manual and US cleaning Flashcards
before using US bath:
should be filled to required level
chemicals added FMIs for volume
before any cycles are ran a degass cycle must first be ran
same loading recommendations should be followed as per the WD
handpieces should not be processed within the US
always check MIs before processing instruments
what lid should be used for US bath and why?
need to use US bath with interlocking lid otherwise aerosol production
cleaning definition
physical removal of organic matter and infectious agents
why is cleaning essential to ensure effective disinfection and/or sterilisation?
organic matter on surgical instruments can inhibit disinfectant, sterilant or steam contacting microbial cells and therefore reduce its activity and effectiveness
Sinner circle
interactions of these elements - cleaning process 4 main elements chemicals temp time energy
chemicals
detergents (surfactants, enzymes etc)
lots of research to determine the optimum formulation to remove abnormal prion protein from surgical instruments
temp
optimise chemical reactions for the detergent agents
ensure that in the initial wash stages the temp does not exceed 40 degrees which will start to coagulate the proteins remaining on the instrument resulting in difficulties on their removal
time
how long does it take for the detergents/jet wash to take effect
length of time needed to clean an instrument should be confirmed during the validation process
energy
brushing as in manual cleaning
use of US energy
water jets in the WD
when should decon be started?
immediately after use or as soon as reasonably practicable
transporting instruments to decon room
regular collections
all items appropriately containerised to prevent damage during transit
ensure staff safety
what instruments should be decontaminated?
all reusable surgical instruments that are used in the clinical env should be decontaminated without exception
unacceptable to only process those instruments that come into direct pt contact
- all instruments and instrument trays opened in the clinical env should be decontaminated between uses
sorting of used instruments
sort reusable from non-reusable devices and dispose of consumable items such as napkins and cotton wool rolls, in the correct waste streams
manual cleaning processing env
area should be dedicated for the purpose and not shared with other activities
- dedicate sink to cleaning process
- where possible a 2nd sink for rinsing
- segregate dirty from clean by appropriate workflow patterns and practices
PPE for manual cleaning and safety
gloves, facemasks, waterproof apron, goggles/visor
first aid kit and eye wash bottle nearby
drying items
hand drying - clean, disposable, absorbent, non-shedding (low linting) cloths
mechanical drying facility
cleaning materials supply
routinely decontaminated/discarded at freq detailed in the documentation
env i.e. air and surfaces
requires an appropriate level of particulate and microbiological control
= purpose of env control is to minimise the possibility of re-contamination and as such, microbiological/infection control advice as to the appropriateness of the reprocessing env should be sought
non-immersion methods
for certain items which will become compromised by soaking in (aq)
e.g. handpieces, electrical and electronic equipment
clean in accordance with MIs
factors affecting manual cleaning
water temp - protein starts to coagulate at >40 degrees, so water above this must not be used for initial immersion of devices prior to cleaning
detergent conc
nature of soil and method of removal
accessibility of fluid to the item
what determines whether immersion/non-immersion?
construction of device
immersion method - how do you minimise risk to operator?
avoid splashing
avoid creation of aerosols - under water surface at all times
preparing for immersion method
PPE
fill clean sink with water and detergent (FMIs/policy)
dismantle/open instrument and fully immerse it in the solution in order to displace trapped air and ensure penetration of lumen if hollow instruments being cleaned
immersion method - what can you consider using when cleaning medical devices with lumens or complex parts?
a protein-enzyme dissolving solution
immersion method cleaning
brush/wipe/agitate/irrigate item under water to dislodge and remove all visible soil
remove item from sink and drain any excess detergent prior to placing it in the second sink (if available) to rinse in clean water
rinse thoroughly with clean water or water jet gun under the surface of the water
remove and drain item before drying using method recommended by manufacturer
complete all necessary documentation to record the item being processed and details of the method employed
what detergent is the wash temp particularly important for?
when using enzymatic detergents
what should you do if during cleaning the solution or rinse water becomes obviously soiled or contaminated?
change and repeat process
types of detergents and pHs
high alkaline pH12-14
mild alkaline pH9-11
neutral pH6-8
enzymatic pH7
high alkaline pH12-14 detergents
should not be used for manual washing as it can be detrimental to operators and also some instruments
mild alkaline pH9-11 detergents
only used for automated processes to minimise contact with operators
neutral pH6-8 detergents
used for manual cleaning - least damaging to operators skin health
enzymatic detergents pH7
can cause allergies in some staff
read material safety data sheet (MSDS) and COSHH
cleaning equipment
manual wash and rinsing sinks
manual cleaning brushes, cloths, volume dispensers, temp monitors and detergent
US cleaners
contaminated items
items contaminated with body fluids or Rx materials
any pack/item opened and not used should be treated as contaminated
record keeping
incs returns logbook, reporting recording of accidents/incidents
US cleaning mechanism
apply high freq sound wave - sound waves produce microbubbles which cause cavitation when they implode, energy released helps remove biological matter from the surface of the instrument
what instruments can be processed in an US?
jointed and serrated SS instruments
cannulated instruments can be cleaned but must ensure cannula is flushed with cleaning solution during the process
plastic instruments absorb US energy so aren’t efficiently cleaned using this method
US cleaner features
be able to control the process time and temp
possess a lid interlock (to prevent operation of the cleaner with the lid open)
choice of load carrier appropriate to the nature of the device to be reprocessed
chamber drain tap to allow chamber to be emptied
US detergent
FMIs
low foaming, good surfactant and soil dispersion properties
operating temp of machine should be within range specified for detergent
where should the US machine be located?
convenient height for loading and unloading
accessible to a water supply and for convenient discharge to drain
prepping the US machine
fill tank with water (tap water with minimal TDS is acceptable) and detergent
bring cleaner up to operating temp and operate for ≥5mins to degass solution
why do you need to degass first?
bubbles in the solution will impede action of US
loading the US basket
not overload (see loading pattern established at validation) open hinged instruments
what should be done after the US cycle?
after a specified time (established during validation) the basket should be removed and thoroughly rinsed in purified water before drying prior to WD
before sterilisation should be visually inspected for cleanliness
how often should the US tank be emptied and refilled with clean solution?
when visibly soiled or every 4 hours, whichever is sooner
when is US degassing necessary?
after each fill
before instruments are processed
if the tank has been sitting unused
brushes
soft-bristled, long-handled, non-metallic
can be processed in a WD on a standard cycle, or disposed of easily with min env impact
US safety
must have lid interlock to prevent aerosol production
operators must not put their hands in the tank while the US cleaner is operating
water used
for manual washing and US, tap water is acceptable providing it has low conductivity and TDS
why are manual and US cleaning insufficient alone?
instruments not disinfected, only cleaned
effective at removing biological matter but should only be used to reinforce the process in a WD
cleaning and maintenance of handpieces
after every pt use: - thermowashed (WD) - lubricated after cleaning - sterilised according to MIs should be serviced every year
top 5 handpiece faults
air pressure
- incorrect compressor settings and lack of maintenance and testing
damaged or oversized bur
incorrect instrument use
poor or inadequate cleaning inc incorrect processing
incorrect/inadequate lubrication
how often should air pressure compressors be inspected
annually - they are pressure vessels like sterilisers
Pressure Systems Safety Regulations 2000
what shouldn’t be processed in an US?
handpieces
dental compressors
oil-free with a dryer and don’t need any day-to-day maintenance
switch on in the morning and off again at end. No oil to check and no moisture gathers in the receiver
dental compressors maintenance
annual - to meet the manufacturers guidelines and ensure continued reliability
breathing air filter elements must be changed at least annually to maintain air quality standards
practice inspections normally require evidence of maintenance also
basic care of handpieces
lubricate and sterilise after every use
thermowash - not all able to
service p.a.
