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.
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 may result in the transmission of infectious organisms when the device is reused. An improperly cleaned device also presents a risk to the healthcare workers handling the device. The intricate design and delicate materials of flexible scopes complicate the cleaning process. This requires repetitive and consistent oversight.
Cleaning Surgical Instruments is the Prerequisite for Sterilization.
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. All disinfection processes, whether done manually or done automatically in a surgical instrument washer decontaminator disinfector, can only be effective if prior cleaning is adequate. Effective disinfection or sterilization of an inadequately cleaned surgical instrument or scope is not possible. Endoscopes should be cleaned with an enzymatic enzyme detergent compatible with the endoscope immediately after use and before manual or automated disinfection. Cleaning involves the entire endoscope, including valves, working channels, connectors and all detachable parts. Enzymatic Surgical Instrument Cleaners, in combination with a high level surfactant detergent chemical complex, have been shown to be effective in removing stains, hard water deposits, and encrusted bioburden, while being safe to use for rigid or flexible scopes. Manufacturers of surgical instruments recommend the use of neutral pH enzyme detergent cleaners. Neutral pH all-in-one or combination enzyme surgical instrument cleaner detergent concentrates have been shown to be effective in optimizing the efficacy of the passive oxide layer. This will provide a longer life for stainless steel surgery instruments. Cleaning concentrates with a high or low pH have been shown to erode the passive layer. The most common of these cleaning concentrates utilize an alkaline detergent with an acid neutralizer. Virtually all manufacturers of surgical instruments and surgical instrument containers recommend against using these and recommend using a neutral ph detergent. Some manufactures of combination or all-in-one surgical instrument cleaning concentrates include a bacteriostatic agent which will prevent the growth of microorganisms. Some detergent complexes contain antimicrobial-microbicidal substances. Although these agents do not replace disinfection they are designed to reduce the risk of infection to reprocessing personnel by rendering instruments that are clean and safe to handle. The cleaning function efficacy of enzyme cleaning concentrates is determined by the ratio of enzymes to bioburden. The higher the proportion of enzymes the higher the efficacy. As a result, if the cleaning solution becomes laden with bioburden from previous cleaning, the efficacy of the enzyme cleaning concentrates is lower. When a cleaning concentrate states that is it multi-tiered, the inference is that is contains: protease enzymes which break protein debris into smaller, more soluble subunits, amylase enzymes which catalyses the breakdown of starch, and lipase enzymes which breaks up fat-containing debris and carbohydrates. When a detergent cleaning concentrate states that is it high-level, the inference is that is contains a high concentration of enzymes. When a cleaning concentrate states that is provides enzyme activity the inference is that is contains enzymes but this is usually is a misrepresentation of ingredients for a detergent cleaning concentrate that does not contain enzymes. Enzymes are effective and they are costly for manufacturers to include in the formulation. As is true for all detergent cleaning concentrates, the most effective test is against your most difficult cleaning challenge. The two most common tests for cleaning concentration efficacy that are commercially available are the TOSI Test and the film test. Be aware that some manufacturers use advertising wordage and product names that imply enzymes are an active ingredient but do not actually include enzymes in their product formulation. Refer to product labels and ingredients for disclosure. Enzyme cleaning concentrates function more effectively at temperatures above room temperature. The optimal range begins as > 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 enzymatic action. The activity of enzymes does not stop at higher temperatures but the level of performance does begin to decrease.