Cost conscious chemical use;
processing carbide insert instruments in the ultrasonic
by Ray Taurasi
Q
Like so many others, our hospital is facing some serious financial
woes and each department is facing significant budget cuts. My budget
is already very tight, the work areas are run down and much of the
equipment is obsolete. We are a small rural hospital. We only have one
very old automated instrument washer, no ultrasonic and one steam
sterilizer. When things get busy or equipment breaks down we have to
do a lot of manual cleaning. I am really at a loss as to how I can
possibly reduce my operational expenses. I know I am going to have to
cut back on my chemical and detergent usage. I don’t see how I can get
by with less detergent usage, but I am thinking perhaps I could
eliminate the use of enzymes, as I doubt that would have much of an
impact on the end results. Do you think it’s that important to use
enzymes? Are there any regulations requiring the use of them?
A
There is no "regulation" that mandates the use of enzymes. However the
use of enzymes in the cleaning process is very important and their use
has become the standard of practice. Blood and other organic matter is
very difficult to remove from medical devices. Because of the design
complexity of many surgical instruments and devices the cleaning
process has become even more challenging. Many medical devices have
moveable parts, crevices, serrations, small channels and the like
where organic matter can adhere. Enzymes should be used during the
prewash phase of the cleaning cycle. They basically attack and break
down large organic molecules which facilitates more effective removal
during the washing process. In today’s environment the use of enzymes
is a critical component in the cleaning process.
You might want to assess your current
practices ensuring that your chemicals and detergents are being used
appropriately and at the correct levels and concentrations. Proper
equipment functioning, water conditions, and temperatures can maximize
the performance of detergents and enzymes. When these conditions are
right concentration and usage can often be reduced, decreasing costs.
Your chemical manufacturer can assist you in that regard and very
likely may be able to provide guidance in your utilization that could
reduce your expenditures.
You also have many options in
detergents and enzymes; you’ll want to choose wisely. Different
enzymes work on different soils so select enzymes that are effective
for the soils we see in sterile processing. The most essential enzymes
are those that are effective on Protease, Lipase and Amylase:
• Protease – Breaks down blood,
mucous, feces, and albumin.
• Lipase – Breaks down fatty deposits
such as bone marrow and adipose tissue.
• Amylase – Catalyzes (changes)
starch.
If you are using a product that is
costing more because it has more enzymes than are necessary for your
application than perhaps you could find a more economical option.
The cleaning process is a critical
function which if not done effectively can adversely affect the
outcome of the sterilization process posing a real risk to patient
safety. There can be no short cuts in this precise process and
eliminating essential products to the efficacy of the process is
non-negotiable as a budget reduction.
Q
I recently attended a seminar
on cleaning surgical instruments and the presenter reviewed the
various cleaning tools that should be used such as brushes, spray
guns, magnifiers, etc. They also reviewed the use of washer
disinfectors, cart washers, AERs and ultrasonics. I was surprised and
puzzled when she said that instruments with carbide inserts could not
be processed in an ultrasonic washer. We always run our needle holders
with inserts through the ultrasonic and have had no known problems.
Should we not do this?
A
I have never heard this before so I consulted with several instrument
manufacturers and repair companies. They all stated that the carbide
insert needle holders can be washed in the ultrasonic assuming the
hospital is using a validated process and cleaning products.
It is very important that you use a
reputable and qualified instrument repair company. The inserts after
normal wear and tear do need to be replaced. As is the case with all
surgical instrumentation it is wise to have a preventative maintenance
program in place where all instruments receive routine professional
inspection and appropriate servicing. When the inserts are replaced
they are secured with a silver-copper-tin-zinc alloy that forms a
strong bond between the insert and instrument jaw. In extreme cases,
if corrosive cleaning agents such as strong oxidizers and those with a
high acid base are utilized, over time they will cause pitting that
can affect silver solder, and any aggressive cleaning and mechanical
action including ultrasonic could loosen the insert. Following
manufacturers’ IFUs and utilizing the appropriate chemical cleaning
agents, there should be no problem processing carbide insert
instruments in the ultrasonic.