How to Load a Medical Automatic Washer

Instrument stringing (top photo), positioning instruments in the tray (middle photo), proper exposure of instruments in the medical automatic washer (bottom photo).

Verification

CSD professionals challenge their sterilizer with a biological indicator (BI); on multi-layer trays many place an indicator on each level to insure sterilization has taken place throughout the tray. It is with that same philosophy we should approach testing the proper loading of the MAW. John MacDougall, RN, MS, past president of the Michigan Society of Central Service Professional, uses the TOSI™ as a tool to help his staff understand how to load instruments properly and verify that his equipment is meeting a standard. MacDougall states, “The TOSI™ represents what I am trying to clean, blood on a stainless steel instrument, and with a physical challenge to the cleaning process. It is a true model of what I am actually processing.”

MacDougall has used the TOSI™ to help show his staff how trays with multi-levels must be separated. The TOSI™ is first used to verify that the equipment is working by testing in an empty load. After that a multi-layer tray is processed using the same cycle parameters with the lid on and a TOSI™ on each level. Upon completion of the cycle the TOSI™ on each level is examined. Notice that the TOSI™ did not come clean on the second level. This simple exercise shows how trays with multi-layers need to be disassembled so they can be properly exposed to the cleaning process. Staff now has a visual understanding of the importance of separating multi-layer trays.

T.O.S.I. Cleaning verification test

Top level has a clean TOSI (top photo); second level TOSI is not clean (bottom photo).

Verification of the automatic cleaning process is now supported by many organizations. AAMI ST 79 states, ”The efficacy of any sterilization process, including saturated steam, depends on a consistent system for lowering and limiting bioburden before sterilization. Appropriate documentation and reporting practices that enable traceability of each facility-sterilized medical device to the patient on whom it is used.”³² This is just one of the many statements throughout this document that supports verification of the cleaning process.