How to Load a Medical Automatic Washer

Standards and Guidelines

Standards and guidelines from the various standards bodies, including the Association for the Advancement of Medical Instrumentation (AAMI), the Association of periOperative Registered Nurses (AORN), and the American Society for Testing and Materials (ASTM), are clear on the importance of cleaning and cleaning correctly:

“Most sterilizer failures result from inadequate cleaning of the instruments before sterilization.”¹⁶

“Instruments should be kept free of gross soil during surgical procedures. (PNDS; 170,198)”¹⁷

Statements like these testify to AORN’s strong commitment to the proper cleaning of instruments. AAMI ST 79 states that medical devices should be disassembled in order for all surfaces to be exposed to the cleaning process.¹⁸ AAMI TIR 12 states that manufactures should instruct medical facilities on the proper method for preparing instruments for reprocessing. These same groups also support the use of quality improvement programs to help ensure that the cleaning process is effective.

Current Literature

Exposure of the instruments to the mechanical action of the washer is important in having clean and safe instruments to handle, and the literature on this subject supports this general statement. A recent CSD article explains that tray selection has a direct correlation on the ability of instruments to get clean by means of a MAW.¹⁹

We also know from published articles (http://www.healthmark.info/proformance.html) that water quality,²⁰ detergent, mechanical failure of the dosage system,²¹ and basic equipment maintenance are major factors to optimal performance of washer disinfector equipment. All must be working properly for any item to be cleaned properly.^22-23 Also, if the MAW process is not independently verified in some way there is no way to know if other factors have impacted the cleaning process.