Washer testing; washer disinfector inspections

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Q Our corporate Supply Chain headquarters recently signed a partnership with a new group purchasing agency and we have been mandated to purchase only items that are on the contract to achieve fiscal cost savings goals. I don’t think that the products we are forced to use are always cost effective. The IFU for the washer test we now have to use requires us to test every level of the washer where as our previous test only required testing one shelf in the washer. The center shelf, by position, presents the greatest challenge to the washer, so if that shelf passes it seems to me all the shelves would pass. Of course a manufacturer would put testing each shelf in their IFU because they know we are required to follow their instructions and this would generate more profit for them. When I brought this to my manager’s attention she said the corporate standards committee selected the new test based on quality and overall value. I would appreciate your thoughts on this, which might help me wake these folks up.

A I am afraid that you are not going to like my answer as I respectfully have to disagree with you regarding your rationale for only wanting to test the center shelf of your washer. I believe that to get a full and accurate assessment of a washer’s performance it is absolutely necessary and advisable to test each level of the washer. The washer racks are very important pieces of equipment with movable parts and mechanisms that must perform precisely. Each level of the rack has spinner arms, excluding the top and bottom levels. Spinner arms attached to the bottom and top of the chamber deliver water and mechanical cleaning action to the top and bottom shelves while the spinner arms on the other rack levels perform the same function. The racks also have connections that align to water feed lines. Discrepancies in the performance of spinner arms and or water delivery on any level will impede the washers functioning and cleaning efficacy. The washer’s performance therefore could differ on any level; testing just one level does not provide an adequate or true assessment of the washer’s overall performance. It sounds like the decision to switch washer testing devices was the consensus of a committee that evaluated the product based on its features, advantages, and quality assurance benefits and not merely pricing.

Q We are conducting daily testing of our instrument washers. The test is conducted at the start of the morning shift. The test is just placed in the washer without any preliminary inspection of the machine. In my previous job each day the shift supervisor was responsible to perform a physical inspection of each machine before a tech would run the performance test. I never knew what the supervisor was looking for but it seemed important and like a good idea. Are physical inspections necessary and if so what should be included in an inspection?

A To maximize the efficient performance of processing equipment, such as washer disinfectors, it is very important to conduct regular inspections of the equipment and its parts. It is also very important to remember that the washer racks are also pieces of processing equipment and need to be carefully maintained and inspected prior to use.

Below is a listing of some of the key points that should be a part of the routine inspection of washer disinfectors.

• Spray nozzles are free from any debris or occlusions: Visually inspect all spray nozzles on the washer racks and in the washer chamber. If any of the nozzle holes are occluded, the water flow and pressure can be impeded, adversely affecting the washer’s performance. The washer water is re-circulated during the cycle and it carries soiled matter with it which may get lodged in the spray arms. The spray arms need to be cleaned regularly.
• Holes in the spray arms are directed at the target surface: Some washers have spray arms that may become loose during use and turn causing the spray to be misdirected from the instruments. Most spray arms have holes on two sides; the holes should be directed straight up and down.
• All spray arms are present: As strange as this may sound, I can’t tell you how many hospitals I have gone into and have found spray arms completely missing and yet the machines are still being used. If a spray arm is missing the washer cannot function properly as the water pressure and distribution will be greatly diminished affecting mechanical cleaning action. The washer should not be utilized if a spray arm is missing. I have often found the missing spray arms in the instrument orphanage for unidentified surgical instruments.
• Spray arms spin freely: Test spray arms to be certain that they spin smoothly and evenly.
• Drain screens at bottom of washer are free of debris: The drain screens at the bottom of the washer chamber capture debris from the sets. The screens need to be removed and cleaned at least daily or more frequently depending on use. Clogged screens can impede water flow and drainage which will affect the washer’s cleaning efficacy.
• Instrument rack coupling aligns properly with manifold: Be certain that the washer water/solution supply inlets align properly with the washer rack manifold. If misaligned, water flow, distribution and pressure will be affected and will not allow the washer to function properly. Inadequate water pressure will prevent the spinner arms from moving properly. Also, inadequate water pressure diminishes the mechanical cleaning action.
• Spray arm bushings are present and not damaged : Be certain that all bushings, couplers, washers and the like are present and free of any cracks or damage.
• Detergent/chemistry delivery lines are clear and functional: Visually inspect all detergent and other chemistry delivery lines and connection ports: Be certain they are clear, clean, and free of any occlusions, air entrapment and kinks. Also inspect tubing for any signs of wear, breaks or leaks. If there are defects in the delivery lines, cleaning agents and proper concentration levels may not be administered and the wash cycle will be ineffective.
• Check all chemical, detergent levels are adequate: Be certain that all detergents and other chemical containers are at adequate supply levels and confirm that the delivery dispensing lines are properly connected to the correct container.
• Observe overall condition of washer: Internal chamber walls and surfaces should be clean and free of stains, scaling and any other signs of soil build up. These are signs of problems that may affect the efficacy of the washer’s performance and cleaning outcome. Stains and scaling may be indicative of problems such as water quality, excessive chemistry concentrations and the like. Be certain that any applicable gaskets, seals, recorders are in order and proper condition.
• Verify that the chamber light is working: Washers have windows and internal lights to allow you to observe their performance during the cycle. During the cycle you should observe that spin arms are moving as they should, that no instruments or trays are interfering with the washer’s performance. Observe for water flow and that there are no signs of over-sudsing, etc.