Understanding Medical Device Reprocessing - Part 2, cleaning & disinfecting

Medical instruments must be thoroughly cleaned before they can be safely reused. Cleaning is a critical step in medical device reprocessing because it removes blood, tissue, and other contaminants that can interfere with sterilization. Without proper cleaning, sterilization may fail, increasing the risk of infection for patients. This post explains how medical instruments are cleaned prior to reprocessing.

Why Cleaning Matters in Medical Device Reprocessing

Before sterilization, medical devices carry organic and inorganic debris from patient use. This debris can shield microorganisms from sterilizing agents, making sterilization ineffective. Cleaning removes these contaminants and reduces microbial load, ensuring sterilization can work properly.

Cleaning also protects delicate instruments from damage. Some devices have complex designs with narrow lumens, hinges, or textured surfaces that trap debris. If not cleaned carefully, these areas can harbor bacteria or cause corrosion.

Steps Involved in Cleaning Medical Instruments

Cleaning medical instruments involves several steps designed to loosen, remove, and rinse away contaminants. These steps include:

• Pre-cleaning: Immediately after use, instruments are placed into a leak-proof and puncture-proof container, and sprayed with an enzymatic foam that starts to break down organic materials like fats and proteins. This foam prevents debris from drying onto the instruments before they can be cleaned.

• Manual cleaning: Using a brushes, detergent, and water, instruments are scrubbed to remove visible debris.

• Ultrasonic cleaning: Instruments are placed in an ultrasonic bath with an enzymatic solution, where sound waves create tiny bubbles that dislodge particles from hard-to-reach areas. The enzymatic cleaner further breaks down organic materials, including virus and bacteria cell walls.

• Rinsing: Thorough rinsing removes detergent residues and loosened debris.

• Drying: Instruments are dried to prevent corrosion and prepare for inspection.

  
  

Each step requires attention to detail and adherence to protocols to ensure effective cleaning.

Manual Cleaning Techniques

Manual cleaning remains essential, especially for instruments with intricate parts. Using a brush that can be sterilized between uses, all instruments are scrubbed in a warm solution with medical-grade detergent to remove as much debris as possible. Instruments are also inspected for any rust spots, which are buffed out using a powder specifically designed for medical instruments. Everything is then rinsed thoroughly before being place into the ultrasonic cleaner.

Ultrasonic Cleaning and Its Role

Ultrasonic cleaners use high-frequency sound waves in a liquid enzymatic solution to remove debris. This method reaches areas that manual cleaning cannot, such as box joints and crevices.

Ultrasonic cleaning improves efficiency and reduces manual labor but does not replace manual cleaning entirely. To ensure the ultrasonic cleaner is working properly, the first load every week includes a quality check. This stainless-steel quality indicator gives visual confirmation that the wash cycle was effective.

Rinsing

After cleaning, instruments are thoroughly rinsed in hot water to remove all traces of detergent and debris. With a brush similar to the one used for manual cleaning, but clean, instruments can be scrubbed again to be sure there is no foreign material remaining.

Drying

Best practice calls for instruments to be dry prior to inspection and packaging for sterilization. Instruments are generally left to air dry. It is acceptable to inspect and package instruments that are still damp, as it will not affect the outcome of sterilization. However, it is easier to thoroughly inspect the instruments if there is no residual water on them, and the lubrication solution for instrument joints is more effective.

Practitioner Safety

Cleaning medical instruments is not risk-free to the practitioner. Full, head-to-toe Personal Protective Equipment is required to reduce the risk of coming in contact with any infective agents that may have been transmitted to the used instruments. Every time instruments are cleaned, it is done in a closed room, and the instruments are scrubbed under the water to reduce airborne and droplet particles from spreading. PPE includes a head covering, safety glasses, a splash-resistant mask, a face shield, a long-sleeved gown, long-cuffed gloves, and shoe covers. Frequent hand hygiene is required during and after the removal of these items to prevent cross-contamination. Most items are single use and are safely disposed of after use. The Public Health Agency of Canada also strongly recommends that practitioners are vaccinated against Hepatitis B, a blood-borne illness that can be contracted from dirty medical instruments and is a known cause of liver cancer.

Summary

Cleaning medical instruments before reprocessing is essential to patient safety. It removes contaminants that block sterilization and protects instruments from damage. The process involves pre-cleaning, manual scrubbing, ultrasonic cleaning, rinsing, and drying. All of these steps are followed at Sole Focus.