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3M Sterile U Web Meeting August 21, 2014 The Nuts and Bolts of Washer-Disinfectors Today s meeting

Audio will commence when the webinar begins. Welcome!

Facilitators: Christophe de Campeau, 3M Larry Talapa, 3M Housekeeping Questions Mute feature (*7 =

www.3m.com/3msterileu How do I get a CE Certificate?

obtaining a CE Certificate for today s meeting.

1 3M Sterile U Web Meeting August 21, 2014 The Nuts and Bolts of Washer-Disinfectors Today s meeting times are 9:00 a.m., 11:00 a.m. and 1:00 p.m. CST To hear audio, call and enter access code Phone lines are muted. Audio will commence when the webinar begins. Welcome! Topic: The Nuts and Bolts of Washer-Disinfectors Speaker: John Nies, Product Manager Belimed, Inc Facilitators: Christophe de Campeau, 3M Larry Talapa, 3M Housekeeping Questions Mute feature (*7 = unmute; *6 = mute) Chat feature Technical difficulties Post session follow-up For more information: How do I get a CE Certificate? Next week, all of today s meeting participants will be sent an containing instructions for obtaining a CE Certificate for today s meeting. The will be sent to the address you provided when you logged-in to today s meeting. If there are others listening with you today who did not log-on, you may forward the CE certificate to them. 1

Disclosure Statement John Nies Product Manager Lean Six Sigma Greenbelt Belimed, Inc.

components are used in each step of a cycle and what they do 3 Similarities and analogies with parts and

2 Disclosure Statement John Nies Product Manager Lean Six Sigma Greenbelt Belimed, Inc Charleston Regional Parkway Charleston, SC Tel: x141 Insert John s Picture Learning Objectives 1 The key components in a washer and how they work 2 What components are used in each step of a cycle and what they do 3 Similarities and analogies with parts and function to consumer products 3M All rights reserved. Purpose of a Washer / Disinfector A washer/disinfector cleans, disinfects and dries soiled surgical instruments so they can be handled safely during the next re-processing step 2

during each cycle Many different cycles can be programmed

Wash Rinse Disinfection (Thermal Rinse) Dry Before we dive

main components in a washer Valves Pump Heating elements

gases and liquids Manual or automatically controlled

3 How Does it Do That? A washer sequences through a number of phases, or steps, during each cycle Many different cycles can be programmed A typical complete cycle consists of 5 phases Pre-Wash Wash Rinse Disinfection (Thermal Rinse) Dry Before we dive in deeper Function, operation, and examples of some of the main components in a washer Valves Pump Heating elements Sensors A little bit about Valves Valves control flow of gases and liquids Manual or automatically controlled Typically on or off but some can control flow rate also Water faucet Heart valve Water valve in a washer 3

or electrically Car water pump Hand pump Air pump Washer water pump

Typically done with electric heating elements Special type of wire that

Heater box in a washer Sensors they measure things!

4 What s a Pump for? Typically moves a liquid, can move a gas Manual or driven Mechanically or electrically Car water pump Hand pump Air pump Washer water pump Heating Elements - How do we heat air? Typically done with electric heating elements Special type of wire that resists flow of electricity Resistance creates heat Toaster Hair dryer Heater box in a washer Sensors they measure things! Sensors are everywhere Measure almost everything The output controls a function Position sensor on a smart phone or tablet Toilet tank float Auto on lighting Water level sensor in a washer 4

how, in each step of a typical washer cycle Before the Automated Washer Follow instrument

Purpose: Used to soften and remove blood Why: Cold water (less than 45 C / 113 F) is used since

5 What happens in the washer? All of these components are in a washer Plus a whole lot more Let s look at what is used, and how, in each step of a typical washer cycle Before the Automated Washer Follow instrument manufacturers instructions (IFU s) for Required pre-cleaning Disassembly Cycle Phase: Pre-wash Purpose: Used to soften and remove blood Why: Cold water (less than 45 C / 113 F) is used since hot water will set blood and make it more difficult to remove (denature) The Nuts & Bolts: 1. Fill the washer with cold water 2. Circulate for the programmed time 3. Drain 5

Nuts & Bolts The Fill Step Washers use two

fills with the same amount of water Dynamic

Always the same amount of water Fill Valves

is full Pump Drain Valve Dynamic Fill Vary

6 Nuts & Bolts The Fill Step Washers use two different filling approaches Static always fills with the same amount of water Dynamic Varies water based upon load size Static Fill Always the same amount of water Fill Valves Hot Cold RO/DI Sump Water is added until sump is full Pump Drain Valve Dynamic Fill Vary Water Fill Cold Smaller sump water also on instruments t 6

Dynamic Fill Vary Water Fill Cold Sensor tells washer to add water stops

lowest point in water system Prevents mixing used water with fresh water

washer drain is not connected to the floor drain An air gap is required

7 Dynamic Fill Vary Water Fill Cold Sensor tells washer to add water stops when full Water level sensor Draining Pump stops Drain opens Drain is at lowest point in water system Prevents mixing used water with fresh water of next step About seconds to drain Drain Valve Draining The washer drain is not connected to the floor drain An air gap is required per plumbing code If drains back-up the water won t push back into the washer 7

Cycle Phase: Wash Purpose: Removes soils Why: Need to remove

prewash Use hot water to start Sensor reads water temperature Mix

is to get as close to set temperature as possible Minimizes

Heating Heating is either steam coils or electric elements

8 Cycle Phase: Wash Purpose: Removes soils Why: Need to remove soils to be clean The Nuts & Bolts: 1. Fill the washer with hot/warm water 2. Bring to correct temperature 3. Add (dose) detergent 4. Circulate for the programmed time 5. Drain Wash Fill step Same process as the fill step for the prewash Use hot water to start Sensor reads water temperature Mix in cold water if hot is above set temperature Hot Cold RO/DI Goal is to get as close to set temperature as possible Minimizes heating time Water Temperature sensor Wash Heating Nuts & Bolts Heating Heating is either steam coils or electric elements Located in the sump Sensor reads water temp Steam or electricity is applied to coils This continues to maintain temperature once it is reached Heating coils Water Temperature sensor 8

Wash Heating Nuts & Bolts This shows steam

Opens steam valve to send steam to coils

that surrounds the coils Electric heating

rather than steam Dosing Nuts & Bolts Dosing

ml/l Calculated based upon water use May

Detergent pumps Detergent containers Dosing

sometimes 4 Detergent Enzymatic Lube Other

9 Wash Heating Nuts & Bolts This shows steam heating coils Washer measures water temp Opens steam valve to send steam to coils Coils heat up Heat is transferred to water that surrounds the coils Electric heating works the same way Heat source is electricity rather than steam Dosing Nuts & Bolts Dosing (adding detergent) Programmed as oz/gal or ml/l Calculated based upon water use May include flow meters Detergent flow meter Detergent pumps Detergent containers Dosing Nuts & Bolts Detergent Pumps Typically 3, sometimes 4 Detergent Enzymatic Lube Other Peristaltic pumps Flow meters Ensure detergent is actually flowing from pumps 9

Detergents & Foaming Consumer marketing tells us that suds are good Water

Like those in high efficiency clothes washers Nuts & Bolts about Foaming A

washer has a pump to circulate the water Does not work well when trying to

Bolts about Foaming? Why does a washer pump dislike air?

10 Detergents & Foaming Consumer marketing tells us that suds are good Water and suds are static though not being pumped We need low foaming detergents Like those in high efficiency clothes washers Nuts & Bolts about Foaming A fan is meant to move air A pump is meant to move water Foam is mostly air A washer has a pump to circulate the water Does not work well when trying to pump foam (air) Circulation rate goes down Pump cavitation (air) Nuts & Bolts about Foaming? Why does a washer pump dislike air? How it works Designed for water not air Extended operation with cavitation could damage the pump 10

Cycle Phase: Rinse Purpose: Remove loosened soils and detergent residue remaining after wash phase Why: Ensure clean.

Intermediate Level Disinfection Why: Items need to be safe to handle with intact skin, for clean side safety The Nuts &

Lube, if called for, is dosed 4. Circulate for the programmed time 5.

11 Cycle Phase: Rinse Purpose: Remove loosened soils and detergent residue remaining after wash phase Why: Ensure clean. Residue can cause discoloration during sterilization process The Nuts & Bolts: 1. Fill the washer with hot water 2. Circulate for the programmed time 3. Drain Same steps as pre-wash using hot water instead Cycle Phase: Thermal Rinse (Disinfection) Purpose: Achieve Intermediate Level Disinfection Why: Items need to be safe to handle with intact skin, for clean side safety The Nuts & Bolts: 1. Fill with De-Ionized (DI) or Reverse Osmosis (RO) water 2. Heat to at least 90 C, for 1 minute 3. Lube, if called for, is dosed 4. Circulate for the programmed time 5. Drain Thermal Rinse Nuts & Bolts Heating is a time challenge Pre=heat tank RO/DI water is at room temperature (24 C / 75 F or so) Need to heat to 90 C / 194 F, minimum Steam heating is fast 4 minutes Electric heating is slow 12 to 15 minutes Pre-heat tank option on some washers 11

minerals Will pick up any minerals left from

spotting all of a sudden No RO/DI System is

- Drying Purpose: To dry instruments Why: Don

12 Thermal Rinse Why RO/DI? Prevents hard water staining RO/DI is void of minerals Will pick up any minerals left from previous steps that use tap water If you see spotting all of a sudden No RO/DI System is bypassing May need filter change Cycle Phases - Drying Purpose: To dry instruments Why: Don t want to pack wet instruments, avoid hand drying time Nuts & Bolts: 1. Air is pulled through filters and heated 2. Circulated through chamber 3. Exhausted to the room or to venting ductwork How does air drying work? Air drying accomplished with a combination of three parameters Humidity of the air Temperature of the air Air movement 12

Drying Nuts & Bolts Exhaust Air is pulled from decontam Washer is set in the decontam area Pulling from clean may disturb pressure

Exhausted to venting or to room Heaters Blowers Incoming air HEPA filter Drying Nuts & Bolts Drying Air heating and air flow Heating box

Blower box 1 2 3 Drying Nuts & Bolts How can we use Decontam side air that may have this in it?

13 Drying Nuts & Bolts Exhaust Air is pulled from decontam Washer is set in the decontam area Pulling from clean may disturb pressure difference between clean (higher) and decontam (lower) Passed over heating elements Dries and heats Circulated through the chamber Exhausted to venting or to room Heaters Blowers Incoming air HEPA filter Drying Nuts & Bolts Drying Air heating and air flow Heating box 1. Contains electrical heating elements Blower Unit 1 1. Pre-Filter 2. HEPA filter 3. Blower box Drying Nuts & Bolts How can we use Decontam side air that may have this in it? HEPA filter High Efficiency Particulate Air 99.97% of 0.3 µm (micrometer) particles. µm or micrometer is one millionth of a meter Bacteria to 2 µm Human hair 90 µm Be sure to maintain these as recommended by the washer manufacturer 13

Drying Exhaust vented or non-vented Vented and non-vented Vented Air is sent to ductwork Vents to

(decontam side) AAMI ST79:2010 & A1-A4 (Consolidated Text) 3.3.6.4 Ventilation.

(negative pressure), with a minimum of 10 air exchanges per hour, and so that all air is exhausted

Summed Up Nuts & Bolts A lot is happening in your washer Valves are opening and closing Water is

circulating air Temperatures are measured and more Nuts & Bolts - Maintenance Regular Preventive

3 For any mechanical cleaning unit, regular preventive maintenance should be performed in

14 Drying Exhaust vented or non-vented Vented and non-vented Vented Air is sent to ductwork Vents to the outside Non-vented Uses cold water to cool exhaust and remove moisture Exhausted to room (decontam side) AAMI ST79:2010 & A1-A4 (Consolidated Text) Ventilation... The soiled and decontamination area should be designed so that air flows into the area (negative pressure), with a minimum of 10 air exchanges per hour, and so that all air is exhausted to the outside atmosphere. Summed Up Nuts & Bolts A lot is happening in your washer Valves are opening and closing Water is heated Detergents are precisely dosed Pump is circulating water Air is heated Blowers are circulating air Temperatures are measured and more Nuts & Bolts - Maintenance Regular Preventive Maintenance checks AAMI ST-79 Recommended, Section For any mechanical cleaning unit, regular preventive maintenance should be performed in accordance with the manufacturer s written instructions The washer manufacturer Manufacturer trained internal personnel Some check points: Valve operation Heating time Inspect hoses, pipes & fittings Inspect door gasket Check detergent pumps and flow meters 14

15 Thank you! Next 3M Sterile U Web Meeting When: Thursday, September 18 th Topic: Steam Sterilization Qualification & Troubleshooting: Process Failures & Wet Packs Register at 3M All rights reserved. Thank you 44 3M All rights reserved. 15

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