Quality Control in Laboratory Washing Cycles

Unloading the Washer-Disinfector

• After unloading the WD, quality checks should be performed to ensure the load is acceptable.
• Check for correct cycle, spray arm not blocked, and no soil or staining on visual inspection.

Quality Checks

• Check the load for:
  • Correct cycle
  • No blockage of spray arms
  • No soil or staining
  • No excessive wetness
  • No damage due to configuration
  • Devices correctly disassembled
  • Completed documentation
• If any issues are found, the load must be rejected and sent back for reprocessing.

Local Policies and Procedures

• Local policies, procedures, and guidelines will determine what happens to the load next.
• Standard processes should also be followed, including:
  • Checking the chart record for the cycle
  • Verifying the operating cycle selected
  • Visual inspection of the load for damage, staining, or residue
  • Checking for dryness

Manually Cleaned Device Acceptance

• Quality checks must also be carried out when accepting items that were not processed in a WD.
• Check for:
  • Soil or staining
  • Excessive wetness
  • Damage
  • Correctly disassembled devices
  • Completed documentation

Inspection and Functionality Test

• All surgical devices unloaded from the WD must be inspected for:
  • Cleanliness
  • Stains
  • Corrosion
  • Cracks
  • Breakage
  • Stiffness of movable parts
• Devices should be checked under magnification, and each device should be inspected separately.
• Check hinges, jaws, and teeth for proper alignment and movement.

Computerized Track System

• The system allows for accurate tracking of devices and device trays throughout the decontamination process.
• The system consists of handheld barcode readers connected to PCs that log and store information for each tray.
• Once the barcode label is scanned, a packing list and unique barcode label are generated.
• A new unique unit number is produced each time a new processing cycle begins.

Alternative to Computerized System

• A manual system may be used, consisting of a pre-printed tray checklist and manual label gun.

Assembling Devices into Trays

• Devices should be arranged in the tray from left to right, in the order they will be required in a procedure.
• Check the tray against the checklist to ensure consistency.

Instrument Pin

• Forceps should be placed on instrument pins to hold them together and reduce tangling.

Ratchets Position

• Leave all forceps with ratchets open, except when stringers are not available, close devices with ratchets on the first ratchet only.

Dealing with Sharp Instruments

• Use validated tip protectors to protect delicate or sharp items.
• Tray liners or silicone mats may also be used to protect devices.

Missing or Extra Devices

• Report any missing or extra devices to the supervisor and document the non-conformance.

Overcrowded or Overweight Trays

• Avoid overcrowding or overweight trays, as they can lead to issues with drying and sterility failure.

Standard for Tray Weight

• According to ANSI/AAMI ST77 and ANSI/AAMI ST79, the maximum weight of surgical instrument sets trays is 25 pounds, including the weight of instruments and containers.

Dealing with Metal Basins

• Position metal basins to allow moisture to drain during sterilization.
• Use wicking material, such as surgical towels, to facilitate drainage and drying.

Packaging

• The main considerations in wrapping materials are the type of wrap and packaging techniques applied.
• Packaging materials and techniques are designed to hold and protect devices, facilitate sterilization, and maintain sterility.

Re-usable Linen

• Re-usable linen is discouraged due to the risk of strike-through and linting, which can lead to cross-contamination.

Common Packaging Materials

• The most common packaging materials used are:
  1. Rigid containers
  2. Peel pouches of plastic and/or paper
  3. Sterilization wraps

Choosing Wrapping Material

• The choice of wrapping material depends on the packaged and sterilization process to be used.