Just as one wouldn’t expect a surgeon to perform a procedure well without wielding the proper quality instrument, sterile processing technicians simply cannot adequately clean instruments and equipment if they’re using an incorrect, dirty or damaged brush.

"The use of surgical instrument cleaning brushes is essential in this day and age of sterile processing, which, more than ever, is responsible for higher volumes with less staff," confirmed Rick Schultz, president and CEO of Spectrum Surgical Instruments Corp., Stow, OH. "The adage is so true — you must always have the right tool for the job to properly remove bioburden from surgical instruments and devices."

Unfortunately, some sterile processing departments aren’t giving their brushes the attention they deserve and, as a result, are making technicians’ jobs more difficult, potentially damaging delicate devices and, most importantly, failing to thoroughly clean instruments and equipment, which puts patients’ health and safety at risk.

To offer valuable insight on these critical, yet oft-overlooked tools, Healthcare Purchasing News asked vendors to weigh in on the most common brush-related misconceptions and mistakes, while also providing easy to implement tips for keeping brushes in tip top shape.

Because instruments come in all shapes, sizes and materials, it’s essential that SPDs have a full assortment of brushes designed to clean these devices properly. No question, there are more sizes and styles of brushes available today to make a technician’s job easier.

"In channel brushes, there are a myriad of lengths and bristle diameters available to make sure technicians have the right tool for the right job," confirmed Brian O’Connell, president of Key Surgical Inc., Eden Prairie, MN. "In toothbrush-style brushes, there are several types of bristle material available to make sure that there is enough cleaning power available, but not too much to damage delicate instruments. Bristles now come in nylon, brass, soft stainless steel, and stainless steel." Beyond that, there’s the availability of double-headed brushes – in nylon and steel – as well as double-ended brushes (triple bristle and single bristle), and a variety of scope, burr and other specialty brushes available.

With so many options available, it’s imperative that staff use the right one at the right time. A common mistake SPDs make is using too small a brush for the cannula needing to be cleaned, pointed out Holly Moorehead, product manager, Aspen Surgical Products, Caledonia, MI.

"The bristle should make contact with all the walls of the cannula at the same time," she said, adding that a brush that’s too large for the cannula is equally problematic because it may require the technician to force the brush down the cannula, which can damage the instrument. Aspen offers brushes from 1mm to 20mm and in a variety of lengths, as well as brushes specially designed to be used with suction, tracheostomy and endoscopic devices. Aspen also recently launched a line of color-coded disposable endoscopic cleaning brushes that come in three different brush diameters and fit scopes as small as 1.1mm.

Using too long a brush — such as an 18- or 24-inch channel brush when a shorter, 8- to 12-inch brush could have done the job — can also bend or crimp the brush handle, warned Peter Huck, president of Prairie Surgical, Eden Prairie, MN.

"Bent or crimped handles will scratch the inside channels of delicate instruments, resulting in damage, replacement and/or costly repairs. Using the correct brush diameter and length will provide effective mechanical cleaning, extend the useful life of the brush and reduce the incremental costs of avoidable repair and replacement," he said.

Aside from the length and gauge of the brush, technicians must also be well-versed on which bristle types should be used on which devices – and when.

"As an instrument company, we caution that the technician must distinguish between wire and nylon bristles," said Bob Regan, vice president of Miltex Inc., York, PA.

Using a soft, nylon-bristled brush is best suited to delicate instruments, he said, adding that stiff wire brushes are good for removing embedded material from an already rough surface, such as a bone rasp, where minimal damage would be done to the working end of the instrument.

Schultz isn’t as concerned about stainless bristles causing damage to the surface of stainless steel instruments’ surface. He explained that the bristles are much softer than the instrument and will safely bend before scratching. To prove this, Spectrum hired an independent testing lab to test instruments before and after stainless bristle brushing. The lab used an electron microscope and examined the metallurgical properties of the stainless steel instrument.

"No scratching whatsoever was documented," Schultz said. Still, his recommendation is to use a nylon-bristled brush first, followed by a stainless steel bristled brush if debris remains on the instrument. He notes that stainless steel bristled brushes are primarily intended for use on bone files, needleholders, hemostats, scissors, orthopedic instruments, vascular instrument serrations and baked-on bioburden. Schultz cautioned that insulated, coated, plated or chrome instruments will be damaged by a stainless steel bristled brush, as will case carts and stainless steel equipment surfaces. Spectrum offers cleaning brushes with patent-pending antimicrobial nylon bristles, as well as those with surgical stainless steel twisted wire. A colored-bead identification system allows for at-a-glance identification and simplified reordering.

"You may not know the length or diameter of a specific brush, but you will be able to easily identify and reorder a needed brush through visual confirmation of the colored bead on the brush," added Schultz. This year, Spectrum will offer a new set of cleaning brushes, as well as a customized brush kit consignment program that will make an SPD’s most frequently used brush kits logistically available.

Whichever brushes a facility makes available to technicians, it’s essential that departmental managers include directions for use in written procedures, stressed Ray Taurasi, director of clinical sales and services, eastern region, Healthmark Industries, Fraser, MI.

"Instructions should include which brush is to be used when cleaning specific medical devices," explained Taurasi. "Procedures can also include the use of visual aids." Healthmark offers a wide range of brushes and brush accessories, including specialty brushes with safety guards that reduce risk of damage to instrument insulation.

Even the best brushes will be ineffective if they’re inaccessible to technicians, improperly stored and poorly maintained, which is why instrument care should also be addressed with staff and prominently highlighted in a department’s policies and procedures.

Vendor experts recommend the use of storage and display racks to keep brushes organized according to size, well protected and within easy reach of technicians. Hanging brushes also prevents them from being coiled. "Coiling brushes can lead to bent handles and bent brush heads, which can lead to instrument damage," stressed Aspen Surgical’s Moorehead.

Proper care – and, of course, proper cleaning – is also dependent upon regular cleaning of the brushes themselves. Schultz stressed that, while it is at a facility’s discretion, it is recommended that brushes be decontaminated at least daily, according to the Association of the Advancement of Medical Instrumentation, 7.5.3.2 Manual Cleaning, ANSI/AAMI ST79:2006.

Taurasi added that brushes may be cleaned manually or run through automated washers. "They can also be soaked in disinfectant or cleaning agents between uses."

Daily visual inspection of brushes is also essential for proper instrumentation cleaning, although it’s a frequently overlooked task, according to Huck.

"During my visits, I commonly find brushes being used that have flattened out bristles and are well past their useful life. This is a simple training issue for SPD managers to share with their technicians," he reasoned. "Mechanical cleaning with brushes depends on the scrubbing action of the bristles. The tips of the bristles provide the cleaning functionality by getting into the creases and crevices. Brushes with flattened and worn bristles no longer offer the functionality to get into areas that need to be cleaned."

Because brushes do not have an infinite shelf life – and because there’s no set timeframe when brushes should be replaced — technicians must understand the importance of checking the bristles and brush handles before each use. As Moorehead explained, technicians should ensure that bristles are clean and intact and not showing visible signs of wear. Aspen Surgical recommends that brushes be thrown out as soon as bristles begin to bend.