What you can't see can hurt you and your patients

 

Effective sterilization depends on...thorough cleaningCleaning is the critical first step that can make or break the efficacy of instrument reprocessing. Yet, we’re reminded again and again of the ways cleaning can go off the rails. Today we’re sharing a true story of the SPD, with a side-by-side comparison that demonstrates the concept of “Caveat emptor,” also known as “Let the buyer beware.”

The case of the murky detergent

One of our Case Medical Representatives recently visited a great sterile processing department to demonstrate the effectiveness of some SuperNova® Instrument Chemistries. Nothing beats a side-by-side comparison, so two sinks were filled with water and the proper amount of detergent for a soak test.

As the sinks began to fill, it was immediately apparent that the two products were not behaving the same way. The basin with SuperNova Detergent (below, left) was crystal clear, while the second basin (below, right) was filling with suds, rising up to 4 inches above the water level!

SuperNova 25 vs the Other Detergent

Reference the standard

Let the buyer beware warning signThe reason this foam is so concerning is three-fold.

  • First, we know that it’s dangerous to put your hands into a sink when you cannot see what your hands may come into contact with. There is risk of injury due to insufficient segregation of sharps.
  • Second, foam can cause problems with automatic washers and pump systems.
  • And third, excess foam can lead to residue if rinsing time is too short or if the water quality is below standard.

AAMI ST79 defines an ideal cleaning agent in section 7.6.3. The cleaning agent should

    1. Checklist with all items checkedbe compatible with the medical device or container system to be cleaned as well as with the materials used in the cleaning equipment itself;
    2. be efficacious on the types of clinical soil typically found on medical instruments after clinical use;
    3. be nonabrasive;
    4. be low-foaming;
    5. be free-rinsing (i.e., easily removed from the medical device);
    6. be biodegradable;
    7. rapidly dissolve/disperse soil;
    8. be nontoxic; and
    9. have a shelf life and use-life consistent with the anticipated clinical use.

 If the detergent in your SPD is not low-foaming, take a look at the longer definition of caveat emptor: it is the principle that the buyer alone is responsible for checking the quality and suitability of goods before a purchase is made.

 

Prevention is the best protection

Safety Data SheetsWhen assessing any chemical for use in your department, check it against the AAMI list of characteristics of an ideal cleaning agent. Review the SDS—get it from the vendor or track it down online—to understand the pH level and any risks to staff and the environment.

Our customers sometimes discover they’ve received incorrect information when depending on verbal assurances from sales reps. Sometimes cleaners cannot be released into the wastewater system. Other times, personnel in decontamination experience skin reactions or headaches triggered by harsh ingredients or unnecessary fragrances and dyes.

SuperNova DetergentIISaferChoice_DfE_RGB-1You can get rid of troublesome cleaners in your department. Utilize our line of SuperNova® instrument chemistries that are U.S. EPA Safer Choice labeled (no other instrument cleaning products can say that!) and possess all the characteristics of an ideal cleaning agent, per AAMI ST79. Contact us now for more information on our U.S. EPA Safer Choice labeled cleaners and lubricant, ideal for ideal for instrument processing and safer for you and your patients.

 

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What to look for, what to avoid

 

While some would say that all instrument cleaners are more or less the same, in reality the products you choose can be as different as using a mallet or a brush to uncover ancient pottery. Formulating cleaners and detergents that are effective while maintaining the integrity of your surgical instruments and containers depends upon two things: 1) scientific understanding and 2) a commitment to using high quality, safer chemical ingredients.

When you evaluate the information on your detergent labels, consider the pros and cons of the elements discussed below.

Decoding: Enzymes

Enzymes break down targeted organic substances (proteins, fats, starches, etc.). They significantly decrease the activation energy required, while increasing the speed of chemical reactions. In some cases, enzymes can make a chemical reaction millions of times faster than it would have been without them. This is true of digestion in our bodies and instrument processing in our Sterile Processing Departments.

Enzyme Activity

Enzymes are highly effective, a natural, targeted component of certain cleaners. Often used for wastewater treatment, enzymes are safe for disposal into the wastewater system. Enzymes and surfactants do the heavy lifting of cleaning. As with all cleaning processes, correct machine settings and adequate rinse cycles also contribute to the best outcomes. (Want to learn more? Register for our CE webinar, "Enzymes and Their Actions.")

Decoding: Silicates

You may even find that your detergent contains silicates. What are silicates? Silicate minerals are rock-forming minerals and make up approximately 90 percent of Earth's Silicatecrust. These compounds are generally colorless transparent solids or white powders, and soluble in water in various amounts. Silicates, when added to detergents, have the effect of raising the alkalinity.

Silicates are often used in detergents, paper, water treatment, and construction materials and have abrasive qualities. If you observe discoloration (white-gray, yellowish brown, or bluish purple) on your instruments, it may be silicate deposits from insufficient rinsing or corrosion.

Decoding: Aluminum Friendly

pH Scale - NeutralDetergents labeled as “Aluminum Friendly” or "Aluminum Safe" are actually highly alkaline, caustic, and damaging to anodized aluminum containers and even your surgical devices. Alkaline detergents are found on the higher end of the pH scale, with water as neutral at 7, and lower values representing acidic substances.  While alkaline cleaners remove soil, they can create more problems than they solve.

In fact, some “aluminum friendly” detergents have a pH as high as 14. Highly alkaline cleaners can cause discoloration, corrosion, and material erosion, characterized by the presence of a white, powder-like coating on anodized aluminum and pitting and rusting on instruments. A simple demonstration using three solutions, pH levels 7.6, 11, and 14, demonstrates the effect of alkaline solutions on anodized aluminum coupons.

Alkaline solution showing damage to anodized aluminum coupons

At just three minutes, the sample exposed to a pH 14 solution shows corrosion (white area). After 14 hours of continuous exposure, the same coupon shows corrosion and metal flaking producing a black appearance, and the pH 11 solution is causing corrosion on the center coupon.

Caustic formulations also result in reduced use life for devices treated, requiring repair, refurbishing, or replacement. Most concerning, alkaline cleaners can cause severe skin burns and eye damage to the user.

Sorting through the messages

Woman with headacheAs with most decisions, choosing instrument chemistries requires sorting through conflicting messages from multiple sources. Do your research, call on people you trust, and learn the science so you can critically evaluate the messages Enzymes and Their Actions Register Nowyou hear. Your choices do matter. They matter to the personnel who have to use these chemicals in their daily work and to the patients whose bodies are susceptible to any retained residue or soil.

Case Medical is ready to help. Get in touch with your questions or request a comparison of our U.S. EPA Safer Choice instrument care and cleaning products versus the products you currently use. The results will be revealing.

 

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