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         Clinical intelligence for supply chain leadership

 
 
 

INSIDE THE CURRENT ISSUE

November 2012

CS Solutions

 
 
 
 


 

Questions can be sent to:jakridge@hpnonline.com
called in to Jeannie Akridge at HPN:(941) 927-9345 ext.202 or mailed to:
HPN CS Questions, 2477 Stickney Point Road, Suite 315B, Sarasota, FL 34231
Names and hospital identification will be withheld upon request.

Ray Taurasi

Cleaning brush protocols; IUSS policies; changing wash water

by Ray Taurasi

Q We are in disagreement at our hospital; some of the staff say that cleaning brushes should only be used once and then discarded while others feel they can be reused as long as they are sterilized after each use. I have asked friends from other hospitals what they do and I got all sorts of answers. What would be your recommendations? Are there any specific regulations on cleaning brushes?

Figure 1

A Using the appropriate brushes to clean medical devices is critical. The manufacturer of the medical devices and instruments you are cleaning should provide detailed information on the specific type, size and design of brushes to be utilized to effectively clean their devices. There are single use and reusable brushes — obviously single use brushes should be discarded after each use. AAMI document ST79 7.5.6 states that reusable brushes should be disinfected and or sterilized at least daily. It is also important that you carefully inspect your brushes prior to each use. If brushes appear to be worn or damaged in any way they should not be used as they may not effectively clean the medical device or could cause damage. In between uses, brushes and other cleaning accessories must be kept free of debris and soil to prevent cross contamination and to maximize performance. To prolong the usable life of brushes they should be cared for and stored properly. There are wall mounted racks available that help keep brushes organized by sizes and provide some protection from

Figure 2

damage. Some storage racks even have soak bins, thus the brushes can be kept moist and soaking in an enzyme detergent between uses (see figure 1). The brush manufacturer’s instructions for use, care and handling should always be followed. You will find that many brushes may be able to be processed through your instrument washer disinfector. When processing brushes through an automated washer, the use of a specially designed washer basket will hold the brushes in proper position and prevent them from being tossed about the washer and damaged (see figure 2). It is important that your hospital develop a policy and procedure for the care and handling of all types of brushes you are utilizing and that all staff consistently follows established protocols.

Q If an instrument or full set of instruments is flashed (or IUSS) is it necessary to inform the surgeon that it was flashed? Our hospital has started to do this and I was wondering if there was a recommendation or regulation that requires this.

A I do not know of any regulation or recommendation that requires that a surgeon be notified of items that have been flash sterilized. If proper procedures and protocols are followed when it is necessary to use IUSS, including cleaning, decontamination, sterilization parameters and aseptic removal and transport, then you should have the same degree of confidence for the sterility of the IUSS items as you do for items that go through the traditional process.

That said, guidelines on IUSS from AORN and AAMI still recommend that IUSS be reserved for emergency and unanticipated events. Hospitals are encouraged to curtail the routine practice of IUSS. In many instances it has been found that perhaps a certain surgeon’s procedures, specific instruments or sets account for the greatest percentage of IUSS processed items. Your policy of alerting the surgeon of IUSS processed items might be a strategy to pull the surgeon into the loop to help decrease the need for IUSS at your hospital.

Q How often should the wash water for manually cleaning instruments be changed? We are an outpatient orthopedic surgery center and hand wash arthroscopic camera cords, light cords, shaver and power instruments as the main items that are hand washed. The manufacturer’s IFUs are followed for mixing the water & enzymatic solution. The new SPD manager had implemented that water be changed after every second case (set of instruments). Prior to this, the water was changed after every use. The manager does not understand the concept of contamination from one set of instruments to the next, dilution of the wash water which diminishes the enzymatic effect on that second set of items. Also, the wash water can set over 30 minutes between uses. Please comment.

A There is no set or one-size-fits-all answer to your question. The frequency of changing the water depends on the amount of soil present. In general terms, the water should be changed when there are visible amounts of organic soil present. Prewash rinsing can reduce the amount of gross soil prior to placing into the wash bath. You stated that you are following the detergent manufacturer’s IFUs, which is very important. In those IFUs the manufacturer should provide the temperature requirement for manual cleaning. It is necessary that the appropriate temperature be maintained to allow the chemical cleaning agents to perform effectively. Instrument cleaning agents contain chelating and sequestering agents which break down and remove organic soils holding them in suspension in the wash bath to help prevent re-depositing the soil on the cleaned items. So if your wash bath is left standing for prolonged periods between wash cycles you will want to be sure the temperature is appropriate each time you wash another load of instruments. Regarding cross contamination of instruments during the cleaning process, it is important to remember that most cleaning agents are not biocidal. The cleaning process is generally focused on the physical removal of soils, thus cleaning agents and the cleaning process is different from disinfectants and the disinfection process. In manual processes you need to follow the medical device manufacturer’s IFUs for cleaning and disinfection.  

Ray Taurasi is Eastern Regional Director of Clinical Sales and Services for Healthmark Industries. His healthcare career spans over three decades as an Administrator, Educator, Technologist and Consultant. He is a member of AORN, AHA, SGNA, AAMI and 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.