Infection Control Today

DEC 2018

ICT delivers to infection preventionists & their colleagues in the operating room, sterile processing/central sterile, environmental services & materials management, timely & relevant news, trends & information impacting the profession & the industry

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For the unabridged version of this article plus references, go to: 8 ICT December 2018 By Nancy Chobin SPD dialogue RN, AAS, ACSP, CSPM, CFER Q Q: I was preparing a manual cleaning detergent solution and was counseled that I did not dilute the detergent properly. I used a capful in the sink that was half full. Can you explain the importance of diluting detergents? A: I am glad you asked this question because proper use of chemicals relates to their use in any setting. I recall taking the sterile processing course 40 years ago and the instructor asked the students to bring in a clean washcloth from home. She had a large basin of water on the table and asked us, one by one, to place our wash cloths in the water, swish them around and see what happened. The water from everyone's washcloth (water was changed after each washcloth) was sudsy, some much more than others. She explained that we were using too much detergent which was costly and because of the excess detergent, the washcloths were not properly cleaned. That made a big impression on all the students, including me; however, when it comes to surgical instruments and devices, the end results can be much more detrimental. For good cleaning to occur we need three things: 1. Chemical action by the detergent 2. Mechanical action (friction by scrubbing or by mechanical washing) 3. Thermal action provided by the water temperature All three must be in proper balance for effective cleaning. This discussion will focus on the chemical action, which is the detergent. The temperature of the water can affect the chemical. Blood denatures and becomes highly insolvent above temps of 113 degrees F. If your detergent manufacturer (most enzyme detergents have a maximum water temperature recommendation), you should have a thermometer probe that can remain in the water to monitor the water temperature. Most detergents work best in a range of temperatures recommended by the manufacturer. Detergents are available in powdered, solid, and liquid form. To ensure the effi ciency of the detergent and to prevent residuals, it is imperative that the detergent be fully dissolved in the solution, which can sometimes be diffi cult to achieve with powdered or solid formulations. No matter which type of detergent is selected, the manufacturer's recommendations on concentration must be followed. Using more than is recommended could, in fact, decrease the effi ciency of the product and result in harmful residuals. In addition, damage could occur to the device if not cleaned properly. In general, detergents used in the decontamination process should be low-sudsing (should not produce a large amount of suds) and free-rinsing (capable of being removed easily during the rinsing process) to prevent residuals being left on sur faces, which can inter fere with subsequent disinfection or sterilization. Many devices are available to facilitate the dispensing of accurate amounts of detergents. These devices include, but are not necessarily limited to, the following: • A simple measuring cup • A manual pump that is inserted into and attached to the detergent container and that dispenses a specifi ed amount with each activation • Automated centralized pumping stations with proportioners that are connected directly to sinks or mechanical cleaning equipment. These proportioners are designed to accurately portion and control the mixing of solutions such as detergent and water. Some proportioners are equipped with a probe to monitor the water temperature. No matter which device is used for dispensing detergents, it is important that it be maintained appropriately. Measuring cups should be cleaned between uses. Manual pumps should be cleaned to prevent buildup of detergent at the dispensing spout; in addition, the amount of solution dispensed should be checked routinely to ensure that it has not changed. There should be a system in place to verify the accuracy of the proportioners used to measure and pump detergent automatically into manual clean-up sinks or mechanical washers. Detergent levels should be observed and monitored at least daily during each shift in the department. Other indicators of detergent problems associated with automatic dispensing equipment are changes in the appearance of instruments after cleaning, discoloration or spotting of equipment or instruments, and unusual odors associated with the instrumentation when it comes out of the washer. If you use a sink or basin to manually clean instruments, you need to ensure accurate dilution of the detergent in the water. To get the correct dilution, it is also necessary to know the volume of water being used. If a basin is being used for manual cleaning, how much water does it hold? How much water does the sink hold? It is recommended that an empty gallon jug be used to fi ll the basin or sink; the jug is fi lled with water and emptied into the basin or sink until the desired water level is reached (a sink is usually fi lled three-fourths full). For example, if the basin water line is at 2 gallons (7.6 liters) and the detergent manufacturer recommends 1 ounce (30 mL) of detergent per gallon, then 2 ounces (60 mL) of detergent should be added for optimum results. Newer manual cleaning sinks now have the various water levels etched into the sink to facilitate diluting detergents. There are various products such as adhesive backed labels to mark the water level however these must be replaced frequently. It is also advisable to post a sign in the area to remind staff: "Water level equals 6 gallons, use 6 ounces of detergent" or similar based on the level of water and recommended detergent amount. Nancy Chobin, RN, AAS, ACSP, CSPM, CFER, is a sterile processing consultant and educator. Detergents in the SPD: Do You Measure or Just Pour? Proportioner to dispense detergents

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