Advanced Instrument Processing Solutions

First, you need to lower the temperature on your wash cycle to the optimum high point of your detergent. Most of the enzymes in an enzymatic detergent will begin to denature over 145°F.

Let’s explore a few scenarios where your washer was set previously to a higher temperature:

1. If your wash cycle was set at a temperature over 160°F, it was probably set up for an alkaline detergent which work best at higher temperatures. 
2. If you were previously using another enzymatic detergent at a high temperature and experiencing poor results, these high wash temperatures would most likely be the cause. 
3. If you were using a two detergent system, your wash cycle would only work properly at the higher temperature if you were following the enzymatic detergent wash by an alkaline one. Following the enzyme wash cycle with a plain neutral pH detergent wash cycle at that high of a temperature, would have just been cooking any leftover soil onto your instruments.

With the aforementioned in mind, if you don’t know how to change the temperature on your washer, please have your service tech come in and show you how! All too often, I encounter facilities where no one knows how to adjust the parameters on their washer. This is a very important piece of “know how.” For example, if you’re testing your washer’s cleaning efficacy according to AAMI recommendations, and it appears you are not using enough chemistry to do the job, how are you going to adjust the dosing if you don’t know how to? Don’t become dependent on your service tech for these minor adjustments—a service call takes time, and it’s down time you can’t afford. Besides, learning how to adjust your machine will ensure you are in control in following recommendations and optimizing your cleaning ability.

Furthermore, if you work at a larger facility with a number of shifts, it’s my belief that at least one person on every shift should know the codes to change the parameters. You wouldn’t own a car without knowing how to put gas in it or an oven that only ran at one temperature, right? And you probably know how to change the parameters on your sterilizer for those “wonderful” extended cycles… so why wouldn’t you know how to do the same with your washers?

I know… I went off on a tangent again… but I hope I answered your question and wish you all a wonderful holiday!

Adding coloring and fragrance to an enzymatic detergent are nice for the reasons you stated… but did you know they reduce the ability of that detergent to rinse free? Coloring agents in detergents can be from plant sources, but more than likely they are the product of chemical salts. If you have read any of my earlier posts, you will realize we don’t want more of these in our wash.

Fragrances can also be sourced from plants or produced in a laboratory, and they are more complex in their composition. Fragrances need to be semi-volatile for you to be able to smell them, yet they cannot completely evaporate from the solution they are in. Because of these traits, they are difficult to completely “rinse free” in the wash cycle. A good example of this is laundry detergent with fragrances (and/or colorant)–even though your clothes have been washed and rinsed, you can still smell the fragrance of the detergent in the clothes (yes I know many laundry detergents are formulated to do just that). If you are allergic to the fragrances (or colorant) used, even though you may not smell (or see) them on your clothes, your skin will let you know that they are still there. This is why Hypoallergenic Laundry Detergent is usually fragrance and color free.

After much testing, the producers of Power Zyme realized this held true for enzymatic detergents when cleaning surgical instruments. Although surgical instruments are not porous like fabric, the residue of fragrances and coloring agents still presented themselves on the instruments when they were tested.

Might I suggest that if you need verification of a detergent add for your soak sink, utilize another method such as a two-colored wall card on a peg that you turn over after detergent is added. If your ultrasonic cleaner has a heater on it, you will know Power Zyme is present because it will cloud (see “our enzymatic becomes cloudy” post).

As far as covering the smell of blood, might I suggest the following:
A. Changing the solution in your sink and ultrasonic more often
B. Wearing your PPE mask over your nose
C. Investing in some fragrance plug-ins or a reed diffuser (I’m only joking here)

I know that the smell of blood can be annoying, if not sickening, but it is part of the job. And if it bothers you that much, perhaps you might consider using some lavender essential oil on your face mask and thank your “lucky stars” you are not doing fecal disimpactions in the OR!

Again, I must say the goal in decontam is to clean the instruments and have them free of residuals from both the procedure they were used in AND the detergent itself.

Enzymes speed the process of cleaning instruments by cleaving their substrates at higher rates (millions of times higher) than would occur without them; however, breaking down soil does not wash it away.  By combining the chemistries that make up a “detergent” (surfactants, sequestering/complexing agents, etc.) with enzymes, the bioburden removal process is increased immensely. The two work cooperative as such:

1. Target soils are broken down by the enzymes, then lifted away from the surface of the instruments and held in suspension by surfactants.
2. Sequestering/complexing agents react with dissolved minerals in water to keep them from interfering with the cleaning process and from re-depositing on the instruments.

If you only had enzymes in solution, you would require a second chemistry (a detergent) to wash away all the broken down soil.

Our manufacturer meticulously combines the correct enzymes for the predominant soils on surgical instruments with de-foaming surfactants and complexing/sequestering agents that will not interfere with the enzymes activity in POWER ZYME™. This eliminates your need to buy multiple cleaning chemistries to break down the soil on your instruments and then wash them away. Furthermore, POWER ZYME™ is compatible for soaking, manual cleaning, ultrasonic cleaners and washer disinfectors, eliminating the need to purchase multiple detergents for each of your cleaning modalities.

Detergents consist of chemistries that work together to break down soil in concert with water. One of the most important groups of these chemistries are known as Surfactants (surface acting agents). Surfactants help make water “wetter,” lift soil from surfaces, and keep the soil suspended in water so that it will not re-deposit on surfaces. One of the drawbacks of surfactants, however, is the foam they produce. Foam is fine in a bathtub or kitchen sink, but in reality, foam is essentially bubbles of air suspended in liquid. You know as well as I do that we are not cleaning with air, but rather, we are cleaning with water. Foam is difficult to rinse and leads to additional water consumption. Furthermore, foam is a real problem in the washer-disinfector (WD), whereby it can damage pumps, impair measurements, and cause heating elements to burn out.

De-foaming agents suppress the foam in detergents and are usually recruited from a group of surfactants called “cloud-point surfactants.” These cloud-point surfactants can produce foam just like any other surfactant until they are brought to a certain temperature. Once that temperature is reached, they become less soluble in water, and the water they are in becomes cloudy; hence, the name “cloud-point surfactants.”

POWER ZYME™ contains these “cloud-point” surfactants. When added to the manual soak, or if you have a heated ultrasonic cleaner, you will notice that once the water temperature reaches 95°F (35°C) and beyond, it will begin to cloud. If you were to place this warmed, cloudy solution in a bottle and shake it, you would see very little foam–and any foam that did form would soon dissipate. This is why POWER ZYME™ optimizes the wash cycle in your washer-disinfector, and why we at Potomac Labs recommend dosing POWER ZYME™ once “cloud-point” temperature is reached in the washer.

When enzymatic detergents first entered the scope of surgical instrument cleaning, they contained only proteolytic enzymes because protein is the major component of instrument soil. Enzymatic detergent manufacturers began to realize that protein was not the only component of surgical instrument soil, and different surgical cases posed different challenges.

A typical multi-enzyme, enzymatic detergent will contain one or more of the following enzyme classifications:

• Protease: break down proteins 
• Lipase: break down fat
• Carbohydrase: break down starches
• 
  

These enzymes are basically digestive enzymes. For example, enzymes within your body break down nutrients to make them easier to absorb.  

Now one may ask, if it’s a multiple enzymatic, why one or more? Each enzyme class listed above also has multiple subclasses of enzymes. Furthermore, each subsequent subclass works a little differently on how or what it breaks down. Therefore, if a manufacturer claims their enzymatic detergent has three enzymes, it will either have one from each class (i.e. one protease, one lipase and one carbohydrase), or it may have two different protease enzymes plus a lipase or a carbohydrase. Most quadruple enzymatic detergents double one of the above enzyme classes (e.g. two proteases).

POWER ZYME™ is a multiple enzymatic cleaner that contains protease, lipase, amylase, and cellulase. The last two enzymes are classified as carbohydrases. I know what you’re thinking: if instrument soil is mostly protein based, why would POWER ZYME™ contain two carbohydrase enzymes?   

Here’s the reasoning: cellulase breaks down cellulose, which is “a complex carbohydrate, the basic structural component of plant cells and the most abundant naturally occurring organic compound” (Encyclopedia Britannica). The molecular structure of cellulose makes it very difficult to break down, and it requires the enzyme cellulase to do so. Fibrin has a very similar structure to cellulose, and is also very difficult to break down. Research has shown that cellulase has the ability to break down fibrin on surgical instruments; hence Borer has added cellulase to POWER ZYME™ to aid in the breakdown of fibrin.

The choice should be obvious: the more different types of enzymes a detergent contains, the more types of soils it can breaks down. In my opinion, I would have to say that today’s multiple enzyme detergents are more effective than their older, single enzyme predecessors.