CLEANING INSTRUMENTSIntroduction Show
The first step in preparing an instrument for reuse after it has been used on a patient is cleaning. The importance of this step cannot be underestimated, as studies [Alfa, 1998] have shown that a soiled instrument cannot be effectively sterilized. This is because the soil shields bacteria and viruses from the sterilizing medium. As a result, the bacteria and viruses may very well survive the sterilization process and can cross infect the next patient. Methods General Precautions Since soiled instruments will normally have body fluids on them, personnel assigned to handle and reprocess them must use universal precautions. Manual
Cleaning Recommended procedures for manual cleaning are to first soak the instrument in a tepid or lukewarm water or detergent bath for at least 10 minutes, preferably until all soil on the instrument is softened. This step softens and loosens much of the soil that may have dried on the instrument between the time it was used and the time cleaning is begun. The duration of the soak depends upon how much soil is on the instruments and how long the soil has been allowed to dry. The use of enzyme detergents is preferred, as they help to break up organic soil more readily and rapidly than do conventional detergents. The next step is to completely brush the instrument with a medium-soft brush while it is in the soak bath. In the case of tubed devices like endoscopes and handpieces, the insides (tubes, lumens, channels, etc.) should be brushed out as well. Care should be taken to use brushes recommended by the manufacturer so as to avoid damaging the instrument. Brushing must be done under the surface of the soak bath with brush strokes away from the body to avoid exposure to spray from the brush, removing the instrument from the soak bath only to inspect its cleanliness. This will remove most to all of the soil on the instrument. The instrument must then be rinsed with clean water, and if difficult-to-remove soil remains, another enzyme soak followed by brushing and rinsing must be done. Clean detergent solutions must be used for each cleaning session, so as to make sure that soil that was removed from on instrument or set does not deposit on the next instrument, creating the chance for cross infection. Manual cleaning is the first step. It removes a great deal of soil from instruments, but does not do a very good job on removal of very small particles that may be found in hinges, textured surfaces, and other hard-to-reach parts of the instruments. For this, ultrasonic cleaning provides a solution that is the next, essential step in reprocessing instruments safely. Ultrasonic Cleaning Automatic Cleaning Aside from increasing throughput and providing specialized solutions to difficult cleaning situations, automatic washers serve one very important purpose, no matter what their specialized capabilities. This purpose is to provide the same level of cleaning every time. These machines remove the variability of cleaning discussed previously. When used as recommended by the manufacturer, and they are properly maintained, these machines eliminate one source of uncertain results in instrument reprocessing, the human factor. In addition, they decrease opportunities for personnel to be exposed to infectious soil by doing some of the work that would otherwise require hands-on involvement of a healthcare worker, providing another benefit from their use. Automatic washers have more things in common than differences. There are basically three classes of washer found in the healthcare reprocessing setting. These are washers, washer-disinfectors and washer-sterilizers. In the US, these categories are defined and regulated by the Food and Drug Administration (FDA), and a unit may not be offered for sale without the permission of that agency. Only washers and washer-disinfectors intended to process "general purpose" articles, such as laboratory glassware, pipettes, bottles and containers, are exempt from FDA review, unless they are promoted for use in the reprocessing of reusable medical devices [FDA, 1998]. The differences between these categories are given in the table below.
Washers Washer-Disinfectors Washer-Sterilizers Instrument Preparation for Cleaning in an Automatic Washer Use of Containers Care of the Washing Equipment Multi-Step Automatic Cleaning Difficult to Clean Instruments Dental
and Orthopedic Handpieces All water and air channels in a handpiece are small, making it difficult to gain access to them and making cleaning difficult. Also, when the handpiece is turned off, the water supply tends to suck water back, pulling soil into the handpiece, and into the areas most difficult to access. How, then does one clean these instruments? The same sort of sequence described above for regular instruments is used. This is to remove gross soil, fine soil and microscopic soil, in that order. Gross Soil Removal The first step in cleaning the inside of the handpiece is to attempt to remove the soil that was sucked into the water channels. To do this, you simply operate the handpiece in the normal manner for 20-30 seconds, pointing the instrument into a narrow-necked receptacle or drain, or a high-speed evacuation receptacle. The handpiece head must be inside the neck of the receptacle, ensuring that none of the spray or spatter is allowed to escape and contact the healthcare worker doing the cleaning. This action flushes out most or all of the soil in these channels. Some handpiece manufacturers also suggest the use of lubricating oil fed through an automatic handpiece lubricator for this rinsing. Following this, the handpiece should be disassembled in accord with the manufacturer's instructions and cleaned following the manual and ultrasonic procedures described above. Note that the handpiece manufacturer's instructions are the final authority on the specific procedures used on a particular handpiece. Endoscopes Manual Cleaning-Rigid Endoscopes The next step is ultrasonic cleaning. This is done in a manner similar to what is done for normal instruments, and does not require any further discussion. After cleaning, the endoscope components are to be rinsed with water or alcohol and allowed to dry. Any joints requiring lubrication are then lubricated and the endoscope may be reassembled in preparation for sterilization. If the endoscope is to be disinfected using a liquid disinfectant, reassembly and lubrication should be done after disinfection. Manual Cleaning-Flexible Endoscopes Ultrasonic cleaning should follow manual cleaning for all submersible parts of the endoscope. Note that due to the small diameter of the endoscope lumens, ultrasonic waves will not penetrate much more than one inch from the end of the tube, so this cleaning method's effects are limited to the outside of the endoscope. Automatic Cleaning Summary References Alfa, 1998: "Comparison of liquid chemical sterilization with peracetic acid and ethylene oxide sterilization for long narrow lumens," Michelle J. Alfa, Pat DeGagne, Nancy Olson, Romeo Hizon, American Journal of Infection Control 1998; 26: 469-77. BSG, 1997: "Cleaning and Disinfection of Equipment for Cleaning and Disinfection of Equipment for Gastrointestinal Endoscopy," British Society of Gastroenterology, Guidelines in Gastroenterology, 1997. CDC, 1993: "Recommended infection-control practices for dentistry," Centers for Disease Control and Prevention, MWMR 1993;42(No. RR-8), 1993. FDA, 1998: "Guidance Document For Washers And Washer-Disinfectors Intended For Processing Reusable Medical Devices," June 2, 1998, U.S. Department of Health and Human Services, Food and Drug Administration, Center for Devices and Radiological Health, Infection Control Devices Branch, Division of Dental, Infection Control, and General Hospital Devices, Office of Device Evaluation, http://www.fda.gov/cdrh/ode/washdsnf.html. FDA, 1998a: "Guidance on the Content and Format of Premarket Notification 510(k) Submissions of Washers and Washer-Disinfectors-Draft Guidance," U.S. Department of Health and Human Services, Food and Drug Administration, Center for Devices and Radiological Health, Infection Control Devices Branch, Division of Dental, Infection Control, and General Hospital Devices, Office of Device Evaluation Forbes, 1999: "Blood Money," Neil Weinberg, Forbes, p. 123, March 22, 1999. Health InfoCom Network News, 1991: Nosocomial Infection and Pseudoinfection from Contaminated Endoscopes and Bronchoscopes -- Wisconsin and Missouri, Health InfoCom Network News, Volume 4, Number 25, Page 6, December 25, 1991, Scottsdale, AZ. Copyright, 2001 SPSmedical Supply Corp. Which is the cleaning process that removes debris from instruments in a process called cavitation?Ultrasonic cleaning works by creating microscopic bubbles in the solution that collapse when they contact the instrument. When the bubbles collapse, the energy that was used to make them is released. This energy 'kicks' any soil that is in the area off the instrument. This process is called cavitation.
What is the first step in cleaning instruments used in minor surgery?The proper cleaning of surgical instruments starts in the O.R. by placing the contaminated instruments into sterile water or an approved enzymatic detergent. Alternatively, the instruments may be sprayed with enzymatic instrument foam to keep the instruments moist and to start the cleaning process.
Which of the following is the first step a medical assistant should take when sanitizing a soiled hemostat?Which of the following is the first step a medical assistant should take sanitizing a soiled hemostat? Rinse the instrument under cold water.
Which protocol helps prevent errors during a surgical procedure?The Universal Protocol for Preventing Wrong Site, Wrong Procedure, Wrong Person Surgery is part of the National Patient Safety Goals® chapter of the Joint Commission accreditation manual.
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