CFSA CSSD Conference Durban ICC Wednesday 8 th March 2017 Using technology to improve patient safety THE ULTRASONIC DISRUPTION OF ORGANIC SOIL ON COMPLEX INSTRUMENTATION Helen Loudon Independent Infection Prevention Practitioner Helen Loudon 2.2017 Risk Management Nurse Specialist
Treat your investment with care and respect Used surgical instruments are like dirty dishes the longer they dry out in the sink, the harder they are to clean! Cleaning is the single most important step in making a medical device safe and ready for reuse Ultrasonic cleaning is considered to be far superior and more reliable than manual cleaning If undertaken correctly, 99.9% soil will be removed in 3-5 minutes 2
Safety challenges Instruments and minimally invasive equipment is becoming more complex Equipment is a huge capital investment Microbial biofilm and organic soil are resistant to manual removal Deadly pathogens are then spread through indirect contact transmission via hard to reach surfaces, lumens and crevices Pressured turn around times! 3
Bioburden on equipment surfaces under high magnification 4
How do ultrasonic cleaners work? Ultrasonic cleaners comprise 3 main parts: transducer = a device which converts one form of energy into another (eg. electricity to sonic waves ) ultrasonic generator cleaning tank Ultrasonic cleaning works through cavitation. The high intensity sound waves make tiny bubbles on the surfaces of the instruments. These bubbles expand until they become unstable and collapse or implode. These shock waves physically loosen and remove micro-organisms and other adherent debris from even the most inaccessible surfaces of a soiled instrument 5
Types of instruments which should undergo ultrasonic cleaning http://www.safmed.co.za/news-articles/articleid/9/what-is-6 Ultrasonic-Cleaning
Important factors which affect ultrasonic cleaning Higher powered (Ie. wattage) machines will produce faster cleaning results The frequency of the sound waves will affect the effectiveness of the cavitation force The temperature, viscosity, density, vapor pressure and surface tension of the cleaning solution are critical to the effectiveness of ultrasonic cleaning Machines with lower frequency (sound waves) machines may be noisier - BUT, higher frequency sound waves will produce weaker cavitation (the collapsing power of each bubble) and the risk of less effective cleaning So BIGGER is not always BETTER seek advice on ultrasonic cleaners best suited to the type of equipment you need to clean 7
The cleaning solution A critically important and often neglected aspect! ph neutral (eg. 6 7.5) enzymatic detergent Low foaming Biodegradable safe to discard to sewer HIGH surface tension Ability to hold organic debris in solution NB! Gross debris should be rinsed off beforehand Do NOT let blood/fluids dry on instrumentation Change the water in the U/S cleaner frequently Run the U/S cleaner for 5-10 minutes to degas the water (to remove dissolved oxygen) before adding instruments 8
Good practice for ultrasonic cleaning Follow the equipment manufacturer s recommendations for the safest cleaning method Use the detergent solution recommended by the U/S bath manufacturer Keep used instrumentation moist until cleaned (Eg. with enzymatic cleaners or sterile pour H 2 O) Remove gross soiling with manual cleaning beforehand Use a mesh tray and don t exceed the recommended equipment capacity Ensure box locks, hinges and ratchets are open during soaking and cleaning Flush the air out of lumens with the cleaning solution Cover the tank in use to prevent aerosols and reduce noise 9
WARNINGS Blood, body fluids and normal saline are highly corrosive and will rust and pit instruments Quartz, silicon, plastic, carbon steel, gold or chromium plated instruments, endoscopic lenses and powered instruments should not be cleaned ultrasonically Do NOT place instruments directly onto the floor of the tank this will interfere with the production of sound waves and cause friction damage to the equipment Do NOT stack, fail to open/dismantle instruments or overload the tank 10
The impact of water quality A water quality assessment (by local municipality) should be undertaken periodically and after major maintenance to the water supply Excessively hard water will spot or stain instruments and the chlorine in tap water will cause pitting of instrument surfaces. Final rinsing should be undertaken with treated (de-ionized) water. De-ionized water removes soil and detergent residues more efficiently De-ionizing water removes dissolved minerals, iron and particles which could harm instruments. Adding water softeners removes calcium and magnesium ions which cause spotting on instruments. 11
Pre-purchasing questions 3 1. What are the dimensions of the ultrasonic cleaner? Is the size of its processing tank sufficient to accommodate the facility's soiled instruments? 2. How much power does the ultrasonic cleaner produce? Does the cleaner feature one power setting, or it is equipped with different power settings to process lightly soiled, heavily-soiled instruments, and delicate instruments? 3. What is the ultrasonic cleaner's frequency setting? Can it be adjusted? 4. What is the ultrasonic cleaner's standard cleaning time? Can this time be adjusted to permit extended cleaning for big loads and heavily-soiled instruments? 5. Does the manufacturer have any data to support its cleaning effectiveness? 6. Is the ultrasonic cleaner indicated for only a few types of instruments? What types of instruments, if any, are contraindicated? 12
Thank you! C mon, make my day wash your hands!
1. Ultrasonic cleaning effect on surgical instruments (30 secs) 2. Testing your ultrasonic cleaner the foil test (2 mins)
References and resources 1. CSSD Forum of South Africa. 2014 Standard Operating Procedures Manual. SOP No. 32 Prepare, Load and Operate Ultrasonic Cleaner; SOP No. 33 Validating an Ultrasonic Cleaner 2. Shelnutt T. Ultrasonic Cleaners. Infection Control Today. September 2001. http://www.infectioncontroltoday.com/articles/2001/09/ultrasonic-cleaners.aspx 3. Muscarella L.F. The Benefits of Ultrasonic Cleaning. Infection Control Today. May 2001. http://www.infectioncontroltoday.com/articles/2001/05/the-benefits-of-ultrasonic-cleaning.aspx 4. The Association of Peri-operative Nurses. Recommended Practices for the Care and Cleaning of Surgical Instruments and Powered Equipment. AORN Journal 1997, Volume 65, Issue 1, Pages 124 128 5. Kaiser H. McDonnell G. et al. Water quality and Reprocessing Instruments. Infection Control Today. May 2000 6. Instrument Reprocessing Working Group. 2012 (10 th Edition). Reprocessing of instruments to retain value. 7. SAFMED Newsletter April 2014. Ultrasonic Cleaning. 15