Surgical Instrument Care
The primary purpose of cleaning surgical instruments and scopes is to remove all inorganic and organic bioburden material from the internal and external surfaces of flexible endoscopes. The secondary purpose of cleaning surgical instruments and scopes is to maintain and improve the “passive Layer” of stainless steel. The passive layer is provided by the manufacturer of surgical stainless steel to resist (prevent) corrosion. Proper cleaning of surgical instruments will maintain and improve this passive layer. (for more information go to: Prevent Corrosion – Importance of Cleaning) If the manual cleaning of surgical instruments, brushing and rinsing steps are not properly carried out, protein debris can harden and lead to formation of biofilm on the biopsy channel of the endoscope. The optimal cleaning surgical instrument protocol will break down bioburden and clean the surface. Inadequate cleaning surgical of instruments can thus result in material remaining on the endoscope surfaces which prevents disinfection and sterilization fluids or gases reaching all parts of potentially contaminated surfaces. Inadequate sterilization or disinfection may in turn result in transmission of infectious organisms when the endoscope is reused. ONEcleaner for Enzymatic Surgical Instrument Cleaners with Detergents and Lubricant Surgical Instrument Enzyme Cleaners. All disinfection processes, whether done manually or done automatically in a surgical instrument washer can only be effective if prior cleaning is adequate. Effective disinfection or sterilization of an inadequately cleaned surgery instrument or scope is not possible. Endoscopes should be cleaned with an enzymatic detergent compatible with the endoscope immediately after use and before manual or automated disinfection. Cleaning involves the entire endoscope, including valves, working channels, connectors and all detachable parts. High level enzymatic formulations Enzymatic Surgical Instrument Cleaners, in combination with a high level surfactant chemical complex, have been shown to be more effective in removing stains, hard water deposits, and encrusted bioburden, while being safe to use for rigid or flexible scopes. Surgical Instrument Cleaners Enzymes are effective and they are costly. Manufacturers usually recommend that Enzyme Surgical Instrument Cleaners should be discarded after each use as these products are not microbicidal and will not retard microbial growth. Some manufactures of "combination" or all-in-one Surgical Instrument Cleaner include a bacteriostatic agent which will prevent the growth of microorganisms. Some detergent complexes contain antimicrobial-microbicidal substances. Although these Surgical Instrument Cleaners do not replace disinfection they are designed to reduce the risk of infection to reprocessing personnel by rendering instruments that are clean and safe to handle. The cleaning function efficacy of enzyme Surgical Instrument Cleaners is determined by the ratio of enzymes to bioburden. The higher the proportion of enzymes the higher the efficacy. As a result, if the Surgical Instrument Cleaners become laden with bioburden from previous cleaning, the efficacy of the enzyme Surgical Instrument Cleaners is lower. When Surgical Instrument Cleaners states that is it multi-tiered, the inference is that is contains: protease (enzyme) which break protein debris into smaller, more soluble subunits, amylase (enzyme) which catalyses the breakdown of starch, and lipase (enzyme) which breaks up fat-containing debris and carbohydrates. When a detergent cleaning concentrate states that is it high-level, the inference is that is contains a high concentration of enzymes. When Surgical Instrument Cleaners state that is provides "enzyme activity" the inference is that is contains enzymes but this is usually is a misrepresentation of ingredients for a detergent cleaning concentrate that does not contain enzymes. Enzymes are effective and they are costly for manufacturers to include in the formulation. As is true for all detergent Surgical Instrument Cleaners, the most effective test is against your most difficult cleaning challenge. Optimal Temperature for Cleaning Surgical Instruments Surgical Instrument Cleaners function more effectively at temperatures above room temperature. The optimal range begins as > 22C - 72°F with performance reaching it's peak at 58.3C - 137F. This is often referred to as the optimal temperature for the performance or activity of enzymatic action. The activity of Surgical Instrument Cleaners enzymes does not stop at higher temperatures but the level of performance does begin to decrease. Enzyme cleaning concentrates enzyme-detergents and all-in-one Surgical Instrument Cleaners, which include enzymes, should be used in accordance with the manufacturer's recommendations and the recommendations of the medical devices being cleaned.
Cleaning Surgical Instruments in the presence of prions Creutzfeld-Jakob disease approach is the same if the presence of pathological prions (including the prions of vCJD Creutzfeld-Jakob disease) is suspected, however attention to detail is more important. It has been long known, that prions are unusually resistant to disinfection and sterilization by physical and chemical methods in common use for decontamination of infectious pathogens. The early prion inactivation approach, using a high concentrate of sodium hydroxide solution or sodium hypochlorite combined with long hold times, is generally lethal for medical surgical instruments and washer-decontaminators- disinfectors. Recently, researchers have been looking for less destructive methods to decontaminate surgery instruments potentially contaminated with prions. The use of “combination” enzymatic-detergent Surgical Instrument Cleaners has offered the highest level of cleaning outcomes.
Enzymatic Enzyme Detergents
The same detergent used for ultrasonic surgical instrument cleaning can be the same as used for manual cleaning. Recommendations for detergents used for ultrasonic cleaning are as follows: a non-foaming detergent must used the labeling of the detergent should recommend the use of the product for ultrasonic surgical instrument cleaner always use enzymatic detergent Surgical Instrument Cleaner for instruments soiled with bioburden (protein, fats, starch) use detergents with surfactant Surgical Instrument Cleaners for removing stains and hard water mineral deposits the treatment cleaning time recommended by the medical device and detergent manufacturers should be observed avoid the inhalation of enzyme-containing detergent aerosols by maintaining a cover over the ultrasonic cleaner when in use. Ultrasonic Surgical Instrument Cleaners are very effective when used with hot water per manufacturer’s recommended temperature and specially formulated detergents. It is recommended that all visible debris and blood be removed from the instrument prior to ultrasonic cleaning. Sort instruments by similar metals to prevent corrosion due to the contact of dissimilar metals.It is not recommended to clean plated instruments in an ultrasonic cleaner since the ultrasonic vibration and the presence of other sharp instruments may crack or rupture the plating. Because Ultrasonic Surgical Instrument Cleaners do not provide the complete proper sequence of treatments i.e. final rinses that are purified, purged between treatments, and/or have temperatures elevated to disinfection levels, they are not considered to be as clinically effective as automated surgical instrument washers. Ultrasonic Surgical Instrument Cleaning can effectively remove: long term encrustation and surgical cements or glues that have dried onto instrumentation.Ultrasonic Surgical Instrument Cleaners will fragment and loosen soil but will not necessarily remove the soil from the surface of the surgery instrument being cleaned.