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Now and Then:
Decontamination for the Future
by Tammy Brock, CSPDT
What would grandma have thought if she were able to choose between permanent press ordelicate cycle on her washing machine? Imagine how her day would have been spent given theextra time she saved by using her "automatic" washer. Those of us who have beenin Central Processing over the last decade can correlate this scenario with the manychanges that have occurred in the decontamination area, primarily with the advancedtechnology 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 everycontaminated instrument was handwashed thoroughly before being placed in thesingle-chamber, washer-sterilizer. However, as surgery schedules began to grow, so did thedemand for quicker turn-around times. To meet the demand and speed up the process, stepsin the decontamination cycle were ignored, leaving CS technicians with less than cleaninstruments. Improper arrangement of instruments caused baked-on soil during thesterilization phase of the washer process. As a result, instruments were returned todecontam for manual cleaning to remove the hardened debris, causing additional delays. CSmanagers began searching for a solution to meet both the demands of the surgical team andease the frustrations of the CS staff.
Hearing the cries for help, manufacturers of sterilization and decontaminationequipment answered the pleas of CS professionals, thus the birth of thewasher-decontaminator. As sacred cows go, many CS managers and techs alike were leery ofthe washer-decontaminator process. Increased focus on employee safety issues along withpressure from state and federal regulatory agencies prompted the need for change. CSmanagers began to take a more objective look at the product lines forwasher-decontaminators.
Processingsurgical instruments and ensuring that thorough cleaning proceeds the disinfecting stageis a crucial step in reducing the bioburden. Whether instruments are cleaned manually ormechanically, cleaning is the most important step in the disinfecting process. Failure toremove the organic material effectively can present a physical barrier and prohibit thesterilant from reaching harmful microorganisms on the surface of the instrument. Thepresence of organic material such as blood, dirt, or body fluids following the washprocess means there is very little chance that the microbes will be killed.
Many types of mechanical cleaning devices are available today. It is important tounderstand the features and benefits offered to ensure that your cleaning objectives aremet. Whether you choose a washer-decontaminator or a washer-sterilizer, specificmanufacturers' guidelines, including limitations, applications, and procedures must befollowed for optimal performance.
The washer-sterilizer is a single-chamber unit that consists of several wash and rinsecycles followed by a steam sterilization cycle at the end. Items processed in thewasher-sterilizer should not be considered sterile since the level of microbialcontamination is unknown due to possible residual soil. Pre-cleaning is almost alwaysnecessary. Detergent manufacturers have introduced enzymatic sprays, foams, and soaks toassist departments using washer-sterilizers in the pre-cleaning stage. Soiled instrumentsmust be arranged properly for optimal cleaning. Special attention should be paid todelicate instruments as the agitation during the wash phase could cause damage.
The single-chamber washer-decontaminator offers thorough cleaning by directing waterand detergent into hard-to-reach places using spray arms that rotate at the top and bottomof the chamber. The multi-level manifold rack can process up to 8 full-size instrumenttrays in as little as 30 minutes. Some systems now offer load and unload modules thatprovide a fully automated rack conveyance system allowing for continuous operation withoutthe technicians involvement.
The single-chamber washer-decontaminator is easy to use. Cycle times and temperaturesare adjustable to meet manufactures' recommendations for processing a variety of itemsfrom basins, glassware, and rubber to delicate instrumentation. Units come preprogrammedand 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 establishedparameters. The control panel displays the cycle status, warnings, and instructionalmessages for each cycle. Trained technicians simply choose the cycle appropriate for theitems 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 reducelifting of heavy trays. The completely mechanized process eliminates the need to pre-cleanthe majority of contaminated instruments returned to decontam. However, common sense alongwith a complete training program will ensure that staff identify and pre-clean heavilysoiled 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 oneside at a time to prevent cross-contamination. The washer will not begin the cycle untilthe door is closed completely, nor will it open during the middle of a cycle until allservices to the unit are shut off or if the cycle is interrupted. One of the biggestbenefits, however, is the reduction in employee handling of contaminated instruments.
The granddaddy of all washer-decontaminators is the large, highly productive indexingwasher. Multiple chambers perform individual tasks simultaneously that includes apre-wash, wash cycle, rinse, ultrasonic, pure water rinse, and dry time. Like thesingle-chamber unit, the multiple-chambered system comes pre-programmed but also offerscustomers the option of adding their own customized cycles. A unique benefit of theindexing, multiple-chamber washer is the ability to process different types of items atthe same time unlike the single-chamber units where the cycle selection is limited to whatis loaded on the tiered manifold rack.
Once the decontam technician identifies the type of instruments for processing, a barcode is selected. Instrument trays are then placed in the bar-coded basket and loaded onthe 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 basketsautomatically advance through the various cleaning stages and unload every 5-8 minutesinto the assembly area of CS.
Daily maintenance of most washers includes checking the detergent levels, cleaning thedrain baskets, reloading the printer, and resetting the conveyor pawls. However, to extendthe 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 shouldevaluate their equipment and choose a PM agreement that best suits their needs. Dependingon the facility, the BioMedical or Engineering department manager can be an excellentresource for information regarding vendor service contracts. Soliciting their expertisecan ensure the best overall preventive maintenance contract for your washer.
Whether you choose a single-chamber washer decontaminator, or the multi-chamberindexing washer, the goal should be to provide CS staff with clean, decontaminated, andsafe-to-handle surgical instrumentation. To make an informed purchasing decision, followthese simple guidelines:
It is often stated that history repeats itself. However, if grandma were here today, itwould 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, wringerwasher. The same can be said for CS professionals across the country who have recognizedthe 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 thesmallest 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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