The art of brushing — how to properly clean medical equipment to ensure patient safety

Although the healthcare industry has made great strides in patient safety in recent years, reducing hospital-acquired infections, delivering quality care and further improving safety remain top priorities for health organizations across the nation. To minimize the risks of adverse events and improve patient safety, sterile processing leaders can employ strategies to ensure medical instruments are always properly cleaned.

In a Dec. 13 webinar sponsored by Healthmark Industries and hosted by Becker's Hospital Review, Stephen Kovach, director of education at Healthmark Industries, discussed how healthcare organizations can ensure medical instruments are clean using manual cleaning tools such as brushes and wipes. Mr. Kovach explained the anatomy of a brush, taught listeners how to inspect a brush, and discussed how to select a brush and how to employ the proper cleaning method for each medical device.

"One of the largest investments a hospital, medical facility, freestanding clinic or endoscopy lab can make is in their medical devices and surgical instruments, so we need to take utmost care and make sure those devices are clean, functional and reusable," Mr. Kovach explained. "Brushing is a vital part of keeping the integrity of those medical devices clean and functional so they can be used on any patient."

Understanding the anatomy of a brush is important

Brushing is used to remove soiled particles, biofilm and tissue prior to sterilization. When done correctly, using both friction and fluidics, brushing can mitigate patient safety issues.

Effectively cleaning medical equipment requires an understanding of both the medical device and the tools needed to clean it. By understanding the parts of a brush, the reprocessing team can easily compare brushes and select the appropriate brush each time.

"If you're going to compare brushes, you have to understand the anatomy. … You need to understand the overall length, type of brush bristle, type of brush, the diameter, if it's steel or plastic or has microfibers, what kind of tip is on the end, what's the intended use of the brush … it is all important," Mr. Kovach said.

Inspecting a brush

Prior to using a brush, it is necessary to inspect it for cleanliness and overall condition, explained Mr. Kovach. It is important to look for wear and tear, damage to the shaft of the brush, and fraying, falling or missing bristles.

"You won't be able to get the friction or physics of [the brush] if the shaft is damaged … and if the bristles are fallen … the bristles have lost their strength … and the brush should not be used," said Mr. Kovach.

To facilitate the inspection process, Mr. Kovach recommended keeping an unused brush to use as a comparison.

"If you hold up the brush, and it doesn't look like [the new brush], I wouldn't use it," he said.

Properly brushing a medical device: Picking the correct brush for the appropriate task

The first step to selecting the correct brush is identifying the medical device, examining the medical device, and understanding its internal and external surfaces. Second, it is imperative to find the device manufacturer's instructions for use, which provides the reprocessing team direction for the type of brush to use and recommended cleaning method.

"Refer to the manufacturer's IFUs. … Those are the people that have done the validation studies on how to properly clean the [equipment]," Mr. Kovach explained. "Manufacturers will tell you to use the push-pull or pull-push method … When they [manufacturers] don't provide you direction, you have to use critical thinking skills based on manuals, guidelines and common sense."

After reading the manufacturer's IFU, the reprocessor will use his or her judgment to select the appropriate brush from the hospital's inventory.

For internal cleaning, it is vital to select the brush with the appropriate diameter. If the brush is too large, it will harm the bristle's ability to clean. If the diameter is too small, the bristles will not make adequate contact.

Many tubular medical devices use the French, or Charriere, scale for size calibration. Mr. Kovach noted there are guides and tools available to pick the proper brush size in every scenario.

"The French size is three times the diameter in millimeters. … So if you have French size nine, the catheter is three millimeters. … You can do the simple math and take the French size and divide it by three or … you can use a brush sizing chart." What you must remember is the sizing chart gives the outside diameter of the medical devices and is a guide.

It is important to note that more than one brush may be needed to properly clean a medical device (external and internal).

After brushing, it is vital to flush or rinse the device. The new regulations in AAMI ST 79, supports the use of air or water spray guns for this scenario.

"Again, you need to refer to the manufacturer's IFU," Mr. Kovach said.. "They will tell you how much pressure is needed. And you will have to monitor both the water and air pressure."

Overall, brushing and rinsing are essential steps in the sterilization process. When friction and fluidics are employed properly — following manufacturers' IFUs or common sense practices — brushing can help ensure patient safety and reduce the risks of adverse events.

Listen to the full webinar for additional insights.

View webinar slides here.

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