Water Quality & Surgical Instruments

Part 6 In closing ,I believe an ounce of?prevention can yield enormous return for your patient. I also believe that we must understand that implementation of any quality improvement or risk-based?program?does not always prevent incidences from happening but?helps reduce and understand them better if they occur. We must not forget the importance of reading and understanding all the IFU in our process and see how they interact with each other to get us to “Best Practice”. Like to hear what you think. Again, we only have so much space to give a viewpoint. #ahrm #spd # mdrd #cnor #OR #aorn #apic #ast #cssd # HAHQ 3wfhss #HSPA #IAHCSMM #cbspd #ASHE #AAMI #CPD #WIPAK #steriking #LTA #getinge #IFUcan #healthmark #sgna

Part 5 Experience has shown that most staining and spotting?problems (regardless, if on an instrument or tray liner) are more geographical in nature, due to such factors as water pH, boiler compounds in water lines, staff training loading technique ,detergent residue and certain chemical incompatible with?the stainless steel on instruments or even surgical trays. My view is any stain/color needs to be investigated and some experts have stated that out of all of the concerns one must look at the water and steam quality and ?generally it is found to be the main source of these stains/colors. With steam sterilization it is the reaction during the steam process that makes these “stains/colors” appear because they were not there before they were sterilized. Thus, suggestive water and steam quality. I believe if you have poor ?water or steam quality it will appear or react with your equipment or medical devise and cause poor outcomes, some place in your process. So why not do simple water tests every day ( think of your pool water) so you can trend and be ahead of the curve and know the exact water quality in your department. Just one simple solution.

Part 4 These spots often happens because of a less-than-optimal blowing process after rinsing and staff not loading the instruments properly ( overshadowing taking place). This can eventually lead to water spots, especially if the blowing dry process is not complete. These spots sometimes appear after sterilization. Thus, in my view if the staff understood the importance of the instruments being dry coming out of the washer ,they would investigate?the reason they were not dry ( data logged could help show the drying temperature). Other information would have to be looked at like the quality of water ,staff technique in loading instrument in the washer. Not just one simple answer in solving the “white spot issue” . Where does a lot of that information come from concerning water quality the Manufacturers Instruction for Use. Remember I believe these standards are needed.

Part 3 Here is why I feel comfortable making this statement. First, the drying step is vital in preventing water spots. What I have seen in similar situations, most medical devices are not dry when they come out of a medical automatic washer they might appear?“dry and visual?clean” but there are spots of water left to dry on their own. Thus, if ?even a?few drops of rinse water are left on the parts, then when water evaporates, it concentrates the possibility of trace salts and leaves calcium, magnesium and other deposits on the instruments. These often appear in characteristic sets of white ring shapes, i.e. water spots. I have observed staff while assembling instruments see spots on instruments and wipe with alcohol and move on. This is when critical thinking needs to take place, if you see spots ,wiping them away does not solve the issue. It needs investigating, or I think it does. These spots often happens because of a less-than-optimal blowing process after rinsing and staff not loading the instruments properly ( overshadowing taking place). This can eventually lead to water spots, especially if the blowing dry process is not complete. These spots sometimes appear after sterilization.

Part 2 Interesting, this is not a new issue ,it has been going on since I have been in this industry ( yes, I am old ) and before me, spots on instruments, what are they ? In the last few months, I have seen so many webinars on water quality and the new standard trying to raise the awareness of the importance of water quality, I wonder if this will help or not. I am not sure because not everyone follows the standard and as my friend DJ states “don’t just meet the standard exceed them”. We all need a water quality team and a plan for managing the water in any facility and how the frontline staff understand their role and why and how important they are in making sure headlines like this do not take place. Do not get me wrong, we need the standard and people to use and follow the standard so why is this still a concern. For me it centers around using critical thinking skills and teaching our staff and trusting them to use this skill every day. Why make such a strong statement. Because these water spots did not just appear for the first time, nobody can make me believe they just appeared that day. They have been going on for some time. So, what was in place for the staff to alert management ahead of time of any spots.