Every Day Every Patient Everytime

13MS8747 Infection Control Q3-WEB_Layout 1 7/18/13 10:02 AM Page 1 Volume 7 | Summer 2013 INSTRUMENT REPROCESSING Every Day Every Patient EveryTime instrument top ten essentiaLs decontamination reprocessing for effective Life cycLe See pages 2–6 instrument See page 10 cLeaning See page 7 13MS8747 Infection Control Q3-WEB_Layout 1 7/18/13 10:02 AM Page 2 Instrument Reprocessing By Joe Tulpinski, Director of Research and Development, Metrex Research surfaces of the instruments can be kept moist by using Table of Contents Introduction In the past several years, much attention a gel, spray, or foam intended for this purpose and to Editorial: Instrument Reprocessing has been focused on patient safety and begin the break down process of the soil. Joe Tulpinski, Director infection prevention. Reports of exposure Alternatively, the used device can be covered with a of Research and Development, to inadequately or improperly reprocessed towel that has been moistened with tap water or sterile Metrex Research.............................2–6 medical devices tell of patient risk of water. Saline solutions should not be used for exposure to infection. As information is moistening or soaking as it may damage devices. more freely available to the patient, their Keeping the soil moist is crucial for proper cleaning. Top 10 Essentials for Effective awareness has increased. The risk of Dried and hardened soil can be impossible to remove Instrument Cleaning ............................7 acquiring such an infection from an and will directly inhibit high-level disinfection or inadequately reprocessed medical device is sterilization. Decontamination Products ..............8–9 relatively low given the number of such medical devices in use.1 However, outbreaks When choosing cleaning products or methods, always due to exposure remain a public health take into account the special requirements of the Decontamination Life concern. device. New devices should be evaluated to ensure Cycle Chart..........................................10 that the devices can be effectively cleaned. Reusable medical devices are medical Sometimes, even when a thorough process is used, devices that can be reused to diagnose and some instruments, due to their design, can be deemed Miltex–Healthy treat patients. As these devices are used, unable to be cleaned. Staff involved in instrument Instrument Program ..........................11 they become soiled and contaminated with reprocessing should follow the manufacturer’s organic matter and microorganisms that instructions and use products that are appropriate for Packaging Products ......................12–13 must be removed between patients to cleaning instruments. Hand soaps, laundry, or dish avoid risk of cross contamination. detergents should not be used to clean instruments. These reusable devices are reprocessed Follow the detergent or enzymatic detergent’s Sterilization Products....................16–17 between patients. Reprocessing is a manufacturer’s instructions for proper dilution and use multistep process that ensures reusable for optimal cleaning. medical devices can be cleaned and Ultrasonic Cleaners disinfected without impairing its The most common type of instrument cleaning is & Sterilizers ......................................18 function. manual cleaning. Manual cleaning is a more flexible method of cleaning in that any type of instrument can Henry Schein Brand Products ............19 We will look at the key steps for the be cleaned manually. The down side to manual proper reprocessing of reusable medical cleaning is that the consistency of cleaning can vary instruments as it relates to cleaning, between technicians and that the employees are at risk Quality Assurance ........................20–21 disinfection, and storage of a of exposure to possible contamination since they are in reprocessed instrument. contact with contaminated instruments. It is for these SPSmedical Biological Indicators reasons that a health care facility establishes protocols for Steam Process ............................22 for instrument cleaning and the disinfection process. Cleaning of Used Instruments A brief overview of the cleaning process is described in The most important step in instrument Table 1. These procedures should also emphasize that reprocessing is cleaning. Studies have appropriate personal protective equipment (PPE) be demonstrated that dirty instruments cannot worn by the employees when performing instrument be effectively disinfected.2 Cleaning is the cleaning. Additionally, proper training, qualification removal of visible soil (organic and and re-qualification of the cleaning process should be inorganic material) from instruments and is implemented to ensure consistency between normally accomplished manually or technicians, ensuring consistent outcomes. automatically using water and detergents with or without enzymes.3 When the instruments are received for cleaning, technicians will take the instruments apart prior to Following the use of a device, gross soil is cleaning (except when the manufacturer’s instructions removed and the device is sent to the say otherwise). The instruments are disassembled, central processing area where cleaning sorted, and allowed to soak. Soaking the instruments will occur. If cleaning is unavoidably makes it easier to remove soil by softening the delayed, devices can be treated to organic and inorganic matter on the instruments. prevent a hardening of the soil. The 2 incontrol Order: 1.800.772.4346 8am – 9pm, et | Fax: 1.800.329.9109 24 hours 13MS8747 Infection Control Q3-WEB_Layout 1 7/18/13 10:02 AM Page 3 Table 1: Manual Cleaning of Used Instruments step procedure Why this is done 1 Disassemble used instrument according to This is done to eliminate areas that are manufacturer’s instructions for use. difficult to clean. These areas can build up organic and inorganic debris over time making disinfection impossible. JOE 2 Soak the used instruments in warm water for 10 This step softens and loosens much of the TULPINSKI minutes. (Time may vary depending on the soil soil that may have dried on the instrument type and degree of soil drying that has taken between the time it was used and the time JOE TULPINSKI is Director of Research and place.) cleaning has started. Development at Metrex/Kerr TotalCare, a subsidiary of Danaher Corporation, located 3 Completely brush the instrument with a medium- Brushing is the physical removal of the soil in Anaheim, California. He holds a soft bristle brush while it is in the soak bath. from the instrument. Bachelor’s degree in Biology and a Master’s To avoid damaging the instrument, follow Degree in Biological Sciences from manufacturers’ recommendations as to the type Note: the insides (lumens, channels, etc.) California State Polytechnic University, of brushes to use for cleaning. Brushing should of tubed devices, like dental handpieces Pomona. Joe has research experience in be performed under the surface of the water or endoscopes should be brushed out formulation chemistry, microbiology, food to minimize aerosolization-cleaning away from as well. microbiology, molecular biology, and in the operator. pharmaceutical quality control. A professional member of ASTM, ASM, APIC 4 Rinse with clean water Water can be either deionized water or and SGNA, Joe has experience in the reverse osmosis water from the facility. medical device, disinfection, and reprocessing areas. Prior to joining If difficult-to-remove soil remains, another enzyme detergent soak followed by brushing and rinsing Metrex/Kerr TotalCare in 2005, Joe was the Laboratory Manager at N-terminus Research should be done. Laboratory, a research facility dedicated to both basic and applied research in the Sorting the instruments allows for the and monitor the water temperature, detergent area of novel antimicrobial technologies. separation of sharps and staging for the or enzymatic dosing and cleaning cycle time. appropriate cleaning process. Cleaners and Some of these automatic cleaning systems References enzymatic detergents should be used when employ a combination of water jets and 1. FDA, 2013, “Reprocessing of compatible. The enzymatic detergents work to ultrasonics to uniformly and thoroughly clean Reusable Medical Devices,” U.S. Department of Health & Human break down proteinaceous soils. Detergents a soiled instrument. Regardless of the Services–Food and Drug dissolve dirt and grease and break down or automatic washer type or system used, Administration. dissolve oils better than soaps. The detergents instruments must be prepared for processing 2. Alfa, et al. 1998, “Comparison of contain wetting agents that allow water to flow (i.e., sorted) before being placed into a washer. liquid chemical sterilization with freely into difficult-to-clean areas like hinges The actual preparation should be done in peracetic acid and ethylene oxide and crevices. Prolonged soaking of instruments accordance with the washer manufacturer’s sterilization for long narrow lumens”. or devices in detergents or enzymatic instructions and facilities standard operating American Journal of Infection detergents can cause damage to an item or procedures. Control. cause biofilm to form on the instrument. 3. Rutala, 2008, CDC: “Guideline for Always ensure that the detergent or enzymatic Disinfection and Sterilization in Healthcare Facilities, 2008” detergents are approved by the device Choice of Disinfection Process 4. Spaulding, 1972, “Chemical manufacturer. It is important to choose the correct method of Disinfection

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