3 Reasons to Flush Medical Instruments Before Using an Ultrasonic Cleaner

One of the most important phases of medical device reprocessing is the manual cleaning. Improperly cleaned surgical instruments are much more likely to contribute to healthcare-associated infections (HAIs) if bioburden is not completely removed prior to the sterilization process. There are many options for cleaning such devices, including ultrasonic cleaners. But can ultrasonics perform an ideal cleaning on their own?

 

Ultrasonic cleaners can be especially effective at cleaning difficult-to-clean medical device instruments, and their hard-to-reach areas such as joints, crevices, and box locks. While their cleaning abilities may be useful, they do not perform the crucial first steps needed for proper manual cleaning. Those include flushing and brushing.

 

Here are three important reasons to properly flush and brush instruments prior to use of an ultrasonic cleaner.

 

1. Ultrasonics do not replace manual cleaning

 

Manual cleaning is a key step in the overall cleaning process. But ultrasonic cleaners on their own were not intended to remove all bioburden from devices.

 

IAHCSMM recommends manual cleaning in conjunction with sonic cleaning (if the department is using an ultrasonic cleaning device). Doing so can “enhance the cleaning process and increase the bactericidal effectiveness of the disinfection and sterilization processes.”1

 

It may seem easy enough to brush devices thoroughly and then use the ultrasonic cleaner. Unfortunately, that doesn’t work.  Brushing alone before ultrasonic cleaning is not enough. While brushes introduce friction into the manual cleaning process, they do not introduce

cleaning chemistries into channels effectively, and do not rinse out residual bioburden. Flushing and brushing may be required cleaning activities prior to your ultrasonic cleaning process per device IFU.

 

2. Irrigating channels benefits from a flush before ultrasonic cleaning

 

As mentioned above, combining the manual cleaning efforts of flushing and brushing with an ultrasonic cleaner can enhance the sterilization process. That enhanced sterilization process occurs when the dual cleaning efforts maximize effective removal of bioburden from difficult-to-clean devices. IAHCSMM recommends all lumens be carefully brushed and flushed prior to sonic cleaning.1

 

Following recommended device IFUs guidelines for flushing prior to sonic cleaning includes the use of proper time, volume, and pressure requirements. Pre-cleaning (or pre-conditioning) using proper flushing can also save time with independent flushing systems such as the FlexiPump, which can flush up to three devices at once and does not require a technician to monitor the PSI.

 

3. Ultrasonic cleaner IFUs require manual removal of bioburden

 

Manual cleaning to remove gross debris prior to ultrasonic cleaning is also recommended in the IFU of ultrasonic cleaners on the market. That is because ultrasonics were not meant to replace the manual cleaning effectiveness of flushing and brushing. The CDC reports, “Failure to adequately clean instruments results in higher bioburden, protein load, and salt concentration. These will decrease sterilization efficacy.”2

 

Ultimately cleaning goals should include:3

  • Removal of visible debris
  • Removal of invisible soilage
  • Elimination of as many microorganisms as possible

 

Proper flushing prior to ultrasonic cleaning can achieve those goals. Removal of overt residue makes ultrasonic cleaning more effective, which is why sonic cleaner IFUs require it.

 

Flushing during manual cleaning meets IFUs, cleans more effectively, and lowers infection risk

 

Ultrasonic cleaners can be an important tool when it comes to effective device and instrument cleaning. Yet it is important to remember their cleaning capabilities alone are not enough to remove all bioburden.

 

Flushing your devices first meets ultrasonic cleaner IFU, as well as device IFU. Proper flushing also makes your ultrasonic work more effectively, which ultimately contributes to lowered HAI risks to patients.

 

Those are all beneficial impacts of flushing prior to using your ultrasonic cleaner.

 

How do you perform manual cleaning tasks before using an ultrasonic cleaner? Tell us in the comments below!

 

Learn more about the Pure Processing FlexiPump Independent Flushing System and how it can support effective cleaning in conjunction with ultrasonic cleaning devices.

 

References

  1. Griffin, Ava and Concu, Patti (2017). Basics of ultrasonic cleaning. IAHCSMM CRST Self-Study Lesson Plan. Retrieved May 30, 2021 from the www.iahcsmm.org website. https://www.iahcsmm.org/images/Lesson_Plans/CRCST/CRCST153.pdf
  2. Centers for Disease Control and Infection (2016). Infection control. Guideline for Disinfection and Sterilization in Healthcare Facilities. Retrieved May 30, 2021 from the CDC website. https://www.cdc.gov/infectioncontrol/guidelines/disinfection/tables/table10.html
  3. Pennsylvania Patient Safety Authority (2006). Patient safety advisory: Bioburden on surgical instruments. National Library of Medicine website. https://collections.nlm.nih.gov/master/borndig/101727488/200603_20.pdf

Two Reasons Following IFUs is a Necessity

Reusable medical devices can present a host of opportunities for hospital acquired infections (HAIs) or surgical site infections (SSIs). One critical area in which the risk for HAIs and SSIs must be reduced involves following manufacturers’ instructions for use (IFU) during the decontamination and sterilization processes.

 

The complexity of instruments that central sterile processing departments are charged with cleaning, is changing and evolving. From laparoscopic instruments with small hinges and lumens to rigid and flexible scopes with delicate channels, these instruments require specific steps to ensure that they are properly cleaned and sterilized. Without doing so, the risk to patient and staff safety increases exponentially.

 

flushing roboticsIFUs are “written recommendations provided by the manufacturer that provide instructions for operation and safe and effective use of its device. …The device manufacturer is responsible for ensuring that the device can be effectively cleaned and sterilized with the means and methods available in health care facilities. Sterilization validation of a device requires microbiological, engineering, toxicological, and sometimes clinical evaluations of the device, which are beyond the abilities of most health care facilities. To ensure patient safety, a reusable device needs to be capable of being thoroughly cleaned and sterilized. The device labeling describes specific methods of cleaning and sterilization that have been validated by the manufacturer.”[1]

 

Throughout the decontamination and sterilization process, ANSI/AAMI ST79: 2017 Comprehensive guide to steam sterilization and sterility assurance in health care facilities, requires that departments ensure effective decontamination and sterilization by following the device manufacturer’s written IFU.  To do so, IFUs should be easily accessible, reviewable, and followed. If no IFU exists for a device, instrument, equipment, or solution, the manufacturer should be contacted and a documented method of cleaning should be provided.

 

flushing ocular instrumentsIFUs address several areas of concern. Many instruments or devices have numerous parts that must be disassembled for proper reprocessing. Understanding how those intricate parts work, the design elements, and possibly overlooked areas for cleaning, are essential to ensuring that a device is sterilized. Cleaning solution IFUs are another area that need to be taken into consideration. Proper dilution, concentration, temperature and contact time are vital for ensuring proper decontamination and sterilization. Additionally, some instruments and devices cannot be treated with specific solutions. Following manufacturers’ IFU will help prevent unnecessary damage the instrument. IFUs for reprocessing equipment are equally important. Without proper knowledge of the tools used to reprocess the instruments, effective reprocessing cannot be achieved.

 

While instrument damage and inventory protection is important, there are only two reasons why manufacturers’ IFU must be made available and followed:

 

  1. Patients: “IFU compliance is a must because we impact patients’ lives when the instruments used are contaminated. Patients come into the surgical suite with a medical problem that can be made better with surgery; the instruments used on that case must be processed following the IFU all in the name of patient safety.”[2]
  2. Staff: Your staff is your most valuable asset. Simply put, without central sterile processing staff, reusable medical devices would not get reprocessed. The risk of injury from equipment and instruments as well as exposure to harmful chemicals can be reduced by following IFUs. Departments cannot afford to lose their most valuable assets to often avoidable injuries.

 

Many tools exist for helping central sterile processing departments to ensure IFUs are followed. From digital databases that can be accessed through a computer at a workstation, to available hard copies of IFUs, departments must make sure IFUs are accessible to all staff. Training and in-servicing help to ensure that IFUs are followed, patient safety is not compromised, and that staff are able to safely perform their tasks.

[1] ANSI/AAMI ST79:2017, Definitions and Abbreviations

[2] https://www.infectioncontroltoday.com/view/importance-following-manufacturers-ifus

Integrating ergonomic tools to reduce injury and strain in packaging and assembly

Improve productivity, reduce staff injuries, and enhance patient safety with a few simple tools

Medical devices or instruments go through numerous reprocessing steps before they’re deemed sterilized. The packaging and assembly area of the sterile processing department (SPD) is critical in assuring “the sterility of an item” while protecting “the contents until use.” To assure sterility, personnel must follow standards and guidelines to make sure the packaged instrument will not pose risks to patients.

 

The rigorous requirements for preparation for sterilization in ANSI/AAMI ST79:2017 requires that “devices should be cleaned; dried; inspected for cleanliness, flaws, and damage; assembled; and packaged according to the manufacturer’s written IFU.”1  To do so, ANSI/AAMI ST79 states that “there should be sufficient space for clean textile storage (both before and after assembly into packs), an illuminated inspection table, and patching equipment. …the clean work area should include space for magnifying lights; processing tables, which should be made of nonporous materials (e.g., stainless steel), ergonomic, and, preferably, height-adjustable.”

 

The effects of packaging and assembly on the musculoskeletal system

The packaging and assembly process during medical device reprocessing is often very labor-intensive and can lead to musculoskeletal disorders (MSDs). Many times, departments have the best intentions when designing and establishing a packaging and assembly area, only to realize a few more options would have helped improve ergonomics and overall employee satisfaction.

 

back painMeet ergonomic compliance

ANSI/AAMI ST79 and OSHA ergonomic guidelines2 require height-adjustable workstations. Sterile processing trays are often extremely heavy. Bending and lifting trays onto workstations that are not at comfortable working levels can lead to musculoskeletal disorders. According to OSHA, MSDs “affect the muscles, nerves, blood vessels, ligaments and tendons. Workers in many different industries and occupations can be exposed to risk factors at work, such as lifting heavy items, bending, reaching overhead, pushing and pulling heavy loads, working in awkward body postures and performing the same or similar tasks repetitively. Exposure to these known risk factors for MSDs increases a worker’s risk of injury.”

 

The repetitive motion tasks that are also associated with packaging and assembly can lead to injury and strain. Did you know that ergonomic options go beyond making workstations height-adjustable?

 

Reduce injuries from repetitive tasks

ergonomic accessoriesKeeping items easily within reach is key to reducing musculoskeletal disorders from repeated reaching. By employing an integrated pegboard wall, shelving, bins, peel pouch rolls and trays, tape dispensers and more can be designed with the user in mind. Pegboards allow items to be easily moved and adjusted to meet the end users physiological and workflow needs.

 

When it comes to workflow, “providing adequate space for supplies and equipment and designing the layout to facilitate the flow of work through the various steps of preparation contributes to the efficiency and accuracy of the sterile processing staff.”3

 

Meet lighting compliance

magnification light with instrumentIn 2013, researchers found that by integrating a few simple ergonomic changes into a department’s design can help improve staff safety. In one department, “a lack of space in the packing area,” led to “…undesirable twists when moving around equipment.”4 By leaving “enough space to establish safe and sound work processes,” the department’s workflow improved.

 

Another area in which prep and pack table design can benefit the end user is integrated lighting. ANSI/AAMI ST79: 2017, 3.3.5.6 states that “adequate lighting of work surfaces should be provided in accordance with the recommendations of the Illuminating Engineering Society of America (IES) for minimum levels of illumination…” The rationale is based on the “importance of speed or accuracy of the work done in the area (the greater the importance of speed or accuracy, the more illuminance needed).”

 

Upon completion of the cleaning process, staff must perform cleaning verification. “Cleaning verification by users should include (a) visual inspection combined with other verification methods that allow the assessment of both external surfaces and the inner housing and channels of medical devices…”

 

magnification light for inspectionMany instruments have very small pieces and tips that look quite similar to the naked eye. It is even more difficult to notice these subtle differences under inadequate lighting. A 2019 study regarding errors in packaging surgical instruments found that “personnel error is the primary reason for packaging errors. Central sterile supply department (CSSD) staff members are not familiar with the clinical utilization of surgical instruments, and therefore it was hard for them to distinguish between instruments with minor differences.”5

 

To avoid errors in packaging surgical instruments, departments can meet compliance with magnifying task lighting. Magnifying task lights improve patient safety by enhancing visual inspection with direct light, as well as allowing technicians to verify cleaning processes and assess any damage to instruments prior to sterilization. Of equal importance, magnification and lighting improve staff safety by reducing eye and neck strain.

 

Find sterile wrap perforations without eye strain

packaging and assembly tabletop lightAdditionally, when wrapping trays with woven and nonwoven sterile wraps, ANSI/AAMI ST79:2017, 9.5 states that departments must “inspect the wrap to ensure that it is free of defects that could have an adverse effect on the performance of the material.”

 

The International Association of Healthcare Central Service Materiel Management (IAHCSMM) recommends that visual “inspection is performed using a light table that has a light source built into the tabletop to help spot small holes and punctures. As the wrap is passed over the lighted table top, light shines through the small holes and punctures making them easier to identify.”6 By doing so, imperfections and perforations in sterile wrap materials can easily be identified and staff do not have to strain to find small holes.

 

Reduce medical costs while increasing productivity and patient and staff safety

In 2008, researchers sought to connect the costs of injuries and strains on a sterile processing department and in turn, design an intervention to alleviate the number of injuries and straining. The study found that in this particular department, “between 2001 and mid-year 2005, employees in the sterile processing center (SPC) experienced 32 injuries, costing $187,266.00 in direct medical costs (i.e., loss expenses), with strain injuries accounting for 94% of the total expenses and 50% of the total injuries.”7 Many departments are already backlogged with cases and need capacity boosting solutions. Adding injuries and strain to staff only creates further backlogs. By integrating ergonomic solutions in the packaging and assembly area, costs are reduced and throughput is increased. Not to mention, staff productivity and employee satisfaction are boosted as well.

 

Learn more about Pure Processing height-adjustable workstations and inspection tables to meet your workflow and workplace environment goals.

Want to earn 1 free CE? Watch Under Wraps: Packaging Materials, Their History, Efficacy and Creating Packaging Material Inspection Protocols

 

References

 

  1. Association For The Advancement Of Medical Instrumentation. Sterilization Standards Committee, Association For The Advancement Of Medical Instrumentation, & American National Standards Institute. (2017). Comprehensive guide to steam sterilization and sterility assurance in health care facilities. Arlington, Va: Association For The Advancement Of Medical Instrumentation.
  2. Ergonomics – Overview | Occupational Safety and Health Administration. (n.d.). Retrieved February 3, 2021, from www.osha.gov website: https://www.osha.gov/ergonomics
  3. Association For The Advancement Of Medical Instrumentation. Sterilization Standards Committee, Association For The Advancement Of Medical Instrumentation, & American National Standards Institute. (2017). Comprehensive guide to steam sterilization and sterility assurance in health care facilities. Arlington, Va: Association For The Advancement Of Medical Instrumentation.
  4. Hall-Andersen, L. B., & Broberg, O. (2014). Integrating ergonomics into engineering design: The role of objects. Applied Ergonomics, 45(3), 647–654. https://doi.org/10.1016/j.apergo.2013.09.002
  5. Zhu, X., Yuan, L., Li, T., & Cheng, P. (2019). Errors in packaging surgical instruments based on a surgical instrument tracking system: an observational study. BMC Health Services Research, 19(1). https://doi.org/10.1186/s12913-019-4007-3
  6. International Association Of Healthcare Central Service Material Management. (2016). Central Service Technical Manual. (p. ). : IAHCSMM.
  7. Boynton, T., & Darragh, A. R. (2008). Participatory ergonomics intervention in a sterile processing center: a case study. Work (Reading, Mass.), 31(1), 95–99. Retrieved from https://pubmed.ncbi.nlm.nih.gov/18820424/

 

 

 

 

 

 

 

 

 

 

 

 

 

5 ways healthcare reprocessing sinks improve workflow and productivity

How healthcare reprocessing sinks are a better option than commercial stainless steel sinks

reprocessing sink blogIn central sterile processing departments, the decontamination area’s reprocessing sinks represent the most critical area in ensuring that instruments are being properly cleaned. While commercial stainless steel sinks are commonly used for reprocessing medical instruments, not all sinks are created equally.

Manual cleaning and disinfection of instruments requires that sinks have either two- or three-basin sections1 to soak, rinse and provide a final rinse with critical water. The American National Standards Institute (ANSI) and Association for the Advancement of Medical Instrument (AAMI) standard ST79:2017 also recommends that sinks have “attached solid counters or adjacent work surfaces on which to place soiled and clean items separately.”

To make the most of the space available in the limited confines of the decontamination area, sinks need to also serve as a workstation. Unlike commercial stainless steel sinks, healthcare reprocessing sinks are designed with the decontamination tasks and users in mind. As such, ergonomics and workflow standards and recommendations are met.

 

5 ways healthcare reprocessing sinks improve productivity and quality

  1. Ergonomics
    Height-adjustable healthcare reprocessing sinks meet Occupational Safety and Health Act (OSHA)2 compliance and reduce musculoskeletal disorders. Central sterile processing personnel heights and physical capabilities vary, making height adjustability a necessity to perform duties optimally. Height-adjustability also comes in varying options. While the overall sink can be height-adjustable, having an attached pegboard or shelf under the sink that moves with the sink, also helps alleviate staff pain from bending and reaching by keeping tools within easy reach.
  2. Protection from aerosolization
    While personal protective equipment (PPE) is a necessity, sinks can also provide another way to ensure the reduction of aerosolization. Aerosols can make contact with personnel from any direction and can transfer microorganisms to personnel. The incorporation of a sink basin splash guard allows for personnel to be able to manually clean instruments without being exposed to dangerous organisms.
  3. Workflow
    Incorporating tools that ensure proper workflow allows healthcare reprocessing sinks to become a training tool. Workflow plates that indicate whether a particular basin is to be used for soaking, rinsing, or a final critical water rinse can be used as a training tool to educate new hires. It also serves as a reminder to veteran personnel when redundant, repetitive tasks can lead to overlook protocols. Workflow plates are also removable for easy cleaning.
  4. Lighting
    ANSI/AAMIST:79 requires adequate lighting of work surfaces.” Ancillary lighting should be considered for areas where instruments are manually cleaned and inspected.” Task lights with magnifying lenses allow personnel to be able to visually verify the cleaning process. Magnifying task lights can be installed on a pegboard with an adjustable arm that meets the ergonomic needs of each staff member for less eye strain and greater inspection capabilities.
  5. Instrument protection
    Tools such as staging panels and sink liners protect the tips of delicate, expensive instruments when more space is needed. By adding a staging panel to an existing sink basin, the sink’s built in counter space is expanded to help stage instruments prior to sterilization. Sink liners in basins and on sink countertops provide a soft-landing area to prevent damage to instruments while they are staged.

 

 

Learn more about Pure Processing healthcare reprocessing sinks, which feature moveable pegboard and shelving accessories to meet your workflow and workplace environment goals.

Looking for more sterile processing articles? Read Central Sterile Processing Education and Training Are Key to Reducing HAIs.

 

References:

  1. United States Department of Labor. Central supply. Occupational Safety and Health Administration.. https://www.osha.gov/SLTC/etools/hospital/central/central.html
  2. Association for the Advancement of Medical Instrumentation (2017). ANSI/AAMI ST79:2017, Comprehensive guide to steam sterilization and sterility assurance in healthcare facilities.