Chemicals Used For Cleaning

Manual Cleaning: Processes & Safety

Dr. Ashraf Abd Elkader El-Kelany
General Directorate, infection Prevention & Control
MOH - KSA
Jan-2014
Every cleaning process and cleaning agent must
help to render the medical device safe for
handling during subsequent processing steps.
CSSD Technicians commonly use several
cleaning agents, each of which is formulated for
a specific action: water, pre-soaks, detergents,
enzymes, enzymatic detergents, and descalers.
Cleaning Chemicals
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Jan-2014
Each agent has a specific purpose in processing
reusable supplies and equipment efficiently , and
each must be used according to the
manufacturer's instructions.
Cleaning Chemicals
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Jan-2014
There are different types
of enzymatic products.
Some can be used at the
point of use to
decontaminate and loosen
the soil on instruments,
and others are used in
manual or automatic
washing processes.
Enzymatic products
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Jan-2014
Enzymes are catalysts
that can accelerate the
speed of chemical
reactions without being
consumed by the
reaction or becoming
part of the products
formed.
Enzymatic products
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Jan-2014
Enzyme products contain protease enzymes that are
especially useful in removing proteins such as
dried-on blood.
The role of temperature is very important when
dealing with enzyme-based products. Temperatures
should not exceed 60C (140F) because the
enzymes become inactive.
Multienzymatic products contain protease, lipase,
and amylase.
Enzymatic products
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Jan-2014
The basic formulas of different detergents
contain emulsifiers and chelating agents:
Chelating agents have an ionic charge that
allows soils with the opposite charge to break
away and attach to the chelating agent.
An emulsifiers surround these particles to
prevent them from reattaching, and they also
help to break bonds that oils create to trap soils.
Detergents
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Jan-2014
When mixed with water, detergents enhance the
water's ability to remove soil. Detergents do not
kill microorganisms; however, germicidal
detergents have this capability.
Detergents take longer to clean if they are not
used in conjunction with multi-enzymes or
protease enzymes.
Detergents
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Jan-2014
Alkaline detergents (pH 10 -
11.5) are effective at removing
organic soils; however, they
can leave an alkaline residual
film.
High Alkaline pH detergents,
require less mechanical action
than their Neutral pH
counterparts to remove soils.
Alkaline detergents
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Jan-2014
When Alkaline detergents are used, an acidic
detergent (pH 3 - 4.5) wash should follow to
neutralize alkaline residues.
Alkaline detergents
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Jan-2014
Acidic detergents work well on inorganic soils,
neutralize alkaline residues, and make stainless
steel shine. However, use of improper
concentrations hinders effective cleaning, and
instruments may be damaged.
Some products should not be cleaned with high
acid detergents (e.g., colored anodized aluminum).
The use of neutral pH or moderately alkaline pH
detergents (pH 7 - 8.5) can prevent this problem.
Acidic detergents
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Jan-2014
Descalers are not typically required if the water
quality and soap / detergent mixtures are correct,
and if equipment is operating properly.
However, this is not always the case, and
problems can go unnoticed until a chalky-
powdery, hard-to-remove substance appears on
the walls of sinks and equipment, then a
specially formulated chemicals are needed to
remove these scales.
Descalers
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Jan-2014
Descalers are specifically
made to remove these
scales. A smaller quantities
of these specific products
will be needed than if
acidic detergents are used;
although, both are the
products of choice to
remove scales.
Descalers
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Jan-2014
Pre-soaking or pre-cleaning products are used in the
first step in the decontamination process.
Pre-cleaning process should begin immediately after
the procedure. Blood and other visible debris, if left
on an instrument, serve as a reservoir for microbial
growth, and may damage an instrument's finish
(corrosive agents in blood or debris penetrate the
protective outer layer of an instrument, and cause
rusting or pitting of the stainless steel).
Pre-soaking chemicals
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Jan-2014
The manufacturers' directions must be followed
when using pre-cleaning products, because
exceeding the time allowed for the instruments
to be exposed to these solutions can damage and
corrode them.
Pre-soaking or pre-cleaning products are
extremely helpful in reducing the time to remove
soil in the actual cleaning process.
Pre-soaking chemicals
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Jan-2014
Some commonly used
pre-cleaning agents are
plain water, detergent
solutions, enzymatic
detergents, and
combined enzymatic-
germicidal detergents.
Pre-soaking chemicals
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Jan-2014
Manual cleaning agents, when mixed
properly, make the water "wetter," and help it
to penetrate under the soil and break the
bonds that attach this soil to the instruments.
Chemicals Used For Manual
Cleaning
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Jan-2014
The effectiveness of the detergent can be
impacted by water hardness, temperature, and
the type and amount of soil to be removed.
Excessive amounts of detergents can be
difficult to rinse off, and will eventually begin
to deteriorate the instrument.
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Chemicals Used For Manual
Cleaning
Jan-2014
Manual cleaners should be low-foaming, and
free-rinsing.
The manufacturer's directions should be
followed concerning proper dilution according
to the quality of water being supplied, and the
recommended water temperature when using
the product for manual cleaning.
Chemicals Used For Manual
Cleaning
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Jan-2014
Mechanical cleaning processes (ultrasonic
washers, washer sterilizers, washer disinfectors,
cart washers, and automatic endoscopic
reprocessors), require the use of products such as
enzymatics, multi-enzymes, and detergents.
The written instructions of equipment's
manufacturer (not those of the solution's
manufacturer), must be strictly followed for the
recommended cleaning solutions.
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Chemicals Used For Mechanical
Cleaning
Jan-2014
If the wrong product is selected, possible damage
or premature replacement of equipment's
components may occur, and it may be impossible
to properly clean the equipment/instruments.
Chemicals that are used should be low-foaming,
and free-rinsing.
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Chemicals Used For Mechanical
Cleaning
Jan-2014
Water temperatures are usually controlled by the
machine. Sometimes fine adjustments are
required to closely follow temperatures
recommended for specific cleaning products.
As with any chemical, no matter what it is used
for, the manufacturer's directions must be well
understood and strictly followed. Failure to do
so can cause health hazards, injuries and/or
damages to the equipment / instruments.
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Chemicals Used For Mechanical
Cleaning
Jan-2014
Low-foaming.
Free-rinsing.
Non-abrasive.
Non-toxic & biodegradable.
Effective on all types of soil.
Have long shelf-life.
Cost-effective.
Can be monitored for effective concentration and
useful life.
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Effective Cleaning Agent
Jan-2014
The water temperatures used for cleaning
products are important for effective cleaning.
Some products are more effective in hot water
because molecules move more quickly.
Temperatures for hot water range from 120F
- 165F (48.9C 73.9C ).
General Recommendations For
Using Cleaning Chemicals
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Jan-2014
While the temperature of the tap water
coming into the sink can not be safely and
accurately increased, automated machines
have steam or electric coils to raise the
temperature to a pre-determined setting.
General Recommendations For
Using Cleaning Chemicals
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Jan-2014
Material Safety Data Sheets (MSDS) for these
products are required, and must be available for
CSSD Technicians to read and study.
Central Service Technicians working with
chemical solutions and exposed to blood and
body fluids must be protected, and even those
who are just in the area must still wear Personal
Protective Equipment (PPE).

Safety Precautions
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Jan-2014
Forearm-length heavy-duty gloves made
specifically for decontamination, a fluid-
impervious gown, mask, eye goggles or face
shield, and protective rubber shoes should be
used when performing cleaning duties including
pre-cleaning, cleaning, and loading automated
machines.
Safety Precautions
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Jan-2014
Safety Precautions
Personal Protective Equipment (PPE)
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Jan-2014
Never mix chemicals unless the product is a
catalyst or activator for another product that
requires mixing. Doing so can cause injury or even
death.
Always follow the manufacturer's dilution
instructions when mixing chemicals with water.
Problems associated with improper dilution range
from an irritated nose, throat or eyes, to nasal
bleeding, dizziness, chemical burns, and asphyxia.
Safety Precautions
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Cleaning and Decontamination
Methods & Processes
(Manual Cleaning: Process & Safety)
Jan-2014
The purpose of manual cleaning is to physically
remove deposits that were not removed, or were
only softened during the pre-soak. This is done
by use of friction.
The use of manual cleaning can produce good
removal of contamination, as the process can be
extended until the item is observed to be clean
(the item can be inspected throughout the
whole process).
Manual Cleaning
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Jan-2014
Manual cleaning may be done:
Prior to mechanical cleaning.
When the decontamination area does not have
washer disinfector or ultrasonic cleaner.
For delicate or complex instruments that cannot be
processed in mechanical equipment.
For instruments with lumens.
To clean powered equipment that cannot be
immersed in water.
Manual Cleaning
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Jan-2014
Wear appropriate PPEs
during manual cleaning.
Disassemble instruments
and items with multiple
parts.
Soak the instruments in the
cleaning solution.
General Recommendations For
Manual Cleaning
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Jan-2014
Always scrub or brush
instruments under the
water's surface to avoid
splashing and aerosol
generation.
All instruments should be
cleaned in a wide-open
position to allow cleaning
of hard-to-reach areas.
General Recommendations For
Manual Cleaning
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Jan-2014
Brush in the grooves, teeth,
and joints where organic
material can stick.
When cleaning aluminum
or stainless steel item, use a
"to and fro" motion in the
direction of the grain.
Flush lumens with an
adapted water jet.
General Recommendations For
Manual Cleaning
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Jan-2014
Rinse items thoroughly
with clean water to remove
all detergent. Any detergent
left on the items can reduce
the effectiveness of
subsequent processing step.
Inspect items to confirm
that they are clean.
General Recommendations For
Manual Cleaning
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Jan-2014
Allow items to air dry or
dry them with electric dryer
or with a clean towel if
chemical disinfection is
going to be used. This is to
avoid diluting the chemical
solutions used after
cleaning.
General Recommendations For
Manual Cleaning
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Jan-2014
Vertical soaking cylinders are required to soak
instruments with lumens so all surfaces will
come in contact with the cleaning solutions.
By contrast, when luminal instruments are
soaked horizontally, air bubbles will likely
become entrapped inside the lumens.
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General Recommendations For
Manual Cleaning
Jan-2014






A three-sink arrangement used for manual cleaning
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General Recommendations For
Manual Cleaning
Jan-2014
A wash sink with water and a detergent solution.
A second sink (intermediate rinse) that contains
plain or softened (de-ionized) water.
A third sink (final rinse) with softened (de-
ionized) / distilled water.
A three-sink technique helps to effectively rinse off
soils, to prevent instrument spotting, and to prevent
the re-deposit of minerals, microbes, and pyrogens.

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A three-sink arrangement used for manual
cleaning should consist of:
Jan-2014
Advantages:
Cheap !!!.
Cleaning items with complex structures.
Can deal with delicate instruments.
Cleaning items with narrow lumens
(endoscopes).
Inspection can occur throughout the process.
Manual Cleaning
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Jan-2014
Disadvantages:
Exposes CSSD staff to infectious agents on the
instruments.
Cannot be combined with a heat disinfection step
in the same process.
Cannot use harsh detergents.
Lacks routine quality assurance of the cleaning
process.

Manual Cleaning
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Jan-2014
Considering the need to clean lumens, the correct
brushes must always be used.
If the brush is too large, it will not fit into the
lumen. If the brush is too small, it will not have
proper contact with the lumen walls.
As well, the brush must be long enough to
extend through the whole length of the lumen.
Cleaning Brushes
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Jan-2014
Disposable Brushes should be discarded after use.
Reusable Brushes must be cleaned & disinfected
or sterilized at the end of the shift, or when heavily
soiled.
Rapid cleaning of brushes and other cleaning tools
eliminates and reduces number of microorganisms
that create biofilms.
Disposable and reusable brushes that are worn or
damaged should be discarded.
Cleaning Brushes
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