Archive Infection Control 2017

Lessons in Lumened Instrument Cleaning

Follow these tips to ensure reprocessing's critical first step is performed correctly each and every time.

Donna Swenson, BS, CRCST, CHL, ACE


cleaning of flexible endoscopes INSIDE JOB The manual cleaning of flexible endoscopes requires the correct style and size of brush to remove bioburden from internal channels.

Lumened instruments are notoriously difficult to clean and can pose a major patient safety risk if their channels and surfaces aren't properly flushed and brushed between uses. The alarming truth: Improperly cleaned instruments can't be disinfected or sterilized, and mistakes continue to be made during this important first step in proper instrument reprocessing. (Exhibit A: The recent carbapenem-resistant Enterobacteriaceae [CRE] outbreaks at several facilities across the country that were linked to improperly cleaned duodenoscopes). That's why even the most dedicated techs in central sterile need regular reminders about proper manual cleaning protocols. Here are some key points to emphasize.

1. Start at the bedside
Cleaning at the point-of-use helps remove gross debris and flushes lumens before instruments arrive at central sterile. Keeping instruments moist immediately after use basically ensures that blood, tissue and other bodily fluid doesn't dry on surfaces and in channels to make manual cleaning even more difficult. It can also help keep instruments in better shape by reducing the amount of corrosion and pitting that bodily fluid can cause. Cleaning at the bedside is a step that's often overlooked, because facilities place an emphasis on turning over rooms quickly instead of making pre-cleaning a priority.

Here's how to do it correctly: After instruments are used in the OR or procedure room, wipe them down with a moistened towel or sponge to remove gross soil. Lumens should be flushed using a syringe and an enzymatic detergent, which starts breaking down bioburden. Enzymatic solutions are considered best practice, although flushing with water is also acceptable. The instruments should be kept either under a moist towel or soaked in a neutral pH enzyme detergent until they're brought to sterile processing.

New gel and foaming enzymatic detergents are specifically designed to make pre-cleaning even simpler by keeping instruments moist without having to fill a basin for soaking. These options form protective barriers that keep instruments wet for longer periods of time. Special transport sacks are also available to keep instruments moist after use and are especially helpful in busy sterile processing departments where techs might not be able to clean lumened devices as soon as they arrive.

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