Association Professionals in Infection Control Epidemiology
APIC Eighteenth Annual Conference and International Meeting
by Ann Drake, President of APIC
The application of universal precautions to instruments/utensils handling became an issue in the selection of replacing surgical instrument decontamination equipment for Central Sterile Supply at Ohio State University. The new technology of an automated Surgical Instrument Washer Decontaminator 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 pursuant to the efficacy of surgical instrument washers, 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 sequential functions of the Surgical Instrument Washer Decontaminator progress from a cold water pre wash at temperatures below 110 F 43 C, elevated temperature ~ 135 degrees F 57.2 C detergent washing, redundant rinses at ~ 194 F 90 C to 209 F 98.3 C, final purified water rinse with lubrication at ~ 194 F 90 C to 209 F 98.3 C, and hot air drying at 240° F 116 C, for 4 minutes. The 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 105 ml suspension of Staphylococcus aureus, domonsaeruginosa, Enterococcus fecalis and Candida albicans in nutrient media and then dried. The instruments were processed in the Washer Decontaminator, in 3 separate loads during times of high volume SPD 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 cleaning process.
The surgical instrument washer decontaminator, using the proper sequence of treatments with an enzyme detergent surgical instrument lubricant cleaning concentrate, is a valid replacement for the conventional washer sterilizer.
Ann Drake, President of APIC, Director of SPD Ohio State University
John Temple, President and Director of Marketing