Instrument Cleaning Washer disinfector is the preferred method Two key reasons – Instruments must be clean prior to sterilization – Prevention of sharps injuries to nurses Why?
Instrument Cleaning Whitworth et al – Burrs study Manual Cleaning 35% Ultrasonic 55% Domestic dishwasher 70% Medical washer disinfector 95% Manual cleaning is inconsistent and less effective
Hands Free Instrument Transfer Clip trays (cassettes) offer hands free instrument transfer
Instrument Cleaning 1. Pre-wash 2. Drain 3. Wash 4. Drain & Rinse 5. Thermal Disinfect 6. Drain & Rinse 7. Forced Air Dry 8. Water Drain Cycles of a washer disinfector
Washer Disinfector Cycles Cycles on a washer disinfector can be varied to suit the size and type of load Heavily Soiled Load – The washer disinfector will wash the instruments twice to reduce bacterial load. Half Load – The washer disinfector is able to reduce the cycle time due to the reduced load Important – Choose the correct cycle for your load!
Compliant Cycles You must refer to the manufacturer’s guidelines when choosing a cycle. You must not alter the cycle in any way. You must put the correct instrument load on the correct cycle in order for that cycle to be complaint.
Washer Disinfector Maintenance The Washer Disinfector must be installed by an approved engineer. Training must be provided on installation and all practice staff should be present. Filters should be changed according to manufacturers instructions. Machines should be cleaned weekly using a rinse aid solution.
Logging Data Cycle data must be logged Data Logger – Information is stored on memory card and then downloaded onto computer. Printer – Data is sent to printer then paper copy is produced which is then kept. Direct Data Download – Machine is attached to PC and data directly downloaded
Bench Top v Under Bench Under Bench Capacity – Under utilized Cycle time – 1.5-2.5 hours Possible electrical work – 30 amp Cost of cycle – Expensive Servicing – Less access Bench Top Capacity – Appropriate Cycle time – 45-60 mins Plug and play – 13 amp mains socket Cost of cycle – Inexpensive Servicing – Easy access
Bench Top v Under Bench Bench Top takes up valuable counter space Bench Top WD that fits under bench? Drainage! – Most Bench Tops use gravity fed drainage so cannot be mounted under bench Solution? – Find a Bench Top that uses pumped drainage!
Choosing a Washer Disinfector What do I get for my money? – accessories, delivery, installation, training etc RO connection as standard? Cycle times - beware! Are all cycles compliant? Forced air drying? Hand Pieces?
Choosing an Autoclave Mentioned in HTM 01-05 Non Vacuum (downward displacement) – Can be used for solid and unwrapped, unpouched instruments only Vacuum – Can be used for wrapped, pouched, or air retentive instruments An autoclave that can do both types of cycle will give you more flexibility
Processing Power! Decontamination bottle neck Capacity to process instruments 11 litre - 22 litre? How do I decide? Tray capacity is the important point – 6 clip trays v 12 clip trays – 60 instruments v 120 instruments
Autoclave Installation & Maintenance Training must be provided at installation Door seal should be cleaned after every cycle Autoclave cleaner should be used weekly Water must be drained at the end of day Filters should be changed annually or according to the manufacturer’s guidelines Maximum weight limit must not be exceeded, so check before adding other trays
Cycle Checks Use Data Logger or Printer to record every cycle Use Bowie Dick test daily to check steam penetration Use TST strips on every cycle to check sterilization (If Data Logger or Printer is not available, you will need to watch the machine go through the first cycle of the day; check that correct bar pressure and sterilization temperature is reached and then log data in book)