Maintaining instrument quality and washer performance in the SPD

Healthcare Purchasing News, Sept, 2007 by Erin Linville, Nancy Kaiser

Surgical instrument processing has evolved into a complex science with many important elements. The everyday function of a sterile processing department (SPD) involves both the production of high quality sterile goods and the maintenance of highly efficient workflow, to keep the hospital or surgical center operating efficiently and profitably. This balance of quality and productivity requires SPD staff to have specialized skills and knowledge, and to apply proven industry standards.

Protect the instrument investment

Surgical instruments are defined as tools or devices that perform functions such as cutting, dissecting, grasping, holding, retracting, or suturing. Most high-quality surgical instruments are made from stainless steel. Some instruments may contain a variety of other metals, including titanium, chromium, vanadium and molybdenum, which help achieve various requirements such as creating more resistant surface finish or a stronger cutting edge.

All medical professionals who come into contact with surgical instruments need to maintain the quality and integrity of these critical tools at all times. The considerable investment made in a hospital's medical devices must be protected. Medical devices are costly to repair and even more costly to replace. Furthermore, there is a hidden cost associated with the impact of instrumentation problems on operating room (OR) productivity. There are more than 10,000 types of hand-held surgical instruments in use today and instrument issues are among the most frequent causes of surgical delays. These delays, due to incorrectly assembled or contaminated instruments sets, can cost an average of $1,000 per hour. (1)

As key participants in the instrument reprocessing cycle, SPD personnel must understand the importance of all the reprocessing steps required to produce a "clean" surgical instrument. They must be properly trained in preventive maintenance, proper handling, and optimal cleaning processes, which can go a long way towards protecting the quality of surgical instruments.

Define the cleaning process

Instrument cleaning, as defined by the Association for the Advancement of Medical Instrumentation (AAMI), is "the removal, usually with detergent and water, of adherent visible soil, blood, protein substances, and other debris from the surfaces, crevices, serrations, joints, and lumens of instruments, devices, and equipment by a manual or mechanical process that prepares the items for safe handling and/or further decontamination." (2) There is currently no standard to define when a device is "clean," but it is generally accepted that a cleaning process to produce an aesthetically "clean" instrument should include the reduction of the microbial bioburden and removal of any organic and inorganic matter, so as to provide an instrument that can be effectively disinfected or sterilized.

All surgical instruments should be cleaned and disinfected as soon as possible after use. Blood and other debris should not be allowed to dry on the instruments, since dried soils are much harder to remove from the surfaces of instruments. In addition to removing the bioburden that is present on surgical instruments after use, the cleaning process removes organic and inorganic matter that could react or interfere with the subsequent steps of disinfection or sterilization. Studies have demonstrated that bacteria and spores can be occluded by both rust and hard water deposits, which allow these organisms to survive steam sterilization cycles, prevent instruments from being sterilized, and provide possible transfer points of infectious organisms. (3)

Proper preparation and cleaning immediately after use can also protect expensive instruments and keep them from deteriorating. In many cases, what may be perceived as rust is in reality dried blood, which, if left on an instrument, can be a focal point for corrosion. Once an instrument has started to rust it will become weak and the damage will eventually destroy or cause an instrument to break. Rust can occur on any stainless steel instrument or utensil. Once corrosion begins, instruments can be further corroded by washing and autoclaving.

The cleaning process can be carried out manually, in an automated washing system, or by a combination of these methods. Optimal cleaning conditions include the correct type of detergent and mechanical cleaning system, acceptable water quality, well maintained and sanitized equipment, and consistent processing techniques.

Select the optimal formulations for cleaning

An important factor in reducing the risk of cross-contamination and instrument damage is the detergent that is used. The choice of cleaner can make the difference between a process that is efficient and effective and one that can contribute to incompletely cleaned instruments and surface damage over time.

Although there are a wide variety of detergent and lubricant products used to clean instruments, three types are most commonly used. These include neutral detergents, alkaline detergents and enzymatic detergents. These three types all have their specific advantages, limitations and patterns of use.