Introduction:
All medical or surgical instruments used for invasive procedures come in contact with sterile tissues or mucous membrane when used in patients. Breach in processes of cleaning, disinfection or sterilization of reusable instruments increase the risk of introduction and transmission of pathogenic microorganisms. For effective disinfection and sterilization, all articles must be freed from soil and organic matter. This is achieved by thorough cleaning of all instruments or devices. Cleaning is considered to be the most essential step in the instrument reprocessing cycle. Improper or inadequate cleaning decreases microbicidal action of chemicals and disinfectants on microorganisms.
Though the principles of cleaning remain the same methods of cleaning can vary. Cleaning can be achieved manually or mechanically, using water with detergents or enzymatic products, brushing or flushing, ultrasonic washer disinfector etc.
Removal of soil at the earliest after use of equipment’s not only reduces the microbial load but also reduces the risk of environment contamination and risk of infection to staff with pathogenic microbes. Cleaning can be enhanced by soaking the disassembled instruments in enzymatic solution. Usage of brushes when required (eg. instruments with lumen) must be done with utmost care to prevent generation of infective aerosols.
Factors affecting the cleaning process include volume and type of soil, quality of water used, the temperature of at which cleaning is done, availability of detergents or chemicals for cleaning and their appropriate use in correct dilution. Any detergent or chemical used for home or laundry are not suitable for cleaning of medical devices.
Effective cleaning can be achieved by rendering periodic training to all staff involved in the process of cleaning and decontamination. Staff must be aware of the policy and procedure for instrument cleaning, adhere to standard precaution at all times and follow the manufacturers’ instruction for cleaning. Selection of cleaning products must be done considering the nature of the product, its shelf life and must be cost effectiveness.
One must remember that devices and be leaned without sterilization but sterilization is cannot occur before an effective cleaning. Hence cleaning is to be considered as the first step in the process of reprocessing of devices.