What is the cycle of instrument use
Cleanin
Disinfection
Inspection (disposal if needed)
Packaging
Sterilization
Transport
Storage
Use
Transport
What is cleaning
The removal of all the biological matter from the surface of the instruments following use
Why is cleaning important
Functionality of instrumentation
To minimise the spread of contamination
Toprevent failed procedures
To acheice steam contact
It is a legal requirement
What is the gold standard cleaning process
AWD
Automated washer-disinfector
True/False it is a legal requirement to use a WD in scotland
True
What is the name of the holder where instruments are placed in a WD
Load carrier
Why is machine washing better than human washing
-There is the potential for human error
-The process poses a risk to the operator carrying it out
-Scrubbing does have a significant mechanical force, but…
-That means you need to have an
operator manually cleaning
Why is WD better than ultrasonic
-The Ultrasonic is powerful and can remove
hard-to-reach contamination
-It is an automated process, but it only has one stage
-The contamination is removed from the
instrument, but remains in the chamber
-It can damage certain instruments and still
requires manual stages such as rinsin
What are the 5 core stages within a WD
Flush/Prewash– this stage removes gross contamination
Main wash– this stage must remove all the biological matter
Rinse– this stage removes any remaining residue
Thermal Disinfection– this stage denatures microorganisms
Drying– this stage removes any remaining moisture
What are the temp ranges of each WD stage
Flush/Prewash – less than <35 degrees
Main wash – temperature dependent on chemical used for process
Rinse – less than <65 degrees
Thermal disinfection – must be between 90 – 95 degrees for minimum of 1 minute
Drying – no specified temperature but generally over 100 degrees
(hot air)
What is the first step in the decontamination process
Use of the Washer Disinfector
What are the daily checks before using a WD
- Verify the condition of the load carrier
- Check that the Sprays arms spin freely without obstruction
- Check the spray jets (on the spray arms) are not blocked
- Make sure there is no debris (tape or labels for instance) on the strainer/filter, and that there are no parts of instruments or any other potential blockages.
- Check the condition of the door seal and wipe and clean if necessary
- Verify there is a suitable amount of chemical in the reservoir
- Record the disinfection temperature of the first cycle every day (commonly referred to as an ACT)
How are instruments inspected and what is assessed
Through an illuminated magnifier
-residual contamination
-functionality
-damage/corrosion
What PPE is needed for manual cleaning
Apron
Face sheild
Heavy duty rubber gloves
What are the set stages to manual cleaning
Dedcated sink NOT used for handwashing
Standard tap water between 30-35degrees
(higher temp for protein coag)
Chemical detergents formulated specifically for manual cleaning - enzymatic or pH neutral
What is MIFU
Manufacturers instructions for use
What instruments are used to aid cleaning
The instruments are scrubbed below the surface of the water with a, long handled, soft bristled brush.
A metallic brush should never be used for manually cleaning as this could damage the instrumentation
Why do you scrub below water
- The instruments must be in contact
with the water and detergent solution - It is essential to minimise splashing.
This will contaminate the surroundings. - Scrubbing above the surface of the
water has the potential to produce
aerosols
When should manual cleaning be carried out
- It is specifically recommended
by the manufacturer’s
instructions for processing - If there is no other alternative
i.e. all automated equipment is
out of service
What should be recorded in the equipment log book
Date
Cycle number
Detergent added
Temp
Time
Operator name
What is the first stage of the process if WD fails or there is visible debre
Cleaning
What processes require rinsing
Manual cleaning
Ultrasonic cleaning
Reasons for manual and ulstrasonic
- Manually scrubbing with a brush exerts
a greater force than the Washer-Disinfector
is capable of producing - Some pieces of equipment must only be
manually washed, in-line with manufacturers
recommendations - Ultrasonic baths have a ferocious process that
is very good at removing contamination
Reasons against manual and ultrasonic cleaning
- A member of staff is required to be present
for the entire process - There is a risk of aerosol production
- There is a risk of contaminating the surrounding environment
- There is the potential for inconsistency in the process due to human error
- There is a high risk of sharps injuries for
members of staff carrying out the process - Ultrasonics have a ferocious process which
has the potential to damage some equipment - There are no automatic water changes in
an Ultrasonic bath - There is no thermal disinfection specifically
targeting microorganisms
