sterilizer to the patient; and 3) monitor sterilizer function with mechanical, chemical, and biologic monitors.

          Category IB. 812, 819, 846, 847, 962

        4. Do not use packaging materials and containers in flash sterilization cycles unless the sterilizer and the packaging material/container are designed for this use. Category IB. 812, 819, 1025
        5. When necessary, use flash sterilization for patient-care items that will be used immediately (e.g., to reprocess an inadvertently dropped instrument). Category IB. 812, 817, 819, 845
        6. When necessary, use flash sterilization for processing patient-care items that cannot be packaged, sterilized, and stored before use. Category IB. 812, 819
        14. Methods of Sterilization
        1. Steam is the preferred method for sterilizing critical medical and surgical instruments that are not damaged by heat, steam, pressure, or moisture. Category IA. 181, 271, 425, 426, 827, 841, 1026, 1027
        2. Cool steam- or heat-sterilized items before they are handled or used in the operative setting. Category IB. 850
        3. Follow the sterilization times, temperatures, and other operating parameters (e.g., gas concentration, humidity) recommended by the manufacturers of the instruments, the sterilizer, and the container or wrap used, and that are consistent with guidelines published by government agencies and professional organizations. Category IB. 811-814, 819, 825, 827, 841, 1026-1028
        4. Use low-temperature sterilization technologies (e.g., EtO, hydrogen peroxide gas plasma) for reprocessing critical patient-care equipment that is heat or moisture sensitive. Category IA. 469, 721, 825, 856, 858, 878, 879, 881, 882, 890, 891, 1027
        5. Completely aerate surgical and medical items that have been sterilized in the EtO sterilizer (e.g., polyvinylchloride tubing requires 12 hours at 50°C, 8 hours at 60°C) before using these items in patient care. Category IB. 814
        6. Sterilization using the peracetic acid immersion system can be used to sterilize heat-sensitive immersible medical and surgical items. Category IB. 90, 717-719, 721-724
        7. Critical items that have been sterilized by the peracetic acid immersion process must be used immediately (i.e., items are not completely protected from contamination, making long-term storage unacceptable). Category II. 817, 825
        8. Dry-heat sterilization (e.g., 340°F for 60 minutes) can be used to sterilize items (e.g., powders, oils) that can sustain high temperatures. Category IB. 815, 827
        9. Comply with the sterilizer manufacturer’s instructions regarding the sterilizer cycle parameters (e.g., time, temperature, concentration). Category IB. 155, 725, 811-814, 819
        10. Because narrow-lumen devices provide a challenge to all low-temperature sterilization technologies and direct contact is necessary for the sterilant to be effective, ensure that the sterilant has direct contact with contaminated surfaces (e.g., scopes processed in peracetic acid must be connected to channel irrigators). Category IB. 137, 725, 825, 856, 890, 891, 1029
        15. Packaging
        1. Ensure that packaging materials are compatible with the sterilization process and have received FDA 510[k] clearance. Category IB. 811-814, 819, 966
        2. Ensure that packaging is sufficiently strong to resist punctures and tears to provide a barrier to microorganisms and moisture. Category IB. 454, 811-814, 819, 966
        16. Monitoring of Sterilizers
        1. Use mechanical, chemical, and biologic monitors to ensure the effectiveness of the sterilization process. Category IB. 811-815, 819, 846, 847, 975-977
        2. Monitor each load with mechanical (e.g., time, temperature, pressure) and chemical (internal and external) indicators. If the internal chemical indicator is visible, an external indicator is not needed. Category II. 811-815, 819, 846, 847, 975-977, 980
        3. Do not use processed items if the mechanical (e.g., time, temperature, pressure) or chemical (internal and/or external) indicators suggest inadequate processing. Category IB. 811-814, 819
        4. Use biologic indicators to monitor the effectiveness of sterilizers at least weekly with an FDA-cleared commercial preparation of spores (e.g., Geobacillus stearothermophilus for steam) intended specifically for the type and cycle parameters of the sterilizer. Category IB. 1, 811, 813-815, 819, 846, 847, 976, 977
        5. After a single positive biologic indicator used with a method other than steam sterilization, treat as nonsterile all items that have been processed in that sterilizer, dating from the sterilization cycle having the last negative biologic indicator to the next cycle showing satisfactory biologic indicator results. These nonsterile items should be retrieved if possible and reprocessed. Category II. 1
        6. After a positive biologic indicator with steam sterilization, objects other than implantable objects do not need to be recalled because of a single positive spore test unless the sterilizer or the sterilization procedure is defective as determined by maintenance personnel or inappropriate cycle settings. If additional spore tests remain positive, consider the items nonsterile and recall and reprocess the items from the implicated load(s). Category II. 1
        7. Use biologic indicators for every load containing implantable items and quarantine items, whenever possible, until the biologic indicator is negative. Category IB. 811-814, 819
        17. Load Configuration
        1. Place items correctly and loosely into the basket, shelf, or cart of the sterilizer so as not to impede the penetration of the sterilant. Category IB. 445, 454, 811, 813, 819, 836
        18. Storage of Sterile Items
        1. Ensure the sterile storage area is a well-ventilated area that provides protection against dust, moisture, insects, and temperature and humidity extremes. Category II. 454, 819, 836, 969
        2. Store sterile items so the packaging is not compromised (e.g., punctured, bent). Category II. 454, 816, 819, 968, 969, 1030
        3. Label sterilized items with a load number that indicates the sterilizer used, the cycle or load number, the date of sterilization, and, if applicable, the expiration date. Category IB. 811, 812, 814, 816, 819
        4. The shelf life of a packaged sterile item depends on the quality of the wrapper, the storage conditions, the conditions during transport, the amount of handling, and other events (moisture) that compromise the integrity of the package. If event-related storage of sterile items is used, then packaged sterile items can be used indefinitely unless the packaging is compromised (see f and g below). Category IB. 816, 819, 836, 968, 973, 1030, 1031
        5. Evaluate packages before use for loss of integrity (e.g., torn, wet, punctured). The pack can be used unless the integrity of the packaging is compromised. Category II. 819, 968
        6. If the integrity of the packaging is compromised (e.g., torn, wet, or punctured), repack and reprocess the pack before use. Category II. 819, 1032
        7. If time-related storage of sterile items is used, label the pack at the time of sterilization with an expiration date. Once this date expires, reprocess the pack. Category II. 819, 968
        19. Quality Control
        1. Provide comprehensive and intensive training for all staff assigned to reprocess semicritical and critical medical/surgical instruments to ensure they understand the importance of reprocessing these instruments. To achieve and maintain competency, train each member of the staff that reprocesses semicritical and/or critical instruments as follows:
          1. provide hands-on training according to the institutional policy for reprocessing critical and semicritical devices;
          2. supervise all work until competency is documented for each reprocessing task;
          3. conduct competency testing at beginning of employment and regularly thereafter (e.g., annually); and
          4. review the written reprocessing instructions regularly to ensure they comply with the scientific literature and the manufacturers’ instructions.

          Category IB. 6-8, 108, 114, 129, 155, 725, 813, 819

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