How to Load a Medical Automatic Washer

AORN’s Recommended Practice for Cleaning and Care of Surgical Instruments and Powered Equipment Recommendation XXII – Quality section is now supporting the testing of mechanical instrument washers before initial use, weekly during service, and after major maintenance. The Joint Commission standard E.C.6.20 states that medical equipment is maintained tested and inspected.

Verifying this process is so important that medical facilities are following the recommendations of the various regulatory bodies that any simulated-use testing be done with a surrogate device that closely approximates the actual types of soils the instrument is to be exposed to in clinical use. Further, the surrogate device should be made of the same type of material as the instrument it represents. They are now making testing part of their everyday quality process improvement program.

Education and Training

Education of staff is vital to achieve the proper processing of instruments. This can only be accomplished by training, teamwork and understanding the various standards and the role they play in the cleaning process. Without training, people will not understand the need for change. Education is two-fold:

CSD: how the technician loads the instrument into the MAW

User: how the user (usually the OR) returns the instruments to be reprocessed

Checklist

Make a simple checklist with the following steps:

Work with your medical automatic washer manufacturer to make sure your items can be processed in their equipment.

Understand the optimal way to use the MAW on your surgical instruments.

Involve your instrument manufacturers' and follow their instructions for cleaning.

Understand how your various cleaning solutions work.

Flow chart your process so you have a complete understanding of what is going on; different instruments might require different processes, (i.e., orthopedic might be processed differently than general or eye instruments)

Expose as much of the instrument as you can to the MAW cleaning process (open those box locks), take apart instruments as directed

Disassemble all instruments and expose them to the cleaning process (manual or automatic)

Monitor your process with quality improvement tools that will help solve and reduce current or future problems

Do not stack instruments on top of each other. Stringing of the instruments in an open position in the decontamination area is a better method

Look at new products to help expose instruments to the cleaning process; notice the exposure of the instruments when using a six-inch stringer over a two-inch stringer

Use the proper type of rack to load instruments into the MAW

Use the equipment for processing instruments

Conduct yearly in-service for all employees

Use cleaning verification products as an independent challenge to your process to ensure your equipment and your staff are working properly