Surgical instrument Washer Proper Sequence of Treatments

The Surgical Instrument Washer

Automated Thermal Disinfection Surgical Instrument Washer

Proper Sequence of Surgical Instrument Washer Treatments

After being cleaned in a properly designed Surgical Instrument Washer, that used an Ultrasonic Surgical Instrument Cleaner (a four enzyme detergent Surgical Instrument Cleaner):

“All instruments and utensils tested were sterile at the completion of the process.”

APIC ABSTRACT Paper accepted for presentation at APIC:

Eighteenth Annual Conference and International Meeting

Nashville Tennessee

Oral Presentation

Validation of the microbial safety of surgical instruments and utensils following automated cleaning by a properly designed Washer Decontaminator Washer Disinfector – Thermal Disinfection. A. Drake, RN and L. Ayers, MD.,

The Ohio State University Hospitals, Columbus, Ohio, 43210

The application of universal precautions to instruments/utensils handling became an issue in the selection of replacement decontamination equipment for Central Sterile supply at our hospital. The new technology of an automated thermal disinfection Surgical Instrument Washer Decontaminator Washer Disinfector (TW)(CESCO TM, Mercersburg, Pa.) offered increased protection to our reprocessing staff due to decreased handling but raised concerns about the efficacy of thermal disinfection as opposed to traditional washer sterilization. Because of the limited scientific documentation of this new technology, a study was undertaken to establish the microbial safety of finished products and to identify any feature or function failure which could adversely affect outcome. The Surgical instrument Washer "Proper Sequence of Treatments" used was: cold water pre-wash, enzyme ultrasonic sonic bath, detergent wash, purified water rinses, instrument lubricant rinse, and hot air drying at 240° F for 4 minutes. The Surgical instrument Washer Decontaminator was challenged with selected instruments and utensils that are considered to be very difficult to clean. Included were 30 each of stainless steel non-perforating towel clips and stainless steel and glass medicine cups. Each item was rinsed with a 10 5ml suspension of Staphylococcus aureus, Pseudomonsaeruginosa, Enterococcus fecalis and Candida albicans in nutrient media and then dried. The instruments were processed in the Surgical instrument Washer during times of high volume operation. All products were tested for sterility. Ten separate cultures were taken of the final rinse solution of instrument lubricant and de-ionized water prior to the drying cycle. A separate culture was taken of the instrument lubricant fluid. All instruments and utensils tested were sterile at the completion of the process. The final rinse, however, was heavily contaminated with the saprophytic bacteria Flavobacterium sp., Pseudomonas (P.) picketti and P. rubrisubalbicans. The source of the contamination was determined to be resin gel in the DI tank and not the instrument lubricant. The contamination can be eliminated by the addition of a 0.22 u filter to the DI line. Our findings support the practice of validating all features of new technologies that may compromise the expected final outcome. The Surgical instrument Washer is a valid replacement for the conventional washer-sterilizer.

Ann Drake

John Temple

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The Surgical Instrument Washer and the

Proper Sequence of Washer Treatments

The purpose of a Surgical Instrument Washer is to deliver surgical instruments that are "clean and safe to handle" for reprocessing and are clean so that they can be sterilized. Surgical instruments that are not clean cannot be sterilized. Surgical Instrument Washers prepare surgical instruments for sterilization. Clean is the "Prerequisite for Sterilization".

Studies have demonstrated how properly designed Surgical Instrument Washers are able to deliver optimal cleaning using a combination of automated mechanical treatments, The Proper Sequence of Washer Treatments, and chemical treatments involving a Four Enzyme Detergent Surgical Instrument Cleaner with Conditioners and Lubricant. After being cleaned in a properly designed Surgical Instrument Washer, that included an Ultrasonic Surgical Instrument Cleaner using a four enzyme detergent Surgical Instrument Cleaner: "evaluation of the Surgical instrument Washer using the Proper Sequence of Washer Treatments confirmed that the efficacy of disinfection was 100%". "All instruments and utensils tested were sterile at the completion of the process."

The Proper Sequence of Surgical Instrument Washer Treatments

includes a series of mechanical and chemical treatments.

The surgical instrument washer mechanical treatments include:

cold water pre-wash,

ultrasonic surgical instrument cleaner,

surgical instrument detergent wash,

purified water rinses,

and hot air drying.

The surgical instrument washer chemical treatments include:

four enzyme surgical instrument cleaner,

(Lipase, Amylase, Carbohydrase, and Protease Enzymes)

surgical instrument detergent ,

surgical instrument cleaner,

surgical instrument surface conditioners,

and surgical instrument lubricants.

NOTE: Surgical Instrument Washers with Ultrasonic Surgical Instrument Cleaning used in this research study were manufactured by CESCO, Mercersburg PA. The Surgical Instrument Washers with Ultrasonic Surgical Instrument Cleaners are not currently available from CESCO. European Manufacturers have developed Surgical Instrument Washers with fully Ultrasonic Cleaning and are manufactured within the ISO/DIS 15883-1 Standard. Studies demonstrate the propensity for Surgical Instrument Washers with Ultrasonic Surgical Instrument Cleaning to deliver optimal cleaning results. The surgical instrument cleaners used in these studies are currently available in the form of the all-in-ONE four enzyme detergent surgical instrument cleaners. A critical component for optimal cleaning is using the best possible surgical instrument cleaner. Recent European studies have illustrated and concluded that four enzyme detergent surgical instrument cleaning is more effective than conventional surgical instrument cleaners. The research was initiated to deactivate prions deactivating prions within the objective to prevent CJD (Creutzfeldt-Jakob Disease).