limited space, where at any given time you might have 20 trays that
need to be sonic-ed before they go into the washer. Too often, people
are inclined to simply skip that crucial step. Now you can handle sev-
eral trays simultaneously in one machine, provided they all require the
same amount of sonication time.
A washer can't do everything. The ideal cleaning process typically starts
with an enzyme soak, is followed by ultrasonic cleaning, and then by
mechanical washing. Virtually every instrument manufacturer's instructions
for use (IFU) recommend including ultrasonic cleaning as part of the repro-
cessing process. If you don't have an ultrasonic cleaner and bypass that
step by placing instruments directly in the washer, you're not complying
with the IFUs. You're in effect saying you know more than the manufactur-
er, and you think you can get the device clean by doing it your way instead.
Mechanical washers and ultrasonic cleaners have different processes
and different functions. Ultrasonic cleaners agitate water and create bub-
bles that implode and create pockets of suction around instruments.
They're good at removing debris out of all the nooks, crannies and serra-
tions, but they don't disinfect. Washers, on the other hand, aren't nearly
as effective at dislodging debris from hard-to-reach areas, but they do
usually raise the temperature at the end of the cycle to a level that
reduces microbial count.
Some facilities may be able to get by with just an ultrasonic cleaner
(as long as that's the instrument manufacturer's recommended proto-
col and the people doing the prepping and packaging wear powder-
free gloves), but most need multiple pieces of equipment to comply
with the manufacturer's IFUs.
And you'll need more than one. You should never have just one of
any type of equipment, because when it goes down, which it inevitably
will, you'll be facing a major problem. This may be one of the reasons
that tunnel washers — the car-wash types that let you put instruments
8 6 • O U T PA T I E N T S U R G E R Y M A G A Z I N E • J A N U A R Y 2 0 1 7
