Medical instrument leaning machines rendered sterile surgical instruments, at the completion of the instrument cleaning process.
APIC Association for Professionals in Infection Control
Presented by: A. Drake, RN, APIC President,
Director Sterile Processing, Ohio State University,
International Annual Conference of APIC,
Oral Presentation by Ann Drake, President of APIC
The medical instrument cleaning machine, using as enzyme detergent medical instrument cleaning solution, offered increased protection to our reprocessing staff due to decreased handling but raised concerns about the efficacy of washer thermal disinfection as opposed to using the traditional washer sterilization.
The medical instrument cleaning temperatures, cleaning times, and cycle treatments used rendered sterile medical instruments at the completion of the medical instrument cleaning process.
Because of the limited scientific documentation pursuant to the efficacy of medical instrument washers, a study was undertaken to establish the microbial safety of finished products and to identify any feature or function failure which could adversely affect the medical instrument washing outcomes.
The medical instrument cleaning machine, manufactured by CESCO, sequence of cleaning cycles were; flush and rinse enzyme cold water washing, ultrasonic cleaning, elevated temperature detergent washing, redundant rinses, lubrication with deionized water (DI) sprays, and to hot air drying at 240° F, for 4 minutes.
The medical instrument cleaning machine was challenged with selected medical instruments and utensils that are considered to be very difficult to clean. Included were 30 each of stainless steel non-perforating towel clips and stainless steel and glass medicine cups. Each item was rinsed (contaminated) with a 105 ml suspension of Staphylococcus aureus, Pseudomonsaeruginosa, Enterococcus fecalis and Candida albicans, in nutrient media, and then dried.
The medical instruments were processed in the medical instrument washer, in 3 separate loads during times of high volume SPD operation. All medical instruments were tested for sterility. Ten separate cultures were taken of the final rinse solution of instrument lubricant and deionized water prior to the drying cycle. A separate culture was taken of the instrument lubricant fluid.
All medical instruments were sterile at the completion of the cleaning machine processing cycles.
The medical instrument leaning machines using the proper cleaning times and cleaning temperatures, using an enzyme detergent medical instrument cleaning solution is a valid replacement for the washer sterilizer.
Surgical instrument cleaning machines that are properly designed and use disinfector cleaning times and temperatures, can deliver sterile medical instruments at the completion of the cleaning cycles. The proper sequence of surgical Instrument washer disinfector temperatures and cycles will deliver consistently clean medical devices that are safe to handle and have received the prerequisite for sterilization.
The medical instrument washer temperature cycles are:
cold water pre wash cycle: ambient to 95 F, 35 C,
wash cycle: 131 to 137 F, 55 to 58 C,
elevated thermal rinse cycles: 194 to 209 F, 90 to 98 C, and
hot air dry cycle temperatures: 158 to 230 F, 70 to 110 C.
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Medical instrument cleaning machines, using the proper cleaning times, cleaning temperatures, and medical instrument enzyme detergent lubricant cleaner, rendered sterile surgical instruments.
All medical instruments were sterile at the completion of the medical instrument cleaning process.