Cleaning Chemicals and Lubricants

: keeping the instruments in good condition

Review of Important Terms

• Bioburden - the number of microorganisms on an item

• D-Value - the amount of time required to kill 90% of the microorganisms present on an item

• PPE - personal protective equipment (shoe covers, gloves, fluid-resistant gown, eyewear, mask)

• STANDARD PRECAUTIONS - treat each item as if it carries the potential for being infectious by protecting yourself using PPE

• IFU - Instructions for Use (written reprocessing instructions and steps for operation for each item in CS)

Properties of WATER in CS

• pH levels

  • 0 - acidic

  • 7 - neutral

  • 14 - basic

• Hardness - may need water softener

• Tap water - water right out the faucet- city or country has filtered

• Softened water - minerals in tap water are reduced usually by using salts

• Deionized water - water that has all the ions removed through an ion exchange process

• Distilled water - water is heated to steam, then allowed to cool and condense. Distillation removes impurities, like gases and organic material and some bacteria

• Reverse osmosis (RO) - water purification in which water has impurities removed after being forced through a semi permeable membrane

• Temperature - higher temperature does NOT equal more effective disinfection

The pH Scale

• 0 - battery

• 1 - stomach acid

• 2 - lemon

• 3 - soda

• 4 - tomato

• 5 - coffee

• 6 - milk

• 7 - water

• 8 - blood

• 9 - egg white

• 10 - stomach tablets

• 11 - ammonia solution

• 12 - soap

• 13 - bleach

• 14 - drain cleaner

Acidic Cleaner (pH 1.6-3)

: used to remove mineral deposits such as hard water, urine, and minerals and scale

• Advantages - excellent for mineral deposits and urine, works well on inorganic soils and makes stainless steel shine

• Disadvantages - can damage surfaces of stainless steel and aluminum bronze and glass, disposal into drains is restricted in some states

Neutral cleaners (pH 6-8)

: most common

• Advantages - effective on organic and inorganic souls and safe for aluminum

• Dis advantages- not effective in hard water, produce foam and more difficult to rinse

Alkaline (Basic) cleaners (pH 8-11)

: Highly effective at removing organic material (blood, fat, and oils) Must follow IFU

• Advantages - remove a wider range of soil than any other type of detergent, economical and low foaming

• Disadvantages - if not rinsed properly can leave a powdery residue on instruments. Cannot be used on bronze, copper, or aluminum)

Proteolytic Enzymes (Protease)

: breaks down proteins

• Blood

• Mucous

• Feces

• Albumin

: They target large insoluble molecules and convert them into small ones to ensure that they can easily be dissolved in water and easily cleaned

Fats-degrading enzymes (Lipase)

: breaks down fats

• bone marrow

• Adipose (fatty) tissue

: These molecules are not as large as proteins and rarely dissolve in water. Lipase’s properties make fats water soluble so that they can dossolve in water

Sugar-degrading enzyme (Amylase)

• Catalyzes (changes)

• Starch (sugars)

: They are utilized as a substance in detergents which are made for complex cleaning of clinical devices

Detergents

• used to enhance cleaning ability

• When properly used, detergents penetrate and remove soil from instruments and keep soil suspended do it does not reattch to instruments

• Detergents do not kill microorganisms (unless they contain a germicide), but they remove the soil that contains bacteria

• Each have a specific task - some work better in hard water, some are low foaming, some are specifically designed for certain types of equipment, such as ultrasonic cleaners

• Can be liquid, solid or foam

Emulsifer - ingredient used to bind together substances that normally do not combine, like water and oil

Surfactant - substance that lowers the surface tension of the water and increases solubility of organic compound

Chelating agents - chemicals that hold hard water minerals in solution and prevent soaps and detergents from reacting with the minerals

Other cleaners

• Lubricants - often called instrument “milk” because of its milky appearance. Preformed after cleaning as one of the final steps in the mechanical wash cycle, or can be applied manually with a spray bottle. Practices used to soak instruments in “baths”, but this has been discontinued due to increase risk of contamination. Follow IFU for proper dilution and ensure it is compatible with instrumentation

• Stain and rust removers - used when notmal cleaning does not temove. Stains are usually a result of soaking instruments in saline. The chemicaks remove hard water deposits, rust scale and discoloration from instruments and are usually acid based (pH 0-6.9)

Rust of stain??

• Use pencil eraser to remove discoloration

• If pit marks under strain - it is corrosion or rust

• If no pit marks - it is a stain (not rust or corrosion)

Strain guide for stainless steel

Brown/orange - high ph

Dark brown - low ph

Bluish/black - reverse plating due to mixed metals during cleaning process

Multicolor - excessive heat

Light/dark spots - water droplets drying on surface

Black - contact with ammonia

Gray - - excessive use of rust remover solution

Rust - dried on blood or bio-film

Note : many of the following stains can be the result of poor steam quality or poor water quality. It is important to determine whether these symptoms are occurring before or after sterilization

How to avoid damaging surgical instruments

• FOLLOWING SHOULDNT BE USED (unless recommended by device manufacturer)

  • abrasive cleaners

  • Saline

  • Buffered iodine

  • Hydrogen peroxide

  • Any chemical not recommended by medical by device manufacturer