Chemicals Used For Cleaning Manual Cleaning: Processes & Safety

Dr. Ashraf Abd Elkader El-Kelany General Directorate, infection Prevention & Control

MOH - KSA

Jan-2014

Every cleaning process and cleaning agent must help to render the medical device safe for handling during subsequent processing steps. CSSD Technicians commonly use several cleaning agents, each of which is formulated for a specific action: water, pre-soaks, detergents, enzymes, enzymatic detergents, and descalers.

Cleaning Chemicals

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Jan-2014

Each agent has a specific purpose in processing reusable supplies and equipment efficiently , and each must be used according to the manufacturer's instructions.

Cleaning Chemicals

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Jan-2014

There are different types of enzymatic products. Some can be used at the point of use to decontaminate and loosen the soil on instruments, and others are used in manual or automatic washing processes.

Enzymatic products

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Jan-2014

Enzymes are catalysts that can accelerate the speed of chemical reactions without being consumed by the reaction or becoming part of the products formed.

Enzymatic products

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Jan-2014

Enzyme products contain protease enzymes that are especially useful in removing proteins such as dried-on blood. The role of temperature is very important when dealing with enzyme-based products. Temperatures should not exceed 60C (140F) because the enzymes become inactive. Multienzymatic products contain protease, lipase, and amylase.

Enzymatic products

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Jan-2014

The basic formulas of different detergents contain emulsifiers and chelating agents:

Chelating agents have an ionic charge that allows soils with the opposite charge to break away and attach to the chelating agent. An emulsifiers surround these particles to prevent them from reattaching, and they also help to break bonds that oils create to trap soils.

Detergents

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Jan-2014

When mixed with water, detergents enhance the water's ability to remove soil. Detergents do not kill microorganisms; however, germicidal detergents have this capability. Detergents take longer to clean if they are not used in conjunction with multi-enzymes or protease enzymes.

Detergents

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Jan-2014

Alkaline detergents (pH 10 - 11.5) are effective at removing organic soils; however, they can leave an alkaline residual film. High Alkaline pH detergents, require less mechanical action than their Neutral pH counterparts to remove soils.

Alkaline detergents

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Jan-2014

When Alkaline detergents are used, an acidic detergent (pH 3 - 4.5) wash should follow to neutralize alkaline residues.

Alkaline detergents

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Jan-2014

Acidic detergents work well on inorganic soils, neutralize alkaline residues, and make stainless steel shine. However, use of improper concentrations hinders effective cleaning, and instruments may be damaged. Some products should not be cleaned with high acid detergents (e.g., colored anodized aluminum). The use of neutral pH or moderately alkaline pH detergents (pH 7 - 8.5) can prevent this problem.

Acidic detergents

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Jan-2014

Descalers are not typically required if the water quality and soap / detergent mixtures are correct, and if equipment is operating properly. However, this is not always the case, and problems can go unnoticed until a chalky-powdery, hard-to-remove substance appears on the walls of sinks and equipment, then a specially formulated chemicals are needed to remove these scales.

Descalers

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Jan-2014

Descalers are specifically made to remove these scales. A smaller quantities of these specific products will be needed than if acidic detergents are used; although, both are the products of choice to remove scales.

Descalers

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Jan-2014

Pre-soaking or pre-cleaning products are used in the first step in the decontamination process. Pre-cleaning process should begin immediately after the procedure. Blood and other visible debris, if left on an instrument, serve as a reservoir for microbial growth, and may damage an instrument's finish (corrosive agents in blood or debris penetrate the protective outer layer of an instrument, and cause rusting or pitting of the stainless steel).

Pre-soaking chemicals

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Jan-2014

The manufacturers' directions must be followed when using pre-cleaning products, because exceeding the time allowed for the instruments to be exposed to these solutions can damage and corrode them. Pre-soaking or pre-cleaning products are extremely helpful in reducing the time to remove soil in the actual cleaning process.

Pre-soaking chemicals

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Jan-2014

Some commonly used pre-cleaning agents are plain water, detergent solutions, enzymatic detergents, and combined enzymatic-germicidal detergents.

Pre-soaking chemicals

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Jan-2014

Manual cleaning agents, when mixed properly, make the water "wetter," and help it to penetrate under the soil and break the bonds that attach this soil to the instruments.

Chemicals Used For Manual Cleaning

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Jan-2014

The effectiveness of the detergent can be impacted by water hardness, temperature, and the type and amount of soil to be removed. Excessive amounts of detergents can be difficult to rinse off, and will eventually begin to deteriorate the instrument.

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Chemicals Used For Manual Cleaning

Jan-2014

Manual cleaners should be low-foaming, and free-rinsing. The manufacturer's directions should be followed concerning proper dilution according to the quality of water being supplied, and the recommended water temperature when using the product for manual cleaning.

Chemicals Used For Manual Cleaning

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Jan-2014

Mechanical cleaning processes (ultrasonic washers, washer sterilizers, washer disinfectors, cart washers, and automatic endoscopic reprocessors), require the use of products such as enzymatics, multi-enzymes, and detergents. The written instructions of equipment's manufacturer (not those of the solution's manufacturer), must be strictly followed for the recommended cleaning solutions.

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Chemicals Used For Mechanical Cleaning

Jan-2014

If the wrong product is selected, possible damage or premature replacement of equipment's components may occur, and it may be impossible to properly clean the equipment/instruments. Chemicals that are used should be low-foaming, and free-rinsing.

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Chemicals Used For Mechanical Cleaning

Jan-2014

Water temperatures are usually controlled by the machine. Sometimes fine adjustments are required to closely follow temperatures recommended for specific cleaning products. As with any chemical, no matter what it is used for, the manufacturer's directions must be well understood and strictly followed. Failure to do so can cause health hazards, injuries and/or damages to the equipment / instruments.

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Chemicals Used For Mechanical Cleaning

Jan-2014

Low-foaming. Free-rinsing. Non-abrasive. Non-toxic & biodegradable. Effective on all types of soil. Have long shelf-life. Cost-effective. Can be monitored for effective concentration and useful life.

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Effective Cleaning Agent

Jan-2014

The water temperatures used for cleaning products are important for effective cleaning. Some products are more effective in hot water because molecules move more quickly. Temperatures for hot water range from 120F - 165F (48.9C 73.9C ).

General Recommendations For Using Cleaning Chemicals

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Jan-2014

While the temperature of the tap water coming into the sink can not be safely and accurately increased, automated machines have steam or electric coils to raise the temperature to a pre-determined setting.

General Recommendations For Using Cleaning Chemicals

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Jan-2014

Material Safety Data Sheets (MSDS) for these products are required, and must be available for CSSD Technicians to read and study. Central Service Technicians working with chemical solutions and exposed to blood and body fluids must be protected, and even those who are just in the area must still wear Personal Protective Equipment (PPE).

Safety Precautions

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Jan-2014

Forearm-length heavy-duty gloves made specifically for decontamination, a fluid-impervious gown, mask, eye goggles or face shield, and protective rubber shoes should be used when performing cleaning duties including pre-cleaning, cleaning, and loading automated machines.

Safety Precautions

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Jan-2014

Safety Precautions Personal Protective Equipment (PPE)

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Jan-2014

Never mix chemicals unless the product is a catalyst or activator for another product that requires mixing. Doing so can cause injury or even death. Always follow the manufacturer's dilution instructions when mixing chemicals with water. Problems associated with improper dilution range from an irritated nose, throat or eyes, to nasal bleeding, dizziness, chemical burns, and asphyxia.

Safety Precautions

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Cleaning and Decontamination Methods & Processes

(Manual Cleaning: Process & Safety)

Jan-2014

The purpose of manual cleaning is to physically remove deposits that were not removed, or were only softened during the pre-soak. This is done by use of friction. The use of manual cleaning can produce good removal of contamination, as the process can be extended until the item is observed to be clean (the item can be inspected throughout the whole process).

Manual Cleaning

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Jan-2014

Manual cleaning may be done: Prior to mechanical cleaning. When the decontamination area does not have washer disinfector or ultrasonic cleaner. For delicate or complex instruments that cannot be processed in mechanical equipment. For instruments with lumens. To clean powered equipment that cannot be immersed in water.

Manual Cleaning

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Jan-2014

Wear appropriate PPEs during manual cleaning. Disassemble instruments and items with multiple parts. Soak the instruments in the cleaning solution.

General Recommendations For Manual Cleaning

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Jan-2014

Always scrub or brush instruments under the water's surface to avoid splashing and aerosol generation. All instruments should be cleaned in a wide-open position to allow cleaning of hard-to-reach areas.

General Recommendations For Manual Cleaning

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Jan-2014

Brush in the grooves, teeth, and joints where organic material can stick. When cleaning aluminum or stainless steel item, use a "to and fro" motion in the direction of the grain. Flush lumens with an adapted water jet.

General Recommendations For Manual Cleaning

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Jan-2014

Rinse items thoroughly with clean water to remove all detergent. Any detergent left on the items can reduce the effectiveness of subsequent processing step. Inspect items to confirm that they are clean.

General Recommendations For Manual Cleaning

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Jan-2014

Allow items to air dry or dry them with electric dryer or with a clean towel if chemical disinfection is going to be used. This is to avoid diluting the chemical solutions used after cleaning.

General Recommendations For Manual Cleaning

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Jan-2014

Vertical soaking cylinders are required to soak instruments with lumens so all surfaces will come in contact with the cleaning solutions. By contrast, when luminal instruments are soaked horizontally, air bubbles will likely become entrapped inside the lumens.

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General Recommendations For Manual Cleaning

Jan-2014

A three-sink arrangement used for manual cleaning 39

General Recommendations For Manual Cleaning

Jan-2014

A wash sink with water and a detergent solution. A second sink (intermediate rinse) that contains plain or softened (de-ionized) water. A third sink (final rinse) with softened (de-ionized) / distilled water.

A three-sink technique helps to effectively rinse off soils, to prevent instrument spotting, and to prevent the re-deposit of minerals, microbes, and pyrogens.

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A three-sink arrangement used for manual cleaning should consist of:

Jan-2014

Advantages:

Cheap !!!. Cleaning items with complex structures. Can deal with delicate instruments. Cleaning items with narrow lumens (endoscopes). Inspection can occur throughout the process.

Manual Cleaning

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Jan-2014

Disadvantages:

Exposes CSSD staff to infectious agents on the instruments. Cannot be combined with a heat disinfection step in the same process. Cannot use harsh detergents. Lacks routine quality assurance of the cleaning process.

Manual Cleaning

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Jan-2014

Considering the need to clean lumens, the correct brushes must always be used. If the brush is too large, it will not fit into the lumen. If the brush is too small, it will not have proper contact with the lumen walls. As well, the brush must be long enough to extend through the whole length of the lumen.

Cleaning Brushes

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Jan-2014

Disposable Brushes should be discarded after use. Reusable Brushes must be cleaned & disinfected or sterilized at the end of the shift, or when heavily soiled. Rapid cleaning of brushes and other cleaning tools eliminates and reduces number of microorganisms that create biofilms. Disposable and reusable brushes that are worn or damaged should be discarded.

Cleaning Brushes

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