Becker’s Healthcare and Healthmark present

Today’s Presenter• I am an employee of Healthmark Industries Fraser,

Michigan USA.• I am involved with the manufacture and

distribution of medical products to healthcare facilities and healthcare professionals.

• All opinions are those of the presenter.• This presentation reflects the techniques,

approaches and opinions of the individual presenter.

• This sponsored presentation is not intended to be used as a training guide or promotion. Before using any medical device, review all relevant package inserts with particular attention to the indications, contraindications, warnings and precautions, and steps for the use of the device(s).

If your brushes look like this you are at the right presentation

Company Mission

To provide innovative and cost effective products that aid our Healthcare

Industry customers in meeting their sterilization, decontamination, storage,

distribution and security needs.

Healthmark Policy

Healthmark’s Policy is to provide our customers and the healthcare community with the highest quality, state of the art medical products and support services in a timely and cost effective manner.

This goal is supported by a staff committed to individual accountability, professionalism, mutual respect, collaboration and service excellence. This webinar is part of that commitment, educating our customers.

During the program we will have some questions for the attendees. Our first set of questions are next:

Who is attending today?

•Please answer the following questions:

–What department do you primarily work in at your facility (medical facility)?•Sterile Processing

•Operating room

•Infection Control

•Dental office

•Other

Where are you from?

• United States• Canada• Other countries

Questions?

• To submit a question, please type your question in the

Q&A box on the left side of your screen and press Submit.

• We will do our best to answer as many questions as we

can during the webinar.

• We are ready to start, we have a lot to cover today.

12/13/2017 8

Objectives

During this webinar, you will learn the fundamentals of instrument manual cleaning performed with brushes and wipes. We will also cover the two essential components of manual cleaning; friction and fluidics. Friction (e.g., rubbing/scrubbing the soiled area with a brush) is an old and dependable method. Learn about the importance of brushes and the role it plays in ensuring medical devices is as clean as possible.

• Understand the role brushing and flushing play in cleaning medical devices

• Learn the anatomy of a brush• Learn how to pick the correct brush for

the appropriate task• Review how to properly inspect a

brush• Understand how to properly brush a

medical device• Understand the role fluids plays in

cleaning

Healthmark Art of Brushing Tips• How do you pick a brush to clean any medical

device?

• First, identify the medical device to be cleaned than examine the medical device to understand what you have to clean

– External surface

– Internal surface

• Second, understand (read/review) the IFU for any specific brushes

• Third, pick the brush(es) from your inventory

• Brushing is done on the dirty side, not the clean side (assembly)

• If you find an instrument that is dirty upon inspection, send it back to be re-cleaned.

• Brush – flush/rinse (repeat as needed) – dry -inspect

• Be sure to keep the instrument completely under the waterline when you brush according to the IFU.

• Never brush outside the water, as you want anything you pull out to stay under the water. Unless directed by the IFU.

• When acquiring new instrumentation, a review of the care and handling should be included in the evaluation to ensure that the reprocessing department has the tools to effectively reprocess said device.

• Always inspect your brush before you use it

• If no direction is given in the IFU, use your critical thinking skills

• You must have a policy that reflects your practice– Based on the

• IFU

• Standards, guidelines...

Protecting your largest investment

One of a medical facilities most largest and most valuable resources are there medical devices (surgical instruments) and medical device reprocessing professional must ensure to keep

the integrity of those device – they must be clean and functional.

Brushing is a vital part of keeping the integrity of those medical devices clean and functional so they can be used on any patient.

Support for proper brushing

• Standards and guidelines

• ANSI / AAMI

• ST 79, 90, 91…

• CDC

• Friction

• Fluids

• Manufacturers Instructions for Use (IFU)

• Professional groups and associations

• Other sources

Learn the anatomy of a brush

• Length of overall brush• Length of brush• Diameter of brush• Bristle composition: Synthetic,

Natural, wire strands (working part of the brush)

• Wand Style ie: handle : twisted stainless steel, molded plastic block, Tubing and Rods, spring coil stainless steel

• Tip/End Style• Intended Brush Application

• For flat surfaces• Lumened items• Orthopedics• Endoscope• Special design for specific purposes

Anatomy of a Brush

1. Brush diameter

2. Brush length3. Overall length

of the brush4. Shaft material5. Tip style6. End Style

Block Style Brush

1. Handle/Block length2. Handle/Block width3. Handle thickness4. Brush face length5. Fill trim length

Questions to the group

• How many of you are now looking at single use (non-endoscope) brushes?• Yes

• No

• If you answered yes answer the following• Per tray (toss after use)

• Per procedure (toss after all of the trays in that case cart cleaned)

Question

• If you are using reusable brushes, what is the frequency of use?• Daily

• After each use

• End of shift

• As inspected

Understand how to pick the correct brush for the appropriate task

Selecting the Right kind/type of Brush

Understand how to pick the correct brush for the appropriate task

• How do I pick a brush to clean any medical device – First, identify the medical device to be

cleaned. Examine the medical device to understand what you have to clean.• External surface

– Smooth, serrated, rough

• Internal surface– Diameter, length

• Second, the IFU for any specific brushes

• Third, pick the brushes from your inventory

• Look at two medical devices– Orthopedic shaver

• External surface to be cleaned• Internal surface to be cleaned

– Suction• External surface to be cleaned• Internal surface to be cleaned

Special Shaver Brushes for the internal surface

Clean inside the lumen step area

Clean inside the drive fork area

You need 3 unique brushes for this shaver** RES_09_10600599B_DYONICS_Handpiece_Cleaning_Poster_v10.indd 1

External surface for this shaver

• Remember that different medical device manufactures have different IFUs.– *Perform rinsing and cleaning as soon as

possible after use.– Thoroughly scrub the device with a

clean, soft brush that is dampened with a mild, enzymatic, pH-balanced detergent. Always avoid any harsh materials that can scratch or mar the surface of the device.

– Remove all traces of blood, debris, and stains.

– Do not immerse the device in soap solution or rinse-water.

*Adapteur Power System™ II (APS II) Shaver Handpieces DFU-0154 Revision 12

Suctions: Many different kinds and types

• They all have in common

– External surface• Majority of IFUs state clean with a soft

bristle brush

– Internal surfaces• Majority of IFUs state use the

appropriate size diameter brush

– Suctions usually in French size• Remember the size is the external

diameter not the inside diameter

External Brush for Suctions

• External

– Soft bristle

– Many choices

Internal Brushes for Suctions

• Disposables

– Intended for 1 time use • Used on 1 surgical case

– All the brushes used for that specific case only than disposed of

• Also flexible endoscope brushes are disposable or “single-use”

– Greatly reduces the risk of cross contamination

– May increase supply cost

Internal brushes for suctions

• Reusable– Designed to be reused after cleaning

and disinfection. • Cost effective if proper care and handling

of brush is implemented. – Decontaminated and inspected after

each use per manufacturer recommendations

– Inspected before use for cleanliness and wear.

– How you store them is important• Never wet always dry when put back

– Vertical

– In a bin

– other

Internal brushes for suctions

• Reposables

• Brush tips are disposable but brush handles/shaft are reusable.

– Reduces cost associated with single use by only replacing the brush bristle.

– Some reusable handles/shafts can be sterilized

– Many sizes of tips

Brush Sizes

The standard French, or Charriere Scale (abbreviated Fr.), is generally used in the size calibration of catheters and other tubular instruments. It is based on the metric system, with each unit being approximately 0.33 mm in diameter between consecutive sizes.

Do the simple math:

3 x mm size = Fr size

Fr size divided by 3 = mm size

Size (mm) Size ( Fr.)

1.0 3

1.3 4

1.6 5

2.0 6

2.3 7

2.6 8

3.0 9

3.3 10

3.6 11

4.0 12

5.0 15

6.0 18

Close up – notice the size

It is important to have a brush sizing tool to ensure that channels get measured

properly if you are not sure of the diameter size.

Remember the outside diameter is bigger than the internal

diameter of a suction.Healthmark has a brush sizing

tool, contact us for more information if you need one.

Inspecting a brush

• When you open it up

• Each time you use it

• How and where you store your brush after you use it (reusable type)

• Have a new unused brush to compare – that is the best source for comparison

– Wall chart

Inspecting a Brush

Inspecting a brush

Think Christmas tree!

And these…!!

Kinks and bends in the handles, organic soils lodged in the bristles

How you store your reusable brushes is important. They must be dry.

Understand how to properly brush a medical device• The act of brushing is a mechanical action used to remove soiled particles, such as blood,

tissue, biofilm and harmful particles, from internal and external channels before HLD or sterilization

• It's absolutely necessary to use the appropriately sized brush. Diameter of the brush is critical to letting bristles create friction against the walls of the lumen.

• The IFU can give you specific ways to brush and with what type, kind of brush.• Manufacture of the medical devices has done the cleaning validation

– Method of brushing• Push pull• Pull push

– Twist turn as the brush goes into the lumen/cannula

• When no direction is given, look to: – Standards– Technical manuals– Manufactures of your brushes– Common sense

• Remember your policy should reflect your practice

Internal Channel Brush Sizing

Too large will impactBristles ability to clean

Too small Bristles willnot make adequate Contact.

Proper bristle diameter

How to brush per one manufacturer IFU:

Other examples of how to brush

Legend Motor/Attachments/Tubes

“…Use ONLY nylon cleaning brushes. Non-nylon cleaning brushes leave residue that may prevent the tool from being secured properly in the hand piece…Brush motor case and collet with a nylon brush dampened with a neutral enzymatic detergent. If using the Legend Touch motor, be sure to brush under the finger control lever…Straight attachments, footed attachments and telescoping straight tubes have special cleaning brushes sized to the attachment’s or telescoping tube’s internal diameter. Push the brush wet with surgical instrument cleaning solution through the attachment or telescoping tube from rear to front to loosen and remove debris trapped inside…”

No place in the IFU* does it state what size or kind of brush to use?Common Sense Approach

* http://aegisspine.com/wp-content/uploads/2015/06/LnK-MIS-STG.pdf

After brushing, you must flush or rinse away what you just

brushed.

Brush, flush, brush, flush

OR

brush, rinse, brush, rinse

Remember: With manual cleaning, the two essential components are friction and fluidics

Air/water/pistol/spray/gun

• AAMI ST 79 supports the use of air/water spray guns in the Sterile Processing Area

• Medical device companies often recommend the use of a spray gun/pistol for both air and water in their IFU• Dirty side (air and water)• Clean side (air only)

• Follow the spray gun IFU for routine cleaning of the spray gun• Use the correct adapters/nozzles for cleaning• Make sure you monitor the water/air pressure during your cleaning

process according to the medical device IFU• Work with your facilities department for connecting to water/air and the

proper gauges to monitor the flow rates• Look at some examples

Must monitor the pressure

Water Pressure minimum 30 psi

air pressure must not exceed 0.5 MPa (71 psig)

IFU stating to use a cleaning gun

Examples

What type of air? Monitor?

• Statements within ST 79

– Excess moisture from cleaning and rinsing should be removed using filtered, instrument air.

The Spray Gun (air/water)

• Why have one in a department

• Instrument manufacture

– The IFU• Pressure requirements

• Water quality

• Air quality

• Other

• A vital part of the cleaning process

Closing thoughts

• Testing for equivalent brushes

• Metal stainless steel brushes

• Wipes

• Flexi-steam

• Specialty brushes

• Other

Which one will clean the best ?

This is why we created Methods to Evaluate the Performance of Cleaning Instrument Brushes

Not all brushes are created equal• Which one will clean better?

• Need for an objective test to look at brushes

• ASTM has a working group

• Draft ASTM test method (WK 53082) for cleaning brushes for lumened medical devices.

• Quantifiable methods are being developed for comparing two brushes that have been designed to clean the same target area(s).

• These tests provide a means to quantitate performance of brushes. They allow objective comparisons of similar design from different sources and also different designs of a brush to clean the same device.

Can I have a stainless steel brush in my decontamination area?

ST 79 on the use of stainless steel brushes…”Nylon cleaning implements are preferred, but stainless steel bristle brushes designed specifically for surgical instrument jaws and box locks may be used following manufacturer's written IFU”.

Remember this on stainless steel brushes, the designed usage of this stainless wire brush is mostly for bone files and orthopedic instruments to help remove cement. Use it wisely if you have them in your department.

Other Specialty Brushes

• Reamer Brushes• Stainless bar with bristle end• Stronger

• Double-Ended Tooth Brush• Extra strong nylon tip• Ideal for cleaning cautery tips• Available Sterile

Endoscopes

• Many different types of scopes

• Many different types of brushes are needed

• Many different areas to be cleaned

• Single use or reusable

• IFU

• CDC Statement

• Standards

Bipolar

Usually a 0.07 mm brush

The tip must be cleaned and watch out not to damage the

insulation

Different Brushes

Sponges and Low-Linting Wipes

• Low linting-wipes and sponges are for use immediately after surgical equipment have been used, and prior to automated or manual disinfection to insure items are dry.

• Pre-cleaning of endoscopes and other surgical equipment is not only important, but absolutely necessary. These products will help insure that surgical instruments are properly reprocessed in compliance with the device manufacturer’s instructions for use.

Wipes

• Wipes can be used per the IFU for external surfaces as noted

• Lint free when possible

General Rule

• “A Sterile Processing Department should probably stock somewhere between 12-15 different sized brushes. It is absolutely necessary to have the appropriate sized brush.”

Nancy Chobin

Healthmark Art of Brushing Tips• How do you pick a brush to clean any medical

device?

• First, identify the medical device to be cleaned than examine the medical device to understand what you have to clean.

– External surface

– Internal surface

• Second, understand (read/review) the IFU for any specific brushes.

• Third, pick the brush(es) from your inventory.

• Brushing is done on the dirty side not the clean side (assembly).

• If you find an instrument that is dirty upon inspection, send it back to be re-cleaned.

• Brush – flush/rinse (repeat as needed) – dry –inspect.

• Be sure to keep the instrument completely under the waterline when you brush according to the IFU.

• Never brush outside the water, as you want anything you pull out to stay under the water. Unless directed by the IFU

• When acquiring new instrumentation, a review of the care and handling should be included in the evaluation to ensure that the reprocessing department has the tools to effectively reprocess said device.

• Always inspect your brush before you use it.

• If no direction is given in the IFU, use your critical thinking skills.

• You must have a policy that reflects your practice.– Based on the

• IFU

• Standards, guidelines,..

BRUSH

• Brushing a medical device size does matter; always use the correct type, size, and diameter to brush cannulated medical devices.

• Reusable or single use brush; always inspect the brush each time before you use it.

• Utilize the correct technique for brushing a cannulated medical devices; “ push “ or “pull” method.

• Scrubbing external surfaces use only approved brushes and wipes for this task.

• Have adequate supply of brushes available for the tasks at hand.

Healthmark Educational Opportunities

Healthmark has been a continued sponsor of the Decontaminator of the Year Award, named in Honor of Anne Cofiell. The Decontaminator of the Year Award, sponsored by Healthmark, recognizes the author (a CSSD technician) of an outstanding paper focusing on understanding the importance of decontamination in their workplace environment. The recipient of this award is recognized annually at the IAHCSMM meeting and receives an engraved plaque plus $1000 and free registration to the IAHCSMM annual.

• Online CEU Programs– Crazy4Clean.com

• Sterile Processing Dollars– Free to sign up– Money that can be used for

educational purposes within a department• Seminar fees• Books• Other

• Speakers at no charge to groups, associations, medical facilities

• Technical support on our products

Closing Reminders

• Please be sure to complete the quiz and form in order to receive your CEU.– IAHCSMM– CBSPD

• https://www.hmark.com/becker_december2017.php

• A link to the quiz will be emailed to attendees at the email address provided when they signed up for the program.

• Thank you to Becker and Healthmark for hosting this educational session.

12/13/2017 62

Contact InformationStephen M. Kovach

1-800-521-6224/Ext.6621

cpdguy@hmark.com

www.cpdguy.net

www.hmark.com

Questions?

A new Online

educational program

coming soon

This is why we do what we do...it could be our family having the procedure and we want those medical devices clean.

Remember, you are the Heart of the Hospital!

Thank you for attending today and good brushing.

Keep it Clean.