MANUAL VRS. AUTOMATED CLEANING OF SURGICAL INSTRUMENTATION. DISCUSS THE RELATIONSHIP BETWEEN THE TWO CLEANING PROCESSES.
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MANUAL VRS. AUTOMATED CLEANING OF SURGICAL INSTRUMENTATION. DISCUSS THE RELATIONSHIP BETWEEN THE TWO CLEANING PROCESSES.

GROUP A: ASSIGNMENT IS DUE ON THE 14TH OF NOV.
 

4 Comments to MANUAL VRS. AUTOMATED CLEANING OF SURGICAL INSTRUMENTATION. DISCUSS THE RELATIONSHIP BETWEEN THE TWO CLEANING PROCESSES.:

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BISMARK ODURO on Friday, November 12, 2010 8:18 PM
Cleaning is the removal of the visible and the invisible soil on reusable equipments. It is the first step to processing devices after use. Cleaning could be accomplished manually or mechanically. Both processes are effective if done properly but automated washer/decontaminators could chemically or physically decontaminate devices by destroying most microorganisms with the exception of spore to make the items safe for handling without gloves at the preparation and packaging area of the sterile processing department. Manual cleaning starts at point of use. It consists of using detergents and enzymatic solutions. Manual cleaning is very important because “it’s a prior step to mechanical cleaning” (CRCST chp9 141). Allowing bioburden such as blood and other soil to dry on the instruments could ruin and rust them. Items with lumens, basins, modern instrument with channels and equipments that cannot be immersed in water (PSIs) are either cleaned manually as a first step before mechanical manual cleaning or just manual only as in PSIs. The manual method is applied in facilities or departments where mechanical washers in the decontamination area are not available. Manual cleaning workload is higher on central service technicians than mechanical cleaners. Manually cleaning is also most effective for delicate instrumentation. Unlike manual cleaning automated cleaning starts from the decontamination area. Automated cleaning is superior to manual cleaning because it cleans and reaches small areas that brushes cannot reach. It further reduces the workload on the central service technicians. An automated washer have several processing cycles such as pre-wash, wash, pre-rinse, final rinse and drying. Automated cleaning can be accomplished by a process of cavitations as in an ultrasonic machine or by the principle of impingement in the washer/decontaminators. Although automated machines have more efficiency, manufacturer recommendations and standard guidelines must be followed for effective cleaning and not all instruments can be processed in the machine. Items such as aluminum which need “a to and fro” motion along the grain with a brush to remove debris” need a first step manual cleaning (CRCST chp9 141). Instruments that have debris such as rust and soil on them cannot be mechanically properly cleaned without baking the soil on the instruments and as such must be manually cleaned as a first step. Since equipments that are not properly cleaned poses an infection control threat to patients and healthcare workers, cleaning is very important in the central service department. It is the first step to the sterilization process and an instrument cannot be sterile without cleaning “one can clean without disinfecting but one cannot disinfect without cleaning”(CRCTS chp9 139). Cleaning is very important and regardless whether automated or manual, it is most effective when processed according to the manufacturer recommendations. CONTRIBUTORS:(Bismark, Peter A., Peter K., Stephen, Adelaide, George & Majelle)
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MCS on Saturday, November 13, 2010 2:10 AM
Great job. Well defined, logical and organised. Group B do have up to the 21st of this month to respond.


CLETUS SIEBUNE on Saturday, November 20, 2010 10:20 PM
Historically, healthcare consumers demand quality in the products and services they receive. They expect nothing less than the best for themselves and their loved ones in using inpatient and outpatient healthcare services. In response to this growing demand for quality services, the healthcare industry has experienced a dynamic state of technology-driven evolution. The technological surge in medical procedures has increasingly evolved to the complex surgical instruments used today to perform medical "miracles”. This has greatly reduced the brute force formally required for certain medical procedures and decreased the time required to perform them. This, in turn, has significantly decreased patient pain and post-operative healing times. Majority of these medical procedures require the use of supplies, utensils, instruments and/or equipment. Some of these items are used once and then discarded, whiles others are used multiple times. The reusable items must however, be thoroughly cleaned, inspected, and disinfected or sterilized before they can be reused on other patients. Cleaning, a complex multi-step process, is the FIRST and the MOST important step in any medical device reprocessing which, if not properly performed, will lead to disinfections or sterilization failures. Cleaning of surgical instruments is the removal of all visible and invisible soil (e.g. blood, body fat, body tissue, bones, and other foreign substances) from the surfaces, crevices, serrations, joints, and lumens of medical devices being processed. Water, a wetting agent, is the primary vehicle of the cleaning process. It is used alongside detergents, both of which should have neutral PH levels to facilitate an effective cleaning cycle. Cleaning of surgical instruments is done to, among others, reduce the number of microorganisms and also decrease the nutrient material that can support microbial growth on the surfaces of the surgical instruments. It is also intended to reduce the potential for environment contamination by aerosolization or spillage and also minimize the damage to devices by blood and other substances. From the early Greek times till date, two methods of cleaning surgical instruments have been used in the healthcare industry; namely, Manual Cleaning, and Automated/Mechanical Cleaning. Manual Cleaning is the physical scrubbing off of deposits that were not removed or soften during the pre-soak at the point of use with the aid of water and detergents. Bioburden is removed by friction generated through the scrubbing with brushes (in many different diameters and length to accommodate special needs), cloths, sponges, and other items including stylets and high-pressure nozzles for water and air. Manual cleaning is so essential that it is even employed prior to automated cleaning. Manual cleaning is used when the decontamination area does not have ultrasonic cleaners or washer decontaminators. It is also used in cleaning delicate and complex instruments that cannot be processed mechanically. In addition to the above, powered equipments are equally manually cleaned to guide against fluid invasion. This method of cleaning surgical instrument is also cheaper since it does not involve the purchase of sophisticated machines, which may cost thousands of dollars. In this cleaning process, when done in the decontamination area, a three-sink methodology is usually ideal. Brushing should be done under water in a "to and fro” motion in the direction of the grain to prevent scratching the surface of the instruments and causing damage. Jointed instruments should be cleaned in the wide-opened position to allow cleaning of the box-lock and other difficult to clean areas. Multi-part instruments on the other hand should be disassembled for effective cleaning. Further more, manual cleaning is the cleaning of choice for instruments with deep serrations and crevices, curettes, and orthopedic surgical instruments, which can conceal gross soil like blood, bone, tissue and fat. Suction tubes with lumens, joints replacement cutting guids, rasps, reamers, and broaches require special attention and hence, must be cleaned with brushes as a first step. Despite all the advantages enumerated above, manual cleaning is laborious and energy sapping. There is also the risk of cross-contamination from one medical device to another when reusable cleaning brushes are used. The use of inappropriate brush size will not have complete contact with luminated devices, and will not thoroughly clean them. These circumstances will hinder proper disinfections or sterilization of surgical instruments. Automated/Mechanical Cleaning on the other hand is where machines such as the ultrasonic washers, washer decontaminators/disinfectors, cart washers and automatic endoscopes reprocessors are used to remove both visible and invisible soil from surgical instruments at the decontamination area of the Central Service Department. The automated machines require detergents, enzymes, multi-enzymes, and/or detergents to clean. Varied machines require different solutions in different proportions at different temperatures. Chemicals used should be low-foaming and easy rinsing. The mechanisms used by the machines vary depending on the process. The ultrasonic washer for instance creates vibrations that implode through a process called cavitation to clean even hard-to-reach areas. There are also the mechanical washers, which are effectively used to clean instrumentations, instrument containers, basins, bowls and pitchers. They range from single chamber to multi-chamber mechanical washers that work on the principle of impingement to effectively disinfect instruments through their thermal action and the enzymatic detergents they use. They rely on a combination of water temperature, special detergents and a spray force action to remove the soil from cracks, crevices and serrations on instruments. The cleaning of case cart, rigid containers, and other miscellaneous medical devices has been automated by the use of the cart washers. Many cart washers have special design features and washer racks to facilitate the processing of basins, pans, bedside commodes, and surgical stainless steel tables. Some automated washers have optical scanning systems that scan washer basket bar codes and then adjust the equipment for proper cleaning cycle. This helps reduce employee errors. Automated washers also have several inbuilt processing cycles, which include pre-wash, wash, lubrication, pre-rinse, final rinse, and drying. It also yields operational speed and efficiency. Added to the above, automated cleaning is superior to manual scrubbing because the cavitations action can reach small areas in the instruments that brushes cannot reach. Comparatively, automated cleaning of surgical instruments is superior to the manual cleaning because it is faster, more consistent, less laborious, and safer since the central service technicians are not directly exposed to the detergents and other chemicals in the chamber of the machine. However, automated cleaning can only be effective and achieve the desired results when the following conditions are met. First of all, the central processing technician must choose the correct cycle for the items being sterilized. Secondly, instruments must be properly loaded so that all surfaces are exposed. Also, trays must not be stacked on one another. Further more, the central service technician must remove all lids or covers from trays. Additionally, the central sterile technician must frequently check the level of the detergent and also follow the manufacturer’s recommendation. In conclusion, the emergence of advanced medical procedures and the ever-increasing complexity of surgical instrumentation present a challenge to Central Service Technicians to consistently satisfy the needs of their internal customers so they can best serve the patient. Processing of surgical instrumentation is an integral part of quality health service throughout the healthcare industry and a deficient Central Service department will defeat the ultimate goal of providing safe, satisfactory, and high quality patient care in any healthcare facility. Co-authored by: Josephine, Shateka, Kofi, Gina, Comfort, James, and Richard. Reference: 1.CRCST MANUAL (Seventh Edition) 2.LECTURE NOTES


MCS on Sunday, November 21, 2010 1:39 AM
Insightful, detailed and very impressive. Each group now has a final turn to constructively critique the presentation of the other. Both groups do have four weeks after your crcst certification to submit your write-ups.
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