Surgical Instrument Care
Cleaning Surgical instruments
If the manual cleaning, brushing and rinsing steps are not properly carried out, protein debris can harden and lead to formation of biofilm on the surgical instrument, i.e. the biopsy channel of an endoscope. The optimal surgical instrument cleaning protocol will break down proteinaceous bioburden and clean the surface. Inadequate cleaning can result in material remaining on the surgical instrument which will prevent disinfection and sterilization fluids or gases reaching all parts of the potentially contaminated device. Inadequate sterilization or disinfection sterilization and may in turn result in transmission of infectious organisms when the device is reused. The intricate design and delicate materials of flexible scopes complicate the cleaning process. This requires repetitive and consistent oversight.
Cleaning Surgical Instruments is the Prerequisite for Sterilization
The reprocessing decontamination Cleaning of Surgical Instruments, whether done manually or automatically in a surgical instrument washer decontaminator disinfector, can only be effective if "cleaning" is adequate. Effectively sterilizing surgical instruments (Generic Sterilization with a Pre-Vacuum Sterilizer (HI-VAC): 270-272° F (132-134° C), 16-minute exposure time, with 4 pulses and a 30-minute dry time. Generic Sterilization with a Gravity Displacement Sterilizer: 270-272° F (132-134° C), 30-minute exposure time, with a 30-minute dry time.) is not possible if "cleaning", the "prerequisite for sterilizing surgical instruments", is not adequate.
All disinfection processes, whether done manually or done automatically in a surgical instrument washer decontaminator disinfector, can only be effective if prior cleaning is adequate. Effective disinfection or sterilization of an inadequately cleaned surgical instrument or scope is not possible. Endoscopes should be cleaned with an enzymatic enzyme 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 enzyme detergent formulations ("Enzymatic" Surgical Instrument Cleaners), in combination with a high level surfactant chemical complex, have been shown to be effective in removing stains, hard water deposits, and encrusted bioburden, while being safe to use for rigid or flexible scopes.
Enzyme Surgical Instrument Cleaner Concentrates
Enzymes: Enzymes are costly, clinically and financially effective.
Manufacturers of surgical instrument usually recommend that Enzyme Cleaning concentrates 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 cleaning concentrates include a bacteriostatic agent which will prevent the growth of microorganisms. Some detergent complexes contain antimicrobial-microbicidal substances. Although these agents 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 cleaning concentrates is determined by the ratio of enzymes to bioburden. The higher the proportion of enzymes the higher the efficacy. As a result, if the cleaning solution becomes laden with bioburden from previous cleaning, the efficacy of the enzyme cleaning concentrates is lower. When a cleaning concentrate 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 a cleaning concentrate states 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 cleaning concentrates, the most effective test is against your most difficult cleaning challenge. The two most common tests for cleaning concentration efficacy that are commercially available are the "TOSI Test" and the "film test". Be aware that some manufacturers use advertising wordage and product names that imply enzymes are an active ingredient but do not actually include enzymes in their product formulation. Refer to product labels and ingredients for disclosure.
Optimal Temperature for cleaning eye surgical instruments
Enzyme Cleaning Concentrates
Enzyme cleaning concentrates 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 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 cleaning concentrates, which include enzymes, should be used in accordance with the manufacturer's recommendations and the recommendations of the medical devices being cleaned.
pathological prions (Creutzfeld-Jakob disease)
deactivating prions (protein and prion contamination)
(Creutzfeld-Jakob disease) deactivating prions (protein and prion contamination)
The approach for cleaning surgical instruments can be the same if the presence of pathological prions (including the prions of vCJD Creutzfeld-Jakob disease) however the attention to detail is more important. It is known, that prions are unusually resistant to disinfection and sterilization by the physical and chemical methods used for decontamination of infectious pathogens. It is a difficult task to gain a consensus opinion on what constitutes optimal and practical conditions for decontamination of prions. Numerous studies have been conducted, but they do not reflect the reprocessing procedures for surgical instruments in a clinical setting. The clinical setting is critical for iatrogenic transmission, the passing of a disease from an infected individual or group to a previously uninfected individual or group. The method of reprocessing prion contaminated surgical instruments includes (1) decontamination by NaOH or NaOCl for 30 or 60 minutes followed by GL-autoclaving at 121°C for 30 minutes, (2) cleaning and (3) routine PL-sterilizing at 134°C. It is known that some surgical instruments cannot be decontaminated by heat and moisture. Disinfectants have been widely used for this purpose even although the disinfectants are ineffective. The most common practice believes that the only completely safe way to prevent transmission of vCJD is to use single-use surgical instruments. Because of the pervasive distribution of these infectious proteins and the long incubation time of the disease, reprocessing cleaning surgical instruments has been identified as a high risk factor for nosocomial transmission of vCJD. Research has shown that the agent of the vCJD disease, an infectious prion protein, is extremely resistant to today’s sterilization methods; therefore, the argument, “It does not matter if instruments are 100 percent clean, as they will be sterilized,” is definitely no longer valid. Today, we understand that cleaning surgical instruments is as important as the sterilizing the surgical instruments. Today’s surgical instrument cleaning process requires increasingly sophisticated surgical instrument cleaning concentrates. Detergents, which are used in these processes, can be mild, with a neutral pH, or they may be more aggressive, with values in the alkaline range of the pH scale. A number of hospitals and surgical centers are effectively using neutral pH “combination” enzymatic enzyme detergent cleaners for reprocessing surgical instruments. The “combination” enzyme detergent cleaners provide optimal cleaning as well as the highest possible level of care for surgical instruments and scopes. The manufacturers of surgical instruments strongly recommend the use of Neutral pH cleaners to enhance the "passive layer" of instrument protection. The early prion inactivation approach, using a high concentrate of sodium hydroxide solution or sodium hypochlorite combined with long holding times, is generally lethal for medical surgical instruments and washer-decontaminators- disinfectors. Recently, researchers have been looking is a minimally destructive method to decontaminate surgical instruments potentially contaminated with prions. The use of “combination” enzyme detergent surgical instrument cleaners has offered the highest level of cleaning outcomes.
Cleaning Surgical Instruments Cleaner.
Cleaning Surgical Instruments
Surgical Instrument Cleaner cleaning surgical instruments cleaner.
The all-in-ONE™ Surgical Instrument Cleaner will lower your
surgical instrument cleaning costs and replace multiple
Surgical Instrument Care products for
Ultrasonic cleaning of reusable endoscope accessories and components may be needed to remove material from hard-to-clean areas. The same detergent used for ultrasonic 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 cleaning
• always use enzymatic detergents for instruments soiled with bioburden (protein, fats, starch)
• use detergents with 'surfactant' cleaning agents 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 (risk of anaphylactic reactions) by maintaining a cover over the ultrasonic cleaner when in use.
Ultrasonic 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. (electrolytic deposition - galvanic corrosion) 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 Cleaners do not provide the complete "proper sequence of treatments" i.e. final rinse(s) 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 washer-decontaminators- disinfectors. Ultrasonic Cleaning can effectively remove: long term encrustation and surgical cements or glues that have dried onto instrumentation. Always refer to the printed manufacturer recommendations prior to using Ultrasonics.
Recommendations for Maximizing the Efficacy of Ultrasonic Cleaning
• items being cleaned must be fully immersed
• hinged instruments must remain open during treatment
• only use cleaning trays that do not obstruct the ultrasonic cleaning process or add mass (e.g. wire baskets)
• large surface bulky items such as kidney shaped bowls must be positioned not to create anechoic (shadow) zones that will block the efficacy of ultrasonic transducer waveform. Position such items vertically or put them on top of the other items.
• always sort instruments by similar metals to prevent corrosion
• do not overload the ultrasonic cleaning tank with excessive mass as this will reduce the efficacy of cleaning
• the soil being removed from devices being cleaned adds to the mass within the tank and decreases the efficacy of the ultrasonic cleaner. Review the level of soil and renew the ultrasonic bath as needed
• ALWAYS follow ultrasonic cleaning with separate rinse treatments. Ultrasonic cleaning will fragment and loosen soil but will not necessarily remove the soil from the surface of the surgery instrument being cleaned.
surgical instrument cleaners Cleaning Concentrates Detergents for
For the cleaning of endoscopes, detergents with or without enzymes, and detergents containing antimicrobial substances may be used. Use of non-foaming detergents is recommended. Foaming can inhibit good fluid contact with device surfaces, and prevent a clear field of vision during the cleaning process with a risk of injury to personnel.
The detergent selected should effectively loosen organic and non-organic material so that the flushing action of the detergent fluid and subsequent rinsing water removes the unwanted material. Combination all-in-one Enzymatic Surgical Instrument Cleaner detergent complexes have been shown to be highly effective.
Detergents may contain the following substances with properties supporting the cleaning action:
surfactants which reduce surface tension thus facilitating removal of debris
activated H2O2 which effectively loosens debris at room temperature
protease (enzyme) which break protein debris into smaller, more soluble subunits
amylase (enzyme) which catalyses the breakdown of starch
lipase (enzyme) which breaks up fat-containing debris
quaternary ammonium compounds, biguanidine, alcohols
Other active substances recommended for cleaning include:
amine compounds
glucoprotamine
peracetic acid
hydrogen peroxide
Aldehydes Contained in Cleaning Concentrates for
When using Cleaning Concentrates which contain Aldehydes, be aware that they denature and coagulate protein.
Amine Compounds or Glucoprotamine in combination with Glutaraldehyde and Cleaning Concentrates
Detergents based on amine compounds or glucoprotamine in combination with glutaraldehyde for disinfection should not be used as chemical reactions may result in formation of colored residues. These residues can appear to be corrosion. The use of a high level cleaning surfactant "combination" enzyme detergent instrument cleaner can be used to remove the corrosion-stains, and prevent corrosion or stains.
John Temple
Product Development
ergo-Logistics Surgical Instrument Cleaning with Conditioning™
will lower your surgical instrument cleaning costs and
replace multiple Surgical Instrument Care products for
Surgical Instrument Cleaner reference web site,
Contact us for product information and ergo-Logistics pricing.
Cleaning Surgical Instruments Cleaner.
Cleaning Surgical Instruments
Cleaning Surgical Instruments Cleaner.
Cleaning Surgical Instruments
Combination surgical instrument cleaners deliver lower surgical instrument cleaning costs while cleaning surgical instruments cleaner. Enzyme Detergent Surgical Instrument Cleaners remove STAINS and bioburden from surgical instruments while cleaning the surface of surgical instruments cleaner and conditioning the surgical stainless steel 'passive layer'. Surgical Instruments will look newer and perform longer. all-in-ONE™ Surgical Instrument Cleaners are non-irritating, 100% biodegradable and Neutral pH. all-in-ONE™ Surgical Instrument Cleaners will clean your surgical instruments cleaner and lower cleaning costs.
Neutral pH, free-rinsing Surgical Instrument Cleaners are designed to provide critically clean Surgical Instruments with a residue free surface. This is especially important when cleaning eye surgical instruments.
Cleaning Surgical Instruments Cleaner.
Cleaning Surgical Instruments
The Importance of Cleaning Surgical Instruments
The primary purpose of cleaning surgical instruments is to remove all inorganic and organic proteinaceous bioburden material from the internal and external surfaces cleaning surgical instruments inside and out with careful attention to cleaning cannulated surgical instruments.
The secondary purpose of cleaning surgical instruments is to maintain and improve the “passive Layer” of surgical stainless steel. The passive layer is provided by the manufacturer of the surgical instruments, within the surgical stainless steel, to resist (prevent) corrosion. Proper cleaning of the surgical instrument will maintain and improve this passive layer. For more information go to Prevent Corrosion.
Contact us for product information and pricing.
Surgical Instrument Care Cleaning Surgical Instruments Cleaner. Importance Cleaning Surgical Instruments
Surgical Instrument Care
enzymatic enzyme detergent surgical instrument cleaners are designed for thoroughly cleaning surgical instrument cleaner in less cleaning time and at a lower cost.
The use of enzymes of various compositions and concentrations, in surgical instrument detergents is becoming common. Over half of all surgical instrument detergents presently available contain some level of enzymes. The enzymatic enzyme surgical instrument detergent industry is the largest single market for enzymes, at rate of 25 - 30% of total sales. Details of which enzymes are used within enzymatic enzyme surgical instrument detergents and the ways in which they are best used, are rarely been published.
Enzyme surgical instrument cleaner detergents should: remove proteinaceous bioburden, dissolve mineral encrustation, remove stains, and enhance the “passive layer” of stainless steel. Enzymatic enzyme surgical instrument detergents should be “free rinsing” to render a residue free surface and should be designed to condition the source water to counter the potential pitting and staining effects of hard water. The primary goal of surgical instrument cleaning is to remove soil (proteinaceous bioburden) which includes proteins, starches and lipids. This requires 4 enzymes ( Lipase Enzymes, Amylase Enzymes, Carbohydrase Enzymes and Protease Enzymes) for cleaning surgical instruments cleaner and faster with lower costs.
Enzymatic enzyme detergent surgical instrument cleaner product claims of "fast acting enzyme" and "strongest enzyme" are typically erroneous. Enzymes all act at the same speed and are of equal strength. The application and the dilution rates determine the speed and the strength as it relates to surgical instrument cleaning outcomes. Unlike detergents, higher concentrations of enzymes will deliver higher levels of surgical instrument cleaning. Applying the enzymes in a foam will deliver a thicker lay than applying enzymes with a spray. The thicker layer allows more of the enzymes to come in contact with the bioburden being cleaned from the surgical instruments.
Common misunderstandings exist pertaining to the application of enzymatic enzyme detergent surgical instrument cleaners including the times and temperatures for optimal cleaning outcomes. There are parameters for the use of enzymatic enzyme detergents that can render a high probability of excellent cleaning outcomes.
It is commonly stated that enzymes “clean”. Enzymes alone do not “clean”. The primary function of enzymes is to break down soil, usually proteinaceous bioburden. For a cleaning product to “clean” surfactants are necessary that will remove the soil from the surface. A combination of enzymes and detergents is necessary for “cleaning”. Enzymes and detergent combination products are referred to as “enzymatic enzyme detergents” or "all-in-one enzymatic enzyme detergents" surgical instrument cleaners.
Surgical Instrument Care
The optimal temperature for maximum enzymatic enzyme detergent surgical instrument cleaner performance peaks at 137 degrees Fahrenheit (58.33 degree Celsius). The detergent components typically peak performance at 185 degrees Fahrenheit (85 degree Celsius). The peak performance for the enzymes and the detergents represent the top of a bell curve with increasing and decreasing enzymatic enzyme detergent performance to each side the peak.
Surgical Instrument Care
osage rate claims as to the cleaning results promised from very small dosage rates of enzymatic enzyme detergent can be misleading. Due to the wide variance of potential applications, the only dosage rates that can be attributed to a level of enzymatic enzyme detergent cleaning performance are those dosage rates that have been observed within your facility to render the cleaning outcomes required. The optimal enzymatic enzyme detergent dosage rate (amount diluted per quantity of carrier solution, usually ounces per gallon of neutral pH water) is a function of the types of enzymes and the concentration level of enzymes within the enzymatic enzyme detergent product. Detergents can render inferior performance with higher levels of concentration. Enzymes can render better performance at higher levels of concentration. To determine the optimal (lowest dosage with highest cleaning result) amount of enzymatic enzyme detergent to use, begin with the dosage recommended by the manufacture and then titrate the dosage higher or lower based on your cleaning outcomes. The cost of enzymatic enzyme detergents products is reconciled by their performance and your cost benefit analysis will be reconciled by the savings in the quantity of enzymatic enzyme detergents used.
Surgical Instrument Care
The optimal application time for maximum enzymatic enzyme detergent cleaning performance depends of the level of soil hydration/encrustation, the amount of soil, and the mass of items being cleaned. Claims as to enzymatic enzyme detergent products “cleaning within minutes” are fallacious without specifics as to the above parameters.
Types of enzymes potentially used within enzymatic enzyme detergents:
Lipase Enzymes: (to breakdown fat) to cleave fatty acid residue from the glycerol residue in a neutral fat or a phospholipid.
Amylase Enzymes: (to breakdown starch) to catalyze the hydrolysis of starch to sugar to produce carbohydrate derivatives.
Carbohydrase Enzymes: (to breakdown starch to a lower level) to catalyze the hydrolysis of higher carbohydrates to lower forms
Protease Enzymes: (breakdown blood) including the proteinases and peptidases, to catalyze the hydrolytic breakdown of proteins.
The use of enzymatic enzyme detergents allows lower temperatures and shorter periods of mechanical cleaning to be employed, often after a preliminary period of soaking. In general, enzyme detergents remove protein from clothes soiled with blood, milk, sweat, grass, etc. far more effectively than non-enzyme detergents. At present only proteases and amylases are commonly used. Although a wide range of lipases is known, it is only very recently that lipases suitable for use in detergent preparations have been deployed.
Surgical Instrument Care
Enzymatic enzyme detergent surgical instrument cleaners must be cost-effective and safe to use. Early attempts to use proteases floundered because users developed hypersensitivity. This was combated by developing dust-free granulates (about 0.5 mm in diameter) in which the enzyme is incorporated into an inner core, containing inorganic salts (e.g. NaCI) and sugars as preservative, bound with reinforcing, fibers of carboxymethyl cellulose or similar protective colloid. This core is coated with inert waxy materials made from paraffin oil or polyethylene glycol plus various hydrophilic binders, which later disperse in the wash. This combination of materials both prevents dust formation and protects the enzymes against damage by other detergent components during storage. It has been reported that spraying enzymatic enzyme detergent surgical instrument cleaning products has resulted in respiratory irritations. It is suspected that this is due to the enzyme aerosols. Applying the enzymatic enzyme detergent in a liquid of foam state should avoid this potential complication.
The “average” compositions of an enzymatic enzyme detergent surgical instrument cleaning product:
Constituent Composition (%)
Sodium tripolyphosphate (water softener, loosens dirt) 38.0%
Sodium alkane sulphonate (surfactant) 25.0%
Sodium perborate tetrahydrate (oxidising agent) 25.0%
Soap (sodium alkane carboxylates) 3.0%
Sodium sulphate (filler, water softener) 2.5%
Sodium carboxymethyl cellulose (dirt-suspending agent) 1.6%
Sodium metasilicate (binder, loosens dirt) 1.0%
Bacillus protease (3% active) 0.8%
Fluorescent brighteners 0.3
Foam-controlling agents Trace
Perfume (optional) Trace to cover the otherwise potentially unacceptable aromas
Coloring (optional) Trace to provide visual evidence to the user that product is present
Water to 100%
Surgical Instrument Cleaner with Conditioners™ product is used worldwide for cleaning surgical instruments cleaner.
This cleaner is 100% biodegradable and Neutral pH.
This Surgical Instrument Cleaner complies with Surgical Instrument and Surgical Instrument Washer specifications.
The enzymes used for enzymatic enzyme detergents are produced using species of Bacillus, mainly by just two companies. Novo Industri A/S produce and supply three proteases, Alcalase, from B. licheniformis, Esperase, from an alkalophilic strain of a B. licheniformis and Savinase, from an alkalophilic strain of B. amyloliquefaciens (often mistakenly attributed to B. subtilis). GistBrocades produce and supply Maxatase, from B. licheniformis. Alcalase and Maxatase (both mainly subtilisin) are recommended for use at 10-65°C and pH 7-10.5. Savinase and Esperase may be used at up to pH 11 and 12, respectively. The a-amylase supplied for detergent use is Termamyl, the enzyme from B. licheniformis which is also used in the production of glucose syrups. a-Amylase is particularly useful in washing glassware and with de-starching detergents.
Surgical Instrument Care
The cost of enzymatic enzyme detergent surgical instrument cleaners is reconciled by their performance. A cost benefit analysis will reconcile the savings and the quantity of the enzymatic enzyme detergent surgical instrument cleaner you use.
Surgical Instrument Cleaner with Conditioners™ is recognized worldwide delivering the highest level of performance for cleaning surgical instruments cleaner.
Surgical Instrument Cleaner with Conditioners™
is 100% biodegradable and Neutral pH.
This Surgical Instrument Cleaner complies with Surgical Instrument and Surgical Instrument Washer specifications.
Product Development
