Here are four tips from industry experts on using enzymatic detergent for ambulatory surgery center infection control.
1. Follow all recommended steps. Shaun Sweeney, vice president of sales and marketing for Cygnus Medical, explains ASCs should follow manufacturer recommendations, which may include using approximately 500 mL of enzymatic detergent and water to suction and flush out channels. Skipping the first step of suctioning enzymatic detergent through the suction channels will not only affect the efficacy of the channels being properly reprocessed but will also release high volumes of gross contamination into the soaking stage. "High-level disinfection is dependent on every stage being performed properly," he said. "A breakdown early on can affect the efficacy of the process later."
2. Use to tackle biofilm and bioburden. The contributing factor to ongoing contamination has been the identification of "biofilm," said Marc Esquenet, vice president of research and development for The RUHOF CORPORATION, U.S.A.
Biofilm has recently been classified as a target soil for elimination from endoscopes, in addition to the previously identified "bioburden." New, highly advanced, neutral pH multi-tiered enzymatic detergent technologies, designed to specifically target and dissolve the insoluble polysaccharide outermost layer of biofilm have been developed, he said. "Dissolving this outermost layer allows for the complete elimination of all bioburden and biofilm on semi-critical and critical medical devices by high-level disinfectants or liquid chemical sterilants," he said. "This new enzymatic detergent technology has been developed to aide in eliminating the challenges presented by biofilm."
3. Always change detergents to avoid contamination. No matter what type of enzymatic detergent an ASC uses to soak scopes, Mr. Sweeney said, it's important to change — not reusing — detergents after each use for optimal effectiveness. Just as a household member would refill a sink with new water and new detergent to clean dirty dishes, ASCs should also be mindful of changing water and enzymatic detergent because detergent will break down, Mr. Sweeney said.
"This may be a case of someone not paying attention to the manufacturer's recommendations or trying to save money, but ASCs must not reuse enzymatic detergent with multiple scopes. Detergents absolutely break down and lose integrity after each use," he said. "ASCs will sometimes reuse a brush to clean a scope too, but they have to remember that there are disposable kinds and reusable kinds. If you use a single-use item, you're supposed to use that item just one time."
4. Boost results with a washer sterilizer. ASCs can install a washer sterilizer, which is a piece of equipment most supply companies offer that can help in sterilizing surgical instruments. Although buying and installing a washer sterilizer is a significant investment, the investment is worth it in the long run, said Denise Kesler, director of Athens (Ga.) Orthopedic Ambulatory Surgery Center.
"For decontaminating instruments, our staff used to do all that by hand, but we just purchased a washer sterilizer that we'll be using pretty soon," she said. "It's like a huge dishwasher that we'll be putting in a sterile work room, and what you would do is place your instrument trays and run it through the machine, which dispenses enzymatic cleaner, detergent and lubricant."
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