Lubricating ortho sets; testing cart washers; flushing scopes with alcohol

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Q I recently attended our local IAHCSMM chapter’s summer fest and educational work shop. At the network round table discussion there was a debate regarding using lubricants on orthopedic instrument sets. There seemed to be many folks that felt that lubricants are not to be used on implants and other orthopedic devices. At my hospital we have a lubrication phase on each cycle we run. We just can’t be switching back and forth. I fail to see this as a problem as there is no visual sign or feel of lubricant on any instruments, and we have had no problems or complaints. I have been in this job for over 25 years and it seems we just keep creating more confusion and unnecessary steps into the reprocessing procedures. Can you please settle this for me? Is lubrication of orthopedic instruments a no-no? If this is something we shouldn’t be doing could you please provide the reason and the source of the mandate?

A There are some medical devices such as implants and other surgical instruments that should not be lubricated. As you know, manufacturers must provide instructions for the care, handling and use of their products. There is no one rule or standard that applies to all orthopedic devices and/or implants and the manufacturer’s instructions for use (IFU) might vary from type of device and the specific manufacturer. As the end user, it is your responsibility to obtain and follow the device manufacturer’s IFUs. I would also consult your washer manufacture regarding cycle programing and options. Many washers can add a no-lubrication option to a cycle setting.

Q I have started a new job and was very surprised to see that on heavy surgery schedule days the cart washer is used to wash full sets of instruments. I have never seen this done in any of the hospitals I have previously worked in. This cart washer has a special instrument washing rack (cart) and a specific cycle to wash instruments. This washer seems to do a good job cleaning instruments and it surely speeds up the work as several large sets can be processed at one time. My question concerns the need to conduct some sort of monitoring of this process. We do testing of our washer disinfectors every day to be sure they are working effectively to clean surgical instruments. Shouldn’t there be some testing done to be sure the cart washer is working correctly to clean instruments? If so, could we use the same test that we use on our instrument washer?

A You raise a very good question. AAMI standards do state that mechanical cleaning equipment should be tested upon installation, weekly (preferably daily) during routine use, and after major repairs. Mechanical cleaning equipment includes any mechanical equipment used for cleaning — instrument washers, ultra-sonic washers, cart washes, automatic endoscope reprocessors (AER) and any other type of washer used for cleaning medical devices. The answer to your question is yes. The cart washer should also be tested weekly, preferably daily, along with all of the aforementioned equipment. The cart washer performs quite differently than your instrument washer. The vehicle wash cycle and instrument wash cycles perform differently and utilize an accessory apparatus. So you might need to do different testing for each of these programs, which might involve a specific testing device or process. You also may be able to use the same testing device in the cart wash instrument cycle that you use on your instrument washer. However, the number of and placement of the testing devices might be quite different than how you would use them in your instrument washer. There are cleaning verification devices available on the market which can and should be used with cart washers. There is one test that’s specific to the vehicle wash cycle of a cart wash which can be used in conjunction with an instrument washer test when running an instrument cycle in the cart washer. Keep in mind that the placement and number of tests that would be run in the cart washer may be quite different than how the device is used in your standard instrument washer. I have only encountered one manufacturer that has testing devices for all cart washer cycles and applications. It is therefore important that you not attempt to use just any washer test in your cart washer. You must consult the testing device manufacturer for appropriate use of their testing device and it’s applicability in a cart washer.

Q Following cleaning and prior to hanging endoscopes in the storage closet, they are all flushed with alcohol to disinfect the channels. If we were to repeat this process daily would that not prevent potential growth and eliminate hang time concerns?

A The purpose of the alcohol flush following scope processing is to help facilitate the complete drying of the scope channels. The alcohol flush is not a disinfection process. As you know the disinfection process occurs post-cleaning either by manual soaking in a disinfectant bath or disinfection in an AER. Disinfectants are then thoroughly rinsed from the scope and its channels with pure water. The alcohol flush through the channel helps any remaining water evaporate. Entrapped water can provided a source for microbial growth and contamination.