Comparison of the first cleaning quality effect of two different cleaning methods for metal precision surgical instruments

Meifeng Liu; Suying Lin; Hongmei Zhu; Dan Liu; Jinfang Xu; Suzhen Sun

doi:10.11910/j.issn.2791-2043.2022.2.04

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Comparison of the first cleaning quality effect of two different cleaning methods for metal precision surgical instruments

MONOGRAPHIC STUDY | Updated：2023-02-22

- Comparison of the first cleaning quality effect of two different cleaning methods for metal precision surgical instruments
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  Disinfection Supply Center of the First People’s Hospital of Changzhou, 213003, Changzhou, Jiangsu, China
  
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  Meifeng Liu
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  Disinfection Supply Center of the First People’s Hospital of Changzhou, 213003, Changzhou, Jiangsu, China
  
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  Suying Lin
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  Disinfection Supply Center of the First People’s Hospital of Changzhou, 213003, Changzhou, Jiangsu, China
  
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  Hongmei Zhu
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  Disinfection Supply Center of the First People’s Hospital of Changzhou, 213003, Changzhou, Jiangsu, China
  
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  Dan Liu
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  Disinfection Supply Center of the First People’s Hospital of Changzhou, 213003, Changzhou, Jiangsu, China
  
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  Jinfang Xu
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  Disinfection Supply Center of the First People’s Hospital of Changzhou, 213003, Changzhou, Jiangsu, China
  
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  Suzhen Sun
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- Sterile Supply Vol. 1, Issue 2, (2022)
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  1.Disinfection Supply Center of the First People’s Hospital of Changzhou, 213003, Changzhou, Jiangsu, China
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- DOI：10.11910/j.issn.2791-2043.2022.2.04
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Liu Meifeng,Lin Suying,Zhu Hongmei,et al.Comparison of the first cleaning quality effect of two different cleaning methods for metal precision surgical instruments[J].Sterile Supply,2022,01(02):55-58.
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Liu Meifeng,Lin Suying,Zhu Hongmei,et al.Comparison of the first cleaning quality effect of two different cleaning methods for metal precision surgical instruments[J].Sterile Supply,2022,01(02):55-58. DOI： 10.11910/j.issn.2791-2043.2022.2.04.

Comparison of the first cleaning quality effect of two different cleaning methods for metal precision surgical instruments

Meifeng Liu ; Suying Lin ; Hongmei Zhu ; Dan Liu ; Jinfang Xu ; Suzhen Sun ;

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Abstract

Objective

To explore effective methods for the first cleaning of metal precision surgical instruments and evaluate the effect to improve the quality of cleaning.

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Methods

The 184 newly purchased precision surgical instruments used in departments including Otolaryngology, Thoracic surgery and Orthopedics were selected and divided into two groups. 94 pieces in the control group were treated in the method of soaking in the alkaline detergent with a ratio of 1:100 and a temperature of 60-80 °C for 10 minutes+mechanical cleaning (alkaline detergent program); 90 pieces in the observation group were treated in the method of soaking in the alkaline detergent with a ratio of 1∶100 and a temperature of 60-80 °C for 10 minutes and then manual cleaning+mechanical cleaning (alkaline detergent program). After cleaning the instruments in both groups, the quality of the lumen instruments was checked by methods of visual inspection, illuminated magnifier, white gauze, and white strip. The sterilization packages were also opened again after autoclave sterilization to evaluate the oily waste degradation.

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Results

The pass rates of visual inspection and illuminated magnifier, white gauze and white strip, visual inspection and illuminated magnifier after sterilization, and white gauze and white strip after sterilization in observation group were significantly higher than those of control group (100.00% vs. 94.68%, 98.89% vs. 92.55%, 98.89% vs. 90.43%, 100.00% vs. 91.49%, respectively, P<0.05).

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Conclusion

To ensure cleaning quality, metal precision surgical instruments should be correctly cleaned before the first use. The method of soaking in alkaline detergent for 10 minutes+manual cleaning+mechanical cleaning (alkaline detergent program) can significantly improve the cleaning quality.

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Keywords

Precision instruments; First cleaning; Cleaning method; Effect evaluation

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Metal precision surgical instruments^[

1] made of different materials are delicate and fragile with complex and diverse structures. The instructions suggest that the instruments should be cleaned normatively before the first use so as to remove inorganic substances such as greases and stains attached to the instruments^{[Reference 2

Baidu Scholar

2]}. Incomplete cleaning will not only reduce the sterilization effect and cause the risk of potential infection, but also have a negative impact on the aesthetics and service life of the instruments.

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The relevant handling methods for new instruments^[

3] provide no information about new handling requirements for precision instruments. The latest guideline^{[Reference 4

Baidu Scholar

4]}requires that the first cleaning of new instruments should follow the instructions of medical devices and the correct cleaning methods should be adopted. However, there is no detailed description of how to perform the first cleaning of precision surgical instruments. Thus, it is necessary to explore the first cleaning methods for precision surgical instruments.

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1 Materials and methods

1.1 Material and grouping

The research objects are 184 pieces of metal precision surgical instruments made of stainless steel or other alloy materials, newly purchased by the operating room. Autoclave sterilization was adopted according to the instructions. A control group and an observation group were set up in the order of the first use of the instruments, with 94 pieces in the control group and 90 pieces in the observation group. Before the experiment, 2 nurses were trained in instrument cleaning methods and cleaning quality inspection standards. There was no significant difference in the cleanliness of instruments between the two groups before cleaning (P>0.05), and the re-evaluation of the quality effect of instruments after cleaning was done by the same nurses in both groups.

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1.2 Cleaning methods

1.2.1 Observation group Open all instrument joints, soak them in the alkaline detergent with a ratio of 1:100 and a temperature of 60-80 °C for 10 minutes and then wash them manually. Scrub the instrument surface more intensively, brush the axial joints, complex structural parts and instrument lumen with matching cleaning brushes, and spray with the steam cleaner. Load them according to the specification and select the alkaline detergent program for mechanical cleaning.

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1.2.2 Control group Open all instrument joints and soak them in the alkaline detergent with a ratio of 1:100 and a temperature of 60-80 °C for 10 minutes. Pre-treat with high-pressure water gun rinsing for tubular cavity instruments. Load according to the specification and select the alkaline detergent program for mechanical cleaning.

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1.3 Observed indicators

1.3.1 Cleaning quality

1.3.1.1 Methods of visual inspection and illuminated magnifier: Visually observe or inspect using an illuminated magnifier. The qualified standards include: the surfaces of the instrument, axial joint tooth and complex metal structure are bright; clean without dirt, rust or oil spot.

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1.3.1.2 Methods of white gauze and white strip: the surface is wiped with white gauze and the lumen is wiped with white strip. The qualified standards include: the gauze or white strip is clean without staining dirt.

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1.3.2 Re-evaluation of the effect after sterilization

1.3.2.1 Methods of visual inspection and illuminated magnifier: Visually observe or inspect using an illuminated magnifier. The qualified standards include: the surfaces of the instrument, axial joint tooth and complex metal structure are bright; clean without dirt, rust or oil spot.

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1.3.2.2 Methods of white gauze and white strip: the surface is wiped with white gauze and the lumen is wiped with white strip. The qualified standards include: the gauze or white strip is clean without staining dirt.

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1.4 Statistical analysis

The statistical analyses were performed using SPSS for Window (version 19.0). Categorized variables are expressed as numbers and percentages. Differences between groups were analyzed using the χ² test, and A two-tailed P-value<0.05 was considered statistically significant.

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2 Results

By checking or re-evaluating the cleaning quality, it was found that the difference between the two different cleaning methods on the effect of instrument cleaning quality was statistically significant (as shown in Table 1, Table 2, Table 3 and Table 4, all P-value<0.05). The effect of cleaning quality in the observation group was significantly higher than that in the control group.

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Table 1 Pass rates of visual inspection and illuminated magnifier

Group	Number of test pieces	Number of qualified	Pass rate (%)	χ²	P-value
Observation group	90	90	100.00	4.921	0.027
Control group	94	89	94.68

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Table 2 Pass rates of white gauze and white strip

Group	Number of test pieces	Number of qualified	Pass rate (%)	χ²	P-value
Observation group	90	89	98.89	4.438	0.035
Control group	94	87	92.55

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Table 3 Pass rates of visual inspection and illuminated magnifier after sterilization

Group	Number of test pieces	Number of qualified	Pass rate (%)	χ²	P-value
Observation group	90	89	98.89	6.408	0.011
Control group	94	85	90.43

Download: Export CSV

Table 4 Pass rates of white gauze and white strip after sterilization

Group	Number of test pieces	Number of qualified	Pass rate (%)	χ²	P-value
Observation group	90	90	100.00	8.008	0.005
Control group	94	86	91.49

Download: Export CSV

2.1 Cleaning quality comparison of the methods of visual inspection and illuminated magnifier (Table 1)

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2.2 Cleaning quality comparison of the methods of white gauze and white strip (Table 2)

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2.3 Quality re-evaluation of the methods of visual inspection and illuminated magnifier after sterilization (Table 3)

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2.4 Quality re-evaluation of the methods of white gauze and white strip (Table 4)

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3 Discussion

3.1 Precision instruments made of different materials should have different disposal processes for the first use. Newly purchased stainless steel instruments should be cleaned and passivated^[

2], while metal precision instruments, most made of alloy materials, are different from normal stainless steel instruments. The instructions have not yet provided a specific disposal process for the first use. Moreover, the conventional method of cleaning and sterilization causes the instrument surface and the lumen may have residual greases and stains, which are difficult to completely remove by cleaning again. It not only has a bad effect on the appearance, but more importantly, does not conform with the cleaning quality and further causes nosocomial infection^{[Reference 5

Baidu Scholar

5]}. Therefore, it is extremely important to establish a cleaning and disposal process for the first use of precision instruments.

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3.2 High temperature has a catalytic effect on the removal of protective greases from the surface of instruments. Most of the newly purchased medical devices are not thoroughly cleaned, and their surfaces may be contaminated with cutting particles, greases and stains. The more complex the structure, the more residual stains may be^[

6]. The protective greases used in the manufacturing process are fat-soluble, which cannot be completely removed without effective manual cleaning. Also, hardly any residual stains can be found by visual inspection. They are in the form of oil films attached to the surface of the instruments during high-temperature sterilization. High temperatures make it easier for grease to penetrate from joints and complex structures to the surface of the instrument and thus be easily removed by wiping. Therefore, this study evaluates the cleaning effect of sterilized instruments again. The best time for evaluation is when the instruments are not completely cooled because it is easier to wipe residual greases off.

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3.3 Newly purchased non-stainless steel precision instruments using this method greatly improved their cleaning quality. Due to the complex structure of metal precision instruments, the method of soaking in the alkaline detergent and then manually washed can effectively remove dirt and grease in virtue of its mechanical friction, which is consistent with the previous study ^[

7]. Thus, before the first use, the correct cleaning method of newly purchased precision surgical instruments ensures the quality of cleaning.

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In summary, it is important to adopt the correct cleaning method before the first use of metal precision surgical instruments so as to not only guarantee the cleaning quality and reduce the risk of infection, but also to better extend the service life of instruments and lower the cost. However, the sample size of this experiment is so small that a deviation may be caused. Thus, it needs further study.

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References

HUANG H, ZHANG Q. Investigation on usage and treatment of precision surgical instruments in hospitals[J]. Chin J Nurs, 2017, 52(10): 1238-1240. [Baidu Scholar]

CHEN Xujun.[Industrial cleaning agents and cleaning technology] [M]. Beijing: Chemical Industry Press,2005. [Baidu Scholar]

LIU Yucun, LIANG Minghui.[Job Tutorial of Hospital Disinfection Supply Center] [M]. Beijing: People's Military Medical Press,2013. [Baidu Scholar]

ZHANG Qing, QIAN Liming. [Sterilization Supply Center Management and Technical Guide] [M]. Beijing: People's Medical Publishing House,2021:109. [Baidu Scholar]

LU Y J, OU S Q. Different cleaning methods of toothed medical devices and their effect evaluation[J]. China Mod Med, 2017, 24(15): 139-141. [Baidu Scholar]

ZHU S J, YU L Y, ZHOU X, et al. [Analysis of surface cleanliness of new recycling operation instruments] [J]. Chin J Disinfect, 2013, 30(4): 317-318. [Baidu Scholar]

OU S Q, ZHANG H H, CAO S J, et al. [Cleaning method and effect of medical equipment before first use] [J]. Chin J Disinfect, 2017, 34(10): 977-978. [Baidu Scholar]

摘要

Abstract

Objective,2,To explore effective methods for the first cleaning of metal precision surgical instruments and evaluate the effect to improve the quality of cleaning.,Methods,2,The 184 newly purchased precision surgical instruments used in departments including Otolaryngology, Thoracic surgery and Orthopedics were selected and divided into two groups. 94 pieces in the control group were treated in the method of soaking in the alkaline detergent with a ratio of 1:100 and a temperature of 60-80 °C for 10 minutes+mechanical cleaning (alkaline detergent program); 90 pieces in the observation group were treated in the method of soaking in the alkaline detergent with a ratio of 1∶100 and a temperature of 60-80 °C for 10 minutes and then manual cleaning+mechanical cleaning (alkaline detergent program). After cleaning the instruments in both groups, the quality of the lumen instruments was checked by methods of visual inspection, illuminated magnifier, white gauze, and white strip. The sterilization packages were also opened again after autoclave sterilization to evaluate the oily waste degradation.,Results,2,The pass rates of visual inspection and illuminated magnifier, white gauze and white strip, visual inspection and illuminated magnifier after sterilization, and white gauze and white strip after sterilization in observation group were significantly higher than those of control group (100.00% vs. 94.68%, 98.89% vs. 92.55%, 98.89% vs. 90.43%, 100.00% vs. 91.49%, respectively,P,<,0.05).,Conclusion,2,To ensure cleaning quality, metal precision surgical instruments should be correctly cleaned before the first use. The method of soaking in alkaline detergent for 10 minutes+manual cleaning+mechanical cleaning (alkaline detergent program) can significantly improve the cleaning quality.

关键词

Keywords

Precision instrumentsFirst cleaningCleaning methodEffect evaluation

references

HUANG H, ZHANG Q. Investigation on usage and treatment of precision surgical instruments in hospitals[J]. Chin J Nurs, 2017, 52(10): 1238-1240.

CHEN Xujun.[Industrial cleaning agents and cleaning technology] [M]. Beijing: Chemical Industry Press,2005.

LIU Yucun, LIANG Minghui.[Job Tutorial of Hospital Disinfection Supply Center] [M]. Beijing: People's Military Medical Press,2013.

ZHANG Qing, QIAN Liming. [Sterilization Supply Center Management and Technical Guide] [M]. Beijing: People's Medical Publishing House,2021:109.

LU Y J, OU S Q. Different cleaning methods of toothed medical devices and their effect evaluation[J]. China Mod Med, 2017, 24(15): 139-141.

ZHU S J, YU L Y, ZHOU X, et al. [Analysis of surface cleanliness of new recycling operation instruments] [J]. Chin J Disinfect, 2013, 30(4): 317-318.

OU S Q, ZHANG H H, CAO S J, et al. [Cleaning method and effect of medical equipment before first use] [J]. Chin J Disinfect, 2017, 34(10): 977-978.

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