As Clean as a Hound’s Tooth?

Automated Washer

Make sure your cleaning indicator measures up

“A gaze as deep as the ocean “

“Hopes as high as the sky”

 “A will as strong as iron”

Metaphors are a great way to make an abstract concept easier to grasp. Essentially, they use something tangible (e.g. iron) as a proxy for something intangible (e.g. a strong will). In some cases, however, the reference is too unusual, and makes the metaphor less effective.

The word “clean” is a good example.  A web search for metaphors using the word “clean” resulted in expressions that, while widely used, are not inherently sanitary or hygienic.

“As clean as a whistle”

“As clean as a new penny”

“As clean as a hound’s tooth”

As SPD professionals, we know that a penny, no matter how clean, is a pretty low bar as a standard for a clean load. At the same time, it is surprising how comfortable our industry has become using wash indicators as proxies for clean loads.

Several manufacturers, including Case Medical, sell wash indicators that are essentially “metaphors” for the most soiled surgical instruments in a load. Used correctly, in properly maintained equipment and according to manufacturer’s guidelines, wash indicators are a prudent final step that validates that all is well or reveals the potential for hidden issues. Used incorrectly, in poorly maintained equipment or using incorrect parameters, a wash indicator is about as much use as a hound’s tooth.

Screen-Shot-2017-05-16-at-10_43_37-AM-300x300-1Case Medical’s Case Soil® wash indicator uses surgical grade stainless steel and dried on bioburden in a hinged tray to recreate real world SPD challenges as accurately as possible. Our indicators are tested under a variety of conditions, using our cleaning products and our competitors’.  Our goal is to make a clean result challenging enough to ensure the rest of the load is clean, but not so challenging that false positives overburden SPD departments with added work and stress. Despite this rigorous process, there is no official manufacturing standard for wash indicators so it is conceivable, and even likely, that different manufacturers can return different results from the same load.

So, which one is right? Maybe neither. The scary thought is that both indicators are wrong. That is why I have long advocated for parametric release as the standard for a clean load. According to this article in the American Pharmaceutical Review, “Parametric release can be defined as a sterility assurance release program where demonstrated control of the sterilization process enables a firm to use defined critical process controls, in lieu of the sterility test…”  This same standard essentially applies to cleaning equipment as well.

I will save an in-depth discussion of parametric release for a future blog post but in brief, a properly maintained/serviced automated washer, following standardized parameters will always result in a positive outcome. In other words, instead of relying on a wash indicator as a reason to check equipment status and settings, parametric release makes this a mandatory step.

Parametric release is the standard currently in Europe and someday soon, hopefully here in the U.S. as well.