Appendix 4 / Cleaning of instruments andmaterials used for early detection and treatment of cervical neoplasia:

Instrument/material	Processing	Suggested procedure
Vaginal speculum, vaginal retractors, biopsy forceps, toothed forceps, ring forceps, Cheatle's forceps	Decontamination and cleaning followed by sterilization or HLD	Decontamination by immersing in 0.5% chlorine for 10 minutes followed by cleaning with water and detergents; cleaned instruments may be immersed in boiling water for 20 minutes (high-level disinfection) or may be sterilized using autoclave before re-use.
Gloves	Decontamination and cleaning followed by sterilization	Decontamination by immersing in 0.5% chlorine for 10 minutes followed by cleaning with water and detergents; sterilized using an autoclave in wrapped packs
Examination table, halogen lamp, torch lights, instrument trolley, trays	Intermediate or low-level disinfection	Wipe with 60-90% ethyl or isopropyl alcohol or with 0.5% chlorine solution

HLD: High-level disinfection

Preparation of 0.5% chlorine solution:
The general formula for making a dilute chlorine solution from a commercial preparation of any given concentration is as follows: Total parts of water = [% concentrate/% dilute] -1. For example, to make a 0.5% dilute solution of chlorine from 5% concentrated liquid household bleach = [5.0%/0.5%] -1 = 10-1 = 9 parts of water; hence add one part of concentrated bleach to nine parts of water. If one is using commercially available dry powder chlorine, use the following formula to calculate the amount (in grams) of dry powder required to make 0.5% chlorine solution: Grams/litre = [% dilute/% concentrate] x 1000. For example to make a 0.5% dilute chlorine solution from a dry powder of 35% calcium hypochlorite = [0.5%/35%] x 1000 = 14.2 g. Hence add 14.2 grams of dry powder to 1 litre of water or 142 grams to 10 litres of water. The instruments should not be left in dilute bleach for more than 10 minutes and should be cleaned in boiled water immediately after decontamination to prevent discolouration and corrosion of metal.
Decontamination of the floor of the screening clinic:
The floor of the screening clinic should be decontaminated on a daily basis with chemical disinfectants including iodophores (e.g., 10% povidone iodine).