sterile u nuts bolts august 2014€¦ · the nuts and bolts of washer-disinfectors today’s...

8/18/2014

1

3M Infection Prevention Solutions

3M™ Sterile U Web Meeting – August 21, 2014The Nuts and Bolts of Washer-Disinfectors

Today’s meeting times are 9:00 a.m., 11:00 a.m. and 1:00 p.m. CST

To hear audio, call 800-937-0042 and enter access code 7333633Phone lines are muted. Audio will commence when the webinar begins.

Welcome!Topic: The Nuts and Bolts of Washer-DisinfectorsSpeaker: John Nies, Product Manager Belimed, Inc

Facilitators: Christophe de Campeau, 3M Larry Talapa, 3M

© 3M 2014. All Rights Reserved.


HousekeepingQuestions Mute feature (*7 = unmute; *6 = mute) “Chat” feature

Technical difficulties

Post session follow-up

For more information: www.3M.com/3MSterileU

How do I get a CE Certificate?

Next week, all of today’s meeting participants will be sent an email containing instructions for obtaining a CE Certificate for today’s meeting.

The email will be sent to the email address you provided



The email will be sent to the email address you provided when you logged-in to today’s meeting. If there are others listening with you today who did not log-on, you may forward the CE certificate email to them.

8/18/2014

2

Disclosure Statement

John NiesProduct Manager

Lean Six Sigma Greenbelt

Belimed, Inc.

2325 Charleston Regional Parkway

Charleston SC 29492

Insert John’s Picture



Charleston, SC 29492

Tel: 843-216-7424 x141

[email protected]

www.belimed.com

Learning Objectives

The key components in a washer and how they work

What components are used in each step of a cycle and what they do

1

2



Similarities and analogies with parts and function to consumer products

3

© 3M 2014. All rights reserved.

A washer/disinfector cleans, disinfects and dries soiled surgical instruments so they can be handled safely

during the next re-processing step

Purpose of a Washer / Disinfector



8/18/2014

3

How Does it Do That?

A washer sequences through a number of phases, or steps, during each cycle

Many different cycles can be programmed

A typical complete cycle consists of 5 phases

Pre Wash



Pre-Wash

Wash

Rinse

Disinfection (Thermal Rinse)

Dry

Before we dive in deeper…

Function, operation, and examples of some of the main components in a washer

Valves

Pump

Heating elements

Sensors



Sensors

A little bit about …Valves

Valves control flow of gases and liquids

Manual or automatically controlled

Typically on or off but some can control flow rate also



Water faucet

Heart valve

Water valve in a washer

8/18/2014

4

What’s a Pump for?

Typically moves a liquid, can move a gas

Manual or drivenMechanically or electrically



Car water pump

Hand pump

Air pump

Washer water pump

Heating Elements - How do we heat air?

Typically done with electric heating elements

Special type of wire that resists flow of electricity

Resistance creates heat



Toaster

Hair dryer

Heater box in a washer

Sensors – they measure things!

Sensors are everywhere

Measure almost everything

The output controls a function

Position sensor on a smart phone



Position sensor on a smart phone or tablet

Toilet tank float

Auto on lighting

Water level sensor in a washer

8/18/2014

5

What happens in the washer?

All of these components are in a washer

Plus a whole lot more

Let’s look at what is used, and how, in each step of a typical washer cycle



Before the Automated Washer

Follow instrument manufacturers instructions (IFU’s) for

Required pre-cleaning Disassembly



Cycle Phase: Pre-wash

Purpose: Used to soften and remove blood

Why: Cold water (less than 45°C / 113°F) is used since hot water will set blood and make it more difficult to remove (denature)



The Nuts & Bolts:1. Fill the washer with cold water

2. Circulate for the programmed time

3. Drain

8/18/2014

6

Nuts & Bolts – The Fill Step

Static – always fills with the same amount of water

Dynamic – Varies water based upon load size

Washers use two different filling approaches



Static Fill – Always the same amount of water

Hot

RO/DICold

Fill Valves

Sump

Water is added until sump is full



Pump

Drain Valve

Dynamic Fill – Vary Water Fill

Cold

Smaller sump –water also on i t t



instruments

8/18/2014

7

Dynamic Fill – Vary Water Fill

Cold

Sensor tells washer to add water –



Water level

sensor

stops when full

Pump stops

Drain opens

Drain is at lowest point in water system

Prevents mixing used water with fresh

Draining



Prevents mixing used water with fresh water of next step

About 40 - 60 seconds to drain

Drain Valve

The washer drain is not connected to the floor drain

An “air gap” is required per plumbing code

Draining



If drains back-up the water won’t push back into the washer

8/18/2014

8

Cycle Phase: Wash

Purpose: Removes soils

Why: Need to remove soils to be clean

The Nuts & Bolts:1. Fill the washer with hot/warm water



2. Bring to correct temperature

3. Add (dose) detergent


5. Drain

Wash – Fill step

Same process as the fill step for the pre-wash

Use hot water to start

Sensor reads water temperature

Mix in cold water if hot is above set temperature

Hot

RO/DICold



Goal is to get as close to set temperature as possible

Minimizes heating time

Water Temperature sensor

Wash – Heating Nuts & Bolts

Heating

Heating is either steam coils or electric elements

Located in the sump

Sensor reads water temp

Steam or electricity is applied to coils Heating



This continues to maintain temperature once it is reached

Water Temperature sensor

Heating coils

8/18/2014

9

Wash – Heating Nuts & Bolts

This shows steam heating – coils

Washer measures water temp

Opens steam valve to send steam to coils

Coils heat up

Heat is transferred to water that surrounds



Heat is transferred to water that surrounds the coils

Electric heating works the same way

Heat source is electricity rather than steam

Dosing – Nuts & Bolts

Dosing (adding detergent)

Programmed as oz/gal or ml/l

Calculated based upon water use

May include flow meters



Detergent pumps

Detergent flow meter

Detergent containers

Dosing – Nuts & Bolts

Detergent Pumps

Typically 3, sometimes 4Detergent

Enzymatic

Lube

Other



Peristaltic pumps

Flow metersEnsure detergent is actually flowing

from pumps

8/18/2014

10

Detergents & Foaming

Consumer marketing tells us that suds are good

Water and suds are “static” though –not being pumped

We need low foaming detergents

Like those in high efficiency clothes washers



Nuts & Bolts about Foaming

A fan is meant to move air

A pump is meant to move water

Foam is mostly air

A washer has a pump to circulate the water



A washer has a pump to circulate the water

Does not work well when trying to pump foam (air)

Circulation rate goes down

Pump cavitation (air)

Nuts & Bolts about Foaming?

Why does a washer pump dislike air?

How it works

Designed for water not air



Extended operation with cavitation could damage the pump

8/18/2014

11

Cycle Phase: Rinse

Purpose: Remove loosened soils and detergent residue remaining after wash phase

Why: Ensure clean. Residue can cause discoloration during sterilization process



The Nuts & Bolts:

1. Fill the washer with hot water


3. Drain

Same steps as pre-wash – using hot water instead

Cycle Phase: Thermal Rinse (Disinfection)

Purpose: Achieve Intermediate Level Disinfection

Why: Items need to be safe to handle with intact skin, for clean side safety

The Nuts & Bolts:



The Nuts & Bolts:

1. Fill with De-Ionized (DI) or Reverse Osmosis (RO) water

2. Heat to at least 90°C, for 1 minute

3. Lube, if called for, is dosed


5. Drain

Thermal Rinse – Nuts & Bolts

Heating is a time challenge

RO/DI water is at room temperature (24°C / 75°F or so)

Need to heat to 90°C / 194°F, minimum

Steam heating is fast

Pre=heat tank



4 minutes

Electric heating is slow 12 to 15 minutes

Pre-heat tank option on some washers

8/18/2014

12

Thermal Rinse – Why RO/DI?

Prevents hard water staining

RO/DI is void of minerals

Will pick up any minerals left from previous steps that use tap water



If you see spotting all of a sudden…No RO/DI

System is bypassing

May need filter change

Cycle Phases - Drying

Purpose: To dry instruments

Why: Don’t want to pack wet instruments, avoid hand drying time

Nuts & Bolts:



1. Air is pulled through filters and heated

2. Circulated through chamber

3. Exhausted to the room or to venting ductwork

How does air drying work?

Air drying accomplished with a combination of three parameters

Humidity of the air

Temperature of the air

Air movement



8/18/2014

13

Drying – Nuts & Bolts

Air is pulled from decontam Washer is set in the decontam area

Pulling from clean may disturb pressure difference between clean (higher) and decontam (lower)

Passed over heating elementsDries and heats

Exhaust



Circulated through the chamber

Exhausted to venting or to room

Incoming air HEPA filter

Blowers

Heaters


DryingAir heating and air flow

Heating box1. Contains electrical heating elements



1

3

2

Blower Unit1. Pre-Filter

2. HEPA filter

3. Blower box

1


HEPA filter

High Efficiency Particulate Air

How can we use Decontam side air that may have this in it?



99.97% of 0.3 µm (micrometer) particles.

µm or micrometer is one millionth of a meter

Bacteria - 0.5 to 2 µm

Human hair – 90 µmBe sure to maintain these as recommended by the washer

manufacturer

8/18/2014

14

Drying Exhaust – vented or non-vented

Vented and non-vented

Vented Air is sent to ductwork

Vents to the outside

Non-vented



Uses cold water to cool exhaust and remove moisture

Exhausted to room (decontam side)

AAMI ST79:2010 & A1-A4 (Consolidated Text)

3.3.6.4 Ventilation... The soiled and decontamination area should be designed so that air flows into the area (negative pressure), with a minimum of 10 air exchanges per hour, and so that all air is exhausted to the outside atmosphere.

Summed Up – Nuts & Bolts

A lot is happening in your washer

Valves are opening and closing

Water is heated

Detergents are precisely dosed

Pump is circulating water



Pump is circulating water

Air is heated

Blowers are circulating air

Temperatures are measured

and more

Nuts & Bolts - Maintenance

Regular Preventive Maintenance checksAAMI ST-79 Recommended , Section 7.5.3.3 For any mechanical cleaning unit, regular preventive

maintenance should be performed in accordance with the manufacturer’s written instructions

The washer manufacturer

Manufacturer trained internal personnel

S h k i t



Some check points:Valve operation

Heating time Inspect hoses, pipes & fittings

Inspect door gasketCheck detergent pumps and flow meters

8/18/2014

15

Next 3M™ Sterile U Web Meeting

When: Thursday, September 18th

Topic: Steam Sterilization Qualification &

Thank you!



Topic: Steam Sterilization Qualification & Troubleshooting: Process Failures & Wet Packs

Register at www.3m.com/SterileU

© 3M 2014. All rights reserved.

Thank you



Thank you

44 © 3M 2014. All rights reserved.

sterile u nuts bolts august 2014€¦ · the nuts and bolts of washer-disinfectors today’s...

Documents