Decontamination Requirements of any cleaning chemistry
include: lIt must include agents to decompose blood, serum and other sources of contamination.
l Any detergent must have good emulsifying and dispersing performance,
l The formula must be low-foaming and defoaming.
l It must provide good wetting performance of surfaces especially on hydrophobic materials.
l The detergent must be effective irrespective of water hardness and heavy metal cations.
l Product should be easy to rinse off without leaving any residue.
l Vitally, it should provide minimal risk for personnel, medical devices and the environment.
Critically, when formulating a new chemistry, especially an alkaline detergent whose function will be to decontaminate surgical instruments, the formula must be designed to provide material protection including corrosion inhibitors. Corrosion inhibitors are chemicals
introduced into a formula which are used to stop rusting and other types of corrosive activity on metals. They serve to protect sensitive surfaces such as anodised aluminium. Surfaces can become corroded through a variety of mechanical and chemical interactions e.g., through contact with softened water, where the ions electrolyte can lead to metal corrosion. Silicates and phosphates are typically used as corrosion inhibitors and work by forming a precipitate on the surface of the metal.
Other influencing factors Outside of detergents and materials used in their manufacture, there are other factors which have a huge influence on the successful reprocessing of surgical instruments. Arguably, the most important of these factors is water and the quality of the water being used in the sterile services department. Water molecules have polarity, electrostatic forces, which cause the water molecules to stick to one another. The surface tension and solvent properties of water are a result of these hydrogen bonds between molecules. Due to water’s molecular properties, it will hold its shape, which prevents ‘wetting’ of most surfaces. Normal ‘pure’ water tends to form as droplets on a surface demonstrating its strong surface tension properties. In the case of non-water- soluble materials, this inhibits the cleaning process, and it is therefore necessary to introduce a ‘surface active agent’ or
detergent to the water. Monitoring water quality is a key factor in the
overall effectiveness and reliability of processing surgical instruments. The quality of the water being used in sterile services departments is a vital consideration for the protection of the patients in terms of safety and infection control. Constituent parts of water can cause discolorations on washware and corrosion on surgical instruments and machines. Water that has a high chloride content leaves stainless steel instruments susceptible to pitting and other types of corrosive damage. This can be exacerbated when there is an increase in temperature, a decrease in pH, increased contact times, insufficient drying and a concentration of chloride from dry residues to instrument surfaces after evaporation. Many detergent and washer disinfector
manufacturers provide water analyses services to ensure that the water being used in the processing of surgical instruments is of a high quality. This will prevent downstream corrosion of instruments, as well as deposits. Application-related recommendations on water treatment in the industrial process itself and regarding program sequences in cleaning and disinfection processes always take into account the available water quality and the water quality stipulated in relevant guidelines or standards.
Surgical instruments or medical devices When considering processing more complex medical devices e.g., endoscopes, the ramifications of using an incompatible and ineffective detergent are serious, most importantly with regards to patient safety, but
“One of the things that attracted us to Versius was the ability to use robotic-assisted surgery across a number of specialities. That flexibility has engaged a whole range of clinicians and allowed a number of patients to benefit from this technology.”
Professor Joe Harrison,
Chief Executive, Milton Keynes University Hospital, NHS Foundation Trust
Go behind the theatre doors to hear directly from the teams working with Versius at Milton Keynes University Hospital.
April 2023 I
www.clinicalservicesjournal.com 57
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