- "The efficacy of disinfection was 100%."
- "All instruments and utensils tested were sterile at the completion of the process."
Proper Sequence of Washer Treatments
- elevated temperature detergent washing,
- purified water rinsing with increasingly elevated temperatures,
in such a manner as to provide thoroughly clean, stain free and lubricated medical devices. Surgical Instruments cannot be sterilized (be sterile) unless all exposed surfaces are properly cleaned, prior to sterilization, to remove soil (debris, bioburden) and properly rinsed to prevent staining.1,2,3 Not all Surgical Instrument Washers, Washer Decontaminators, Washer Disinfectors provide adequate pre-rinsing, pre-cleaning, purified water rinsing, and thereby render higher rejection rates of processed surgical instruments. 4,5.
Proper
Surgical Instrument Washers,
Washer Decontaminators,
Washer Disinfectors
Design Secures Performance
Surgical Instrument Washers, Washer Decontaminators, Washer Disinfectors employ a cold water pre-wash (below 100 degrees F) to remove gross debris. This combined with an enzyme surgical instrument cleaner, removes proteins and lipids, preventing them from being baked onto devices during the high temperature treatments to follow. 9, 10. Then, the ultrasonic process creates millions of micro implosions to loosen and free debris from lock boxes, hinge pins, serrations and other difficult-to-access surface areas.
The Surgical Instrument Washers, Washer Decontaminators, Washer Disinfectors detergent wash then apply high flow low pressure water with a cleaning concentrate (at ~ 135 degrees F) in such a manner as to evenly reach all areas of the load and strip bioburden from the surgical instruments. The elevated temperature (at ~ 194 to 209 degrees F) purified water final rinse secures the biocidal process, removes mineral deposits from prior cycles and lubricates the instruments. The high temperature (at ~ 158 to 230 degrees F) dry cycle presents heated, forced air which dries each device. The critical cleaned medical devices are now clean, safe to handle, have the prerequisite for sterilization, and are properly prepared for further reprocessing.
Complete Removal of Pathogens
The Washington University School of Medicine at Washington University Medical Center examined the performance of a properly designed Washer Decontaminator Washer Disinfector (CESCO washer Decontaminator Model 520) and found that it removed all organisms from the surgical instruments tested. 11
The Surgical Instrument Washers, Washer Decontaminators, Washer Disinfectors was tested for its ability to complete remove pathological organism from surgical instruments.
Pure cultures of the following organisms were grown on appropriate agar plates:
1. Staphylococcus aureus;
2. Pseudomonas aerations;
3. Escherichia coli;
4. Bacillus species
Kelly clamps, tweezers and scissors wee placed on these plates of organism, taking care to ensure that all serrated edges were packed with all the organisms. Each contaminated instrument was then dipped into the tube of Thiogycolate medium before being placed in all the washer baskets. The instruments were then processed through the complete Washer Decontaminator Washer Disinfector cycle. At the end of the drying cycle, the instruments were allowed to cool and then dipped into another tube of Thioglycolate medium.
Results
All tubes of the Thioglycoate medium tested before the wash grew the appropriate organism within six to 18 ours after testing. All tubes tested at the end of the wash showed no growth after 14 days of incubation. This Washer Decontaminator Washer Disinfector removed all organisms from the instruments.
Efficacy of Disinfection 100%
Another evaluation of Washer Decontaminators Washer Disinfectors confirmed that the efficacy of disinfection was 100%. In this study, L.P. Jette and N.G. Lambert used two test methods.12 One method (N) was to test the effect of heat only within the disinfection process and the other test method (G) was to test the efficacy of both heat and washing. Each method gave reproducible results and confirmed the efficacy of the Washer Decontaminator Washer Disinfector.
Critical Cleaners Will Work for You
Surgical Instrument Washer, Washer Decontaminator, Washer Disinfector Critical cleaners demonstrated the ability to completely remove pathological organisms with effective repeatability. There operation is automatic, reliable, labor saving and easy to use. Central Processing departments rarely find the need to manually treat devices and report an exceptionally low rate of rejected devices.
Conclusion
The Surgical Instrument Washers, Washer Decontaminators, Washer Disinfectors sequence, cold water pre-wash, ultrasonic cleaning, detergent washing action, final rinse and drying treatment of a properly designed Surgical Instrument Washer, Washer Decontaminator, Washer Disinfector Critical Cleaner will provide critical cleaning, the prerequisite for safe handling, optimal disinfecting, and sterilizing of medical devices.
References
1. Peggy Ryan, RN, “Concepts of Cleaning Technologies and Processes,” Journal of Healthcare Material Management, (Nov./Dec. ’87), pp. 20-27.
2. Marimargaret Reichert, RN, “processing Reusable Medical Devices, “Journal of Hospital Material Management, p. 40.
3. Training Manual for Central Service Technicians, American Society for Central Services Personnel of the American Hospital Association, (Chicago, IL, 1986), p. 69.
4. Ryan, op. cit.
5. Training Manual for Central Service Technicians, op. cit.
6. Ryan, op. cit.
7. Interview with Charles A. Reed, Washington University School of Medicine, Washington University Medical Center, Dec. 1985.
8. 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.
9. Training Manual for Central Service Technicians, op. cit.
10. Ryan, op. cit.
11. Ryan, op. cit.
12. L.P. Jette’and N.G.Lambert, op.cit.
John Temple
John Prohonic
Product Development
NOTE:
The Surgical Instrument Washers, Washer Decontaminators, Washer Disinfectors, using a 'combination' enzyme detergent instrument cleaner with the mechanical and chemical Proper Sequence of Washer Treatments used in this research study were manufactured by CESCO, Mercersburg PA. Although these Surgical Instrument Washers, Washer Decontaminators, Washer Disinfectors, using a 'combination' enzyme detergent instrument cleaner are not currently available, the studies demonstrate the propensity for Surgical Instrument Washers, Washer Decontaminators, Washer Disinfectors, using a 'combination' enzyme detergent instrument cleaner to deliver optimal cleaning results.
The surgical instrument cleaners used in these studies are currently available in the form of the all-in-ONE combination 4 enzyme detergent surgical instrument cleaners. A critical component for optimal cleaning is using the best possible "surgical instrument cleaners". Recent European studies have illustrated and concluded that combination enzymatic enzyme detergent surgical instrument cleaners are 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).
ABSTRACT
Paper accepted for presentation at APIC:
Eighteenth Annual Conference and International Meeting
Nashville Tennessee
Oral Presentation
Validation of the microbial safety of surgical instruments and utensils following automated cleaning by properly designed Surgical Instrument Washers, Washer Decontaminators, Washer Disinfectors,.
A. Drake, RN and L. Ayers, MD., The Ohio State University Hospitals, Columbus, Ohio, 43210
The application of universal precautions to instruments/utensils handling became an issue in the selection of replacement decontamination equipment for Central Sterile supply at our hospital. The new technology of an automated thermal disinfection Surgical Instrument Washer, Washer Decontaminator, Washer Disinfector, (TW)(CESCO TM, Mercersburg, Pa.) 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 of this new technology, 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 Proper Sequence of Treatments of the Surgical Instrument Washer with an Ultrasonic Cleaner Solution Treatment progress from cold water prewash at <110 F initial flush rinse elevated to 135 degrees F (optimal for enzyme cleaning activity), to detergent wash with elevating temperature from 135 to 209 degrees F (optimal for detergent cleaning activity), to final rinses, to lubricant/deionized water (DI) sprays, to hot air dry cycle at ~ 158 to 230 degrees F for 4 minutes. The Surgical Instrument Washer, Washer Decontaminator, Washer Disinfector, 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 10 5ml suspension of Staphylococcus aureus, Pseudomonsaeruginosa, Enterococcus fecalis and Candida albicans in nutrient media and then dried. The instruments wee processed in the Surgical Instrument Washer, Washer Decontaminator, Washer Disinfector, 3 separate loads during times of high volume 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 process. The final rinse, however, was heavily contaminated with the saprophytic bacteria Flavobacterium sp., Pseudomonas (P.) picketti and P. rubrisubalbicans. The source of the contamination was determined to be resin gel in the DI tank and not the instrument lubricant. The contamination can be eliminated by the addition of a 0.22 u filter to the DI line. Our findings support the practice of validating all features of new technologies that may compromise the expected final outcome. Surgical Instrument Washers, Washer Decontaminators, Washer Disinfectors are a valid replacement for the conventional washer sterilizer.
Ann Drake
John Temple
Product Development
