Cleaning surgical instruments
prior to sterilization.
Surgical instrument washing rendered sterile surgical instruments, at the completion of the washing process.
APIC Association for Professionals in Infection Control
Presented by: A. Drake, RN,
Director CS, Ohio State University, President of APIC
International Annual Conference of APIC,
Oral Presentation by Ann Drake
The application of universal precautions to instrument and utensil handling became an issue in the selection of replacement decontamination equipment for Central Sterile supply at our hospital. The new technology of a surgical instrument washer disinfector, used with a combination enzyme surgical instrument cleaner detergent, offered increased protection to our reprocessing staff due to decreased handling but raised concerns about the efficacy of washer thermal disinfection as opposed to using the traditional washer sterilization.
The surgical instrument washer times and temperatures, for the washing cycles used, rendered sterile surgical instruments at the completion of the washer cycles. Our reprocessing goal is the proper cleaning of surgical instruments prior to 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 the washing outcomes.
The sequential functions of the surgical instrument washer progress from flush/rinse ultrasonic cleaner cycle, enzyme cold water washing, elevated temperature detergent washing, redundant rinses, lubrication with deionized water (DI) sprays, and to drying at 240° F, for 4 minutes.
The surgical instrument washer was challenged with selected surgical 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 (contaminated) with a 105 ml of Staphylococcus aureus, Pseudomonsaeruginosa, Enterococcus fecalis and Candida albicans, in nutrient media, and then dried.
The surgical instruments were processed in the washer, 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 deionized water prior to the drying cycle. A separate culture was taken of the instrument lubricant fluid.
All surgical instruments and utensils tested were sterile at the completion of the surgical instrument cleaning process, prior to sterilization.
The surgical instrument washer using the proper sequence of times and temperatures, and a surgical instrument cleaning detergent with enzymes and surface lubricant, is a valid replacement for the washer sterilizer.
Surgical instrument washers that are properly designed and that deliver disinfector times and temperatures, can deliver sterile medical devices at the completion of washing cycles. The proper sequence of surgical Instrument washer times and temperature cycles can consistently deliver clean medical devices that are safe to handle and have received the prerequisite for sterilization.
When cleaning surgical instrument prior to sterilization, the optimal cycle washer disinfector temperatures are;
cold water pre wash cycle: ambient to 95 F, 35 C,
wash cycle: 131 to 137 F, 55 to 58 C,
thermal rinse cycles: 194 to 209 F, 90 to 98 C,
hot air cycle temperatures: 158 to 230 F, 70 to 110 C,
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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 produce the times and temperatures that can effectively deliver disinfected surgical instruments.
Automated surgical instrument washers can safely contain within their chambers the cleaning, decontamination, and reprocessing functions that removal of debris, and contain the contaminated aerosols.
Surgical instrument washers can consistently remove all pathogens from surgical instruments rendering them residue free, for cleaning surgical instruments prior to sterilization.
Our goal is to deliver superior outcomes for cleaning surgical instruments prior to sterilization. APIC study "all surgical instruments and utensils were sterile at the completion of the washing process."