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Ultrasonic Royalty: Ten Keys to Crowning Your Department the Kings and Queens of Clean

What does ultrasonic excellence look like in your sterile processing department? Would your technicians pass a pop quiz on the ins and outs of this critical aspect of the surgical instrument cleaning process? Would they consider themselves Kings and Queens of Clean, or admit they need a little boost before they claim the crown?

Wherever your team is on their journey to ultrasonic confidence, here are at least 10 keys to put front and center as the roadmap for technician growth and department excellence at your facility. Whether you use these keys in your equipment competencies, weekly staff meetings, or daily huddles, the ultimate result will be cleaner instruments, a faster workflow, and better quality for your surgical patients.

1. Cycle time compliance
As with steam sterilization, correct cycle length for ultrasonic cleaners is a critical aspect of true cleaning compliance and should be driven by the requirements set out in each individual instrument instruction for use (IFU). Before loading instrument trays into an ultrasonic system, technicians should be aware of these requirements and realize that cycle lengths may vary from instrument manufacturer to manufacturer, across different instrument variations. If necessary, standard cycles on the ultrasonic cleaners may need to be adjusted to meet specific instrument requirements.

2. Equipment weight limits
Nearly all ultrasonic cleaners have a mechanism to raise and lower instrument trays into the processing basin, and nearly all of us have seen examples of when those mechanisms were pushed beyond the breaking point because of excessive loading. That is why equipment manufacturers put total weight limits on the instrument loads their cleaners are able to safely process. Pay special attention to these limits in multibasin cleaners to ensure technicians understand whether the limit is per-basin, or total across both basins.

3. Lumen cleaning connections
While ultrasonic technology does wonders for the internal cleaning of lumens and cannulated instruments, the ability for these machines to do this can be drastically lowered if attachments and connections provided by the ultrasonic manufacturer are not properly used while running lumen cleaning cycle. Yes, all those tubes and plastic attachments really matter. If the instrument is not properly connected to the irrigation hoses (with correct sizing and seating), or the hoses themselves are not plugged into the cleaning unit, important stages of the cleaning process will get missed.

4. Machine and load testing/release
As with other equipment in your sterile processing department, ultrasonic cleaners must be tested on a regular basis to ensure all cleaning parameters are being met. AAMI ST79 recommends daily performance testing of this equipment to verify cleaning effectiveness, and manufacturers also give instructions for routine load testing. Instructions provided by the equipment manufacturer should be followed closely at this point, and all records of testing should be retained according to your hospital’s record-retention policy.

5. Load configuration and overloading
The loading of ultrasonic cleaners is as much art as it is science, but good loading practices can and should be taught. This is not an area where technicians should be encouraged to be creative or save time in the processing workflow. Important concepts here include opening hinged instrumentation to enable detergent and cavitation contact, removing gross bioburden prior to placing trays in the unit, and ensuring adequate room in the tray for instruments to breathe throughout the cleaning process.

6. Postwash inspection
Perhaps one of the most underrated and misunderstood aspects of ultrasonic cleaning is the need for postwash inspection of devices prior to sending them on through the sterile processing workflow. This is not only a recommendation of AAMI ST79, but it is also required by most manufacturer IFUs. Even though this equipment is a cleaner, instruments must still be visually inspected after the load to ensure there is no remaining debris on or inside these devices. If found, this debris must be removed prior to an automated washing process.

7. Alerts and troubleshooting
As the technology of ultrasonic cleaning has advanced, so has the ability of this equipment to automatically alert staff to important aspects of its operation, such as low detergent, fill line faults, and irrigation flow issues. Technicians who are tasked with using this equipment should be competent in what each alarm means, whether it means the cycle must be aborted, and how to do simple troubleshooting to find the root cause of the issue. Constant alarming should be reported to your service provider to ensure there are not bigger problems underneath the proverbial hood.

8. Disinfecting procedures
Each equipment manufacturer will have specific procedures for disinfecting your ultrasonic cleaner after use. Some recommend daily disinfection, others recommend spraying the basin and tray after every shift. There may be additional recommendations for weekly disinfection of the irrigation system of your ultrasonic machine, which may require specific chemicals and a temporary adjustment to your equipment’s detergent timer. Using a checklist for your staff is a good way to integrate this responsibility into the regular expectations of a decontamination work assignment.

9. Knowledge of preventive maintenance schedules
While there may be a distinction between the type of maintenance the SPD team is responsible for (operator maintenance) and the more in-depth requirements of your service teams (biomed maintenance), as the user of this equipment you should be aware of all preventive maintenance requirements in the IFU. Do your technicians know where the O-rings are on the irrigation tubes? If not, they probably do not know they should be checking them for cracks on a weekly basis. Knowledge of all your ultrasonic preventive maintenance enables you to hold your biomedical team accountable for their regular duties, as well. 

10. Magic box syndrome
The overarching key to creating a culture of ultrasonic excellence in your department is confronting what I call the magic box syndrome. This syndrome can infect new and experienced personnel alike, and it happens when too much faith is placed in the performance of the equipment, and too little is understood regarding the how and why behind the way ultrasonic technology actually works. As with every aspect of sterile processing, certain steps and stages must happen for any piece of equipment to operate correctly and efficiently, and ultrasonic cleaners are no different. Though powerful and precise, the laws of physics and the realities of technician competency still apply to these mechanical wonders of the sterile processing world.

As you integrate these ten keys to crowning your team Kings and Queens of Clean, never forget the power and purpose of ultrasonic cleaning is up to you. If you agree with that, then it’s time we give our instruments and our patients the royal treatment.

Feature articles exclusively for Ultra Clean Systems by Weston “Hank” Balch, BS, MDiv, CRCST, CER, CIS, CHL

Weapon of Mass Microbial Destruction * Professional Clean Freak * Podcast Host * Safety Addict * CS/SPD Consultant

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