Infection Control Today - 02/2001: Instrumental Knowledge

How to Clean Delicate Instruments Manually

By Sybil Williams, BS, CST, CRCST, CHL, ACE

In the race to processsterile surgical instruments quickly for the operating room or other clinicalareas, there is a strong reliance on mechanical washers. Most Central Service(CS) departments are equipped with mechanical washers. These washers assist CSin meeting one of its objectives: to provide the department with a tool thateffectively and efficiently decontaminates instruments prior to preparation forsterilization. What about delicate instruments? Eye instruments, microinstruments, and other delicate instruments should be hand washed. Or shouldthese types of instruments be decontaminated in a mechanical washer? Someprofessionals would agree and some would disagree. Some might say that the sonicwasher can be used for cleaning delicate instruments.

Suppose the facility does not have a sonic washer? These delicate instrumentsmust be cleaned manually.

Proper Training and Certification

There are basically five objectives in the cleaning process:

1) To remove the visible soils.

2) To remove the invisible soils.

3) To remove pyrogens.

4) To prepare the surface of any item to be sterilized or disinfected byallowing direct contact with the sterilizing agent.

5) To provide protection and safety to the patients and hospital personnel (IAHCSMM,1999).

The responsibility for cleaning contaminated instruments in a CS area isprobably the most important task performed by the CS technician. Most often,improperly trained technicians or managers do not take the cleaning taskseriously. This is why it is imperative to have properly trained and certifiedtechnicians performing this important duty. Qualified and properly trainedmanagers are needed to ensure the proper decontamination and sterilizationprocedures are performed correctly. It is understood in the CS profession if aninstrument has not been thoroughly cleaned, it can not be sterilized--period.

Attire:

Anyone assigned to the decontamination area must wear protective coverings,including gowns, gloves, shoe coverings, head coverings, and a mask. If a faceshield is worn, it is advisable to wear a mask to protect the mouth.

Equipment:

Have a sink that is deep enough to prevent unnecessary spillage and splashingof water in the work area. Use a detergent disinfectant designed for manualcleaning when performing this type of process. Ideally, the pH should be between7 and 8. An enzymatic cleaner should be used to break down protein-type soils.Use a receptacle (a pan with a perforated container inside of it) that allowsthe water to drain, thereby, providing visibility for the technician who iscleaning the instruments. A soft-bristled brush is needed to clean theinstruments effectively.

Water is definitely needed, as it is the main agent needed in any cleaningprocess. Use cold water initially to remove the blood soils from theinstruments. Water with a temperature of no more than 140°F should be used todissolve fatty tissue, grease, and other water soluble soils. Highertemperatures would coagulate the protein soils and prevent the technician fromsuccessfully performing the cleaning process.

The Process

The instruments are sortedwhen received in the decontamination area. Care should be taken to avoiddamaging the instruments. Delicate instruments should not be handled carelessly,and heavier instruments should not come in contact with them. Broken instrumentsshould be identified as such, and decontaminated before removing from the tray.The damaged or broken instruments should be placed in the area designated forinstruments to be repaired.

To begin the soaking process, instruments are opened and placed in a soak panthat has a perforated container. The perforated container prevents thetechnician from putting their hands into a basin of contaminated instruments.This type of container also prohibits the possibility of contaminated soilsbeing re-deposited on the instruments. The technician can reach for the handlesof the container to pull it from the soak pan. The soaking process will makecleaning easier and faster by loosening the protein soils that are on theinstruments.

Using the soft bristled brush, the instruments are washed under runningwater. The technician should handle each instrument individually to ensureproper cleaning. Additionally, the technician must wash the instrument underrunning water to prevent the formation of contaminated aerosols.

The instruments are rinsed thoroughly in tap water. Rinsing removes residualsoil particles and detergent solutions from the instruments being cleaned. Thefinal rinse is performed with distilled water. Distilled water is not availableat all healthcare facilities; however, the more thorough the tap water rinse,the more effective. The following steps follow a final rinse:

• The instruments are dried with a clean lint-free cloth.

• The instrument tray or container that held the delicate instruments is decontaminated according to the manufacturer recommendations.

• The instruments are returned to the instrument tray or container.

• The instruments are transported to the assembly or preparation area for inspection, assembly, and sterilization.

Conclusion

Any surgical instrument represents a costly investment for the healthcarefacility. The purchase of instruments is an investment to be used wisely.Physicians and the healthcare administrators rely on the CS staff to take careof their investment. The money invested in surgical instruments can be realizedif proper care and handling is given by the CS staff. Continuous training isneeded in the CS department so that the life span of any surgical instrument isnot shortened due to of inexperienced technicians.

Ask the instrument manufacture questions regarding the cleaning process ofits instruments. Require the sterilizer manufacturer to perform water samples onthe washing and sterilizing units to determine what type of water is beingdistributed in the CS area. Be aware of the cleaning agents used to manuallyclean surgical instruments.

Sybil Williams is the director of central sterile processing at Children'sMedical Center in Dallas, Tex.For a complete list of references click here