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In mechanical washing the rinse phase is automated, and typi- cally there is a dual rinse with the last rinse being a thermal rinse to achieve thermal disinfection. It is important to understand the washer disinfector’s requirements for what type of water should be used to achieve the best outcomes for the instruments. Water quality differs in all locations. If you see staining, rusting etc. on your instruments as they exit the washer check to ensure the water source meets the required quality, that it is connected and turned on, and that tanks (if applicable) are not empty. Any residual left on a device or instru- ment is potential for irritation, inflammation, and/or infection when the device or instrument is used in a procedure.
Device design and point of care There may be some devices such as flexible endoscopes that provide cleaning challenges due to the design of the device. Device design not only plays a role in cleaning but also in rinsing. All devices must have manufacturer’s written instructions for use available. Staff must be inserviced and competency assessed for appropriate cleaning. The competency should include appropriate rinsing. There are other instruments such as ophthalmology instruments that require a rinse with sterile or distilled water. If you do not have clear and concise manufacturer’s written instructions for cleaning and rinsing the facility should contact the manufacturer for clarification. A review of the cleaning processes should be performed in all areas of the facility that perform cleaning. That review should in- clude appropriate rinsing, especially for those specialty devices that require special rinse water, or procedures. A simple auditing tool will assist in verifying compliance. Some examples of inappropriate
28 January 2016 • HEALTHCARE PURCHASING NEWS •
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rinsing include: rinse basins/tubs labeled “change water daily” when water should be changed after every rinse; questioning staff on how many rinses the high-level disinfectant requires and how many are actually performed; and staff stating they change the rinse water when they change the high-level disinfectant which can be from 14 days to 21 days.
Support of quality management systems Staff does not always know what they don’t know. Are there tools and resources available to assist in appropriate cleaning and rinsing of devices? Having the manufacturer’s written instructions, ANSI/ AAMI Documents, facility work instructions, policy and procedures and competencies are all key components of staff education, but if the tools are locked in a manager’s office or outdated are they truly tools accessible to the staff? Get creative. Assign staff a guideline of the month to research and present, have staff review manufacturer’s instructions for use and present key points during staff meeting. Education should be ongoing not just a monthly in-service, staff should feel comfortable using the tools to enhance their performance and provide a positive outcome to all customers. HPN
References:
1. Association for the Advancement of Medical Instrumentation, Technical Information Report 34, Water for the reprocessing of medical devices, 2014.
2. AAMI Comprehensive guide to Steam sterilization and sterility assurance in health care facilities – ST79:2010. Arlington, VA: AAMI.
3. AAMI Chemical Sterilization and High-Level Disinfection in Healthcare Facilities – ST58:2013, Arlington, VA AAMI. 4. AAMI/ANSI ST91. Flexible and semi-rigid endoscope processing in health care facilities (2015).
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