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CS SOLUTIONS


SUBMIT YOUR QUESTIONS: editor@hpnonline.com


Testing insulated electrosurgical devices for safety, monitoring washers, cleaning effi cacy


by Ray Taurasi, Principal, Healthcare CS Solutions.


Since this seemed to be somewhat of a hot topic, I decided to combine some of the concerns, precautions and questions into one response to share with all readers.


Q A


Minimally-invasive surgical (MIS) procedures provide many advantages for patient care, including smaller incisions, faster recovery times, reduced pain and scarring. MIS procedures frequently require the use of electrosurgical devices, helping to prevent blood loss. Electrosurgical devices utilize high-frequency electric currents to heat, cut and cauterize tissue with great preci- sion fi gure 


Figure 1 Figure 2


Over the past few months, I have received several calls and notes with questions pertaining to insulated medical devices.


nurse for the past four years. Recently I accepted a position as the sterile processing liaison my numer one charge is to get  ready for the Joint Commission inspection in a few months. I want to focus fi rst on ringing our washers monitoring policy up to the cur- rent standards s once a week still acceptale oes every washer need to be tested? Is it necessary to test every level of a washer or would a random shelf testing be acceptable? I want to have a good record of washer performance to prove that instruments processed through our washers are clean and safe for patient care.


elcome ack to terile rocessing our previous experience combined with your nursing experience in the operating room will be of great value.


A he current   standards state Mechanical cleaning equipment performance should be tested


Electrosurgical instrumentation requires an insulation coating to contain the electrical cur- rents, preventing them from burning the patient or staff. Stray currents can provide a source of ignition, causing a fi re he insulation of these instruments can be damaged or worn over time, resulting in breaks in the insulation and allowing the dangerous escape of electrical currents. Annually, there are thousands of patient burn incidents documented in the US. One study showed that 25% of patients who are burned by stray currents will die. Findings have shown that one in fi ve reusale laparoscopic instruments have an insulation failure. Approximately 67% of stray electrosurgical burns go unnoticed during surgery. Such events can result in severe patient care complications, infections, pain, extended hospitaliza- tion and prolonged recovery. he  in  issued a safety communication alert stating that, “Evidence shows that a patient is injured by capacitive coupling or intraoperative insulation failure every  minutes in the  anufacturers s, as well as , ,  standards and guidelines state the necessity of thoroughly inspecting all electro- surgical insulated instrumentation for any defects, cracks and pin holes for the leakage of electrical currents  and  oth specifi cally note that an insulator scannertesting device should be utilized to detect the release of stray electrical currents from the instruments’ insulation and tip. As evidenced by the vast number of patient burn incidents, visual inspection alone is not adequate to detect a leak or small hole in the instruments insulation he only effective way to detect electrical current leakage and to ensure the safety of insulated electrosurgical instrumentation is to utilize an insulation testing device fi gure 


While completing my nursing degree, I worked in sterile processing as a shift supervisor for a few years; I enjoyed the position very much. After graduating, I have worked as an OR


Q 34 July 2020 • HEALTHCARE PURCHASING NEWS • hpnonline.com


each day the equipment is used. All test results should be recorded. It is important to note that these standards pertain to all mechanical cleaning equipment, such as washer disinfectors, ultrasonic wash- ers, cart washers, automatic endoscope preprocessors (AERs) and their accessory components, e.g. washer racks, manifolds, adaptors and the like.


Whatever testing tools you utilize, they must be able to demon- strate the effective performance of the mechanical washer disinfector and its essential components esting an instrument disinfector would require testing each level of the washer. Each level of the washer rack contains spinner arms, which deliver the water, clean- ing chemistry and necessary impingement to dislodge and remove soil. It is possible to have problems with a spinner, which would impede the effective functioning of the washer. he testing of mechanical washers provides verifi cation that the equipment is performing appropriately and can clean the contents of items placed in them he tests do not prove that the instruments are clean.


ollow all s for


• reprocessing of each instrument, e.g. disassembly, precleaning, inspection


• processing equipment manufacturer, e.g. proper loading, posi- tioning contents, appropriate cycle selection


• detergents, etc., e.g. appropriate chemicals and concentrations • ensuring staff competency for all related tasks • monitoring individual performance ncluding all of the aove with mechanical profi ciency will pro-


vide a high confi dence level for cleaning effi cacy of items processed in the mechanical washer. ost cleaning, individual instruments can e tested to verify there


is no presence of residual soil on or within the device rofessional organizations, such as AAMI, SGNA and AORN, have recommen- dations for performing cleaning verifi cation tests on certain com- plex instrumentation, such as those with channels, movable parts, crevices, angulations and diffi cult design features, which present a greater challenge to the cleaning process here are various types of tests available for detecting residual soils, such as hemoglobin and carbohydrates. HPN


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