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This series of self-study lessons on Central Service topics was developed by the International Association of Healthcare Central Service Materiel Management (IAHCSMM). The lessons are administered by Purdue University’s Continuing Education Division.

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Lesson Plan CRCST 106
Cleaning and Maintenance of Sterilizers and Washers
[Reprinted from Communiqué: May/June 2009]

Managers and staff members in busy Central Service departments recognize the importance of proper cleaning and preventive maintenance tasks for processing equipment. However, these responsibilities may be de-emphasized in an environment of trying to accomplish more with fewer resources. For example, it is easy to believe there is no time to shut down equipment to clean sterilizer chambers or to de-scale washers when, seemingly, all human and equipment resources are needed to prepare surgical trays for reuse.

Still, an effective cleaning process takes less time when it is done regularly by incorporating it into normal departmental routines. Regular cleaning also reduces the need to retain the services of outside contractors to clean equipment for which on-going cleaning has been ignored.

Objective 1 – Discuss the need to properly clean sterilizers and washers

Most sterilizer chambers require cleaning because, left unclean, the sterilization process may be impeded, causing wet packs to form. As well, the soil from chamber walls can be transferred to the outside and, in some cases, into the inner folds and liners of instrument trays.

The manufacturers’ cleaning recommendations must always be followed, and daily or weekly cleaning is typically suggested. To do so, turn off the sterilizer and allow it to cool, if necessary. Central Service technicians should use lint-free cloths and the recommended cleaning solutions. Never use any abrasives including de-scaling chemicals and cleansers in the sterilizer’s chamber. After cleaning, the chamber should be flushed with water in the amount specified by the manufacturer, and the unit should be rinsed and checked for cleanliness. If a chemical residue remains, it should be re-cleaned or rinsed. Door gaskets should be wiped clean daily and, if the sterilizer has a chamber drain, it should be flushed.

The sterilizer’s exterior should be cleaned including under and/or in back of the unit since dust accumulation can affect the sterilizer’s operation by clogging valves, drains, and other components. Note: dust accumulations can also contaminate newly sterilized items and the processing environment.

Washer-decontaminators also require regular cleaning according to the manufacturers’ recommendations. Chambers should be de-scaled whenever white film is present, and inner chambers should be wiped down regularly using a clean lint-free cloth. The sonic chambers of tunnel washers should be drained prior to cleaning, and external surfaces should be cleaned at least weekly. Again, remember to clean under and/or behind the equipment.

Conveyors, loading stations, and transport carts should also be cleaned regularly to avoid microbial growth in drainage areas. As well, gross soil should be removed immediately.

Objective 2 – Explain the need for effective equipment maintenance

Most individuals who purchase a new car assure that scheduled oil changes and maintenance checks are done in a timely manner to maintain the warranty and keep the car running at optimal performance. Likewise, routine preventive maintenance of Central Service processing equipment is also important. When properly maintained, processing equipment can often operate effectively for many years with little down time.

Without proper maintenance, however, white scale can form in the washing and drying chambers of washer-decontaminators and impede the effectiveness of the cleaning process. This scale can chip off of chamber walls onto the instruments and clog the unit’s spray arms. It may also be pulled into one or more of the machine’s pumps and cause them to malfunction. In both cases, the items being processed will need to be reprocessed causing even more work for department personnel.

While the term “maintenance” usually makes Central Service personnel think about their facility’s Biomedical or Clinical Engineering departments, the task should be a collaborative effort between these departments and qualified service technicians and Central Service employees. Required maintenance takes only a few minutes a day per machine, and this time will extend the life and effectiveness of the equipment and result in less work and frustration.

Objective 3: Review routine maintenance protocols for sterilizers

ANSI/AAMI ST79 20061 emphasizes the importance of sterilizer maintenance. If your sterilizer uses a printer with a paper and ink roll, it should be checked at least daily, and graphs and graph pens should be inspected daily when the new graph is inserted into the unit. Printers should be monitored to assure proper operation of the sterilizer throughout the day.

Printer keyboards should be cleaned regularly to keep them in top operating condition and to minimize the dust levels in the Central Service department.

Sterilizer gauges, traps, and drains should be inspected according to a predetermined schedule. Central Service technicians should be aware of these items and provide the “first” set of eyes as they undertake daily checks to reduce the possibility of major malfunctions. Leaky steam traps and malfunctioning gauges and clogged drains should be reported and repaired before a major breakdown, flood, or leak can occur. Insulation jackets should be checked on a regular basis to ensure they are intact because worn or torn insulation hinders the unit’s efficiency.

Carriages and carts should be inspected daily and removed from service for repair if any defects are noted. Note: common problems include broken wheels and dented or damaged shelves.

Each basic type of sterilizer requires specific maintenance efforts. While manufacturers’ recommendations should always be followed, examples of these maintenance tasks include:

• Steam sterilizers – Central Service technicians should remove and check sterilizer drain screens at least daily, and these drains should also be visually checked before the start of each cycle. This is important because screens can become clogged with lint from wrapping material, and tray identification and lot control labels can become dislodged from the external surfaces of packaging materials. As well, clogged screens will impede the exhaust phase of the sterilization cycle and cause air pockets within the chamber. Inadequate steam evacuation can also interfere with proper monitoring of the chamber’s temperature, and wet loads can also occur. Each of these problems can cause unsterile trays and create the need for re-work.
  
  Steam and water quality should be checked at least annually because minerals in the water and steam supply can damage the chamber and its inlet valves, exhaust drains, pipes, and jackets. This will, in turn, decrease the sterilizer’s effective life. Loading arms should also be inspected to confirm they are in proper working order.

• Ethylene oxide sterilizers – In addition to the above maintenance activities, tank connections and holding devices should be checked each time a tank is changed. Cartridge pins should be checked whenever a new cartridge is installed, and sterilizer alarms, scrubbers, and catalytic converters should be maintained to ensure the safety of all Central Service staff.
  
  
• Gas plasma sterilizers – Representatives of the sterilizer’s manufacturer should perform necessary routine maintenance which is based on the number of cycle runs. When the printout indicates the need for maintenance, the manufacturer’s representative should be contacted to provide it. Also, the cassette door and slide mechanism should be inspected each time a cassette is changed.
  
  
• Ozone sterilizers – Service technicians trained by the manufacturer should perform extensive operational checks to ensure units are operating correctly. As with other types of sterilizers, they should check valves, filters, and related elements. Data stored within the sterilizer should also be reviewed at least every three months to ensure that the unit is operating properly.

Bowie Dick and biological testing, while not part of a formal preventive maintenance program, can still be considered part of the daily maintenance cycle because these tests can provide early or real time identification of potential sterilizer trouble. All adverse readings should be carefully investigated to identify and correct the reason for test failure.

All sterilizer manufacturers recommend routine preventive maintenance checks by qualified service specialists. Annual, semi-annual, and quarterly inspections are necessary to extend the life of the equipment and to help ensure that the equipment runs properly every day.

Objective 4 – Describe routine maintenance protocols for washer-decontaminators

Washer-decontaminators will last many years if they are properly maintained. As with sterilizers, all manufacturers of washer-decontaminators recommend routine preventive maintenance checks performed by qualified service specialists. These inspections, whether based on cycle count or scheduled on an annual, semi-annual, or quarterly basis, are essential to the life of the equipment and help to ensure that the equipment operates properly for every cycle.

Preventive maintenance procedures do not typically differ for tunnel washer-decontaminators or their single chamber counterparts. Protocols include:

• Chemical levels should be marked and dated daily to ensure the proper amount of chemicals is being utilized. If the level of any chemical does not decrease as it should, this may indicate clogged lines or dispensing valves or a malfunctioning pump. Daily marking and dating of chemical levels will help service technicians to troubleshoot problems and Central Service technicians to determine how long the chemical container has been opened. (Note: many chemicals allow microbial growth after they are exposed to air. If the equipment is operating correctly and, if the chemicals are not completely utilized within one month, consider replacing the opened container with a new container and then utilize a smaller container size.) Routine checks to ensure that the proper chemicals are used and attached to the appropriate chamber or cycle are important because different types of chemicals such as enzymes, detergents, and lubricants may be required for each cycle.
  
  
• Detergent pumps should be inspected daily if they can be accessed and, if they are vibrating or making excessive noise, the unit should be placed out of service until it is properly repaired.
  
  
• Screens should be checked and cleaned at least daily to ensure that the chamber drains properly and to decrease the opportunity for items to be pulled into the pump.
  
  
• Water quality should be checked at least annually to ensure that needed purity and pH is maintained. Minerals such as calcium, magnesium, zinc, and copper (among others) will damage the chambers of washer-decontaminators and the pipes that carry the water to the equipment. Improper pH levels can also cause damage to equipment, instrumentation, and container systems. Some hospital engineering departments perform water testing, and sterilizer and chemical companies may provide no-cost water testing service.
  
  
• Rotating arms within the equipment should be checked at least once each shift to ensure they move freely, are not clogged, and that they are properly attached to the washer or its manifold because loose or clogged spray arms greatly reduce the washer’s cleaning ability. Bushings, bearings, o-rings, and similar parts should be replaced as recommended by the equipment manufacturer.
  
  
• Printers, ink, and paper should be checked daily, and printers should be monitored throughout the day to ensure they are working properly.
  
  
• Traps, drains, and gauges should be checked regularly including during routine cleaning and routine preventive maintenance activities to ensure they are in proper working order.
  
  
• Baskets, manifolds, and transport carts should be checked every time they are used to ensure they are intact and safe for use. If sharp edges or damage of any kind are noted, the items should be removed from service until they are properly repaired to reduce employee safety concerns. Damaged items can also cause expensive repairs to the unit and its instrumentation.

Efficacy testing should be done at least weekly to ensure proper cleaning and operation. Commercially-prepared products can be used to test the cleaning ability of washer-decontaminators. As noted above in our discussion of biological indicators for sterilizers, these tests can provide an early warning that the equipment needs attention.

In Conclusion

Sterilizers and washers are expensive and essential life safety equipment that, if properly cleaned and maintained, will last many years with minimal down time. These tasks are not difficult, and they should be among the responsibilities of Central Service managers and technicians in all healthcare facilities.

Endnote:

1. Association for the Advancement of Medical Instrumentation. Comprehensive guide to steam sterilization and sterility assurance in health care facilities. ANSI/AAMI ST79. 2006.

Take the CRCST 106 Quiz