INFECTION PREVENTION & CONTROL
further pressure loss. The push-in type adaptors that almost every washer disinfector uses for minimally invasive instruments often lose pressure, or are left open with no instruments connected to them.
In all of those scenarios, the outcome will be affected. Given the number of possible loading patterns, it becomes difficult to identify the worst-case scenario. A good starting point would be an instrument rack with all connections in use, and it is critical that it is evaluated for this worst-case scenario during validation.
Loading the instruments – making every cycle unique
Every time a new set of instruments is loaded to the washer, we create a unique challenge for the washer. Instruments and instrument baskets become a part of the complex
system of cleaning mechanics. They introduce surfaces of which water jets get deflected from and create obstructions that prevent water from reaching all surfaces of different instruments – the shadowing effect. On top of that, instruments become a part of the thermal mass that gets heated up together with water affecting the time of the process. Each cycle, therefore, becomes unique.
Conclusions
Sinner’s Circle identifies mechanics as one of the core variables in a cleaning process alongside chemicals, temperature and time. However, mechanics in case of automated processes should not be seen as a black box but through the perspective of technologies involved. Only then we will be able to truly control an open-loop system where so many aspects come into play. When we consider the case of a blindfolded technician that had to clean complex lumen instruments we have to again focus on the critical variables to form a worst-case scenario – the worst type of soil, difficult to clean instruments, heavy loading. This needs to be applied having the mechanics of cleaning we inherit from the washer-disinfector design in mind. Once optimised, the performance qualification would allow us to develop a regime that delivers a desired cleaning performance – we would have created a parametric release of the cleaning process. CSJ
About the author
Pawel de Sternberg Stojalowski, founder and managing director at Aseptium, is an R&D engineer with a background in mechanical engineering, automation, robotics and business stem innovations, interdisciplinary and cooperative approach to projects. He has been involved in R&D of equipment and technologies for decontamination and sterilisation of complex surgical instruments since 2007. Pawel has a focus and drive to impact the global problem of hospital-acquired Infections. He leads an expert team researching, designing, prototyping and evaluating solutions aimed at solving challenges in decontamination of complex surgical instruments, contamination detection and identification - as well as fluid dynamics and ultrasonic waves in washers.
SEPTEMBER 2019
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