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Instrument Cleaning 101: Back to Basics

Sterile processing professionals (SPs) have long been at the frontlines of protecting patients from cross-contamination from used operating instruments and other hospital equipment, but their intimate knowledge of virus transmissions risks, decontamination techniques, and processing protocol has never been as critical as it is during the age of coronavirus. SPs already follow an array of strict guidelines established by regulatory, governmental, and accrediting agencies, as well as standards from state agencies and their own facility’s protocol when cleaning, reassembling, and sterilizing operating instruments prior to the next procedure. There is no time like a pandemic to review, refresh, and even strengthen sterile processing protocol to protect patients, doctors, and other hospital professionals.

Photo Credit: Mary Olivera

Universal precautions, fundamental cleaning, and disinfecting steps must be followed to prevent transmission of any infectious disease, including COVID-19. Precise adherence to these basic principles is required when coming into contact with contaminated surgical devices.

Instrument cleaning basics
A reassessment of basic processing protocols can help you to keep your team and your patients safe. 

  • Wear appropriate PPE: Full PPE means hair covering, face shield and mask, gloves appropriate to the task, gown, and shoe covers, and it must be worn regardless of how simple the task may be. Reviewing and following the correct sequence for donning and doffing PPE is as important as wearing the appropriate garments.
  • Adequate tools for cleaning: Technicians must ensure to apply the best cleaning methods and use the suitable cleaning tools to remove all soil residues from lumens and hard-to-reach areas of the instrument. Use the right size cleaning brushes for lumens based on the medical device’s instructions for use (IFU) and tools such as water pressure nozzles to remove contamination and debris.
  • Test your automated washing equipment regularly: Regularly test your automated cleaning equipment’s efficiency and efficacy to confirm that the promised cleaning is taking place. There are many commercially marketed products to test the efficacy of the washer-decontaminator, the ultrasonic cleaner, and automated endoscope reprocessors. Perform all routine equipment tests and document the results according to the manufacturer’s specifications.
  • Cleaning chemistries: There are different types of detergents depending on the chemical action required. Be sure to have the proper cleaning chemicals, as water alone or using the wrong chemistry is an ineffective decontamination agent. Water quality and temperature must also be considered according to the detergent specifications to provide adequate conditions for cleaning and disinfection.
  • Follow IFUs: Adhere to manufacturers’ IFUs when mixing and using cleaning solutions and be sure to factor in water quality and temperature for the most effective solution. It is important to select the correct detergent or disinfectant for the task at hand and review the steps the manufacturer validated to render a device cleaned or disinfected. It is crucial to follow the product:
    • Contact time: How long the solution should remain wet on the contaminated surface
    • Dilution rate: The ratio of water to detergent for highest efficacy
    • Temperature: The water temperature that will yield the most effective detergent or disinfectant solution
    • Storage temperature: Some chemicals degrade when exposed to temperatures that are too high or too low. Store your cleaning solutions at each one’s correct storage temperature to maintain efficacy.

Meticulous processes in the decontamination area
Cleaning operating instruments and tools requires meticulous processes and unyielding attention; there is no room for error when you are eradicating infectious microorganisms and bioburden from lifesaving instruments. In the SPD, technicians must be laser-focused while:

  • Sorting: Determine the category instruments fall into: Are they delicate? Can they be submersed? Do they need to be disassembled? Are there even more specific cleaning procedures for the device?
  • Preparing to manually clean instruments: Prep the right detergents, at the right dilutions and temperatures, to manually clean instruments and tools that cannot go through mechanical washing.
  • Inspecting: All items processed in the decontamination area must be inspected to ensure the cleaning process was successful. Visual and chemical aides to detect bioburden should be used. If bioburden is detected, clean the items again.
  • Mechanically cleaning: All multilevel trays must be separated, and instruments must be disassembled to ensure that the cleaning action of the mechanical washer and sonification process touches every instrument surface.

Preventing cross-contamination in the decontamination area
The decontamination area will become soiled and contaminated over the course of a day as instruments and tools are brought through for processing. As such, we must follow the appropriate procedures to disinfect the decontamination area in between processes. The steps must be consistently followed during the cleaning process, items disassembled, and rinsed after cleaning. Rinsing will remove lose debris and bioburden from the device, allowing the next steps in the cleaning process to take place.

  • Disinfect all cleaning tools such as brushes. Cleaning sponges and cloths should be cleaned after each use following the manufacturer’s instructions for use. Disposable tools should be discarded. Sinks must be disinfected after each tray is cleaned to limit the transfer of loose bioburden or contamination to the next item.
  • Keep separate clean and dirty spaces so there is no cross-contamination after processing.
  • Clean surfaces regularly with hospital-approved disinfectant. Clean surfaces when they become visibly soiled.
  • Environmental cleaning procedures for cleaning floors, walls, and vents must be on a regular schedule to minimize microbial growth in the environment. AAMI ST79:3.4.1 is a recently published guideline for environmental cleaning of all areas in sterile processing.
  • Wipe water faucets and handles, doorknobs, phones, equipment panels, tables, and case carts after each use.
  • Mechanical equipment must also go through a disinfection process. Follow the equipment manufacturer’s IFU for steps and frequency. Thoroughly clean the outside of the equipment and ensure the strainers are not clogged, as it may prevent water circulation.
  • Don and doff PPE in the proper order. If uncertain, become familiar with the facility donning and doffing procedures to ensure the proper steps are followed.
  • Perform proper handwashing procedures before and after removing PPE.

Infectious diseases are a great concern, not only for healthcare workers, but for the population in general. Consistent procedures, performance expectations, process audits, collaborative teams, and open communication create a culture of safety and minimizes the risk to harm patients and healthcare workers. 

Mary Olivera, MHA, CRCST, CHL, FCS has over 30 years of experience in numerous roles in healthcare sterile processing, distribution, and materials management. Ms. Olivera participates in monitoring, surveying, and training interdepartmental staff in the proper cleaning, decontamination, and sterilization practices, and has been highly committed to the standardization of interdepartmental processes. A regular recruit on expert panels regarding sterile processing and a past president of the New York State Central Service organization, she continues to play a major role in promoting higher educational requirements for central service professionals to increase patient safety.

Ms. Olivera brings to the table extensive knowledge of Joint Commission, DNV-GL, AAMI, OSHA, CDC, and DoH regulations. She specializes in budgeting, change management, inventory management, process re-engineering, program and project management, vendor relationships, quality control, Six Sigma, supply chain, and total quality management.

Ms. Olivera is an educator and has published numerous articles related to sterile processing, surgical services, process improvement, and guides to achieve successful accreditation surveys.

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