Manual Cleaning Methods

Manual cleaning is the cornerstone of decontamination. Even when automated cleaning equipment is available, some instruments require manual cleaning due to their design, material, or manufacturer IFU. Manual cleaning is also the first step before automated processing for heavily soiled instruments.

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When Manual Cleaning Is Required

• Instruments with dried or hardened soil (pre-soaking may be needed)
• Delicate instruments that could be damaged in automated washers
• Instruments with complex designs (lumens, hinges, ratchets, moving parts)
• When automated equipment is unavailable or broken
• As specified in the manufacturer's IFU
• Items that require pre-cleaning before automated processing

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The Manual Cleaning Process

Step 1: Sort and Disassemble

• Open all hinged instruments (hemostats, needle holders, scissors)
• Disassemble multi-part instruments
• Separate sharps for safe handling
• Group similar items for efficient processing

Step 2: Pre-Rinse

• Rinse instruments under cold to lukewarm water to remove gross soil
• Cold/cool water first — hot water can cause proteins (blood, tissue) to coagulate and adhere to surfaces
• Flush lumens with a syringe or irrigation tip

Step 3: Soak (if needed)

• Soak instruments in enzymatic detergent solution according to manufacturer instructions
• Soaking time and temperature per manufacturer IFU (typically 1-10 minutes)
• Do not over-soak — prolonged soaking can damage instrument finishes and promote corrosion
• Enzymatic solutions should be changed frequently — once contaminated, they lose effectiveness

Step 4: Wash/Scrub

• Submerge instruments below the water surface while scrubbing to prevent aerosolization
• Use the appropriate brush for each instrument:
  • Lumen brushes sized to contact all interior surfaces
  • Detail brushes for hinges, box locks, and ratchets
  • Soft-bristle brushes for delicate surfaces
• Scrub all surfaces: interior and exterior, including lumens, serrations, teeth, and box locks
• Work from least soiled to most soiled areas

Step 5: Rinse

• Rinse thoroughly with treated/filtered water to remove all detergent residue
• Flush all lumens completely
• Detergent residue left on instruments can:
  • Interfere with sterilization
  • Cause patient reactions
  • Leave deposits that attract new soil

Step 6: Inspect

• Visually inspect each instrument for remaining soil
• Use magnification if available
• Check functionality (scissors cut, hemostats close properly, ratchets hold)
• If soil remains, repeat the cleaning process

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Water Temperature Guidelines

Key rule: Never use hot water for initial rinsing — heat causes blood proteins to denature and coagulate, bonding them permanently to instrument surfaces. This is similar to cooking an egg — once the protein changes structure, it becomes very difficult to remove.

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Cleaning Chemistry

Types of Detergents Used in CS:

Enzymatic Detergent Key Facts:

• Contains proteases (break down proteins/blood), lipases (break down fats), and amylases (break down starches)
• Optimal temperature varies by product — check IFU (typically lukewarm)
• Prepare fresh solution for each use or per manufacturer directions
• Enzymatic detergents are not disinfectants — they clean but do not kill organisms
• Must be thoroughly rinsed from instruments after cleaning

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Brush Selection and Care

Brush Maintenance:

• Inspect brushes daily for broken or bent bristles, worn tips
• Clean and decontaminate brushes after each use (run through washer-disinfector)
• Replace brushes regularly per facility policy — worn brushes are ineffective and can harbor organisms
• Single-use brushes are preferred for lumens when possible