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refer to the manufacturers’ instructions for use (IFU).
Quality of air for medical device drying
Staff in SPD and endoscopy use a combi- nation of tools to dry devices. Non-linting towels quickly absorb surface moisture. Air nozzles supply forced air to hard-to- access areas, lumens and channels. Drying cabinets enhance drying of surfaces and lumens by directing warmed air to and through devices. Independent air pumps flow air through long lumens, such as endoscope channels.
Having good quality air available for
medical device drying is vital for safe reprocessing in SPD and GI departments. Healthcare facilities often use instrument air and/or hih e ciency particulate air (HEPA) to assist in the drying process. Instrument air is sometimes mistaken for medical-grade air. Medical-grade air (respired) is administered to patients and/ or used for calibrating powered ventilator equipment, whereas instrument air is a medical gas that falls under the general reuirements for medical gases as defi ned by the National Fire Protection Association, NFPA 99: Health Care Facilities Code. It is compliant with the American National Standards Institute and International Soci- ety of Automation ANSI/ISA 7.0.01, which recommends air fi ltered to . microns free of liquids and hydrocarbon vapors, and dry to a dew point of -40°C (-40°F) as the quality standard for instrument air. SPD leadership should work with facilities to ensure that the air supplied meets these requirements. This requires specialized equipment or gas cylinders to deliver the appropriate air. In addition to its quality, the placement of instrument air tools helps optimize its use by SD staff during reprocessing. Specifi - cally, instrument air should be available in the decontamination area to help loosen/ remove debris from surgical devices, such as lumens and drills, and in the prep and assembly area to remove residual moisture on inner and outer device surfaces when needed.
There are also growing numbers of SPDs and GI departments using HEPA- fi ltered drying cabinets with or without automated flushing pumps/channel purge components, on manually cleaned, disinfected or liquid chemical sterilized heat-sensitive devices, such as flexible endoscopes, cystoscopes, bronchoscopes,
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cameras, light cords and drills. In GI areas, the cabinets are used to enhance drying and protect endoscopes from environ- mental contamination during storage. In SPDs, the transfer cabinets are used to dry devices before packaging for sterilization. -fi ltered enclosed drying cabinets can remove up to 99.97% of particulates from the air. In addition, a recent study conducted by Perumpail et al. (2019) found that using a -fi ltered drying cabinet helped to speed up endoscope drying and reduced the risk of microbial growth.
Drying instructions
It’s critical to follow each manufacturer’s drying instructions to prevent retained moisture and device damage. Manufac- turers are required to conduct thorough testing and validation to assure that each device’s reprocessing IFU will successfully achieve a safe, reusable device for patient use when all instructions are followed. Instructions may be unique to a particular device, so they may state different dry- ing times, or may specifically require forced fi ltered air to remove moisture for example. Reprocessing staff must know which drying process to use for each device they process. In addition, a manufacturer’s IFU may provide several methods for drying a particular device. Managers can deter- mine which methods are best for their departments. Regardless of the method used facilities can perform verifi cations of the drying process. opular verifi cation methods include: • Visualization of internal lumens with a borescope (see Figure 1)
• Surface, internal lumen and box lock checks with moisture-sensitive indicator papers (Ofstead et al.)
SPD and endoscopy teams should also
review the manufacturer’s IFU for all the automated disinfection and steriliza-
tion equipment in the department. These systems are also classified as medical devices, so their IFU are thoroughly tested and validated and are, therefore, equally as important to follow in order to assure disinfection or sterilization.
Gas and vapor sterilization methods
often include warnings and precautions about wet devices. IFU of some automated endoscope reprocessors (AERs) or liquid chemical sterilant processing systems state to use processed devices immediately after processing or to dry them according to the device manufacturer’s IFU. ANSI/AAMI ST58, which provides recommendations for HLD and chemical sterilization, states in Section 6.6.6 that all devices should be dried in accordance with their IFU, to remove residual liquids. It’s also important to follow any IFU
specifi cations for pressure air type humid- ity level and temperature. Ensuring that the pounds per square inch (PSI) is regulated and within a device’s safe range will help prevent damage. Also, if a drying cabinet is used, its temperature must be set to a safe level according to the medical device’s IFU. Higher temperatures can damage some heat-sensitive components and adhesives.
Where drying takes place In SPD, drying happens at several points along a surgical device’s journey. By under- standing the whole process, leadership can better supply the drying resources needed at each point. Items begin their journey at the decon-
tamination sink. Items are cleaned and rinsed, then they either move on to the washer-disinfector or the pass-through window. At this point, technicians can remove residual moisture before loading them into the automated washer. Residual moisture can be blown from lumens, box locks and other surfaces.
Figure 1: Borescope insertion for visualization of residual moisture within an endoscope channel
Machine-washed devices must be thor- oughly dried before they are assembled into sets for HLD or steril- ization. Lint-free tow- els and instrument air should be used to remove all residual moisture. Some facilities will also use a drying cabinet to enhance the drying process. Pass-through cabinets are often used to allow access to the dried devices on the clean side.
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hpnonline.com • HEALTHCARE PURCHASING NEWS • September 2020 41
Self-Study Test Answers: 1. C, 2. B, 3. A, 4. A, 5. D, 6. C, 7. B, 8. D, 9. D, 10. C
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