Instrument Cradle for Automated Washers
For years, we in CSSPD have been trying to find a method to clean instruments with minimal contact of bio-burden to our employees. We have also been instructed to open all ring-handled instruments and arrange them so that full water impingement can occur in the washer disinfector.
One attempt at this was the 6-inch stringer which meant that all ring-handled instruments had to be pre-strung on the dirty side and de-strung on the clean side to complete PM testing of scissors, needleholders, and clamps. If used properly the 6-inch strimger did improve the washer process as long as the instruments were placed in an upright position, not laying on one side or the other.
This added additional time to both the pre and post washer and was the main reason why most hospitals did not adapt the practice. If you pre-string then you must have a well defined manual process starting in the OR with soaking and moving forward to cleaning following the stringer manufacturer’s recommendations for the angle of the stringed instruments, again preferably standing up-right to allow full impingement.
With impingement representing about 60% of the washers ability to remove contaminates the need to develope a product to enhanced the washers ability has never been more needed. The introduction of the instrument cradle answered all that. This simple device allows full water impingement in a washer disinfector as well as proper drainage and faster cooling. The time spent pre-stringing is eliminated while improving assembly time due to the instruments becoming more visible to the CS tech.
If you are experiencing spotting or staining on surgical instruments especially in the box-lock area of ring-handled instruments the reason is due to lack of water impingement in the washer disinfector and a poor manual process. A poor pre-washer, soak, and clean process adds to the problem.
Furthermore, if you can see visible staining, rusting, or pitting then you have a high potential for forming bio-film and something needs to be done to correct it. Visible rust on a surgical instruments means that your process is failing and that all levels of cleaning need to be addressed.
- Sorting
- Disassembly
- Soaking
- Poor manual hand washing
- Improper racking
- Plugged spray arms
- Washer chemical level to low
- DI/RO rinse water cycle to short
- Over use of flash sterilization along with poor manual hand washing technique.
- Using surgical towels in wraped or containerized instrument sets
- Over use of rust remover chemicals
- Overloading the washer racks
- Poor rack selection
- Poor placement on chosen rack
- layering of instruments and use of hold-down screen
Relying on automated washers would be your first mistake in correcting the problem. The use of the cradle will greatly enhance your washer’s ability to properly disinfect ring-handled instruments which are the bulk of your instrument inventory.
We have been using the cradle at our hospital for eighteen months and have seen a reduction in repairs as well as remarkable increase in the look and feel of ring-handled instruments. No visible staining or spotting problems , no complaints from staff regarding the use of the cradle, and no employee sharps injuries for the past eighteen months while using the cradle both pre and post washer during tray assembly.
For direct infromation contact:
Call Michele Bell at Tru-Clean Innovations - 1-866-453-1842
http://csspdmanager.com/Cradle/TruClean_V1-2.wmv
Your home dish washer is designed to place everything in an up-right position allowing for fully contact and drainage. Not one of the current manufacturers of hospital washers have a racking system to solve what the home industry has, load configurations and limits.
Instruments with brown stains can be either blood or rust and should not be placed in an tray for sterilization.
A breakdown in the passivation layer due to poor instrument management will result in staining and spotting. Having your instrument repair service complete routine passivation as part of the monthly maintenance service along with a quality cleaning process will eliminate this.
The pictures above are from sets of instruments that were sterilized and ready for use. Instruments with visible black or browned stains should never make it to the sterile field.
.png)
Box-lock with staining and rusting that should never make it to the sterile field.
