How to Clean Delicate Instruments Manually
By Sybil Williams, BS, CST, CRCST, CHL, ACE
In the race to process sterile surgical instruments quickly for the operating room or other clinical areas, there is a strong reliance on mechanical washers. Most Central Service (CS) departments are equipped with mechanical washers. These washers assist CS in meeting one of its objectives: to provide the department with a tool that effectively and efficiently decontaminates instruments prior to preparation for sterilization. What about delicate instruments? Eye instruments, micro instruments, and other delicate instruments should be hand washed. Or should these types of instruments be decontaminated in a mechanical washer? Some professionals would agree and some would disagree. Some might say that the sonic washer can be used for cleaning delicate instruments.
Suppose the facility does not have a sonic washer? These delicate instruments must be cleaned manually.
Proper Training and Certification
There are basically five objectives in the cleaning process:
1) To remove the visible soils.
2) To remove the invisible soils.
3) To remove pyrogens.
4) To prepare the surface of any item to be sterilized or disinfected by allowing direct contact with the sterilizing agent.
5) To provide protection and safety to the patients and hospital personnel (IAHCSMM, 1999).
The responsibility for cleaning contaminated instruments in a CS area is probably the most important task performed by the CS technician. Most often, improperly trained technicians or managers do not take the cleaning task seriously. This is why it is imperative to have properly trained and certified technicians performing this important duty. Qualified and properly trained managers are needed to ensure the proper decontamination and sterilization procedures are performed correctly. It is understood in the CS profession if an instrument has not been thoroughly cleaned, it can not be sterilized--period.
Anyone assigned to the decontamination area must wear protective coverings, including gowns, gloves, shoe coverings, head coverings, and a mask. If a face shield is worn, it is advisable to wear a mask to protect the mouth.
Have a sink that is deep enough to prevent unnecessary spillage and splashing of water in the work area. Use a detergent disinfectant designed for manual cleaning when performing this type of process. Ideally, the pH should be between 7 and 8. An enzymatic cleaner should be used to break down protein-type soils. Use a receptacle (a pan with a perforated container inside of it) that allows the water to drain, thereby, providing visibility for the technician who is cleaning the instruments. A soft-bristled brush is needed to clean the instruments effectively.
Water is definitely needed, as it is the main agent needed in any cleaning process. Use cold water initially to remove the blood soils from the instruments. Water with a temperature of no more than 140°F should be used to dissolve fatty tissue, grease, and other water soluble soils. Higher temperatures would coagulate the protein soils and prevent the technician from successfully performing the cleaning process.
The instruments are sorted when received in the decontamination area. Care should be taken to avoid damaging the instruments. Delicate instruments should not be handled carelessly, and heavier instruments should not come in contact with them. Broken instruments should be identified as such, and decontaminated before removing from the tray. The damaged or broken instruments should be placed in the area designated for instruments to be repaired.
To begin the soaking process, instruments are opened and placed in a soak pan that has a perforated container. The perforated container prevents the technician from putting their hands into a basin of contaminated instruments. This type of container also prohibits the possibility of contaminated soils being re-deposited on the instruments. The technician can reach for the handles of the container to pull it from the soak pan. The soaking process will make cleaning easier and faster by loosening the protein soils that are on the instruments.
Using the soft bristled brush, the instruments are washed under running water. The technician should handle each instrument individually to ensure proper cleaning. Additionally, the technician must wash the instrument under running water to prevent the formation of contaminated aerosols.
The instruments are rinsed thoroughly in tap water. Rinsing removes residual soil particles and detergent solutions from the instruments being cleaned. The final rinse is performed with distilled water. Distilled water is not available at all healthcare facilities; however, the more thorough the tap water rinse, the more effective. The following steps follow a final rinse:
- The instruments are dried with a clean lint-free cloth.
- The instrument tray or container that held the delicate instruments is decontaminated according to the manufacturer recommendations.
- The instruments are returned to the instrument tray or container.
- The instruments are transported to the assembly or preparation area for inspection, assembly, and sterilization.
Any surgical instrument represents a costly investment for the healthcare facility. The purchase of instruments is an investment to be used wisely. Physicians and the healthcare administrators rely on the CS staff to take care of their investment. The money invested in surgical instruments can be realized if proper care and handling is given by the CS staff. Continuous training is needed in the CS department so that the life span of any surgical instrument is not shortened due to of inexperienced technicians.
Ask the instrument manufacture questions regarding the cleaning process of its instruments. Require the sterilizer manufacturer to perform water samples on the washing and sterilizing units to determine what type of water is being distributed in the CS area. Be aware of the cleaning agents used to manually clean surgical instruments.
Sybil Williams is the director of central sterile processing at Children's
Medical Center in Dallas, Tex.
For a complete list of references click here