CS Questions & CS Answers
How to tackle foul odor, film build-up and discoloration
with Ray Taurasi

Editor’s Note:
Questions can be emailed to:jakridge@hpnonline.com, called in to Jeannie Akridge at HPN, (941)927-9345 ext.202, or mailed to: HPN CS Questions, 7650 So. Tamiami, Ste.10, Sarasota, FL 34231. Names and hospital identification will be withheld upon request.

CS Question: I have noticed that the inside walls, tracks and working mechanisms of our automated cleaning equipment (instrument and cart washers) have a film build-up on them and have discolored to a dark greenish/black color. Is this ordinary and something to expect with aging equipment or is it something more that I should be concerned about?

CS Answer: The inner chamber walls of all processing equipment such as washers, and sterilizers should be attended to and kept clean. With routine usage over time it is likely that the chamber walls may become soiled or have a film build-up caused from residual detergents, protein soils or water sediments. Routine cleaning, care and maintenance of all processing equipment should be incorporated into standard CPD procedures and monitored closely. Soil allowed to accumulate on the chamber walls or working mechanisms of processing equipment could have an adverse affect on the effective functioning and usable life of this critical and costly equipment. Soils can clog drains and spray arms, damaging the equipment and impeding performance efficacy. Depending on the nature and source of the soil build-up on the chamber walls and mechanisms, it is possible that corrosion, pitting and rusting could occur. It is imperative that appropriate and precise concentrations of neutral PH detergents, enzymatics and other cleaning agents be utilized. Water and steam quality is also an important factor; water hardness and other impurities present in water can leave scale-forming deposits on washer walls and mechanisms. You should refer to and follow your equipment manufacturers’ instructions for the care and use of your processing equipment. Most do recommend routine (weekly/monthly) cleaning procedures for their equipment. Descaling chamber walls and internal working mechanisms is usually a recommended procedure to be done on a monthly basis. It may be possible to have your bio engineering department schedule descaling as a part of your preventative maintenance (PM) program. There are many methods and processes for doing this. Some automated processing equipment has a designated feed line, which a liquid descaling product may be connected to. Some detergent manufacturers have descaling products in a tablet format, which can be dropped into the machine; there are also descaling sprays and liquids, which can be poured directly into the chamber in measured volumes. Through proper care and preventative maintenance there is no reason for the inner chamber walls and working mechanisms of your washers to discolor or lose their shine and fine finish.

CS Question: My staff has been complaining about a foul odor coming from our washer disinfectors and they claim that the instruments also smell like stale blood after coming out of the washer. The equipment seems to be working fine and the instruments look and feel clean, and are free of any soil or residual films. I have adjusted the volume and times of our enzymatic presoak and wash cycles but the problem continues – do you have any suggestions?

CS Answer: Many CS departments have experienced the problem of foul odors coming from their washers and or processed instruments. As a consultant I have worked with clients to ascertain and correct the source of such problems. There could be many contributing factors which cause such a problem. The previous question addressed the issue of PM and care of automated washers. Often times film or soil allowed to accumulate on the walls, internal mechanisms, drains and accessories will result in producing a foul odor. Proper routine care, cleaning, descaling and PM can obviate this problem. Inappropriate use of cleaning agents and enzymatic products can also promote problems. The proper selection, application and use of cleaning solutions is essential for the intended processing method and equipment. Users must adhere to manufacturers’ instructions regarding concentrations, temperatures, processes and cycle times. The inappropriate loading and overloading of automated washers can impede the proper functioning of washers and as a result thorough cleaning or rinsing may not occur and remnant soil can produce a foul odor. Remember all soil is not visible and the goal of cleaning/decontamination is the removal of all soil, visible and invisible. As you know, enzymes work to break down soil in order to facilitate thorough removal during the cleaning process. Enzymatic agents are intended for use as a pre soak prior to cleaning. Pre soaks should be done using cool water to prevent the coagulation of protein and organic soils. Enzymes work best in water temperatures between 68 – 140°F. Temperatures in excess to this can deactivate and destroy enzymes. Destroyed enzymes can produce a very foul odor. Quite often I have found the problem of the mysterious odors to be a result of:

(a) the inappropriate use of enzymatic agents

(b) excessive water temperatures used during the pre wash/ soak cycle in automated washers

(c) inadequate rinse cycle following the pre soak cycle.

If you are utilizing enzymatic solutions in your automated washers and are noticing a foul odor you may want to do the following:

• be certain that solutions containing enzymes are stored in a cool place or at room temperatures

• be certain you are using the precise concentrations recommended by the manufacturer

• be certain that your presoak temperatures do not exceed 140°F

• be certain your rinse cycle times are adequate to remove all residual enzymes prior to the wash cycle

• be certain your enzyme products are not used during the wash cycle which normally functions at higher temperatures

• use environmentally friendly, odorless, and pH neutral products. HPN

Ray Taurasi is director of professional services for Case Medical Inc. Ridgefield, NJ.

Question: My staff often gets confused between the difference of Fahrenheit, Celsius and Centigrade temperatures. Is there an easy way to help them understand this?

Answer: It is very important to clarify temperatures as serious problems could result if one confuses Fahrenheit and Celsius. Centigrade is the same as Celsius. Outside of the U.S., Celsius is the standard used for temperatures. Fahrenheit is commonly abbreviated as "F" and Celsius as "C" following a numeric temperature e.g. 60°C = 140°F. To convert from Celsius to Fahrenheit multiply by 1.8 and then add 32. To convert from Fahrenheit to Celsius subtract 32 and then divide by 1.8. HPN

RayTaurasi is Director of Professional Services for Case Medical Inc. Ridgefield, NJ. His healthcare career spans over three decades as an administrator, educator, technologist and consultant. He is a past president of IAHCSMM and has served on and contributed to many national committees with a myriad of professional organizations, manufacturers, corporations and prestigious healthcare networks. Taurasi has been a faculty member of numerous colleges teaching in the divisions of business administration and health sciences. In addition to this column he has authored several articles and has been a featured speaker on the international scene.

March
2006