Performing intermediate and high-level disinfection and sterilization of medical equipment, devices, and supplies has been a top citation from organizations such as the Joint Commission and DNV (Det Norske Veritas) for the last several years despite increased knowledge, education, and exposure to the risks associated with failing to performing adequate cleaning and disinfection.
According to Rutala, Weber, and the Healthcare Infection Control Practices Advisory Committee (2019) before disinfection and sterilization, cleaning is required to remove both inorganic and organic material that may be on the surface of instruments. Failure to remove material results in a less effective disinfection and sterilization process putting the patient at risk1.
Point of Use Cleaning
Assessment of point of use cleaning has become a common trend during accreditation surveys. Preparation of instruments for decontamination is expected to begin at point of use including in the operating room or suite. Often clinicians have feared using a cleaning product based on guidelines that have been published with little supporting evidence that aerosolization or contamination is likely2,3. Point of use cleaning typically involves rinsing or wiping of gross bioburden during the surgical procedure and using an enzymatic product after the patient procedure is complete, decreasing any aerosolization risk to a patient. Furthermore, today’s products are produced in a pre-diluted, ready-to-use formulation that further reduces contamination risks. The AORN Guidelines for perioperative practice, 2023 edition describe criteria for selection of cleaning products including compatibility, nonabrasive, low foaming, effective, and environmentally friendly.
Enzymatic Cleaners for Consistent Cleaning
The CDC guidelines have referenced that there is no difference in cleaning efficiency between enzymatic and alkaline-based cleaners; however, enzymatic cleaners have become increasingly popular in the cleaning process of surgical instrumentation. Recent studies have concluded that enzymatic chemistry does provide a more consistent and improved cleaning of scopes3 and surgical instrumentation4. Given the complexity of instrumentation, use of enzymatic is helpful to ensure adequate removal of bioburden in areas that are difficult to access or even to be seen by the clinician. Clinicians performing point of use cleaning are often not trained in sterile processing and providing a product that makes the process simple is the goal. ProEZ Gel™ is a unique biodegradable surfactant that provides enzymatic action targeting organic material for breakdown quickly. This neutral pH formulation is compatible with most materials providing moisture resisting drying during transport. The ready to use gel pre-cleaner is tinted green to provide increased visibility for monitoring compliance while also preventing injuries related to sharps that can often be difficult to visualize with foams. Once applied the ProEZ Gel™ continues to provide soil breakdown, wetting action, and protection from corrosion for up to seventy-two hours. The extended nature of the action of ProEZ Gel™ makes it an ideal product selection when there are anticipated delays in transportation at centralizing sterile processing facilities or in ambulatory clinics where resources are limited.
Pretreat to Help Avoid Dried Bioburden
Despite the attention and risk associated with instruments that are not adequately cleaned at point of use, sterile processing departments continue to receive instruments that are ladened with bioburden including dried blood. According to most stainless and scope instrumentation manufacturer instructions for use, dried bioburden noted on instrumentation requires extended soaking times for removal which has operational impact on turnaround and reprocessing. ProEZ Gel™ provides a unique formulation that targets organic material. When applied to instrumentation you can see bioburden dissolving even when organic material has dried. When testing the product in a sterile processing department in a large tertiary hospital, the team members noted that ProEZ Gel™ remained visible and wet for several hours; however, easily washed off when rinsed at the sink. The product also eased removal of staining and had virtually no odor, which team members noted was a plus when using the product. Ease of use and quick bioburden breakdown helps to improve productivity in an environment that is focused on turnaround. The ProEZ Gel™ requires no additional exposure controls than are normally utilized when applying a detergent reducing additional burden that can be associated with a new chemical.
1 Rutala, W., Weber, D., & the Healthcare Infection Control Practices Advisory Committee (2019). Guideline for Disinfection and Sterilization in Healthcare Facilities, 2008. Update: May 2019. https://www.cdc.gov/infectioncontrol/guidelines/disinfection.
2 Kyle, E. et. al. (2023). AORN Guidelines for Perioperative Practice – 2023rd Edition. STAT! Ref Online Electronic Medical Library. https://online.statref.com/document/fN0k16SntdiQgzxm02Cr8t.
3 ANSI/AAMI ST79: 2017. Comprehensive guide to steam sterilization and sterility assurance in health care facilities. 2017. Association for Advancement of Medical Instrumentation, Arlington, VA.
4 Gonzalez, J., Vanzieleghem, T., Dumazy, A., Meuris, C., Musters, J., Christiaens, G., Leclercq, P., et. al. (2019). On-site comparison of an enzymatic detergent and a non-enzymatic detergent-disinfectant for routine manual cleaning of flexible endoscopes. Endoscopy International Open. 7(4): E412-E420. doi: 10.1055/a-0838-4995.
5 de Melo Costa, D., Castillo, R., Vickery, K., Ferreira Veiga Tipple, A., de Oliveira Lopes, L., Hu, H. (2022). Hinged surgical instruments: efficacy of double manual cleaning versus automated cleaning on biofilm removal. Journal of Hospital Infection. 124: 67-71. https://doi.org/10.1016/j.jhin.2022.03.011.
About the Author:
Melissa Morgan, a distinguished figure in the field of healthcare, has extensive leadership in Sterile Processing. She has earned a reputation as a leader and expert in infection prevention and control. With an extensive background in healthcare management, Melissa holds a master’s degree of Nursing and has dedicated her career to ensuring the highest standards of patient safety and regulatory compliance. She serves as an expert consultant, an influential thought leader, and a trusted advisor to medical staff senior leadership, and medical center personnel.