June 20, 2013


Until the Water Runs Clear? Really? That’s it? 

The other day, I was reading through a Reprocessing Instructions Manual explaining how to properly clean, disinfect, and sterilize a certain kind of laparoscopic instrument.  I know, I know, you wish your life was as exciting as mine. Anyways, as I was reading, I came across this phrase under the “Flush” step of cleaning (the step in which the inside of the instrument’s flush port is rinsed with pressurized water): “Continue flushing until all water exiting the instrument is clear”. After that sentence, the “Flush” was complete, and the worker was supposed to move on to the next step. Does that worry you at all? Maybe not yet. Let me try to explain why that simple sentence made me feel sick to my stomach.

Let’s Compare: Lasagna vs. Bioburden

Have you ever had to wash the dishes after a lasagna dinner (I swear this is relevant, I’m not just craving some Italian)? If you have, then you know what a pain in the you-know-what it is. Lasagna sticks. The tomato sauce, noodles, and cheese form a gooey paste that sticks to the pan and the prongs of your fork. It sticks kind of like the way blood and bacteria sticks to surgical instruments.

If, when washing that sticky pan, I spray it until I think the water “runs clear”, I’m going to end up with leftover residue that will harden to the pan and make my future dishes taste like stale lasagna. And that’s all I could picture when I read those Reprocessing Instructions. Except, instead of lasagna residue on a pan, it’d be blood and bioburden caked onto the inside of a laparoscopic instrument. And, instead of lasagna residue mixing into my future meals, it would be bacteria mixing into someone else’s blood in future surgeries. And that’s why I felt sick to my stomach.

What’s my Point?

Obviously, there are quite a few major differences between washing a lasagna pan and cleaning surgical instruments. The lasagna image is a metaphor, not a literal comparison. So don’t panic, I’m not trying to tell you that since my lasagna pans are a pain to get clean, your SPD (Sterile Processing Department) is a mess as well.

My point is just to help you visualize what could happen if a clean vs. unclean judgment is made based on human observation. Flush the inside of the instrument or the surface of a pan until the water looks clear to me? What if my glasses are smudged, so I can’t see that clearly? What if I’m tired, so I’m not paying as close attention as I should be? Thankfully, if my lasagna pan isn’t actually clean, cheese and tomato sauce is easy to spot and scrub away. And a clean lasagna pan isn’t a life or death situation.

But SPD workers can’t see the inside of the laparoscopic instruments they are cleaning to spot blood and tissue residue. And the cleanliness of a surgical instrument IS a life or death situation. So is flushing an instrument “until the water runs clear” really the best we can come up with?

If you think there should be a better way, you’re not alone. Take a look at the surgical washers on our website, using the latest technology, automated processes, and consistent cleanliness levels rather than relying on human judgment.


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Filed under Daily Blog Posts, Surgical Instrument Cleaning, Thursday Thought of the Day

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