Reprocessing of instruments for office based practices including Day surgeries, dental practices and aged care facilities - PowerPoint PPT Presentation

1 / 69
About This Presentation

Reprocessing of instruments for office based practices including Day surgeries, dental practices and aged care facilities


Reprocessing of instruments for office based practices including Day surgeries, dental practices and aged care facilities Lynne Noring – PowerPoint PPT presentation

Number of Views:43
Avg rating:3.0/5.0
Slides: 70
Provided by: SWSAHS


Transcript and Presenter's Notes

Title: Reprocessing of instruments for office based practices including Day surgeries, dental practices and aged care facilities

Reprocessing of instruments for office based
practices including Day surgeries, dental
practices and aged care facilities
Lynne Noring
National standards
and State Policy
  • Australia/ New Zealand 4815 2006 Office based
    health care facilities Reprocessing of reusable
    medical and surgical instruments and equipment,
    and maintenance of associated environment.
  • NSW infection Control policy

Cleaning and handling of used equipment
Standard precautions
  • Treating all used items as a potential source of
  • Wash hands and cover any skin lesions with
    occlusive dressings
  • Wear appropriate personal protection such as
    utility gloves specially designed repellent
    masks/eye protection/face shields and fluid
    resistant aprons or gowns.
  • Thermal disinfect the cleaning brushes either at
    the beginning or end of each day.

why is the pre-requisite to sterilisation the
cleaning process.
  • Reduce the microbial contaminates.
  • Remove tissue debris, blood and other organic
    material so the sterilant can make contact with
    every part of the item being sterilised.
  • To prevent the deterioration of instruments and
  • If an item is not clean prior to being placed
    into the steriliser it will not be sterile.

There are 2 types of soil you will come in
contact with when cleaning reusable equipment.
  • Visible contaminates
  • including blood,bone.tissue and inorganic soils
    such as dirt or dust.
  • Non-visible contaminates Micro organisms,
    bacteria, and virus.

Water quality for cleaning
  • Water supply should be of good quality.
  • Water suitable for drinking is suitable for
  • Water with high mineral content is unsuitable
    due to mineral deposits shortening the equipment
    life and interfering with the effect of the
    cleaning agents.

Collection procedures
  • Procedures for the collection of used reusable
    items from treatment areas shall be formulated by
    each office based health care facility.
  • Collection equipment shall be puncture and leak
    resistant, and made of a material that is able to
    be cleaned.

Reprocessing Area
  • All used items are to be cleaned in a designated
    area to prevent the possible contamination of
    items processed.
  • On receipt in the reprocessing area, items should
    be sorted to type and corresponding cleaning
    method. Example manual, mechanical and cannualted.

Sorting for reprocessing
  • All equipment that is unwrapped is considered to
    be contaminated whether used or not.
  • A check for completeness and defects shall be
    made during the sorting process.
  • All facilities should have written procedures for
    handling specialized equipment.

The equipment the facility should ideally include.
  • Separate hand washing facilities
  • Adequate bench space with smooth surfaces without
  • Good lighting
  • Efficient ventilation
  • Adequate storage space
  • Bins for disposal of waste
  • Non-slip flooring
  • Cleaning sinks and washer /disinfector
  • Ultrasonic cleaner
  • Drying facilities.

The four steps to the cleaning process
  • Pre-rinse cold water
  • Wash- hot water and a cleaning agent
  • Rinse 1 or more rinses with hot water
  • 80 to 90 c with a drying agent added, in
    accordance with manufacturers recommendations.
  • Drying shall be by means of a drying cabinet or
    lint free cloths or disposable lint free cloths.

Cleaning agents
  • Shall be used to remove residual soil and organic
    matter from instruments and equipment. Only those
    intended by the manufacturer for use in cleaning
    medical devices shall be used.

Safe use of cleaning agents
  • Staff should be trained in application, handling
    and safe use of cleaning agents for instrument
  • Product data bulletins and material safety data
    sheets for all cleaning agents shall be obtained,
    read and implemented.

Cleaning agents should be,
  • Biodegradable
  • Non-corrosive
  • Non-toxic
  • Non-abrasive
  • Low foaming
  • Free rinsing
  • Preferably liquid
  • mild alkali formation with a ph range 8.0 to 10.8
  • However some instruments and equipment maybe made
    of materials where the use of neutral detergents
    are more appropriate.

Labelling of cleaning agents should include,
  • The name of the product
  • The manufacturer
  • The purpose of the product
  • The directions for dilution and use
  • The batch number
  • The expiry date
  • Advice not to be mixed with other chemicals
  • Safety and first aid
  • Specific storage
  • Hazards nature

Abrasive cleaners
  • Steel wool
  • Stainless steel brushes
  • Powders and pastes

Manual cleaning equipment
  • Sinks
  • Assorted brushes with soft and hard bristles.
    lumen brushes with a variety of diameters and
  • Soft lint free cloths

Mechanical cleaning methods
  • Ultrasonic washers
  • Indexing/tunnel washer disinfectors
  • Stand alone washer/disinfectors
  • Cannulised sonic washers

Thermal disinfection
  • Thermal disinfection is not a sterilisation
    process. Items used for critical procedures must
    be sterilised.
  • Thermal disinfection uses heat and water at
    temperatures that destroy pathogenic vegetative

Thermal disinfection 0-100 temp/Celsius100-0.32
Methods of mechanical cleaning
  • Washer cycles include, cold pre-rinse
  • Hot wash with cleaning agent
  • One or more rinses with hot water at a suitable
    temperature for thermal disinfection to be
  • Drain, leaving the contents at a temperature for
    quick drying.
  • Drying.
  • Washer disinfectors need to cleaned and
    maintained regularly to prevent colonizing and
    formation of biofilms which could contaminate the
    instruments processed within.

Ultrasonic cleaners
  • The tank must be filled with cold or tepid water
    add a measured amount of recommended detergent.
    Operate the machine to degas the solution.
  • Tested to see if the transducers are functioning
    correctly and the results recorded.
  • Rinse the instrument of visible contaminates
    before immersing the instruments.
  • The instruments should be placed in a suitable
    basket in an open position before being submerged
    into the water tank close the lid and commence
    the cycle.
  • After the specific time, remove the instruments
    and rinse in clean running hot water.

Method of manual cleaning
  • Flush the item with running water.
  • Fill the container or bowl with warm water and
    neutral or in some cases enzymatic cleaning
  • Dismantle all removable parts or open items
    before placing into the cleaning solution.
  • Hold the items low in the container and wash all
    surfaces, brush lumens and valves.
  • Remove stubborn stains by soaking in an approved
    stain removing solution if the instrument
    manufacturers recommendation permits.

Method of rinsing and drying for manual cleaning.
  • Rinse the item thoroughly in hot running water.
  • Dry in a drying cabinet or with lint free cloths
    or disposable lint free cloths. items should
    never be dried in ambient air.
  • Then visually inspect the cleanliness of all

Manually cleaning of respiratory equipment.
  • All items shall be dismantled and thoroughly
    cleaned in detergent and water. Manufactures
    recommendations should be considered, followed by
    thorough rinsing in clean running water to remove
    any residue.
  • Where thermal disinfection or sterilisation
    processes are not available for semi-critical
    items, single use devices shall be used.

Chemical disinfection
  • Chemical disinfection can only be used when
    thermal disinfection is unsuitable.
  • Any chemical disinfectants that are used must be
    registered with the Therapeutic Goods
    Administration in Australia
  • Instruments should not be stored in chemical
    disinfectants before or after any form of

Materials that may inhibit or restrict chemical
  • Hard water
  • Fibres or lint from cleaning materials
  • Food, fluid and fats
  • Body fluids and excrements
  • Organic materials
  • Physical soils

Instrument Grade Disinfectants
  • High level instrument grade disinfectant is the
    minimum level to be used on semi-critical
    instruments which contact unbroken mucous
    membranes that are normally not sterile.

Instrument grade disinfectants
  • Intermediate or low level disinfectants may be
    used for non-critical instruments which are
    normally restricted to contact with unbroken
  • There may be instances where a hospital grade
    disinfection maybe used in a office based health
    care facility.
  • Formal policies and procedures need to be
    developed for the use of hospital grade

General housekeeping
  • There needs to be written policies and procedures
    for the routine cleaning of all the sterilising
    and ancillary equipment including
  • Method
  • Frequency
  • Manufacturers instructions
  • Cleaning agents and materials.
  • All waste should be removed from the
    reprocessing area via designated disposals exits.
    AS4031,AS/NZS4261,NZS4304 should also be

Education and training
  • Office - based health care facilities responsible
    for instrument reprocessing are also responsible
    for ensuring the appropriate education and
    training of staff is kept up to date on a regular
    basis .

Interchange of instruments and equipment.
  • Instruments should not be interchanged between
    necropsy, human and animal use.
  • Instruments used on animals should not be
    reprocessed in sterilisers and associated
    equipment and environments used for reprocessing
    instruments used for humans.
  • Infection transmission hazards exist where these
    requirements are not met.

Instruments on loan
  • On receipt into the health care facility,
    instruments on loan from loan companies or other
    health care facilities or individual clinicians ,
    shall undergo a complete routine cleaning and
    processing prior to sterilisation.
  • Perceived lack of time shall not be permit the
    cleaning process to be bypassed.
  • There should be a contracted arrangement between
    the health care facility and the loan supplier to
    define the responsibilities of the parties.

Sterilisation of unwrapped instruments.
  • To avoid danger of contamination, use unwrapped
    instruments for critical procedures immediately
    after sterilisation.
  • However this is an unacceptable practice and
    should only take place when an item is dropped
    and another one is not available and the item
    must have undergone a full cleaning process prior
    to being placed in the flash sterilising unit.
  • Lack of time or equipment is not an acceptable
    excuse for this process to take place.
  • The lack of a drying process causes instruments
    to corrode, and jointed instruments to become

  • If lubricants are required for basic instruments
    they need to be,
  • Water miscible
  • Compatible to the sterilising agent.
  • Lubrication is not a way of overcoming inadequate
    cleaning practices.
  • Routine lubrication of instruments following the
    cleaning process often results in extremely heavy

Insulated instruments
  • Need to be tested to ensure the integrity of the
    insulation material
  • This can be done by trained SSD staff member or a
    bio-medical engineer depending on the frequency
    of the equipment use.

  • Such as those used for ear,nose,oral
    maxillo-facial surgery, dental and oral surgery
    and invasive podiatry shall to be cleaned and
    sterilised after each use.
  • The internal surfaces of handpieces may become
    soiled with patient debris during use which can
    be expelled into or onto subsequent patients.

Processing handpieces.
  • Documented cleaning procedure must be followed.
  • At the end of the procedure, handpieces need to
    be operated and run to discharge water and air
    for a minimum of 30 seconds. This is to flush out
    any gross debris that may have entered the
    turbine and air or water lines.
  • Handpieces maybe hand clean and lubricated
    following manufacturers recommendations or hand
    cleaned and then processed using an automatic
    flush-through and lubricated system.
  • Handpieces need to be also packaged and steam
    sterilised and remain in a sterile package before
    each use.
  • It is not an acceptable practice wiping or
    soaking handpieces in a chemical disinfectant.
  • Handpieces pose a challenge to the downward
    displacement sterilisation process, due to
    limitations to the air removal process and steam

Air water syringes for dental
  • The tip needs to be removed after each use for
    cleaning and sterilisation.
  • The air water line needs to be cleared by
    flushing thoroughly with water for 30 seconds.
  • If sterilising is not possible, single use tips
    shall be used.
  • Ultrasonic scalers for dental procedures the tip
    needs to be cleaned and sterilised and the scaler
    flushed with running water for 30 seconds. And
    the handle hand cleaned.

Diagnostic ultrasound transducers.
  • Intracavity probes such as (transvaginal
    transrectal or transoesophageal ) require
    cleaning in accordance to the manufacturers
    recommendations and either sterilisation if
    possible or high level disinfectant using only
    instrument grade disinfectant should be used.
  • Sheaths/ sleeves or protective barriers must not
    be used as a substitute for cleaning,
    disinfection or sterilisation procedures.

Use of textiles
  • Where an office- based health care facility has a
    laundry which is dedicated to processing drapes,
    gowns and other textiles that need to be sterile
    and area needs to be set a side for inspection,
    folding and assembly of these textiles. If this
    is not possible consideration should be given to
    outsourcing textiles or the use of single use.
  • Inappropriate textiles and laundering practice
    pose an infection risk.

Packaging and wrapping prior to sterilisation
  • The purpose of packaging is to provide an
    effective bacteria barrier against potential
    contamination and to maintain sterility.
  • Materials should permit the removal of air from
    the pack and allow penetration of the sterilising
    agent and removal of the sterilising agent and
    water vapour.
  • Materials need to be compatible to the
    sterilising method selected.
  • Sharp instruments should be packaged in such a
    way the tips cannot pierce the packaging

Pack size
  • The principle determining the size, mass and
    contents of packs is that the contents are dry
    and sterile immediately on completion of the
    sterilisation cycle.
  • This is usually established when the performance
    qualifications are conducted on your sterilisers,
    using thermocouples and biological indicators.

Labelling packs
  • Labelling should always be done prior to
    sterilisation so the packaging material integrity
    is not compromised.
  • All Packaged items for sterilisation needs labels
    for identification of the contents
  • The following is the only methods that should be
    used for labelling packages for sterilisation,
  • Soft tipped alcohol-based felt marking pens.
  • Pre-printed tapes
  • Pre-printed bags
  • Stamping systems
  • Pre-printed labels
  • Computerized generated labels.

Sealing of packs and bags
  • The purpose of sealing is to maintain pack
    integrity ,to ensure the package will remain
    sealed during the sterilisation process.
  • Sealing is usually achieved by the use of heat
    seals, self sealing pouches or sterilising
    indicator tape.

Methods which compromise pack integrity.
  • String
  • Non-adhesive tape
  • Staples
  • Elastic bands
  • Paperclips
  • Ball point pens or pencils

Sterilisation equipment
  • Methods of sterilisation in office -based health
    care facilities are steam under pressure and dry
  • Steam kills micro-organisms by coagulation of the
    cell protein.
  • Dry heat kills micro organisms by oxidation this
    causes the continuous loss of moisture by the
    micro-organism in the heated environment.

Steam sterilisation
  • Steam possess three important qualities that make
    it an effective sterilant.
  • Latent heat
  • Moisture
  • Penetration

Types of Steam
  • Saturated steam
  • Wet saturated steam
  • Superheated steam
  • Saturated steam is the
  • only steam suitable for steam sterilisation.
  • The maximum allowable steam wetness is 3 which
    is equivalent to 97 dry saturated steam.

Small steam sterilisers.
  • In Australia and New Zealand small steam
    sterilisers are known as bench top or portable.
  • AS2182 specifies the manufacturers requirements
    for this type of steriliser.

Types of sterilising cycles and their intended
  • Type N the sterilisation of unwrapped, solid
  • Type B The sterilisation of all wrapped (single
    or double) or unwrapped items, including porous
    and cannulated items that do not exceed the
    specifications of hollow load type A from the
    AS4815 2006
  • Type S the sterilisation of items as specified
    by the manufacturer of the steriliser. The
    available cycles needs to be capable of
    sterilising unwrapped solid items and at least
    one other of the following types
  • Porous items
  • Small porous items
  • Hollow load type A
  • Hollow load type B
  • Single layer wrapped items
  • Double wrapped items.

  • Tubing poses a challenge to the sterilisation
    process due to the inability of effective
    cleaning. There is also a risk of air entrapment
    during sterilisation. Therefore it is wise to use
    sterile single use tubing.

Dry heat sterilisers
  • The portable dry heat type steriliser is
    different from the steam because air removal is
    not part of the process.
  • Items need to be sealed within impermeable
    containers. And can withstand a temperature of
    160c for a minimum holding time of 120 mins plus
    penetration time.
  • Dry heat steriliser (hot air Type) are specified
    in AS2487 appliances that do not meet the
    requirements of this standard should not be used
    under any circumstances.
  • This type of steriliser is not designed to
    sterilised liquids therefore this should not be

Peracetic acid liquid chemical sterilisation
  • Peracetic acid (PAA) is generally used in
    operating theatres or endoscopy units.
  • When used correctly it provides them with a
    sterile product rather than a chemically
    disinfected product.
  • PAA is an effective biocide and for sterilisation
    35 peracetic acid is mixed with 10 litres of
    warm water rendering a final concentration of

PAA as a Sterilant
  • Concentration 0.2
  • Temperature range 50 56 c
  • Holding Time 12 minutes
  • The cycle time is between 20-35 minutes and is
    dependant on the initial water temperature and
    water pressure.
  • Items need to be thoroughly cleaned before being
    loaded into purpose built trays that sit into the
    chamber. As it is a wet process the items are
    immersed for 12minutes followed four rinses with
    filtered portable water. At the end of the cycle
    filtered air is purged into the chamber to remove
    excess water. The unit remains sealed until
    released by the operator.
  • The PAA system is designed for just in time
    processing as items cannot be stored following
    the process.

(LTP) Low Temperature Hydrogen peroxide plasma
  • LTP is a relatively new process when compared to
    other sterilisation methods.
  • The plasma is created in ambient temperature. The
    substance used for the sterilisation process is
    hydrogen peroxide (58). This is in liquid form
    originally and is vaporised in the chamber then
    converted to plasma by the addition of an energy
    field which in this case is created by the
    turning on of a radio frequency within the
    chamber during deep vacuum.

LTP how it kills micro-organisms.
  • LTP destroys micro-organisms by creating a plasma
    cloud. This cloud contains free radicals known to
    have a biochemical interaction with cell
    membranes, enzymes or nucleic acids to disrupt
    the life functions of micro-organisms.

Loading the sterilisers
  • Correct loading is essential for successful
  • Because the sterilant must contact the surface
    for sterilisation to be achieved loading trays
    shall be loosely loaded to capacity. only a
    single layer of packs shall be loaded on each
  • Packs must remain in the confines of the chamber
    and not touch the walls, floor or door.

Unloading sterilisers
  • The load must be removed immediately on
    completion and visual inspection shall be made to
    ascertain that the load is dry, packaging is
    intact and that the sterilising indicators colour
    change has taken place.
  • Directly after the sterilisation process items
    are very vulnerable to contamination by moisture
    or improper handling.
  • After sterilisation the loading trays shall be
    kept away from high activity areas.

Unloading procedures
  • Procedures for unloading each type of steriliser
    shall be developed and documented and ongoing
    compliance with such procedures need to be

Performance qualification
  • After commissioning performance qualification is
    preformed annually or when significant changes
    are made to any aspect of reprocessing activities
    e.g. changes to packaging material, loading
    configurations and sterilisation process
  • Also after major repairs to the steriliser.

Performance testing
  • Leak rate vacuum test
  • Air removal and steam penetration test.
  • Air detector test (where applicable)
  • Note sterilisers that use downward displacement
    as a method of air removal cannot be effectively
    performance tested prior to use.

  • Chemical indicators
  • biological indicators
  • enzymatic indicators
  • Process challenge devices.
  • Data loggers
  • Thermocouples and digital readout thermometers.

Monitoring of packaging following sterilisation.
  • Integrity of the outer wrap
  • Integrity of seals
  • Correct labelling including
  • Date of manufacture
  • Batch number
  • Steriliser cycle or run number
  • Steriliser number
  • Contents of pack and operators identification
  • Correct colour change of chemical indicator.

Criteria for release of processed items
  • To release the processed items, there should be
    evidence that the process has compiled with all
    specific requirements, therefore achieving the
    sterility assurance level or the level of
    disinfection required.
  • The person responsible for authorizing the
    release must have full knowledge of all aspects
    of the validated process and be satisfied that
    monitoring and control of the entire process has
    met specifications.

Storage of sterile stock.
  • Storage areas for sterile stock should be
    controlled to prevent contamination and shall be
    dedicated for that purpose only.
  • The storage environment should be free of dust,
    insects and vermin.
  • Storage containers, trolleys and cupboards need
    to be kept clean and dry and in good condition
    cardboard boxes should not be used as they are
    porous and cannot be cleaned and will harbour

  • Staff health infection control
  • Cleaning , disinfection and chemical disinfection
  • Inspect, prepare and packaging
  • Loading for sterilisation
  • Steam
  • Sterilisation
  • Unloading of sterile items
  • Monitoring
  • Release of sterile stock
  • Storage of sterile stock.

Thank you
Write a Comment
User Comments (0)