Wednesday, 19 May 2021 12:51

The Problem with Water Softeners

The Problem with Water Softeners


All water is not created equally on whitePer USGS, Nearly 85% of the U.S. is a hard water area.”

And water treatment companies are actively promoting water softeners to SPD.

Water softeners work through a process called ion exchange, a typical water-softening system removes calcium and magnesium ions from hard water and replaces them with sodium ions. Filtration solely removes and does not add anything to the water. Water softening adds stuff you may not want. While water softeners may remove mineral ions, they do not remove contaminants such as bacteria or heavy metals like lead, mercury, or even iron.

RO Water System on whiteRemember, RO and DI water systems are currently available for treating water used for instrument processing. These systems use filtration or resin instead of salt. Then, why add a water softener as recommended by some suppliers? On a personal note, should we drink softened water or even shower with it? Did you ever feel the slimy residue on your skin after bathing? Consider the effect on your valuable instrumentation.

Is any sodium in water a benefit?

Softening “adds about 750 milligrams of sodium to each gallon of water,” * effectively turning tap water into saline solution. The amount of sodium added by a water No Saltsoftener is linearly related to the number of hardness minerals being reduced. For every milligram of hardness in the water, the softener releases two milligrams of sodium.

                *Ref. Scientific American - Chuck Wight, a chemistry professor at the University of Utah, September 24, 2001

Should Water Softeners Be Used for Instrument Processing?

We do not think so. Water softeners can contribute to corrosion. Saline and hydrogen peroxide applied to metal causes a rusty surface sometimes valued as a patina to make the new metal into aged-looking pieces of art. That may be desirable if you want to put a patina on a metal object as a garden feature or a work of art. However, a rusty patina or corrosion on surgical devices has no place in the SPD or the OR.

If you would like to experiment at home, visit this website to experience this process firsthand. - How-to-Turn-Metal-Rusty

Strong Chlorides Cause Pitting Corrosion in Stainless Steel and Aluminum
Before Rusting

Many types of stainless-steel alloys will suffer extreme pitting corrosion when exposed to environments that are rich in salt. Most surgical devices undergo a passivation process to render the material non-corrosive. Exposure to salt accelerates or directly contributes to corrosion.

Case Medical, a manufacturer of sealed containers

After ALT

We have learned a thing or two about how metals can rust. We’ve learned how the combination of saline residue from water softeners followed by hydrogen peroxide sterilization can corrode our products. We strongly advise that when you process instruments and any aluminum container you find a better water source, most importantly for low temperature sterilization.

In conclusion, water filtration is a better choice. Reverse osmosis which pushes water through a membrane eliminating dissolved solids, salts, and even microorganisms from the water contributes to better outcomes. That is why Case Medical offers RO water systems for the highest quality critical water available for instrument processing.

To learn more about safe and effective water treatment options from Case Medical contact us at This email address is being protected from spambots. You need JavaScript enabled to view it. or CLICK HERE for more information.

Please join us on June 3rd and earn FREE CE credits while learning about

Using Digital Systems for a Paperless SPD

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Published in News
Wednesday, 05 May 2021 12:41

Dive into the science of cleaning

The water is fine! Or is it??


The Science of CleaningCleaning is complex, with multiple parameters that must be controlled. They can either enable—or inhibit—the effectiveness of your cleaning process. AAMI ST79 notes the purpose of cleaning and why it is known as the critical first step in instrument reprocessing.

“The first and most important step in reprocessing reusable medical devices is thorough cleaning and rinsing. Cleaning removes microorganisms and other organic and inorganic materials… Rinsing removes detergent and other residues that might interfere with subsequent processes.”


Because so much of the cleaning process cannot be seen, it’s important to understand the critical parameters and the underlying science in order to effectively manage the outcomes. Cleaning requires mechanical action, high purity water, proper detergent dosing and concentration, correct temperature and contact time, and validated, non-hazardous instrument chemistries.

The science of detergents

AAMI ST79 7.4.1 directs sterile processing personnel to use a cleaning solution that is compatible with the device and to follow the cleaning product manufacturer’s written IFU for proper dilution, concentration, temperature, and contact time. Such cleaners need to have excellent detergency, low surface tension, good chelating action, and rinse freely.

Enzymatic Cleaner vs Alkaline CleanerThe chemicals that come in contact with surgical instruments, containers, and equipment must be compatible with the materials of construction and comply with the guidance provided in the instructions for use (IFU). Deviation from the IFUs can destroy instruments and be very costly to replace.

pH Scale - NeutralFor instance, SteriTite containers must be cleaned with pH neutral cleaners. Surgical instruments also benefit from pH-neutral cleaners, and they may be even more effective. Cleaners that are not pH neutral are caustic and corrosive (even if they’re labeled aluminum safe!) and can lead to a range of detrimental effects:

      • Compromise the passive layer of instruments and medical devices
      • Lead to pitting, staining, and rusting
      • Cause colored anodized devices to bleach, fade, and discolor
      • Pose a safety hazard to patients and staff
      • Over time, destroy medical devices

Case Solutions® Instrument Chemistries are pH neutral, designed to work together as an integrated system, and are safe for instruments, containers, personnel, patients, and the environment. Use with reverse osmosis (RO) water for best results.

The science of water

The Association for the Advancement of Medical Instrumentation (AAMI) and the Association of periOperative Registered Nurses (AORN) both recommend using critical water in the final cleaning step (see AAMI TIR34:2007). Surgical instrument cleaning requires high purity, low endotoxin water. Critical water is extensively treated, usually by a multistep treatment process. Distilled water and reverse osmosis (RO) water qualify as critical water.

Tap water may contain toxins, hazardous chemicals, hard water ions, and microorganisms. Water softener systems require consistent and routine maintenance and can create issues in medical device reprocessing leading to corrosion and pitting of surgical devices. Deionization (DI) does not remove all minerals nor is it effective for removal of microorganisms. Both softeners and DI require replenishment of salt or resins for removal of minerals or contaminants. RO utilizes filtration.

All water is not created equally

Water works in conjunction with the proper detergents, which may include enzymes, to loosen, lift, and remove contamination from surgical instruments. Poor water quality can inactivate detergents and lead to substandard results. Contaminants can also cause damage to instruments.

Facilities should conduct regular maintenance and ongoing water quality monitoring to ensure water systems are performing to standards and to prevent adverse patient safety effects.

Follow the instructions

Cleaning parameters in the manufacturers’ IFUs, including time or duration of each step, are requirements for effective outcomes. Your best bet for patient safety is to process Instructions for Useinstruments by the book and use validated, science-based cleaners, right from the start.

For all these reasons, facilities that are using caustic cleaning products should assess converting to pH neutral instrument chemistries. The Case Medical team has formulated an entire line of instrument chemistries to effectively clean medical devices while being responsible stewards of the environment and the safety of healthcare personnel. Case Medical is a long-time U.S. EPA Safer Choice partner (since 2011) and a three-time Safer Choice Partner of the Year.

Read the label

IISaferChoice_DfE_RGB-1Case Medical’s instrument cleaners and lubricant proudly display the U.S. EPA Safer Choice label. Originally designed to decontaminate and preserve the company’s SteriTite containers, you can use our validated instrument chemistries to obtain best results for all your reprocessing needs.

The U.S. EPA's Safer Choice label attests to the superior safety of the products and equal or better effectiveness compared to others in the comparison class. Contact us at This email address is being protected from spambots. You need JavaScript enabled to view it. to get more information about optimizing your cleaning process with Case Solutions® and SuperNova® super concentrated cleaners.

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Register to join us this Thursday, May 6 for "The Case for Rigid Containers" live webinar.


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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.


Published in News

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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