Contaminated instruments in healthcare settings pose a significant risk of infection to both patients and healthcare workers. Ensuring the highest level of safety during instrument cleaning is of utmost importance. With numerous challenges and guidelines to follow, how can healthcare professionals ensure proper cleaning procedures? Let’s dive into the crucial steps and best practices to optimize safety precautions during manual cleaning of contaminated instruments.
Personal Protective Equipment (PPE) for Manual Cleaning
Healthcare professionals can guard against potential hazards and infections during manual cleaning by employing personal protective equipment (PPE). PPE serves as the first line of defense against infectious material present on surgical instruments and other medical devices. Recommended PPE for manual cleaning includes:
- Face masks
- Eye protection
- Protective clothing
Appropriate PPE can help healthcare workers reduce their exposure to potentially harmful substances during sterilization.
Moreover, the proper use of PPE ensures that the ultrasonic cleaning or manual and mechanical cleaning processes are carried out safely. This, in turn, enhances the overall safety of cleaning instruments contaminated with body fluids and facilitates a more efficient instrument processing procedure.
A well-equipped healthcare professional not only promotes patient safety but also ensures occupational safety in medical environments.
Pre-Cleaning at Point of Use
Removing visible debris and preventing bioburden from drying and adhering to the instruments, pre-cleaning at the point of use becomes a critical step in the sterilization process. Pre-treatment steps, such as using a sterile, radiopaque surgical sponge moistened with sterile water, are recommended to remove gross soil from instrument surfaces during the procedure. This practice is particularly important for cleaning reusable medical devices, as it helps prevent visible impairment and potential risks from pathogenic microorganisms or transmissible proteins.
Instrument transport gels, like Pre-KlenzTM Point of Use Preprocessing Gel, are specifically designed to initiate the cleaning process in a timely manner. This is beneficial for instruments used in surgical, endoscopic and robotic procedures. This helps prevent the drying of bioburden and facilitates the cleaning of instruments.
Incorporating pre-cleaning at the point of use can boost the overall cleaning process’s efficiency and foster a safer healthcare environment.
Decontamination Area Setup
A proper decontamination area is fundamental for successfully sanitizing and safely handling soiled instruments. Sharp instruments, including delicate or complex devices, must be segregated from other instruments and securely contained in a puncture-resistant container prior to transport to the decontamination area. Additionally, delicate instruments such as endoscopes, microsurgical instruments, and robotic instruments should be segregated into different containers or placed on top of heavier instruments to protect them during transport.
A well-equipped decontamination area should have sinks of appropriate number, size, and configuration to ensure proper cleaning and removal of body fluids and other contaminants from instruments. Implementing a water management program, consisting of a collaborative team to create a process and establish a frequency for monitoring water quality, is also recommended for successful instrument processing.
Following these guidelines can help in setting up a decontamination area that promotes safety and efficiency.
Manual Cleaning Techniques
Manual cleaning involves removing visible soil from the surfaces, crevices, serrations, joints, and lumens of instruments, devices, and equipment through a manual or mechanical process in preparation for safe handling and further decontamination. Healthcare professionals responsible for instrument preparation and processing face a range of issues related to infection control, complex instrument designs, virulent pathogenic microorganisms, guideline compliance, and ongoing education. Following the manufacturer’s instructions for use is a reliable way to address these challenges, as it allows healthcare professionals to set up and carry out procedures that lessen inconsistencies in the cleaning process and curb the likelihood of transmitting infectious microorganisms.
Ultrasonic cleaning is a highly effective cleaning process used for instruments with intricate details such as crevices, hinges, and lumens. Some key points to remember about ultrasonic cleaning are:
- Low-foaming enzymatic cleaners are suitable for use in ultrasonic cleaners, as long as the foam does not impede the cavitation process.
- After the ultrasonic cleaning process, it is essential that instruments are rinsed properly.
- This can be done with either deionized or softened water.
Washer/disinfectors utilize spray arm technology with pressurized water for mechanical cleaning action. Successful cleaning using these devices depends on four parameters:
- Water temperature
- Chemical concentration
- Flow rate
- Thermal rinse phase
Understanding the importance of these parameters and maintaining the recommended temperature range for detergents used in washer/disinfectors (typically between 122-180 F/50-82 C) enables healthcare professionals to perform effective cleaning and uphold patient safety.
Cleaning Solutions and Chemicals
The suitable selection and utilization of cleaning solutions, including detergent solution, and chemicals are indispensable for successfully cleaning and reducing bioburden. The recommended practice is to change the cleaning solution between each use, unless otherwise specified by the manufacturer’s instructions for use (IFU). Moreover, it is advised to utilize accessories that are compatible with the ultrasonic cleaner, such as a metal open weave basket. This ensures the proper function of the ultrasonic cleaner and maximizes cleaning efficiency.
Degassing the ultrasonic unit as per the instructions for use (IFU) provided by the ultrasonic cleaning device manufacturer is another important aspect of the cleaning process. Utilizing cleaning solutions in a well-ventilated area is essential to minimize the potential danger of inhalation of hazardous fumes and vapors.
Cleaning Verification and Inspection
Post-cleaning verification and inspection of instruments are crucial to confirm cleaning effectiveness and adherence to regulations and instructions from governing agencies and manufacturers. Governing agencies provide guidelines for cleaning and disinfection. Prominent among these are AAMI/ANSI, FDA, and AORN.
After cleaning surgical instruments, including dental instruments, it is imperative to visually inspect the instruments thoroughly with a lighted magnifying glass. This ensures that all surfaces and crevices of the instruments are free from residual soil and potential contaminants.
Specific device IFUs must be followed to ensure that a device is reprocessed according to the manufacturer’s instructions. Conducting thorough cleaning verification and inspection helps healthcare professionals uphold high patient safety standards and reduce the risk of infection transmission in healthcare facilities.
Common Causes of Cleaning Failures
Understanding the common causes of cleaning failures can help healthcare professionals prevent residual soil and potential risks to patients. Some common causes of cleaning failures include:
- Inadequate pre-cleaning
- Inefficient cleaning methods
- Using unclean cleaning tools
- Not cleaning prior to disinfecting
- Rubbing stains instead of blotting
- Wiping surfaces prematurely
- Not utilizing the appropriate tools
- Using harsh chemicals
- Cluttered workspaces
By addressing these causes, healthcare professionals can improve the effectiveness of their cleaning practices and ensure a safe and clean environment for patients.
Residual soils left on devices can detrimentally affect the device’s surfaces or impede its correct functioning. Identifying and addressing these common causes of cleaning failures can lead to a more comprehensive cleaning process and a safer healthcare environment for patients and staff.
Improper Use of Cleaning Solutions
Improper use of cleaning solutions, such as incorrect concentration or temperature, can lead to cleaning failures and potential harm to instruments and patients. The misuse of cleaning solutions can result in a variety of risks, such as health hazards, chemical reactions, and irritation. Adhering to instructions when using cleaning solutions is critical to guarantee that the cleaning solution is utilized accurately and securely.
Using cleaning solutions in a well-ventilated area can reduce the risk of inhaling hazardous fumes and vapors. Ensuring proper use of cleaning solutions and adhering to recommended guidelines can help healthcare professionals limit cleaning failures and uphold a safe, efficient cleaning process for contaminated instruments.
Healthcare professionals must implement and follow best practices for the manual cleaning of contaminated instruments to ensure patient safety and minimize the risk of infection transmission. By understanding the importance of PPE, pre-cleaning at the point of use, proper decontamination area setup, effective cleaning techniques, suitable cleaning solutions and chemicals, thorough cleaning verification and inspection, and addressing common causes of cleaning failures, healthcare professionals can optimize safety precautions and contribute to a safer healthcare environment.
Frequently Asked Questions
How do you clean contaminated instruments?
To clean contaminated instruments, start by pre-rinsing them in cold water and soaking them in an enzymatic or neutral detergent solution. Then, manually brush them using instrument cleaning brushes and rinse with sterile water. Finally, remove debris from the instrument either manually with a detergent or by using automated equipment and chemical agents.
How do you manually clean surgical instruments?
Manually cleaning surgical instruments requires a three-bay sink and includes steps of rinsing in cold water, brushing with soft brushes, and rinsing again with sterile water.
What are the guidelines for cleaning medical equipment?
Medical equipment should be cleaned using a neutral detergent and water. If necessary, general cleaning should be followed by a disinfectant clean with chlorine releasing product/sodium hypochlorite or a chlorine dioxide solution. Additionally, internal and external surfaces should be mechanically cleaned and each internal channel flushed with water and a detergent or enzymatic cleaner.
What types of PPE are recommended for manual cleaning of contaminated instruments?
Protective gloves, masks, eye protection, and clothing are essential for manual cleaning of contaminated instruments.
Why is pre-cleaning at the point of use important?
Pre-cleaning instruments before sterilization is an essential step to ensure debris and bioburden are removed, preserving the effectiveness of the sterilization process.