Now and Then:
Decontamination for the Future
by Tammy Brock, CSPDT
Washer-decontminators assist CS Techs in ensuring that instruments are cleaned and sterilized properly.
What would grandma have thought if she were able to choose between permanent press or delicate cycle on her washing machine? Imagine how her day would have been spent given the extra time she saved by using her "automatic" washer. Those of us who have been in Central Processing over the last decade can correlate this scenario with the many changes that have occurred in the decontamination area, primarily with the advanced technology available for decontamination equipment
Just as grandma proudly displays her battle scars from the old wringer-washing machine, many of us "old-timers" can boast about the good 'ole days when every contaminated instrument was handwashed thoroughly before being placed in the single-chamber, washer-sterilizer. However, as surgery schedules began to grow, so did the demand for quicker turn-around times. To meet the demand and speed up the process, steps in the decontamination cycle were ignored, leaving CS technicians with less than clean instruments. Improper arrangement of instruments caused baked-on soil during the sterilization phase of the washer process. As a result, instruments were returned to decontam for manual cleaning to remove the hardened debris, causing additional delays. CS managers began searching for a solution to meet both the demands of the surgical team and ease the frustrations of the CS staff.
Hearing the cries for help, manufacturers of sterilization and decontamination equipment answered the pleas of CS professionals, thus the birth of the washer-decontaminator. As sacred cows go, many CS managers and techs alike were leery of the washer-decontaminator process. Increased focus on employee safety issues along with pressure from state and federal regulatory agencies prompted the need for change. CS managers began to take a more objective look at the product lines for washer-decontaminators.
Processing surgical instruments and ensuring that thorough cleaning proceeds the disinfecting stage is a crucial step in reducing the bioburden. Whether instruments are cleaned manually or mechanically, cleaning is the most important step in the disinfecting process. Failure to remove the organic material effectively can present a physical barrier and prohibit the sterilant from reaching harmful microorganisms on the surface of the instrument. The presence of organic material such as blood, dirt, or body fluids following the wash process means there is very little chance that the microbes will be killed.
Many types of mechanical cleaning devices are available today. It is important to understand the features and benefits offered to ensure that your cleaning objectives are met. Whether you choose a washer-decontaminator or a washer-sterilizer, specific manufacturers' guidelines, including limitations, applications, and procedures must be followed for optimal performance.
The washer-sterilizer is a single-chamber unit that consists of several wash and rinse cycles followed by a steam sterilization cycle at the end. Items processed in the washer-sterilizer should not be considered sterile since the level of microbial contamination is unknown due to possible residual soil. Pre-cleaning is almost always necessary. Detergent manufacturers have introduced enzymatic sprays, foams, and soaks to assist departments using washer-sterilizers in the pre-cleaning stage. Soiled instruments must be arranged properly for optimal cleaning. Special attention should be paid to delicate instruments as the agitation during the wash phase could cause damage.
The single-chamber washer-decontaminator offers thorough cleaning by directing water and detergent into hard-to-reach places using spray arms that rotate at the top and bottom of the chamber. The multi-level manifold rack can process up to 8 full-size instrument trays in as little as 30 minutes. Some systems now offer load and unload modules that provide a fully automated rack conveyance system allowing for continuous operation without the technicians involvement.
The single-chamber washer-decontaminator is easy to use. Cycle times and temperatures are adjustable to meet manufactures' recommendations for processing a variety of items from basins, glassware, and rubber to delicate instrumentation. Units come preprogrammed and also allow for custom programmable cycles to meet the specific needs of each facility. Microcomputers monitor the system to ensure the cycle selected meets the established parameters. The control panel displays the cycle status, warnings, and instructional messages for each cycle. Trained technicians simply choose the cycle appropriate for the items they have prepared for processing, loading the unit, and pressing the start button.
Transfer carts may be used to transport soiled trays to the loading modules and reduce lifting of heavy trays. The completely mechanized process eliminates the need to pre-clean the majority of contaminated instruments returned to decontam. However, common sense along with a complete training program will ensure that staff identify and pre-clean heavily soiled items, such as orthopedic instrumentation and cannulated items.
Employee safety features standard to the single-chamber units include cable latches, which prevent the door from falling in case of a cable break. Double doors only open one side at a time to prevent cross-contamination. The washer will not begin the cycle until the door is closed completely, nor will it open during the middle of a cycle until all services to the unit are shut off or if the cycle is interrupted. One of the biggest benefits, however, is the reduction in employee handling of contaminated instruments.
The granddaddy of all washer-decontaminators is the large, highly productive indexing washer. Multiple chambers perform individual tasks simultaneously that includes a pre-wash, wash cycle, rinse, ultrasonic, pure water rinse, and dry time. Like the single-chamber unit, the multiple-chambered system comes pre-programmed but also offers customers the option of adding their own customized cycles. A unique benefit of the indexing, multiple-chamber washer is the ability to process different types of items at the same time unlike the single-chamber units where the cycle selection is limited to what is loaded on the tiered manifold rack.
Once the decontam technician identifies the type of instruments for processing, a bar code is selected. Instrument trays are then placed in the bar-coded basket and loaded on the conveyor for automatic processing. From the point of entry into the pre-wash chamber, the entire cycle takes about 25 minutes. When the unit is fully loaded, instrument baskets automatically advance through the various cleaning stages and unload every 5-8 minutes into the assembly area of CS.
Daily maintenance of most washers includes checking the detergent levels, cleaning the drain baskets, reloading the printer, and resetting the conveyor pawls. However, to extend the life of your unit(s), a preventive maintenance (PM) agreement should be considered. Most manufacturers offer PM contracts that range in service levels. Each facility should evaluate their equipment and choose a PM agreement that best suits their needs. Depending on the facility, the BioMedical or Engineering department manager can be an excellent resource for information regarding vendor service contracts. Soliciting their expertise can ensure the best overall preventive maintenance contract for your washer.
Whether you choose a single-chamber washer decontaminator, or the multi-chamber indexing washer, the goal should be to provide CS staff with clean, decontaminated, and safe-to-handle surgical instrumentation. To make an informed purchasing decision, follow these simple guidelines:
- Determine department processing needs
- List requirements, desired options, budget constraints
- Gather product information from all vendors
- Research, Research, Research
- Schedule site visits (Be sure to include at least one CS tech who actually will be using the equipment on a daily basis.)
- Plan for future growth
- Obtain facilities water quality records
- Review PM agreements
- Compile data and make purchasing decision
It is often stated that history repeats itself. However, if grandma were here today, it would be an awesome task to convince her to give up the technologically advanced, self-operating, washing machine and return to the back-porch, hand-cranked, wringer washer. The same can be said for CS professionals across the country who have recognized the vast benefits of the washer-decontaminator. A return to the "good 'ole days" of handwashing surgical instruments would surely be a step back in time that even the smallest CS department would not want to take.
Tammy Brock, CSPDT, is the CSR Manager at Athens Regional Medical Center (Athens, Ga). She has 19 years experience in CS/SPD.
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