DECONTAMINATION
The process challenge: it looks clean, but is it?
Pawel de Sternberg Stojalowski MSc, BSc, MBA presents a case study which demonstrates the value of using process challenge devices designed to simulate cleaning of heavily soiled instruments in automated washers.
In one of the latest online posts from Beyond Clean, they wrote: “The most difficult thing in our industry is to constantly question the status quo – even when others around us seem not to notice. All members of the patient care team must feel empowered to raise a concern and stop the line – regardless of how long the issue has been at play.” I thought about the cleaning of surgical instruments from this quote’s perspective, and realised that the problem is not only about raising concern and stopping the line but identifying that the problem is there in the first place. Process challenge devices (PCDs) for evaluation of cleaning processes are partially to blame because they promise to do part of the job for us. Wouldn’t it be nice to have a tool that tells you that your instruments are clean without rigorously inspecting every single instrument for contamination? A great idea indeed, but there is a caveat. All PCDs for cleaning evaluation aim to represent contamination on instruments – the question is how well do they do it and what is lost in translation?
Process assessment
Evaluating cleaning effectiveness isn’t easy. There are many aspects or variables of the process that affect it – shape, size and material of the instruments, type of contamination (well-dried blood vs fresh soil), type of pre-cleaning process,
Picture 1. VeriTest PCD containing VeriTest AW Tags with VeriTest Multi Basic block.
mechanics of the washer, temperature and concentration of the cleaning chemistry. PCDs, if we are to rely on them, must provide an adequate representation of the worst-case scenario. Following the ST79 guidance, the process challenge device for sterilisation should provide an equal or greater challenge than a most difficult
There are many aspects or variables of the process that affect it – shape, size and material of the instruments, type of contamination (well- dried blood vs fresh soil), type of pre-cleaning process, mechanics of the washer, temperature and concentration of the cleaning chemistry.
SEPTEMBER 2020
item routinely reprocessed – in short, a worst-case scenario. Same principles should apply to PCDs for evaluation of the cleaning process.
The absence of colour
The concept of reading PCDs was transplanted into the realm of cleaning from the field of sterilisation. In sterilisation, a colour change would indicate the process met its critical parameters, and in cleaning, we got used to verifying the effectiveness of the process by observing the removal of a substance from the token. While with chemical inks the removal of the colour might indicate the process was good enough to clean the substance from the surface, the situation is a lot more complicated when natural test soils are used. Especially those where the red colour of the soil, like in the case of blood, is generated by the presence of haemoglobin.
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