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Q We were recently surveyed by The Joint Commission and cited for not performing the cavitation test on the ultrasonic cleaner. Our department has been utilizing a dyed protein pad in a plastic holder to verify the effectiveness of the ultrasonic washer; but the surveyor said this testing device only verifies the presence of the cleaning detergent and doesn’t monitor the presence of cavitation in the chamber bath. I read an article about using aluminum foil to assess the presence of cavitation in ultrasonic washers. We have tried the aluminum-foil-test method but found a lot of aluminum foil particles on the bottom of the machine and have discontinued using it because we felt that it was not safe. Our fear is that this procedure could lead to small, sharp, aluminum foil particles adhering to the ophthalmic instruments if they are not fully removed. I understand that AAMI standards require a test for cavitation and I want to do what is right, but to be honest I don’t understand the reason we have to run two different tests if the one I am using verifies the presence of detergent and passes the clean test. Can you suggest a different process for performing safe cavitation testing?
A AAMI SST79 2017 standards do specifically state that cavitation testing should be performed daily whenever the equipment is in use. There are commercial tests available for safely monitoring the presence of cavitation within the ultrasonic bath. (See figure 1.)
As you know there are four essential criteria for effective mechanical cleaning:
- Chemistry: Proper detergents and concentration must be utilized to break down and remove soil.
- Temperature: Temperature must be maintained at the required level to allow chemistry to perform effectively. If it is too high it can cause organic soils, such as blood, to coagulate, making them more challenging to remove.
- Mechanical action: The presence of agitation, friction or cavitation is necessary to remove soils from the devices that need to be cleaned.
- Time: Adequate cycle time must be achieved to allow all components of the cleaning process to perform effectively. It would be possible to have an adequate level of detergent, proper temperature and a required cycle time without the presence of cavitation, in which case the cleaning process would not be effective. A cavitaion test run alone in an ultrasonic bath with just water and no chemistry could pass, confirming there was adequate cavitation in the bath. Yet a cavitation bath absent of the other essential criteria would not be capable of verifying performance and cleaning capability of the process. Therefore it is necessary to test the ultrasonic performance for fulfillment in meeting all of the essential criteria of mechanical washing. This then may require the combination of more than one testing device. As an end user it is essential that you obtain validation documentation for cavitation testing devices.
Q I am the clinical manager in an ambulatory surgery center. We have some metal storage shelves with equipment in the OR hallway with reusable vinyl cart covers to protect the items on the shelves from dust and damage.The materials manager has now placed two suture carts in the hallway. Since the sutures are in boxes with plastic protection do those carts still need to be covered? I have not been able to find any relative information in, AORN or AAAHC documents. What are your thoughts on this?
A
You want to be certain that you are not violating any fire or safety codes relative to the obstruction of passage in corridors or hallways. Ideally, sterile and clean supplies and equipment should be stored in a restricted, clean, low-traffic and controlled environment. When open shelving is utilized, stored items need to be protected from damage or contamination. Cart covers can be used to enclose all sides. Solid containment devices, such as plastic covered bins, tote boxes and drawers can also provide protection of items stored on the shelves. When items are placed in such containment devices a cart cover may not be necessary. And if you are utilizing wired shelving units, be certain that the bottom shelf is solid. (See figure 2.)
Ray Taurasi
Ray Taurasi is Principal, Healthcare CS Solutions. His healthcare career spans over five decades as an Administrator, Educator, Technologist and Consultant. He is a member of AORN, SGNA, AAMI and a past president of IAHCSMM. Taurasi has been a faculty member of numerous colleges teaching in the divisions of business administration, nursing, and health sciences. He is the author of numerous articles and textbook chapters; he is a frequent speaker at national and international healthcare conferences.
Note to readers from Ray Taurasi - In 2021, my life’s career path will transition to one of new opportunities and adventures. As a result, after nearly 19 years and 225 CS Solution columns, this edition will be my last.
“All changes, even the most longed for, have their melancholy; for what we leave behind us is a part of ourselves; we must die to one life before we can enter another.”– Anatole France
I wish you and your loved ones a healthy and joyful holiday season and a beautiful New Year! God Speed, Ray
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