This series of self-study lessons on Central Service topics was developed by the International Association of Healthcare Central Service Materiel Management (IAHCSMM). The lessons are administered by Purdue University’s Continuing Education Division.
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Managers and staff members in busy Central Service departments recognize the importance of proper cleaning and preventive maintenance tasks for processing equipment. However, these responsibilities may be de-emphasized in an environment of trying to accomplish more with fewer resources. For example, it is easy to believe there is no time to shut down equipment to clean sterilizer chambers or to de-scale washers when, seemingly, all human and equipment resources are needed to prepare surgical trays for reuse.
Still, an effective cleaning process takes less time when it is done regularly by incorporating it into normal departmental routines. Regular cleaning also reduces the need to retain the services of outside contractors to clean equipment for which on-going cleaning has been ignored.
Objective 1 – Discuss the need to properly clean sterilizers and washers
Most sterilizer chambers require cleaning because, left unclean, the sterilization process may be impeded, causing wet packs to form. As well, the soil from chamber walls can be transferred to the outside and, in some cases, into the inner folds and liners of instrument trays.
The manufacturers’ cleaning recommendations must always be followed, and daily or weekly cleaning is typically suggested. To do so, turn off the sterilizer and allow it to cool, if necessary. Central Service technicians should use lint-free cloths and the recommended cleaning solutions. Never use any abrasives including de-scaling chemicals and cleansers in the sterilizer’s chamber. After cleaning, the chamber should be flushed with water in the amount specified by the manufacturer, and the unit should be rinsed and checked for cleanliness. If a chemical residue remains, it should be re-cleaned or rinsed. Door gaskets should be wiped clean daily and, if the sterilizer has a chamber drain, it should be flushed.
The sterilizer’s exterior should be cleaned including under and/or in back of the unit since dust accumulation can affect the sterilizer’s operation by clogging valves, drains, and other components. Note: dust accumulations can also contaminate newly sterilized items and the processing environment.
Washer-decontaminators also require regular cleaning according to the manufacturers’ recommendations. Chambers should be de-scaled whenever white film is present, and inner chambers should be wiped down regularly using a clean lint-free cloth. The sonic chambers of tunnel washers should be drained prior to cleaning, and external surfaces should be cleaned at least weekly. Again, remember to clean under and/or behind the equipment.
Conveyors, loading stations, and transport carts should also be cleaned regularly to avoid microbial growth in drainage areas. As well, gross soil should be removed immediately.
Objective 2 – Explain the need for effective equipment maintenance
Most individuals who purchase a new car assure that scheduled oil changes and maintenance checks are done in a timely manner to maintain the warranty and keep the car running at optimal performance. Likewise, routine preventive maintenance of Central Service processing equipment is also important. When properly maintained, processing equipment can often operate effectively for many years with little down time.
Without proper maintenance, however, white scale can form in the washing and drying chambers of washer-decontaminators and impede the effectiveness of the cleaning process. This scale can chip off of chamber walls onto the instruments and clog the unit’s spray arms. It may also be pulled into one or more of the machine’s pumps and cause them to malfunction. In both cases, the items being processed will need to be reprocessed causing even more work for department personnel.
While the term “maintenance” usually makes Central Service personnel think about their facility’s Biomedical or Clinical Engineering departments, the task should be a collaborative effort between these departments and qualified service technicians and Central Service employees. Required maintenance takes only a few minutes a day per machine, and this time will extend the life and effectiveness of the equipment and result in less work and frustration.
Objective 3: Review routine maintenance protocols for sterilizers
ANSI/AAMI ST79 20061 emphasizes the importance of sterilizer maintenance. If your sterilizer uses a printer with a paper and ink roll, it should be checked at least daily, and graphs and graph pens should be inspected daily when the new graph is inserted into the unit. Printers should be monitored to assure proper operation of the sterilizer throughout the day.
Printer keyboards should be cleaned regularly to keep them in top operating condition and to minimize the dust levels in the Central Service department.
Sterilizer gauges, traps, and drains should be inspected according to a predetermined schedule. Central Service technicians should be aware of these items and provide the “first” set of eyes as they undertake daily checks to reduce the possibility of major malfunctions. Leaky steam traps and malfunctioning gauges and clogged drains should be reported and repaired before a major breakdown, flood, or leak can occur. Insulation jackets should be checked on a regular basis to ensure they are intact because worn or torn insulation hinders the unit’s efficiency.
Carriages and carts should be inspected daily and removed from service for repair if any defects are noted. Note: common problems include broken wheels and dented or damaged shelves.
Each basic type of sterilizer requires specific maintenance efforts. While manufacturers’ recommendations should always be followed, examples of these maintenance tasks include:
Bowie Dick and biological testing, while not part of a formal preventive maintenance program, can still be considered part of the daily maintenance cycle because these tests can provide early or real time identification of potential sterilizer trouble. All adverse readings should be carefully investigated to identify and correct the reason for test failure.
All sterilizer manufacturers recommend routine preventive maintenance checks by qualified service specialists. Annual, semi-annual, and quarterly inspections are necessary to extend the life of the equipment and to help ensure that the equipment runs properly every day.
Objective 4 – Describe routine maintenance protocols for washer-decontaminators
Washer-decontaminators will last many years if they are properly maintained. As with sterilizers, all manufacturers of washer-decontaminators recommend routine preventive maintenance checks performed by qualified service specialists. These inspections, whether based on cycle count or scheduled on an annual, semi-annual, or quarterly basis, are essential to the life of the equipment and help to ensure that the equipment operates properly for every cycle.
Preventive maintenance procedures do not typically differ for tunnel washer-decontaminators or their single chamber counterparts. Protocols include:
Efficacy testing should be done at least weekly to ensure proper cleaning and operation. Commercially-prepared products can be used to test the cleaning ability of washer-decontaminators. As noted above in our discussion of biological indicators for sterilizers, these tests can provide an early warning that the equipment needs attention.
Sterilizers and washers are expensive and essential life safety equipment that, if properly cleaned and maintained, will last many years with minimal down time. These tasks are not difficult, and they should be among the responsibilities of Central Service managers and technicians in all healthcare facilities.
1. Association for the Advancement of Medical Instrumentation. Comprehensive guide to steam sterilization and sterility assurance in health care facilities. ANSI/AAMI ST79. 2006.
Scott Davis, CMRP, CRCST, CHMMC
Susan Klacik, ACE, CHL, CRCST, FCS
Patti Koncur, CRCST, CHMMC, ACE
Natalie Lind, CRCST, CHL
David Narance, RN, CRCST
Carol Petro, CRCST, RN, BSN
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