How to Load a Medical Automatic Washer

With the increase of complicated medical devices, central service departments (CSDs) face challenges like this one posted on a CSD chat room: “Is it acceptable to wash instrument sets through the washer in the rigid containers with the lids on? Or should the lids at least be taken off? And how much handwashing should be done before processing? I am told that our operating room (OR) cleans and washes its own instruments and then sends them down to us in CS to sterilize, run the sets through the washers in the containers with the lids on. To me, this just doesn’t sound as if the instruments would be getting cleaned.”¹

An example of instrument trays entering the automatic washer, all inner trays enclosed in the container with lids securely fastened and stacked on top of each other.

An example of instrument trays entering the automatic washer, all inner trays enclosed in the container with lids securely fastened and stacked on top of each other.

Every CSD has issues with dirty instruments. The difficulty has increased, however, as surgical instruments and surgical instrument cases have gotten more complex, creating a greater challenge to the cleaning process. Research shows that dirty medical devices are a real problem:

16 percent of loaner instruments tested positive for blood²

When placing the tissue protector on the drill, old dried blood and tissue came out³

Particles of tissue were found in cannulated instruments⁴

There are eight factors that affect the cleaning process:

1. Soil type

2. Medical device design

3. Water quality

4. Water temperature

5. Chemical activity of the cleaning solution

6. Mechanical action

7. Human factor (loading and training)

8. Verification

One of the main reasons for the aforementioned problems is that the instruments are not being exposed and rinsed properly during the cleaning process. The focus of this article is to look at the human factor – and the impact of how surgical instruments are loaded into a medical automatic washer (MAW).