Cleaning Surgical Instruments
The importance of surgical instrument cleaners
Cleaning and the importance of Cleaning Surgical Instruments
Proper Surgical Instrument cleaning prevents stains. Surgical Instrument cleaning prevents corrosion. Surgical Instrument Cleaning is the Prerequisite for Sterilization. The primary purpose of cleaning surgical instruments is to remove all inorganic and organic proteinaceous bioburden material from the internal and external surfaces cleaning surgical instruments inside and out with careful attention to cleaning cannulated surgical instruments. The secondary purpose of cleaning surgical instruments is to maintain and improve the passive Layer of surgical stainless steel.
The passive layer is provided by the manufacturer of the surgical instruments, within the surgical stainless steel, to resist (prevent) corrosion. Proper cleaning of the surgical instrument will maintain and improve this passive layer. for more information go to: Prevent surgical instrument Corrosion If the manual cleaning, brushing and rinsing steps are not properly carried out, protein debris can harden and lead to formation of biofilm on the surgical instrument, i.e. the biopsy channel of an endoscope. The optimal surgical instrument cleaning protocol will break down proteinaceous bioburden and clean the surface. Inadequate cleaning can result in material remaining on the surgical instrument which will prevent disinfection and sterilization fluids or gases reaching all parts of the potentially contaminated device. Inadequate sterilization or disinfection sterilization and may in turn result in transmission of infectious organisms when the device is reused. The intricate design and delicate materials of flexible scopes complicate the cleaning process. This requires repetitive and consistent oversight.
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Surgical Instrument Cleaning is the Prerequisite for Sterilization
The reprocessing decontamination Cleaning of Surgical Instruments, whether done manually or automatically in a surgical instrument washer decontaminator disinfector, can only be effective if "cleaning" is adequate. Effectively sterilizing surgical instruments (Generic Sterilization with a Pre-Vacuum Sterilizer (HI-VAC): 270-272° F (132-134° C), 16-minute exposure time, with 4 pulses and a 30-minute dry time. Generic Sterilization with a Gravity Displacement Sterilizer: 270-272° F (132-134° C), 30-minute exposure time, with a 30-minute dry time.) is not possible if "cleaning", the "prerequisite for sterilizing surgical instruments", is not adequate. All disinfection processes, whether done manually or done automatically in a surgical instrument washer decontaminator disinfector, can only be effective if prior cleaning is adequate. Effective disinfection or sterilization of an inadequately cleaned surgical instrument or scope is not possible. Endoscopes should be cleaned with an enzymatic enzyme detergent compatible with the endoscope immediately after use and before manual or automated disinfection. Cleaning involves the entire endoscope, including valves, working channels, connectors and all detachable parts. High level enzymatic enzyme detergent formulations ("Enzymatic" Surgical Instrument Cleaners), in combination with a high level surfactant chemical complex, have been shown to be effective in removing stains, hard water deposits, and encrusted bioburden, while being safe to use for rigid or flexible scopes.
Enzyme Surgical Instrument Cleaning Concentrates
Enzymes: Enzymes are costly, clinically and financially effective.
Manufacturers of surgical instrument usually recommend that Enzyme Cleaning concentrates should be discarded after each use as these products are not microbicidal and will not retard microbial growth. Some manufactures of "combination" or all-in-one surgical instrument cleaning concentrates include a bacteriostatic agent which will prevent the growth of microorganisms. Some detergent complexes contain antimicrobial-microbicidal substances. Although these agents do not replace disinfection they are designed to reduce the risk of infection to reprocessing personnel by rendering instruments that are clean and safe to handle. The cleaning function efficacy of enzyme cleaning concentrates is determined by the ratio of enzymes to bioburden. The higher the proportion of enzymes the higher the efficacy. As a result, if the cleaning solution becomes laden with bioburden from previous cleaning, the efficacy of the enzyme cleaning concentrates is lower. When a cleaning concentrate states that is it "multi-tiered", the inference is that is contains: protease (enzyme) which break protein debris into smaller, more soluble subunits, amylase (enzyme) which catalyses the breakdown of starch, and lipase (enzyme) which breaks up fat-containing debris and carbohydrates. When a detergent cleaning concentrate states that is it "high-level", the inference is that is contains a high concentration of enzymes. When a cleaning concentrate states that is provides "enzyme activity" the inference is that is contains enzymes but this is usually is a misrepresentation of ingredients for a detergent cleaning concentrate that does not contain enzymes. Enzymes are effective and they are costly for manufacturers to include in the formulation. As is true for all detergent cleaning concentrates, the most effective test is against your most difficult cleaning challenge. The two most common tests for cleaning concentration efficacy that are commercially available are the "TOSI Test" and the "film test". Be aware that some manufacturers use advertising wordage and product names that imply enzymes are an active ingredient but do not actually include enzymes in their product formulation. Refer to product labels and ingredients for disclosure.
The all-in-ONE Surgical Instrument Cleaner will lower your costs and replace multiple surgical instrument cleaners for decontaminating and cleaning surgical instruments.
Surgical Instrument Cleaners and Conditioning
Optimal Temperature for Enzymatic Surgical Instrument Cleaners and Enzyme Surgical Instrument Cleaners
Enzyme cleaning concentrates function more effectively at temperatures above room temperature. The optimal range begins as > 22C - 72°F with performance reaching it's peak at 58.3C - 137F. This is often referred to as the optimal temperature for the performance or activity of enzymatic action. The activity of enzymes does not stop at higher temperatures but the level of performance does begin to decrease. Enzyme cleaning concentrates enzyme-detergents and all-in-one cleaning concentrates, which include enzymes, should be used in accordance with the manufacturer's recommendations and the recommendations of the medical devices being cleaned.
Creutzfeld-Jakob disease deactivating prions protein prions
The approach for cleaning surgical instruments can be the same if the presence of pathological prions (including the prions of vCJD Creutzfeld-Jakob disease) however the attention to detail is more important. It is known, that prions are unusually resistant to disinfection and sterilization by the physical and chemical methods used for decontamination of infectious pathogens. It is a difficult task to gain a consensus opinion on what constitutes optimal and practical conditions for decontamination of prions. Numerous studies have been conducted, but they do not reflect the reprocessing procedures for surgical instruments in a clinical setting. The clinical setting is critical for iatrogenic transmission, the passing of a disease from an infected individual or group to a previously uninfected individual or group. The method of reprocessing prion contaminated surgical instruments includes (1) decontamination by NaOH or NaOCl for 30 or 60 minutes followed by GL-autoclaving at 121°C for 30 minutes, (2) cleaning and (3) routine PL-sterilizing at 134°C. It is known that some surgical instruments cannot be decontaminated by heat and moisture. Disinfectants have been widely used for this purpose even although the disinfectants are ineffective. The most common practice believes that the only completely safe way to prevent transmission of vCJD is to use single-use surgical instruments. Because of the pervasive distribution of these infectious proteins and the long incubation time of the disease, reprocessing cleaning surgical instruments has been identified as a high risk factor for nosocomial transmission of vCJD. Research has shown that the agent of the vCJD disease, an infectious prion protein, is extremely resistant to today’s sterilization methods; therefore, the argument, “It does not matter if instruments are 100 percent clean, as they will be sterilized,” is definitely no longer valid. Today, we understand that cleaning surgical instruments is as important as the sterilizing the surgical instruments. Today’s surgical instrument cleaning process requires increasingly sophisticated surgical instrument cleaning concentrates.
Ultrasonic surgical instrument cleaners are very effective when used with hot water per manufacturer’s recommended temperature and with enzyme detergent surgical instrument cleaners. It is recommended that all visible debris and blood be removed from the surgical instruments prior to ultrasonic surgical instruments cleaning. Sort surgical instruments by similar metals to prevent corrosion due to the contact of dissimilar metals electrolytic deposition - galvanic corrosion. It is recommended not to clean plated surgical instruments in an ultrasonic cleaner since the ultrasonic vibration and the presence of other sharp instruments may crack or rupture the surgical instruments plating. Because Ultrasonic surgical instrument Cleaners do not provide the complete "proper sequence of treatments cleaning surgical instruments", they are not considered to be as clinically effective as automated washer-decontaminators- disinfectors. To render the effective cleaning of surgical instruments, final rinses that are purified, purged between treatments, and/or have temperatures elevated to disinfection levels must be used. Ultrasonic surgical instrument Cleaning can effectively remove long term encrustation and surgical instrument cements or glues that have dried onto surgical instrumentation. Always refer to the printed manufacturer recommendations prior to using Ultrasonic. Recommendations for Maximizing the Efficacy of Ultrasonic Cleaning. Surgical Instruments being cleaned must be fully immersed under the ultrasonic cleaning solution, Hinged surgical instruments must remain open during ultrasonic cleaning. Use cleaning surgical instrument trays that do not obstruct the ultrasonic surgical instrument cleaning process or add mass. Wire surgical instrument trays and baskets are recommended. Large surface bulky items such as kidney shaped bowls must be positioned not to create anechoic shadow zones that will block the efficacy of the ultrasonic surgical instrument cleaner transducer waveform. Position such items vertically or put them on top of the other items. Always sort surgical instruments by similar metals to prevent the corrosion of surgical instruments.
The all-in-ONE Surgical Instrument Cleaner will lower your costs and replace multiple surgical instrument cleaners for decontaminating and cleaning surgical instruments.
Optimal Temperature for Enzymatic Surgical Instrument Cleaners and Enzyme Surgical Instrument Cleaners
