Risk of Cleaning Surgical Instruments
The risk of the surgical Instrument cleaning reprocessing exposes the Reprocessing Staff to unidentified microorganisms
Product Development - Washer Decontaminators
John Temple
John Prohonic
Summary: It is a recognized risk of exposure to unidentified microorganisms that reprocessing personal endure during the decontamination, reprocessing-cleaning 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 clean: safe to handle, safe for patient care, and reprocessed at the lowest cost. Optimal reprocessing cleaning of surgical instruments will secure the prerequisite for disinfecting surgical instruments and/or sterilizing surgical instruments.
Typically, Healthcare Facilities manually clean [hand-wash] surgical instruments: with dried on or excessive debris, cannulated surgical instruments, surgical instruments with working channels and/or surgical instruments with lumens. Healthcare Facilities also manually clean [hand-wash] surgical instruments, when a surgical instrument washer decontaminators or washer disinfectors is not available. Hand washing surgical instruments places the reprocessing 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 reprocessing area, surgical instruments requiring further reprocessing are handled by unprotected reprocessing personnel.
REPROCESSING CLEANING SURGICAL INSTRUMENTS BY HAND CAN LEAD TO INJURY AND INCREAESED EXPOSURE TO HERPATITIS. THE CDC BELIEVES THAT AS MANY AS 18,000 HEALTH CARE WORKERS PER YEAR MAY BE INFECTED BY THE HBV,” AND “AS MANY AS 300 DEATHS MAY RESULT ANNUALLY.”
Reprocessing Workers at Risk Cleaning Surgical Instruments
Inherent in the manual cleaning-decontamination-reprocessing of surgical instruments is power spraying, splashing, and the creation of contaminated aerosols. The manual cleaning-decontamination-reprocessing of surgical instruments presents the risk of infectious puncture wounds. The handling of each individual surgical instrument device is time consuming, labor intensive, renders limited through-put and has high overhead costs.
Reprocessing Exposure Contained by Automated Surgical Instrument Washer Decontaminators Disinfectors
Reprocessing Surgical Instrument Washer Disinfectors
In the United States manufacturers of Surgical Instrument Washers are not approved by the FDA to market their products as Washer Disinfectors. However, many of the Surgical Instrument Washers are manufactured to produce the times and temperatures that can effectively deliver disinfected surgical instruments. If it is your preference to have cleaning reprocessing results of a "washer disinfector", refer to the Surgical Instrument Washer Specifications for assurance that the times and temperatures available are those you consider to be appropriate for disinfecting surgical instruments.
Reprocessing Surgical Instrument Washer Decontaminator Disinfectors can safely contain within their chambers the cleaning-decontamination-reprocessing functions, removal of debris, and contaminated aerosols. The batch treatment of reprocessing surgical instruments using automated Surgical Instrument Washer Decontaminators Disinfectors saves time, increases material through-put, improves surgical instrument turnaround times, provides for FTE reduction, and lowers cost for surgical instrument cleaners. 7 8 It has been demonstrated that a properly designed Surgical Instrument Washer Decontaminator Disinfector, that is used to manufacturer’s specifications, will consistently and repeatedly remove all microorganisms from surgical instruments. Reprocessing Surgical Instrument Washer Decontaminators Disinfectors should be used in accordance with the manufacturer’s direction for use, to secure the most consistent and efficacious results. Worker safety and reprocessing efficacy can be compromised by violating the manufacturer’s recommendations. Examples of such recommendations are: Keeping the cannulated surgical instrument working chambers and lumens exposed during cleaning-reprocessing and the use of purified water final rinses.
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A Clean Surgical Instrument Device is Safe to Handle - Clean is Safe
It is critical that devices are cleaned properly to secure the safety of reprocessing workers in the Clean Area. During the steps of inspection, sorting and packaging of devices, the unprotected reprocessing personnel are repeatedly at risk from a surgical instrument that has remained contaminated with microorganisms.
Within the implementation of the Universal Decontamination Precautions, it is our goal to eliminate exposure and reduce the risk to Reprocessing personnel whenever possible.
The use of proper hand washing surgical instrument reprocessing decontamination methods can render surgical instruments that are clean, but requires the continual exposure of the Reprocessing Staff to contaminated surgical instruments. The Reprocessing Staff performance is influenced by skill level, knowledge and work load. This may impact the efficacy of the process. The use of a properly designed reprocessing surgical instrument washer decontaminator disinfector reduces the: overhead cost of reprocessing, risks to the Reprocessing Staff and provides consistence removal of all microorganisms from soiled surgical instruments. Once a surgical instrument is clean, it is then safe for further reprocessing and handling. Proper cleaning is the prerequisite for disinfecting and/or sterilizing surgical instruments. Optimal reprocessing cleaning can render surgical instruments that, at the end of decontamination, cleaning, and reprocessing, are sterile.
The all-in-ONE Surgical Instrument Cleaner will lower your cleaning costs and replace multiple Surgical Instrument Care products for cleaning Surgical Instruments and conditioning surgical instruments.
The Surgical Instrument Cleaning Process:
the primary surgical instrument cleaning process and the
secondary surgical instrument cleaning process.
The Cleaning Surgical Instruments Process:
Optimal Temperatures for Cleaning Surgical Instruments using an enzyme detergent cleaning concentrate will impact the surgical instrument cleaning process. Enzyme detergent cleaning concentrates function more effectively at temperatures above room temperature. The optimal range for enzyme detergent cleaning begins at > 22C - 72°F with performance reaching it's peak at 58.3C - 137F. This is often referred to as the optimal temperature for the performance or activity of enzyme detergent cleaning. The activity of enzyme detergent cleaning does not stop at higher temperatures but the level of enzyme detergent cleaning performance does begin to decrease. Enzyme detergent cleaning and all-in-one cleaning enzyme detergent cleaning concentrates, which include four, or less enzymes, should be used in accordance with the manufacturer's recommendations and the recommendations of the medical devices being cleaned.
If the manual cleaning, brushing and rinsing steps are not properly carried out, protein debris can harden and lead to formation of biofilm on the surgical instrument, i.e. the biopsy channel of an endoscope. The optimal surgical instrument cleaning protocol will break down proteinaceous bioburden and clean the surface. Inadequate cleaning can result in material remaining on the surgical instrument which will prevent disinfection and sterilization fluids or gases reaching all parts of the potentially contaminated device. Inadequate sterilization or disinfection sterilization and may in turn result in transmission of infectious organisms when the device is reused. The intricate design and delicate materials of flexible scopes complicate the cleaning process. This requires repetitive and consistent oversight.
The reprocessing decontamination Cleaning of Surgical Instruments, whether done manually or automatically in a surgical instrument washer decontaminator disinfector, can only be effective if "cleaning" is adequate. Effectively sterilizing surgical instruments (Generic Sterilization with a Pre-Vacuum Sterilizer (HI-VAC): 270-272° F (132-134° C), 16-minute exposure time, with 4 pulses and a 30-minute dry time. Generic Sterilization with a Gravity Displacement Sterilizer: 270-272° F (132-134° C), 30-minute exposure time, with a 30-minute dry time.) is not possible if "cleaning", the "prerequisite for sterilizing surgical instruments", is not adequate.
The Surgical Instrument Cleaning Process:
the primary surgical instrument cleaning process and the
secondary surgical instrument cleaning process.
Enzyme Detergent Surgical Instrument Cleaner: Care and Cleaning
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Prevent Surgical Instrument Corrosion
Your first-line-of-defense against Corrosion is the passive layer of Surgical Instruments.
Stainless steel surgical instruments are made of corrosion resistant high-grade specialty steels. The key word here is “resistant”. Corrosion resistant does not mean corrosion proof. One of the special characteristics of these steels is that the manufacturer forms a "passive oxide layer" on the surface of all surgical instruments, which protects them against corrosion. This makes surgical instruments as corrosion resistant as possible. It is imperative that you maintain the passive layer of surgical instruments to prevent corrosion and maintain your surgical instruments in optimal condition. If this is not done the surgical instrument stainless steel will corrode or stain more readily which will reduce the life of the surgical instrument and/or render it useless. Initially, all “stainless steel” surgical instruments have the same corrosion resistance. When strength and hardness requirements are important factors for instrument function, corrosion resistance is generally lower. Increasing the corrosion resistance would soften the surgical instruments stainless steel. Manufacturers of surgical instruments and surgical instrument containers recommend the use of neutral pH surgical instrument cleaning concentrates. Neutral pH all-in-one or "combination" cleaning concentrates have been shown to be effective in optimizing the efficacy of the passive layer of surgical instruments. This will provide a longer life for stainless steel surgical instruments. More information and studies regarding the passive layer of Surgical Instruments is below.
The Surgical Instrument Cleaning Process:
the primary surgical instrument cleaning process and
the secondary surgical instrument cleaning process.
Surgical Instrument Rust
Yellow brown to Dark brown Stains or Spots
Yellow-brown to dark-brown stains or spots on surgical stainless steel instruments are frequently mistaken for "rust". These residue deposits (stains or spots arranged in groups or along edges or in crevices) are usually the instrument being exposed to result of high chloride content. They will lead to pitting of the surgical instrument surface if not removed. (see Avoiding High Levels of Chloride below) Excessively hard water can contain high levels of salt sufficient to cause stains or spots that appear as rust. Boilers used to generate the steam for steam sterilizers, if not cleaned properly, will produce contaminated steam which can deposit minerals onto instruments during the sterilization process.
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Avoiding High Levels of Chloride
use neutral pH surgical instrument cleaners as recommended by all manufacturers of surgical instruments. Dry and cool surgical instruments as soon as possible following cleaning surgical instruments and sterilizing. Use purified water (DI or RO) to thoroughly rinse instruments prior to drying surgical instruments. Avoid exposing the surface protective layer of the surgical instruments to abrasive conditions and treatments. Minimize the time surgical instruments are exposed to high temperatures. Avoid using agents containing chloride (do not exceed ~ 120 mg/l, 200mg/l NaCl Sodium Chloride - Salt). A common problem is the inadvertent use of NaCl Sodium Chloride Salt containing solutions. Soak surgical instruments at the point of use to maintain hydration of debris and prevent encrustation on surgical instruments. Avoid using surgical instruments cleaning agents containing other halogen ion agents such as glutaraldehyde (e.g. iodides, bromides). Use surgical instrument cleaning agents containing Nonionic Surfactants whenever possible.
Surgical Instrument Cleaner with Conditioners™ for cleaning Surgical Instruments cleaner, cleaning surgical instruments cost effectively and fast. Surgical Instrument Care
