CRCST Self-Study Lesson Plan

Lesson No. CRCST 150 (Technical Continuing Education - TCE) by Gwendolyn Byrd, CHL, CIS, CRCST
CPD Educator, Children’s Hospital of Philadelphia
Sponsored by:
Christina Parson, CHL, CIS, CRCST
SP Manager, Brandon Regional Hospital

The Manual
Cleaning Process
I
LEARNING OBJECTIVES NSTRUMENT CLEANING HAS BECOME A TOPIC OF INTEREST IN
1. Define manual cleaning TODAY’S news. It is also a major focus in hospitals because of the increase in
2. Outline the importance of manual healthcare-associated infections (HAIs). The importance of proper learning of
cleaning to prevent healthcare instrumentation or equipment used on patients is a key factor in HAI prevention.
associated infections and promote Knowledge of the latest industry recommendations, guidelines and standards,
employee safety combined with practical skills, ensures that reusable medical devices are safe for
3. Review the manual cleaning process handling and patient use. The US Food and Drug Administration (FDA) requires
4. Address the need for quality assurance that manufactures provide instructions for use (IFU) to outline proper care and
testing handling, and appropriate methods for device cleaning and reprocessing. This
information would include disassembly instructions, types of detergents to be used,
proper use of cleaning tools, type of rinse water, and type of mechanical cleaning
approved for processing the devices.

OBJECTIVE 1: DEFINE MANUAL Using an approved post-operative

CLEANING pre-cleaning spray to keep blood and
Manual cleaning is the physical removal protein substances from drying on the
of all visible soil (gross debris) from an instruments is an effective approach.
item to render it safe for handling and Covering instruments with a lint-free
further processing for patient care. This cloth that is moistened with water is
process begins with point-of-use cleaning another option for keeping blood and
in the surgical suite. Gross soil should be protein from drying on the instruments
wiped from the instruments and lumens prior to being transported to the
should be flushed with sterile water decontamination area. Keeping soiled
during and after the surgical case. instruments moist after the procedure
Any soil left on the instruments makes cleaning easier and less time
should be not be allowed to dry. consuming.

This series of self-study lessons on CS topics was de- Purdue University, Stewart Center Room 110, 128 For More Information:
veloped by the International Association of Healthcare Memorial Mall, West Lafayette, IN 47907-2034. IAHCSMM provides online grading service for
Central Service Materiel Management (IAHCSMM). any of the Lesson Plan varieties. Purdue University
Purdue University’s Extended Campus and IAHCSMM Scoring: Each quiz graded online at www.iahcsmm.org or provides grading services solely for CRCST and
both offer grading opportunities. through Purdue University, with a passing score of 70% CIS lessons. Direct any questions about online grading
or higher, is worth two points (2 contact hours) toward to IAHCSMM at 312.440.0078. Questions about
Earn Continuing Education Credits: CRCST re-certification (12 points). written grading are answered by Purdue University at
800.830.0269.
Online: Visit www.iahcsmm.org for online Subscription Series: From January 1 to June 30 each
grading at a nominal fee. year, Purdue Extended Campus offers an annual mail-in
or online self-study lesson subscription for $75 (six
By mail: For written grading of individual lessons, specific lessons worth 2 points each toward CRCST
send completed quiz and $15 to: PEC Business Office, re-certification of 12 CE). Call 800.830.0269 for details.
 CRCST Self-Study Lesson Plan

In some cases, such as for non-critical

devices, manual cleaning will be the only
step required in the reprocessing cycle;
however, Central Service (CS) technicians
should carefully follow the manufacturer’s
Instructions for Use (IFU) to ensure that
proper steps are being taken.

OBJECTIVE 2: OUTLINE THE

IMPORTANCE OF MANUAL
CLEANING TO PREVENT
HEALTHCARE-ASSOCIATED
INFECTIONS AND PROMOTE
EMPLOYEE SAFETY
Patients enter the healthcare facility in
a weakened and compromised state,
which makes them more susceptible
to contracting an infection. The CS
department plays an important role
in infection prevention; therefore, it Figure 1: Immersible instruments should be cleaned below the water’s surface.

is important that CS professionals

meticulously follow standards, instruments as potentially disease What follows are the basic steps for
recommendations and manufacturers’ causing. CS professionals’ use of standard proper manual cleaning. Note: The
IFU for manual cleaning. Proper precautions when handling contaminated manufacturer’s IFU for each device should
orientation and annual competency instruments, along with their consistent be carefully followed to ensure proper
within the facility also helps ensure that adherence to proper cleaning processes, cleaning.
all staff members are following standards is critical for reducing the likelihood
properly and consistently. of cross contamination. Note: The use PRESOAK: Presoaking helps loosen
Thorough cleaning is the first step in of proper personal protective equipment soil on devices and makes the devices
the disinfection and sterilization process. (PPE) in the decontamination area is easier to clean. The manufacturer’s
Failure to completely follow the defined required by the Occupational Safety and IFU should be followed when mixing
cleaning process (as outlined in the latest Health Administration (OSHA) to protect soaking solution, and the temperature
standards, recommendations and IFU) personnel from potentially infectious should be monitored and documented.
may cause inadequate decontamination, microorganisms. Optimal temperature ranges should be
interfere with the disinfection or between 80°F to 110°F (27°C to 44°C),
sterilization process, and cause patients to OBJECTIVE 3: REVIEW THE and not exceed 140°F (60°C). These
become exposed to infectious agents. MANUAL CLEANING PROCESS temperatures will prevent coagulation
Infection prevention and control Most items that enter the decontamination and assist in the removal of protein
goes hand in hand with reprocessing area will be subjected to some type of substances. Once items are received and
of medical devices in the healthcare manual cleaning. For some instruments, sorted in the decontamination area, they
setting. An infection is a type of disease manual cleaning is used as a preparation should be disassembled before soaking
that is caused by microorganisms, also of instruments before the use of in an approved solution. CS professionals
known as pathogens. Improperly-cleaned mechanical cleaners; however, for some should be careful not to lose small
medical devices can be the cause of an medical devices, such as delicate parts. All surfaces of the instruments
infection. It is important to note that microsurgical, lensed and power surgical must be exposed to the solution; hinged
not all microorganisms are disease instruments, manual cleaning will be the instruments should be opened to
causing; however, CS professionals only cleaning process performed prior to completely expose the box locks.
must consider all contaminated disinfection, sterilization or patient use.
 CRCST SELF-STUDY LESSON PLAN

CLEAN: Cleaning solutions should

be mixed according to the chemical
manufacturer’s IFU. Recommendations
for dilution, temperature and water pH
should be followed.
Immersible devices should be cleaned
under water to minimize aerosolation.
Figure 1 shows instruments being cleaned
below the surface of the water. Using a
lint-free cloth and the recommended
brush type, all areas of the device should
be carefully cleaned, brushed and flushed.
Lumened or cannulated medical devices
should be cleaned with the appropriate
size brush, bristle type and material,
followed by flushing the lumens to
remove all loosened debris. Ensure all
areas of the instrument are cleaned,
including any crevices.
Devices that cannot be immersed
should be cleaned in a manner that
will protect the instrument from water
invasion, and they should be rinsed and
dried according to the manufacturer’s
IFU. Immersing items that should not be
immersed will damage the device, causing
expensive repair or replacement of the
item. Figure 2 shows power instruments
immersed.

RINSE: After cleaning, the device should

be thoroughly rinsed with clean water to
remove any detergent residue and debris.
Following the initial rinse, the devices
should be rinsed in treated water. This
final rinse helps ensure all residues and
debris have been removed, as well as any
fever-producing pyrogens. Some items
that cannot be immersed may be rinsed
under running water. CS professionals
should follow the manufacturer’s IFU for
the proper rinsing method.

LUBRICATE: Some manually-cleaned

items require lubrication after cleaning.
The use of a water-soluble lubricant is
recommended. Be sure the lubricant is
approved for the type of sterilization Figure 2: Immersion of power instruments
 CRCST Self-Study Lesson Plan

method that will be used. To ensure the instruments) is recommended to

proper lubrication, carefully follow the keep blood and protein substances IAHCSMM ACKNOWLEDGES
manufacturer’s IFU for both the lubricant from drying on devices prior to being THE FOLLOWING CS
PROFESSIONALS FOR THEIR
and the instrument. transported to the decontamination
ASSISTANCE IN THE CRCST
Carefully check the device for area. CS professionals must continue the
LESSON PLAN SERIES
cleanliness before sending it to the cleaning process wearing proper PPE and
assembly area. If a soiled instrument follow the manufacturers’ IFU in each Damien Berg, CRCST
is found, it should undergo the entire step of reprocessing to render the medical Nicholas Schmitz
cleaning process again. devices safe for handling and continued Susan Klacik, ACE, FCS, CHL, CIS,
processing for patient use. A quality CRCST
OBJECTIVE 4: ADDRESS THE assurance program should also be put Anna Clarkson, CHL, CIS, CRCST
NEED FOR QUALITY ASSURANCE in place to ensure that CS professionals Don Williams, CHL, CIS, CRCST
TESTING are following cleaning procedures Gwendolyn Byrd, CHL, CIS, CRCST
Quality assurance testing of the cleaning consistently, and that the cleaning Deborah Bunn, ACE, CHL, CIS, CRCST
process should be a routine process and decontamination processes were Mattie Castro, CHL, CHMMC, CIS,
within the CS processing cycle. Any effective. CRCST
organic material left on the devices Michelle Clark
after cleaning lowers the effectiveness RESOURCES Christina Poston, CHL, CIS, CRCST
of the disinfection or sterilization Association of periOperative Registered Nurses. Donna Serra, CHL, CRCST
process, and may lead to subsequent 2016. Guidelines for periOperative Practice.
infection. It is not feasible to test each
instrument for cleanliness, so a system Centers for Disease Control and Prevention.
to select instruments for testing should 2013. Infection Control Frequently Asked
be developed. Some difficult-to-clean Questions – Sterilization, Cleaning.
instrument types may be tested each
time they are cleaned, whereas other Association for the Advancement of
instruments should be selected on a Medical Instrumentation. ANSI/AAMI ST79,
random basis. Disassembled instruments Comprehensive guide to steam sterilization
should be tested prior to reassembly. and sterility assurance in health care facilities,
There are several types of commercial Sections 7.5.3.2 and 7.5.3.3.
tests available; regardless of the type used,
it is essential to follow the manufacturer’s
IFU. Instruments that fail cleanliness
testing should be sent back to the
decontamination area for recleaning.
When soiled instruments are found, the
cleaning process should be evaluated
to determine where the process was not
effective. Items that have been tested
should be recleaned after testing to
remove any testing chemical residue. WANT TO BE AN AUTHOR?
IAHCSMM is seeking volunteers to write or contribute information for our CRCST
IN CONCLUSION Self-Study Lessons. Doing so is a great way to contribute to your own professional
Manual cleaning begins with point- development, to your Association, and to your Central Service department peers.
of-use cleaning in the surgical suite. IAHCSMM will provide guidelines and help you with the lesson to ensure it will
Post-operative use of an enzymatic be an enjoyable process. For more information, please contact Natalie Lind
pre-cleaning spray (or a water- ([email protected]).
moistened, lint-free cloth placed over
 Sponsored by:

CRCST Self-Study Lesson Plan Quiz -

The Manual Cleaning Process
Lesson No. CRCST 150 (Technical Continuing Education - TCE) • Lesson expires September 2019

OBJECTIVE 1 OBJECTIVE 3 12. When a soiled instrument is found

1. Manual cleaning: 6. Presoaking: after the cleaning process, it should be:
a. Is the removal of visible soil a. Helps loosen soil a. Rinsed to remove the debris
b. Is the only cleaning process for b. Coagulates proteins b. Resoaked following the
non-critical items c. Is done at the point of use manufacturer’s Instructions for Use
c. Starts at the point of use d. All the above c. Subjected to the complete cleaning
d. All the above process again
7. Manual cleaning may be the only d. All the above
2. Keeping instruments moist after use: cleaning process an item receives.
a. Keeps instruments from rusting a. True OBJECTIVE 4
b. Makes instrument easier to clean b. False 13. Quality assurance testing of the
c. Is required by the Association cleaning process should be performed
for the Advancement of Medical 8. This type of device only needs good on each instrument cleaned.
Instrumentation manual cleaning: a. True
d. All the above a. Critical b. False
b. Semi-critical
OBJECTIVE 2 c. Non-critical 14. Some types of difficult-to-clean
3. Following manual cleaning standards: d. All the above instruments may be tested for
a. Ensures increased competency scores cleanliness each time they are
b. Keeps soil from drying on the 9. All items that cannot be immersed cleaned.
instrument in cleaning solution can be rinsed a. True
c. Helps improve patient outcomes under running water. b. False
d. All the above a. True
b. False 15. After quality assurance testing, the
4. Failure to follow defined cleaning tested instrument should be sent to
processes: 10. Instruments that cannot be immersed the decontamination area for cleaning,
a. May expose patients to infection should be: even if the instrument tested as clean.
b. Interrupts the chain of infection a. Protected from fluid invasion a. True
c. Is citable by the Occupational b. Soaked according to the b. False
Safety and Health Administration manufacturer’s instructions for use
d. All the above c. Wiped down after presoaking
d. All the above
5. The use of personal protective equipment:
a. Is required by the Association 11. Manually-cleaned instruments do not
for the Advancement of Medical require lubrication.
Instrumentation a. True
b. Protects the patient from cross b. False
contamination
c. Protects personnel from possible
infectious microorganisms
d. All the above

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