Clean is Safe Cleaning Surgical Instruments
The Surgical Instrument Washer and the
Proper Sequence of Washer Treatments
Clean is Safe for Central Service Staff Cleaning Reprocessing Surgical Instruments
Repressing Surgical Instruments, Utensils & Scopes
John. Campbell
John Temple
Summary: It is a recognized risk of exposure to unidentified microorganisms that processing personal endure during the cleaning and reprocessing of surgical instruments. Our goal is to minimize the amount and degree of reprocessing personal exposure to this risk and provide surgical instruments that are safe to handle, safe for patient care, and are reprocessed at the lowest cost. The use of optimal mechanical ( washer decontaminator “proper sequence of washer treatments” ) and chemical (enzyme detergent and purified water rinse) reprocessing methods will minimize the risks to healthcare workers, reduce the costs of reprocessing, and render surgical instruments, utensils, and scopes that are clean and safe to handle. Within the implementation of the Universal Decontamination Precautions, it is our goal to eliminate exposure and/or reduce risk whenever possible.
The majority of hospitals hand wash some of their reusable surgical instruments, utensils, and scopes. The most common example of is the manual washing is the cleaning of cannulated surgical instruments, the most frequent manual reprocessing involved cleaning eye surgical instruments. Hand washing places the processing personnel at risk. In the decontamination area, surgical instruments are received that are contaminated with variable amounts of debris and unidentified microorganisms. In the clean side processing area, surgical instruments requiring further processing are handled by personnel wearing minimal protection due to the physical/mechanical requirements of reprocessing surgical instruments, utensils and scopes.
Cleaning surgical instruments by hand can lead to injury and increased exposure to Hepatitis. 1
The CDC believes that as many as 18,000 healthcare workers per year may be infected by the HBV and that as many as 300 deaths per year may result. 2
Workers at Risk Cleaning Surgical Instruments
Inherent in the manual decontamination process is power spraying, splashing, the creation of the contaminated aerosols and the potential for infectious punctured wounds. The handling of each individual device is time consuming, labor intensive, renders limited through-put and has high overhead costs.3
Exposure Contained by Automated Surgical Instruments Washers
An automated decontamination system can, and should, safely contain within its chambers the forceful washing action, removal of debris and contaminated aerosols. The batch treatment of devices by washer decontaminators saves time, increases material through-put, provides for FTE reduction, and lowers reprocessing costs.7, 8 It has been demonstrated that a properly designed washer decontaminator system, that delivers the “proper sequence of treatments”, when used properly, will consistently and repeatedly remove all microorganisms. 9, 10
Equipment should be used properly to secure the most consistent and efficacious results. Worker safety or processing efficacy can be compromised by violating the manufacturer’s recommendations. Examples of such recommendations are: using enzyme-detergents for chemical cleaning, assuring that the surface of all devices are exposed to the mechanical- chemical cleaning treatments, keeping working chambers closed during processing, and using purified water for final rinse.
A Clean is Safe to Handle surgical instruments11
It is critical that devices are cleaned properly to secure the safety of workers in the prep and pack clean area. During the steps of inspection, sorting and packaging of devices, the unprotected processing personnel are repeatedly at risk from a device that has remained contaminated with microorganisms. Within the implementation of the Universal Decontamination Precautions, it is our goal to eliminate exposure and/or reduce risk whenever possible.
The Surgical Instrument Washer and the
Proper Sequence of Washer Treatments
Conclusion
The use of proper hand washing decontamination methods can render surgical instruments, utensils, and scopes that are clean, but requires continual worker exposure to contaminated devises. The workers performance is influenced by skill level, knowledge and work load. This may impact the efficacy of the process. The use of a properly designed decontamination system eliminates and reduces overhead cost and provides consistence removal of all microorganisms. Once a device is clean, it is then safe for further processing and handling.
References
1. Bryan P. Simmoms, MD. Et. Al., Guideline for Hospital Environmental Control and Guideline Ranking Scheme, Center for Disease Control, (Feb. 1981), Section 2, pp.1-10.
2. Letter from the secretary of Labor, U.S. Department of Labor, Oct. 30, 1988.
3. Peggy Ryan, RN, “concepts of Cleaning Technologies and Processing,” Journal of Healthcare Material Management, (Nov./Dec. ’87), pp.20-27.
4. Bertha Y. Litsky, PhD, “Microbiology Sterilization,” J. AORN, Aug. 1977.
5. CDC, MMWR, Aug. 21, 1987.
6. Ryan, op. cit.
7. Training manual for Central Services Technicians, American Society for Central Service Personnel of the American Hospital Association, (Chicago, IL, 1986).
8. Ryan, op. cit.
9. L.P. Jette’ and N.G. Lambert, “Evaluation of Two Hot Water Washer Disinfectors for Medical Instruments, “ Infection Control Hospital Epidemiology, Vo.1 9, No. 5, (1988), pp. 194-199.
10. Interview with Charles A. Reed, Washington University School of Medicine, Washington University medical Center, Dec. 1985.
11. Simmons, op. cit.
The Surgical Instrument Washer and the
Proper Sequence of Washer Treatments
After being cleaned in a Surgical Instrument Washer with Ultrasonic Surgical Instrument Cleaner delivering the "Proper Sequence of Washer Treatments", including ultrasonic cleaning (Washer Decontaminator, Washer Disinfector) and a combination enzyme detergent cleaning concentrate: "evaluation of Surgical Instrument Washer with Ultrasonic Surgical Instrument Cleaner Decontaminators Disinfectors confirmed that the efficacy of disinfection was 100%". "All instruments and utensils tested were sterile at the completion of the process."
Properly Designed Surgical Instrument Washer with Ultrasonic Surgical Instrument Cleaner Decontaminators Washer Disinfectors
Provide the Prerequisite for Sterilization
John Temple
John Prohonic
Product Development
NOTE:
The goal of cleaning (decontaminating reprocessing) surgical instruments is to deliver Clean Surgical Instruments that are safe for the Reprocessing Staff and have received the prerequisite for disinfecting and/or sterilizing surgical instruments. It is a recognized risk of exposure to unidentified microorganisms that reprocessing personal endure during the decontamination, reprocessing, and cleaning of surgical instruments. Our goal is to minimize the amount and degree of reprocessing personal exposure to this risk and provide reprocessed surgical instruments that are clean: safe to handle, safe for patient care, and are cleaned (decontaminated reprocessed) at the lowest cost. The optimal decontamination cleaning-reprocessing of surgical instruments will secure the prerequisite for disinfecting surgical instruments and/or sterilizing surgical instruments, deliver surgical instruments that are safe to handle, and reduce reprocessing costs.
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).
The Surgical Instrument Washer and the
Proper Sequence of Washer Treatments
The "Proper Sequence of Washer Treatments" includes a series of mechanical and chemical treatments. The mechanical treatments include: cold water surgical instrument pre-wash, surgical instrument ultrasonic cleaning, surgical instrument detergent wash, multiple surgical instrument purified water rinses, and surgical instrument hot air drying. The chemical treatments include combination of four enzyme cleaners, surgical instrument detergents, surgical instrument surface conditioners and surgical instrument lubricants.
The Surgical Instrument Washer and the
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.
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,
detergent wash,
purified water rinses,
and hot air drying.
The surgical instrument washer chemical treatments include:
four enzymes, (Lipase, Amylase, Carbohydrase, and Protease Enzymes)
detergent surgical instrument cleaner,
surgical instrument surface conditioners,
and surgical instrument lubricants.
