Decontamination: coming clean with today's most innovative product features

Look into an even moderately modernized central service department and you'll likely spot a bevy of decontamination equipment aimed at improving instrument cleaning, reducing turnaround time and boosting overall process efficiencies.

Whether it's ultrasonic cleaners, single- or multi-chamber washer disinfectors, tunnel washers or washer/pasteurizers, one thing remains certain: sterile processing professionals have come a long way from days where manual washing was their only option.

Just ask Natalie Lind, central processing department manager for Saint Cloud Hospital, Saint Cloud, MN. Over the course of her 25-year career, Lind has witnessed firsthand the dramatic upswing in decontamination equipment technology--a development that has been maven in great part by the level of sophisticated instrumentation that's flooding the marketplace and making its way into hospital inventories.

"Going from a manual to automated process was a major [shift], but I've seen a lot of other changes as well. Years ago, we mostly saw instruments made of metal, rubber and glass. Fibar optics and plastics were rare and there were no computer chips to [complicate the process]. It also wasn't uncommon to have just two pans of instruments for total joint procedures," she recalled.

"That couldn't be more different than what we see now. These days, we deal with high tech instrumentation on a daily basis," Lind continued. "If you are going to have these kinds of instruments, you really need to have high tech decontamination equipment that is better equipped to handle them."

Sources agreed that a heightened emphasis on infection control and emerging pathogens--along with the push for worker and patient safety, and the ongoing desire to maximize resources--are also forcing manufacturers to broaden their product offerings. The result is a range of equipment options as varied as the departments that employ them.

"[CS departments] can now choose the technology and features that are best suited to their individual needs, caseloads and budgets," noted Charlie Hancock, president, Charles O. Hancock Associates Inc., Fairport, NY.

European influence

Some of today's most sought-after equipment features and designs got their origins abroad. More effective and efficient spray impingement is just one key element being pulled into American models, enabling more effective cleaning of even the most complex instruments. "In the past, machines in the US primarily used high pressure, [whereas in Europe], cleaning solutions were delivered using high volume, low pressure, which is less damaging to instruments," explained Mike Cain, global marketing product manager for Getinge USA Inc., Rochester, NY. "Today, more US machines are using more water volume at a lower pressure."

US manufacturers are also beginning in focus more attention on decontamination monitoring and validation--an area that British facilities are already required to address for rigid and endoscopic instruments. A broad European standard for validating the effectiveness of washers is also on the horizon, and while the US has yet to adopt decontamination monitoring and validation standards, sources said experts are already beginning to move in that direction.

"There are currently no US standards in place that mandate the [quantifying of the cleaning process], The standard is still visual inspection, but the bar is definitely being raised worldwide in this area," said Jeff Pollis, senior marketing manager of washing systems for STERIS Corp.

STERIS, which recently acquired Switzerland-based Hamo Inc., is one US vendor that is already offering an optional independent monitoring system for its Reliance Synergy Washer/Disinfector. The system checks virtually every vital component of the cycle--independent of the control center--using different probes and sensors for redundant assurance of pump pressure, detergent flow, final rinse water intake conductivity, washing time and washing temperature.

"We wanted to answer those 'What if' questions," Pollis explained, adding that by offering independent monitoring systems on US washers, STERIS is already preparing itself for US standards, if and when they take effect. Pollis predicts that as more emphasis is placed on quantifying the decontamination process, more vendors will likely follow suit.

Getinge USA Inc., Rochester, NY, also has the capability of adding independent monitoring checks, which are standard on its European washers, to models sold in the US. According to Cain, Getinge's strong European presence has helped it stay on top of evolving US customer demands.

Facilities that don't have washers equipped with such system checks, yet don't want to rely solely on visual inspection to determine the effectiveness of their automated cleaning process, do have other options. Healthmark Industries Co., St. Clair Shores, MI, manufactures an output test to monitor the cleaning performance of automated washers. The product, which is comprised of test soft, a grooved stainless steel plate and a transparent plastic holder, was designed to provide a standardized method for challenging washer effectiveness. Healthmark also offers tests that monitor input parameters, such as temperature and water quality. If a washer fails the output test, these products can help identify the cause, according to Ralph Basile, vice president of marketing for Healthmark Industries.

"We know that an item can't be sterilized if it isn't clean. Unfortunately, until recently, there haven't really been ways to monitor the cleaning process beyond visual inspection and ensure that a washer is performing at a consistent level I every day," Basile said.

While some have concerns that today's complex instruments may challenge the effectiveness of such independent tests, Hancock said he applauds any effort aimed at improving the cleaning process. "Many people would agree that this is definitely a step in the fight direction."

Flexibility meets efficiency

Mounting resource constraints coupled with a rise in surgical caseloads continues to underscore the need for equipment that can maximize overall efficiency. Manufacturers are responding by offering decontamination equipment that delivers faster cycles and more automated features that enable CS personnel to focus their attention on other critical tasks.

Getinge, for example, recently introduced the Air Glide Shuttle System, which automates multiple Getinge 8666 washers in a space-saving design, provides single point loading and unloading, as well as automatic load, cycle select and start of decontamination. Three consecutive loads can be processed without operator attention, freeing up to 90 minutes for other tasks. Getinge also offers an automated indexing washer designed to prewash, sonic clean, wash, rinse/lubricate and dry. The washer deans and decontaminates up to 40 instrument trays per hour with virtually no help from the operator. It also features photo sensors that identify each load and automatically apply the appropriate treatment processes.

STERIS' Synergy washer features a capacity expanding five-level washing manifold and can process ten trays per cycle. Airtight doors and vented drying speeds the cycle further, allowing CS staff to turn around instruments in 28 minutes.

Enhanced flexibility is also being built into the latest wave of washers, thanks to the avail ability of user-controlled programs that can be tailored to a range of cycle and product use options. Richmond, British Columbia-based Scientek manufactures systems with ten programmable cycles, allowing staff to select cycles best suited to the instrumentation load at hand. Skytron, Grand Rapids, Ml, offers similar flexibility with its stand alone and automatic pass through washer-disinfectors.

As scientists learn more about bioburden and the role chemicals play in fighting prion diseases, such as Creutzfeldt-Jakob Disease, equipment vendors are looking at ways to prepare for potential future needs. For some, including Skytron, Getinge USA mad STERIS, providing customers with the option of additional injection pumps is one way to stay ahead of developments and reduce the risk of equipment obsolescence. Currently, three detergent pumps are needed (for enzymatic solution, detergent and lubricant), but as many as five are being offered on some of the newer models.

"If specific chemicals are identified as effective against Creutzfeld-Jakob Disease, for example, we want to have enough pumps already built into the washer to [accommodate] them," Pollis said. Five injection pumps come standard on STERIS' Synergy washer.

Gelinge's washers come equipped with three pumps, but can accommodate up to four. While European washers don't use as many chemicals, Cain said US customers have come to rely more on chemicals and solutions to enhance the cleaning process. "We have to listen to our customers and let them drive the developments," he noted.

Acknowledging that utility and supply costs can also cut into departmental budgets, vendors are seeking innovative ways to minimize both--a trend that, despite. European manufacturers' lead in other areas of equipment innovation, is being spearheaded by US vendors. Pollis said washers that can reduce steam, electricity, water and consumable usage will be the wave of the future. The Synergy Washer requires less detergent and uses 9.5 gallons of water per operating phase at high impingement, representing a 25% reduction from first-generation designs.

At low impingement, me washer uses only 5.8 gallons. Some CS staffers are finding that equipment designed for high level disinfection can also be used for efficient instrument cleaning. Washer/ pasteurizers, for example, provide high-level disinfection for a variety of medical devices using only a biodegradable cleaning solution and water, but may also offer the option for a "wash only" cycle.

"We wanted to give those who work in CS an alternative. Not only is pasteurization safe and effective, it costs just pennies per load," noted Richard Radford, president of HLD Systems, a subsidiary of Cenorin LLC, adding that having the flexibility of a system that can wash mad pasteurize instruments promotes greater labor efficiency and faster throughput.

HLD Systems offers three models of washers/ pasteurizers designed for multiple device types and sizes, such as anesthesia bags, croupettes, aerosol generators, endoscope and laryngoscope blades, circuits, large and small containers, and miscellaneous parts.

A better solution

Manufacturers of decontamination equipment aren't the only ones working to improve the critical instrument cleaning process. The same can be said for manufacturers of the cleaning products used in those washers--and on their own.

CS departments now have a broader of choices when it comes to detergents and enzymatic solutions. "It seems that [vendors] are really working on providing better chemicals at a better price," noted Lind, adding that many products are more con centrated, which helps users to get the most from their money.

By and large, there's a growing trend by manufacturers to offer multi-enzyme solutions, which are formulated to power through more bioburden matter, including blood, protein, fats, oils and carbohydrates. 3M Healthcare, St. Patti, MN, features a 4-enzyme detergent that digests build-up of human proteins, mucopolysaccharides, lipids and carbohydrates after only two to 10 minutes of immersion.

"Substrate is like a lock and different enzymes work as a key to break it down," explained 3M marketing manager Joseph Scollins. 3M's Rapid MultiEnzyme detergent, which currently can only be used for manual cleaning, will be reformulated in April for use in washer/decontaminators.

Mineola, NY-based Ruhof Healthcare, which created the first enzymatic cleaner in 1976, has been at the forefront of instrument and scope cleaning ever since. Ruhof's newest Multi-Tiered enzymatic detergent, Endozime AW Triple Plus, uses a synergistic mixture of protease, lipase, carbohydrase and amylase to quickly and effectively remove bioburden, and also includes rest inhibitors. The product was designed for use in all washers, washer sterilizers and ultrasonics, as well as for manual cleaning.

"The major cause for not achieving high level disinfection or sterilization is using an ineffective enzymatic detergent. This is the first and foremost important step in reprocessing," noted Jack Kinville, marketing manager for Ruhof. "If you don't have an enzymatic detergent that has a specific enzyme to remove each contaminant, it is impossible to properly clean the instrument."

Rick Schultz, president of Spectrum Surgical Instruments Corp., Stow, OH, also touted the benefit of enzymes for post-operative instrument care, but added that facilities can also benefit from using wetting agents and simple practices that prevent blood and bioburden from drying on instruments.

"Any time someone tells me they axe using an enzymatic for post-op instrument care, I give them a thumbs up. But what I really stress is the importance of using anything--whether it's an enzymatic, wetting agent or simply a towel saturated in water that is laid over the instruments--to keep the instruments moist," he said. Spectrum Surgical offers a detergent-based moisturizer that doesn't allow blood to dry for up to four hours.

"We know that you can't sterilize what isn't clean," he added. "Any effort that goes into keeping blood from drying on instruments prior to sending them to decontam is a great start."

COPYRIGHT 2004 Healthcare Purchasing News
COPYRIGHT 2004 Gale Group