Cover story - advertising feature
Selecting the right sonic for your CSSD
Andreia Messias, international marketing manager at STERIS, provides an insight into ultrasonic cleaning and how to select the right sonic solution to ensure the optimum results.
Advancements in surgical instruments have dramatically improved patient outcomes. However, the intricate device designs required to achieve these advancements make manual cleaning challenging and labour intensive, creating potential bottlenecks. Cleaning is the most important step in reprocessing a medical device, and without adequate cleaning, disinfection and sterilisation can’t be performed effectively. Ultrasonic cleaners/sonic irrigators are an important tool to help your CSSD keep pace with reprocessing these more intricate devices, as well as following the manufacturer’s Instructions For Use (IFUs) to support procedures in the Operating Theatre.
How does ultrasonic cleaning work? The ultrasonic cleaning process uses mechanical vibrations to agitate a water and detergent solution to aid in the removal of soil from surfaces, and depending on the model of ultrasonic washer, inside lumens of surgical devices. The sound waves in the liquid produce microscopic implosions of bubbles that collapse on contact with surfaces, creating a vacuum-like scrubbing action dislodging soil from surfaces; this effect is called cavitation. Cavitation removes bioburden from the surface of items submerged in the chamber. Ultrasonic cleaning systems, like the InnoWave™
Ultrasonic Cleaners from STERIS, provide effective cleaning using a combination of three parameters: l Cavitation l Flow/Sonic Irrigation l Detergents
The right combination of these parameters provides an efficient cleaning system for delicate and difficult-to-clean medical devices such as Minimally Invasive Surgical (MIS) instruments,
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laparoscopic devices and robotic surgical attachments. Ultrasonic cleaning is particularly useful in hard-to-reach areas on a device such as fine serrations or box lock joints, but it is also gentle – and effective – on delicate instruments including microsurgical and ophthalmology devices.
Cavitation and ultrasonic cleaners The efficacy of the cavitation process is dependent on the design of the ultrasonic system, ultrasonic frequency (measured in kilohertz, kHz) and power density. It is important to align the frequency and power density in an ultrasonic with your device inventory by checking with your most common device IFUs. How the cavitation bubbles are generated is also important. For example, older technology uses metal transducers to generate the sound waves while some newer designs use ceramic transducers that are gentler on devices. Some systems mount the transducers to the bottom of the tank which is effective at removing soil on a one or possibly two layers of instrument trays. Since the ultrasonic waves are coming up from the bottom, the cavitation will be more effective on the instrument surfaces placed on the most immediate tray that the ultrasound waves encounter. If multiple trays are stacked, trays on the second or third level will not be exposed to the ultrasonic energy. Some large ultrasonic cleaners however, mount transducers to the sides of the tank, allowing multiple layers of trays to be cleaned effectively.
Sonic irrigation, pressurised flow and rinsing Some ultrasonic cleaners provide sonic irrigation, which is useful for devices with small channels. Sonic irrigation uses a sonically charged flow of solution to create cavitation inside the channel
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and dislodge and flush soils through a device, providing more efficient cleaning of internal channels of lumened or cannulated devices, while the use of pressurised flow can provide additional mechanical cleaning. When sonic irrigation is combined with cavitation the lumen of the device gets the benefit of ultrasonic cavitation. Some cleaning validations for specific complex
surgical instruments require a minimal pressure for the flow, which also becomes a key parameter to ensure bioburden is removed from channels within instruments. The combination of pressurised flow and ultrasonic cavitation results in a highly efficient method to ensure detailed and complex instruments are reprocessed effectively on both the exterior and interior of the devices processed. Some sonics also have spray nozzles to provide rinsing capability, known as deluge wash, to help reduce soil redeposition.
Cleaning chemistries for ultrasonic cleaning Choosing a cleaning chemistry is an important component of the ultrasonic cleaning process. These detergent-based products should provide cleaning, be effective over a range of different water qualities, not harm the device while simultaneously protecting the device from the damaging effects of water, be easy to rinse and be compatible with the ultrasonic cleaning system. An inappropriate detergent could generate excess foam during the ultrasonic process or not facilitate proper cavitation. Consider using a chemistry that’s formulated and designed for ultrasonic cleaning and instrument protection.
Benefits of ultrasonic cleaning Many devices in the surgical environment today are intricate, delicate and complex in design.
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