Surgical Instrument Washers
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APIC Presentation The Proper Sequence of Surgical Instrument Cleaning Treatments
Properly designed automated surgical instrument washers and automated endoscope washers can deliver the proper endoscope disinfecting temperatures and provide cleaner surgical instruments and cleaner endoscopes with less damage. Properly designed automated endoscope washers can deliver the proper endoscope disinfecting temperatures. Always refer to manufacturers specifications prior to establishing your surgical instrument and endoscope reprocessing protocol.
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Washer Disinfectors, Surgical Instrument Washers, Dishwashers
It is often of value to look across geographical boundaries when reviewing the standards of care. The British standards as presented by HTM 2030 is the NHS standard governing the washing and disinfection of medical equipment disinfection of surgical instruments, surgical instrument decontamination, and disinfection of dental instruments. We all know that infection control in health care environments has become a major concern for both patients and clinicians, and breaking the connective chain of risk is now a first priority. There is continuing debate over the adoption of hospital standards of instrument decontamination in dental and primary care, and while guidelines exist there is no absolute imperative. Nevertheless, common consent and common sense agree that the hand washing of instruments is wholly inadequate. Hospital CSSD departments work to NHS standards to ensure effective instrument decontamination. HTM 2010 is the NHS standard for instrument sterilization, but many instrument manufacturers state categorically ‘if it is not clean it cannot be sterile.’ HTM 2030 is the NHS standard governing the washing and disinfection of surgical and dental instruments – this is the standard that ensures the instrument is ‘clean’ prior to sterilization. To equate to hospital standards, 2010 and 2030 must be achieved in the dental surgery. The BDA guideline A12 states that ‘all instruments contaminated with oral and other body fluids must be thoroughly cleaned and sterilized after use.’ So why can’T we use a dishwasher? Dishwashers look like washer disinfectors, they come in a variety of models and they have similar spray arms, nozzles, racks and baskets. At issue is the definition of ‘clean.’ A scientist would say ‘completely free of harmful organisms’ and a dishwasher salesman would say ‘lemon fresh.’ It is accepted that sterilization alone is not enough, as debris remaining on an instrument will act as a barrier to the steam and prevent sterilization. Proteins, including prions (the agents believed to responsible for vCJD) are also not susceptible to steam sterilization, but prions are removed by correct washing and disinfection procedures. Cleaning and Removing Prions.
The dishwasher will undoubtedly deliver your crockery ‘lemon fresh.’ It performs a series of cycles that typically operate to a maximum of 60°C, but there is no designated minimum temperature.
The washer disinfector is specifically designed to ensure instruments are clinically ‘clean’ after processing. Although it’s cycle is similar to the dishwasher, the initial flushing is carried out at a designated temperature of less than 35°C to prevent protein coagulation (proteins coagulate at 35°C, so an initial hand wash in hot water is equally ineffective). During the wash phase there is a controlled release of chemical detergent and the load carrier and spray distribution are designed to facilitate total cleansing. The rinsing phase includes a thermal disinfection - a high temperature (93°C) water rinse which has a micro-biocidal action against a wide range of infective organisms and also removes any chemical residues from the wash phase. The whole cycle is monitored and any faults reported, which enables the operator to verify that the process has been successfully completed and the instruments are ‘clean’ in accordance with HTM 2030. Independent monitoring is a key element in achieving the required standard.
Washer Disinfectors, Surgical Instrument Washers, Dishwashers
The dishwasher does not disinfect and nor does it monitor its process.
Ultrasonic surgical instrument cleaning provides no reliable means of validation, and their use for instrument decontamination is, at best, questionable as they do not provide the full and proper sequence of surgical instrument cleaning treatments.
You could respond by suggesting that you’re a dentist, not a heart surgeon, and it’s all a bit over the top. After all, the risk of cross infection in a dentist’s surgery must be lower than for an invasive surgical procedure.
Well, while the individual risk may be less (a case not proven), the number of lower risk incidents outside the hospital environment is very much higher. And to put the case for stringent hygiene measures even more forcefully, you and your staff are the ones at greatest risk. To protect those who work in general practice, doctors and nurses et al, and dentists and their staff, the Department of Health is beginning to insist that all instrument decontamination meets HTM 2010 and 2030. In a nutshell, dentists must meet hospital standards, and the equipment they use must be manufactured to and compliant with those standards. There are currently very few manufacturers from the medical NHS hospital market in the UK that is now providing GDP’s with tabletop sterilizers, Table top Autoclaves, surgical instrument disinfecting equipment, and endoscope disinfecting equipment. For Information refer to: surgical instrument washers, surgical instrument enzyme cleaners, surgical instrument detergents, tabletop sterilizers, Table top Autoclaves, surgical instrument disinfecting equipment, and endoscope disinfecting equipment. The domestic dishwasher lacks accurate time and temperature controls and does not validate its cleaning cycle.
Washer Disinfectors, Surgical Instrument Washers, Dishwashers
‘Lemon Fresh,’ however attractive it sounds, is not a scientific measure of cleanliness. The domestic dishwasher lacks accurate time and temperature controls and does not validate its cleaning cycle. Ultrasonic cleaning baths also provide no reliable means of validation, and their use for instrument decontamination is, at best, questionable as they do not provide the full and proper sequence of surgical instrument cleaning treatments. The dishwasher washes dishes; the washer disinfector will decontaminate your surgical instruments to hospital standards and verify its own performance; you, your staff, your patients and the Department of Health will be confident that your instruments really are clean.
Automated Endoscope Washer Temperature Parameters for Cleaning Endoscopes should not be heated over 199,4°F (93°C). Automated Endoscope Washer Temperature Parameters for Cleaning Flexible scopes should not be heated over 149°F (65°C).
Properly designed automated endoscope washers can deliver the proper endoscope disinfecting temperatures.
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