How Clean Are Your Instruments? Manual vs Automated Cleaners

Cleaning medical and dental instruments and devices is the first critical step towards disinfection and sterilization. Cleaning is defined as the removal of foreign material from instruments and items used in any healthcare facility. Meticulous cleaning of instruments is required before high-level disinfection and sterilization can occur. Materials, either inorganic or organic, that are left on instruments impede the effectiveness of these processes. In addition, if materials become dried on the items, the removal process becomes more difficult. This in turn will make the sterilization/disinfection processes ineffective.

Cleaning medical devices can be done either manually or automatically. It should be done as soon as possible after the items have been used to prevent drying of materials on the devices. When cleaning is not done immediately, a holding solution may be used to keep debris moist to facilitate cleaning later. A holding solution is not needed when instruments are cleaned soon after use and after being transported to the reprocessing area. If a holding solution is utilized, remember to use an enzymatic detergent or solution deemed a holding solution. Never use a high-level disinfectant for a holding solution.

Manufacturers’ instructions for use must be followed when utilizing cleaning agents to ensure compatibility with the instruments and effective cleaning. An important factor to consider when cleaning instruments is the nature of the object. When hinges, crevices, lumens, or complex moving parts are present, these require special attention to cleaning. Disassembling and opening the hinges may be necessary to properly clean the device.

Manual cleaning is done in areas without automated cleaners present. Manual cleaning is also done when the instruments or items are fragile or have difficult-to-clean areas. When performing manual or utilizing automated cleaning it is imperative that the appropriate personal protective equipment (PPE) be worn. Cleaning of instruments requires the use of detergents and water. Never use a high-level disinfectant for cleaning.

There are two components of manual cleaning: friction and fluidics. Friction is accomplished by rubbing/scrubbing the soiled instruments with a long-handled brush. Fluidics means fluids under pressure, and it is used to remove debris from the internal aspects of a device after cleaning. This occurs when a brush cannot pass through the internal components of a device.

When manual cleaning is performed:

• Use work practice controls to reduce the chance of injury from sharp objects
• Clean only two or three instruments at a time
• Never reach into trays or containers holding sharp instruments that cannot be seen
• Scrub instruments low in the sink under running water and use a long-handled brush to keep the scrubbing hand away from sharp instruments
• Wear appropriate PPE, including puncture-resistant, heavy-duty gloves
• Inspect all instruments for any remaining debris
• Dry instruments by allowing them to airdry or by carefully patting (not rubbing) with several thicknesses of towels.

After cleaning, instruments should be rinsed with water to remove chemical detergent residue, taking care to minimize splashing. Clean instruments are not sterile. Clean simply means all debris has been removed. Sterilization or high-level disinfection must occur after cleaning.

The preferred method of cleaning instruments is utilizing an automated or mechanical cleaner. The most common types of mechanical cleaning are ultrasonics and washer-decontaminators/ disinfector. All equipment used for cleaning must be FDA approved. Household dishwashers are not FDA approved to clean medical/dental instruments.

Ultrasonic cleaners use cavitation to remove debris from the instruments. Important things to consider when utilizing an ultrasonic cleaner:

• Always follow the manufacturers’ instruction for use (IFU) on solutions used, test recommendations, and maintenance needed. The amount of solution and cycle times for loose instruments versus cassettes is found in these instructions.
• Test cleaning solution for effectiveness. Testing can occur by utilizing the aluminum foil test or by utilizing commercially available test vials. The foil test is the most common method used. This is done by immersing a strip of foil at least 2” wide and 3” long in the cleaner for 20 seconds. When you remove the foil, if evenly distributed dents are present, the cleaner is working. If they are not present, the cleaner would need to be serviced. Testing must be done at least monthly or more often following IFU.
• Don’t overload the tank! The instruments should be placed loosely in the basket, submerged completely in the solution. The lid of the ultrasonic must be in place while running to reduce aerosols.
• Use the appropriate solution for the ultrasonic. Never use disinfectants- these may create the potential for hazardous fumes being released. Follow IFUs for solution types for the cleaner.
• Rinse instruments after the cycle. If the instruments were in a holding solution prior to the ultrasonic, rinse the instruments prior to placing them in the ultrasonic cleaner.
• Inspect instruments to ensure debris has been removed.
• Once the cycle and rinsing are complete, allow the instruments to dry. Dried instruments will reduce rusting or wicking when packaged.
• Best practice is to empty the ultrasonic daily or when IFU states a frequency.

A washer-disinfector/washer-decontaminator is another automated device used in healthcare settings to clean, decontaminate and disinfect heat-resistant and heat-sensitive items. These are FDA-regulated devices and work like a household dishwasher. They use a combination of water temperature, detergent, and spray technology to remove bioburden, ensuring instruments are safe for handling and sterilization. It is commonly used for rigid endoscopes, utensils, basins, and anesthesia equipment. Maintenance of the device is done by checking, cleaning, and ensuring proper function for optimal disinfection.

Once this critical step of cleaning to remove all debris from instruments and devices used in healthcare is complete, the instruments will be ready for packaging and sterilization. So, I ask you: how clean are your instruments prior to sterilization? What processes do you have in place to ensure cleaning is appropriately completed?

If you need help with this or any sterilization/disinfection processes, reach out to us and inquire about our Infection Control-Sterilization/Disinfection program. We are here for you!