Presentation on theme: "Consumable Business Manager APAC"— Presentation transcript:
1Consumable Business Manager APAC PROLYSTICA®SO MUCH MORE THAN CLEAN™The Decontamination and Cleaning Process – Concerns regarding Manual Washing and BiofilmsAnnie WattConsumable Business Manager APAC
2What should we be monitoring routinely? PROLYSTICA®SO MUCH MORE THAN CLEAN™What should we be monitoring routinely?Automated washersManual washingWaterDetergentsInstrument protectionWasher protection
3What can we do to reduce the risk? PROLYSTICA®SO MUCH MORE THAN CLEAN™What can we do to reduce the risk?Safe TransportCleaningDisinfectionSterilizationUniversal PrecautionsThese are Universal Precautions that we all need to follow to ensure we can reduce the risk of infections from contaminated instruments or scopes.
5Cleaning and disinfection of medical devices is regulated by: PROLYSTICA®SO MUCH MORE THAN CLEAN™Cleaning ProcessesCleaning and disinfection of medical devices is regulated by:Medical Device DirectiveRecommendations of National AuthoritiesNational Guidelines – AS/NZ4187EN ISO 15883ISO17664
6ISO 15883 Washer-Disinfectors PROLYSTICA®SO MUCH MORE THAN CLEAN™ISO 15883Washer-Disinfectors‘machine intended to clean and disinfect medical devices and other articles’Performance requirements for washer-disinfectors and their accessories that are intended to be used for cleaning and disinfection of re-usable medical devices and other articles used in the context of medical, dental, pharmaceutical and veterinary practice
7ISO 15883 Published standards Published Technical Specification (TS) Part 1: General requirements, definitions and testsPart 2: Washer-disinfectors employing thermal disinfection for surgical instruments, etc.Part 3: Washer-disinfectors employing thermal disinfection for human waste containersPart 4: Washer-disinfectors employing chemical disinfection for thermo-labile endoscopesPart 6: Washer-disinfectors employing thermal disinfection for noninvasive medical devices etc.Published Technical Specification (TS)Part 5 (2005): Test soils and methods for demonstrating cleaning efficacy of washer-disinfectors
8EN ISO 15883 Under development Proposal for ultrasonic washers Part 7: Washer-disinfectors employing chemical disinfection for non-invasive, non-critical thermolabile devices/equipmentprEN Storage/drying cabinets for flexible endoscopesRevision of Part 5: standard test soil and cleaning test method (ISO lead)Proposal for ultrasonic washers
9Standards and Guidelines PROLYSTICA®SO MUCH MORE THAN CLEAN™Standards and GuidelinesStandardsISO 17664: Sterilization of medical devices. Information to be provided by the manufacturer for the processing of resterilizable medical devices‘A validated method of manual cleaning shall be specified.’‘At least one validated automated method using a washer-disinfector shall also be specified unless the medical device cannot withstand any such process, in which case a warning should be issued’Details of manufacturer's instructionsAll channels brushed?ISO is a standard for re sterilizable devices however we believe this standard should also be followed for HLD. Good practice and standards need to be applied to HLD if we are to be successful.If brushing is so important then why do we only brush one lumen?? Do we really need to brush at all if the WD has a validated cleaning method?
10ISO 17664 3.1 Reprocessing instructions PROLYSTICA®SO MUCH MORE THAN CLEAN™ISO 176643.1 Reprocessing instructionsAt least one validated method for reprocessing the medical device shall be specified.The following information shall be stated where it is critical to the maintenance of the intended function of the medical device and the safety of the user(s) and the patient:Details of process steps;A description of special equipment and/or accessories;Specification of process parameters and their tolerances.
11PROLYSTICA®SO MUCH MORE THAN CLEAN™ISO 176643.5 CleaningA validated method of manual cleaning shall be specified. At least one validated automated method using a washer-disinfector shall also be specified unless the medical device cannot withstand any such process, in which case a warning should be issued.Where appropriate, at least the following information shall be included:A description of the accessories required for cleaning processIdentification and concentration of chemicals required for cleaningIdentification of water quality to be used for the processLimits and monitoring of chemical residues remaining on the deviceLimits on temperature, concentration of solution(s), exposure time to be usedProcess temperature(s) to be usedTechniques to be used including rinsing
12Why Cleaning is Important PROLYSTICA®SO MUCH MORE THAN CLEAN™Why Cleaning is ImportantDevice damageVisually unacceptable devicesCancelled proceduresIneffective disinfection-sterilisationMicrobial transmissionPrion disease transmissionToxicityAdverse patient reportsVisually accepted devices – it’s not what you can see that should worry you it’s what you can’t seeInfection leads to toxicity which leads to more damage to the patient
13Requirement for Cleaning PROLYSTICA®SO MUCH MORE THAN CLEAN™Requirement for CleaningWaterMechanical effectsCleaning chemistryTemperatureConcentrationRequirement for cleaning is not just flowing liquid through a tube as this is NOT good cleaningBefore the no brushing technique was introduced brushing was the mechanical effect for cleaning. So if we are to remove the brushing then we need some power or vortex in the water to replace brushing as the mechanical component
14PROLYSTICA®SO MUCH MORE THAN CLEAN™Cleaning ProcessesOrganic matter is typically made up of carbohydrate, lipid and protein and it is essential that this is removed prior to sterilization.Proteins are generally unique in that they must be washed off surfaces with water at a temperature of ≤55ºC otherwise the protein can coagulate and become extremely difficult to remove.By contrast, lipids require a high temperature for adequate removal, often in the presence of a surfactant (detergent).Each stage of the washer disinfector cycle therefore has a role to play in the removal of this organic debris
15The implication…PROLYSTICA®SO MUCH MORE THAN CLEAN™Manual cleaning should be limited to only those items not compatible with the mechanical cleaning process
16What are Biofilms?Biofilm is a generic term used to describe a sludge likematerial that develops in association with organicmaterials.Biofilms result from a variety of sources, andnegatively impact a number of industrial and medical applications.Biofilm is composed of a densely packed group of microorganismsIndividual microorganisms bound together by a polymeric substance excreted by the microorganisms.The polymeric substance forms an adhesive matrix that holds the biofilm together, allows it to attach to surfaces, and protects the colony forming the biofilm.Encapsulation is believed to play a role in some antibiotic resistant infections.
17Functional States BIOFILMS This picture helps to illustrate how biofilms are formed. Bacteria grow naturally on surfaces as biofilms. To form a biofilm, bacteria bind to a surface, multiply, form a matrix that protects the bacteria from the environment, including disinfectants, and then can mature by binding other microorganisms or release parts of the biofilm to form new biofilms. They essentially become a reservoir for bacterial growth. Biofilms have been implicated in healthcare acquired infections (HAI) due to contaminated washer-disinfectors and medical devices.
18Biofilms – how they form? The polymeric substance excreted by the microorganisms is known as an extracellular polymeric substance (EPS). It is also commonly called an extracellular adhesive matrix.A key aspect of biofilms is a complex interaction among the mircoorganisms.A biofilm forms when individual microorganisms cease to exhibit individual, free floating behaviour, and begin to associate with each other, and a surface, and begin to act in concert with each other.A biofilm grows by both simple cell division, and by new free floating microorganisms associating with the developing biofilm.Biofilms usually develop on solid surfaces immersed in a liquid.
19What is Biofilm?What is Biofilm explanationA few hoursA few days
20Four functional states BIOFILMSFour functional statesAttachmentAggregationBiofilm formationDetachmentBiofilms are difficult to treatThe existence of biofilms has been recognized for years. Their development is typically a progression through four functional states:Freely mobile, known as “planktonic” bacteria, recognize and attach to a surface.Once attached, the bacteria aggregate and form into micro-colonies.Chemical signals are then released within and between micro-colonies and biofilm formation, including what is known as exopolysaccharide encasement, begins.Once biofilm is formed, a natural pattern of programmed detachment of planktonic bacteria occurs and the process starts over in a new location.It’s important to understand that freely floating planktonic bacteria, unshielded by protective excretions, are generally susceptible to antibodies and antibiotics. However, once encased in a biofilm, the bacteria are generally not susceptible to either, making them difficult or impossible to treat with antimicrobial agents.
21The Decontamination Process PROLYSTICA®SO MUCH MORE THAN CLEAN™The Decontamination ProcessDecontamination is the process that renders contaminated items safe to use for their intended purpose and safe to handle with reasonable care.A two step processBegins with cleaningFollowed by a microbicidal processDisinfection orSterilization
22Decontamination Practices at Point of Use Importance of quick cleaning after useIt’s critical to start the decontamination process immediately after the surgeon is finished with the device, particularly if the device is complex.Blood remains encrustedon instruments.
23Decontamination Practices at Point of Use STERIS Pre-Klenz – Transport GelClings to instruments to maintain moisture during transportWill not stain instrumentsBroad material compatibilityReduces extra weight and splashingDon’t use foam as it restricts you from seeing what is in the tray
24PROLYSTICA®SO MUCH MORE THAN CLEAN™Contain & TransportItems should not be transported in liquid because of the risk of spills, the promotion of biofilm formation, and the possibility of employee injury from lifting heavy containers.
25Manual Cleaning 3 sink configuration Low sudsing PROLYSTICA®SO MUCH MORE THAN CLEAN™Manual Cleaning3 sink configurationFirst sink: soakLow sudsingSecond sink: washThird sink: rinseTreated water for final rinsing(deionized, distilled, softened, or reverse osmosis)Decontamination area sinks should be large enough to contain large utensils and instruments, and there should be enough sinks to accommodate concurrent soaking, washing, and rinsing. Treated water (deionized, distilled or reverse osmosis) should be available for final rinsing.An ideal decontamination sink is a three sink configuration that is approximately 36 inches from the floor, 10 inches deep, and wide and long enough to allow a tray or container basket of instruments to be placed flat for pretreatment or manual cleaning.All cleaning should be done under the water line to prevent exposure to microorganisms through aerosolization, especially when brushes are used to clean lumens. The detergent should be low foaming so that the worker can see into the sink to identify all instruments and prevent injuries from sharp objects.
26Manual Cleaning Decontamination Area PROLYSTICA®SO MUCH MORE THAN CLEAN™Manual Cleaning Decontamination AreaMay be used for any deviceMost often used if devices are delicate, complex or cannot tolerate mechanical cleaning
27Manual Cleaning SOAPS to avoid RISKS to Staff Housekeeping soaps PROLYSTICA®SO MUCH MORE THAN CLEAN™Manual CleaningSOAPS to avoidHousekeeping soapsLaundry soapsSurgeon’s hand scrubIodine based soapsRISKS to StaffPATHOGEN EXPOSURE FROM CLEANING PROCESS: AirborneSplash and splatterPuncture Wounds
28X Cleaning Brushes Quantity in sizes Replace when worn PROLYSTICA®SO MUCH MORE THAN CLEAN™Cleaning BrushesQuantity in sizesReplace when wornMust be cleaned, disinfected dailyMetal bristle brushes must be designed for use with surgical instrumentsXBrushes need to be the correct size and not damaged to prevent damage to the instrument. The device manufacturer should provide recommendation for the cleaning method most appropriate depending on the device’s size, fragility, immersibility, complexity, working parts, sensitivity to the cleaning agents , and other properties. Wire brushes should never be used unless they are specifically designed for cleaning surgical instruments.
29PROLYSTICA®SO MUCH MORE THAN CLEAN™Organize InstrumentsThese are poorly loaded and organized trays for processing through an automated washer. The multi-layered set cannot possibly come into contact with water and detergents if the layers are stacked on top of each other. The other try is overloaded, the hinged instruments are not opened, and the basin on top of the instruments could potentially damage the instruments below it, as well as deflect water and detergents from coming into contact with the tray contents.The multi-layered set cannot possibly come into contact with water and detergents if the layers are stacked on top of each other.
30Cleaning Chemistries All Different PROLYSTICA® SO MUCH MORE THAN CLEAN™Cleaning ChemistriesAll Different
31New Cleaning Chemistries PROLYSTICA®SO MUCH MORE THAN CLEAN™New Cleaning ChemistriesImproved cleaning chemistriesEnvironmental concernsErgonomicsCleaning performanceSpecified cycle conditionsPre-cleaning technologyBiofilm removalNew cleaning formulationsPrion inactivation/removal – check the process does not involve extended wash and sterilization times
32IMPORTANCE OF CHEMISTRY FORMULATION PROLYSTICA®SO MUCH MORE THAN CLEAN™IMPORTANCE OF CHEMISTRY FORMULATIONSoil removalContain chelating ingredientsControlled / low foamControl / inhibit corrosionCompatible with substrates– Maintaining the useful life, function, and appearance of instruments depends on the attributes of the cleaning compounds that are used on them. It is particularly important to pay attention to some of the more technical aspects of these attributes, for example, chelating ability. All soap is not created equal and price should not be the only thing that matters.Soils that are left on instrument surfaces can harbor microorganisms that interfere with decontamination and sterilization. When these instruments are subjected to the heat or pressure of the sterilization process, instrument degradation (deterioration in instrument finish) is accelerated. In order to avoid this, the cleaning compound selected must be able to remove organic substances, such as blood and other body tissues. The product must also be able to remove inorganic substances, such as hard water deposits, that may cause the instrument to rust.Chelating ability refers to the chemical ability to tie up water hardness ions or minerals such as calcium or magnesium and keep them in solution. Without agents to keep them in the solution, minerals will settle on the instruments. The better a product is able to counteract adverse water conditions, the better the surfactants in that product will be able to clean.
33CHEMISTRY SELECTION Universal Usage - Effective in all water types PROLYSTICA®SO MUCH MORE THAN CLEAN™CHEMISTRY SELECTIONUniversal Usage - Effective in all water typesCost Effective - cost per cycleInstruments - substrate compatibilityEnvironmental factors - meets European REACH and EPA agreementsConcentrated product - Don’t pay for waterLow In available alkalinity - Maximum 2%UNIVERSAL USAGE – The product should be designed to be used in both ultrasonic and washer/disinfectors. In the washer/disinfector, the cleaner should be able to perform within the parameters of time, temperature, concentration, and pressure. In the ultrasonic, the cleaner should be able to enhance the ultrasonic process. By using one cleaner in both the ultrasonic and the washer/disinfector, a cost savings can be realized through reduction in inventory.COST EFFECTIVENESS – Cost, of course, is always a major consideration. However, you should consider the actual cost in use of a product before making a decision about cleaner A comparison of active ingredients and concentrations often lead to the discovery that a significantly larger quantity of the less expensive product would be required to achieve the same cleaning results. Differences in ingredients also point out the reasons why some products actually do perform better than others.PRICE PER INSTRUMENT CLEANED – If the wrong cleaner is used, the lives of the instruments cleaned will be shortened. The wise selection of cleaning chemicals can prevent problems in the long run. The proper cleaner can eliminate spotting, staining, and corrosion problems.DILUTION RATES – Check to see how the price compares once the product is diluted as per label instructions. More expensive products are frequently more concentrated and make up more gallons of solution than their less expensive counterparts.
34Acu-SinQ - Automated dispensing system at the sink! PROLYSTICA®SO MUCH MORE THAN CLEAN™
35Water Level Permanent Sticker PROLYSTICA®SO MUCH MORE THAN CLEAN™
36How Clean Are Your Instruments? PROLYSTICA®SO MUCH MORE THAN CLEAN™How Clean Are Your Instruments?The top picture shows a scope after cleaning which looks very clean to me.However the second picture is using the same scope which has had a special staining technique added to the scope which picks up soil. As you can see this is more than enough soil remaining on this scope to pass on a C Diff or Prion infection
37Routine Monitoring of the Manual process PROLYSTICA®SO MUCH MORE THAN CLEAN™Routine Monitoring of the Manual processConsult Device IFU for correct reprocessing proceedureEnsure the device remains moist from OT to CSSDMonitor correct dose of detergent in correct amount of waterMonitor correct temperature for detergent to be activeVisual inspection of all devicesResidual Protein Detection TestSoil test - educationRapid -10 seconds without incubationSensitive -Accurate down to 1μg protein residue
38Soil Test as per ISO 15883-5 Technical specification PROLYSTICA®SO MUCH MORE THAN CLEAN™Soil Test as per ISOTechnical specificationTest soils and test methods employed globally.No technical preference givenA good list, but fails to standardiseProposal for revisionStandardized test soils and methodsCommercial options available