Global Processing

A necessary innovation
A proven efficacy

Jakarta - 23 / 09 / 2012

I. The Cleaning
A multi-step process that plays a major role in the
prevention of disease transmission.
Effective cleaning is the most important step in this
process, because devices must be clean before they can
be sterilized.
Cleaning also presents the greatest microbiological
hazard to personnel handling contaminated devices.
=> Importance of pre-treatment

Timing is everything
when it comes to decontamination
It is critical to start the decontamination process
immediately after the surgeon is finished with
the device
Blood and other debris can dry and coagulate on
the surfaces of surgical instruments very rapidly,
making cleaning more difficult

Recommended Practices for

Cleaning Surgical Instruments
AORN Recommended Practices Committee.
Please refer to recommendation n5.

Cleaning and decontamination should occur as soon as possible after

instruments and equipment are used. (PNDS:I70)
should occur as soon as possible after instruments and equipment are
used to prevent the formation of biofilm.
Preparation for decontamination of instruments should begin at the point
of use. (PNDS:I70;I98).

All instruments opened during a surgical procedure are considered

contaminated. Scrubbed persons may touch instruments without being
aware of it. Used instruments also may come in contact with other
instruments.

Action on biofilm
Biofilm is constituted of a matrix, named
glycocalyx, constituting protective carapace
for micro-organisms against attacks from
external medium.

Biofilm observed in S.E.M.* surface state

New Silicone
Tube

* Scanning Electron Microscope

New Silicone Tube

+ Biofilm

Aged Biofilm

Biofilm formation

Attachment

Colonization

Growth

Dispersal

Preventing & Eradicating Biofilm

Microbial biofilms are responsible for 65% of

treated infections in the developed world

Proper and thorough cleaning is critical to the

eradication of the biofilm

Some chronic biofilm-related diseases include

cystic fibrosis, endocarditis, otitis media,
prostatitis, chronic wounds

References
1.
Ryder MA. Catheter-related infections: its all about biofilm. Topics in advanced Practice Nursing
Journal 2005;5(3)
2.
Donlan RM. Biofilms and device-associated infections/ Emerg Infect Dis. Vol.7, N2. March/April
2001

Importance of chemistry

Surfactants, buffers, chelating agents, enzymes.

Improving cleaning capability of

water: Surfactants (tensides)

Removing of soil with water to which a surfactant was added.

Removal can be aided by a mechanical action such as brushing
and flushing.

Wetting effect

Water, without the wetting effect or with a poor wetting

effect, does not penetrate cracks properly.

Enzymatic activity
Enzyme + Substrate

Enzyme +

Hydrolyzed
substrate or
degradation
products

The enzyme is not consumed in the reaction.

Its action continues on the substrate as long as
environmental conditions are respected (temperature, pH)

Recommended Practices for Cleaning Surgical Instruments

Countries

References

Protocol

Remarks

Argentina

Esterilizacion Hospitalaria
Volumen 2 - 2005

Pre-soaking with an enzymatic

solution

Dry transportation

France

Guide des bonnes pratiques

dsinfection des des dispositifs
mdicaux 1997

Pre-treatment by wiping and

soaking into a detergent-disinfectant
solution (aldehyde-free)

Wet transportation
(dry if external CSSD)

Spain

Prevencion y control de la
infeccion nosomial SaludMadrid

Pre-treatment by wiping and

soaking into a detergent/disinfectant
solution

Dry transportation

UK

A guide to decontamination of
reusable surgical instruments 2003

Under normal circumstances,

it is not necessary to soak at
point of use

Reprocessing should
occur as soon as
possible

Germany

Instrument Preparation Working

Group (AKI) 9th edition - 2009

Detergent with disinfecting

properties is recommended in case
of wet disposal.

Disinfection properties
should be tested
under dirty conditions

USA

ANSI/AAMI ST-35

Pre-soaking with an enzymatic

solution

Dry transportation

Wet disposal
When the way to CSSD is long
In case the instruments are re-sorted and
theres a risk of injury
Taking staff protection into account, it is
recommended to use a combined disinfection
and cleaning solution for wet disposal

Dry disposal
As a rule, blood and proteins should not be
allowed to dry
Instruments must be reprocessed within 30
Risk of contamination is transferred to the
next step

Risk of cross-contamination ?