Dear sir,

Do we need to disinfect the medical devices in disinfectants (sodium hypocholrite) before manual cleaning?

In our country, many ICNs recommend the CSSD technicians to immerse the dirty instruments in the disinfectant before manaul cleaning due to they're afraid about needle and sharp injury. What's your recommendation?

What's the advantage and disadvantgae to immerse in disinfecatant?

Regards
MG

Environmental engineer

Dear Maliwan G,

Soaking is an important part of the cleaning process to soften and loosen contaminants on medical devices. I would personally prefer the use of an enzymatic cleanser to soak medical devices because they can remove contaminants from the surface. Removing the contaminants will lower the number of organisms on the item. A disinfectant is only effective on surfaces it can reach. Therefore, the disinfectant can not disinfect under contaminants on items, and may provide a false sense of security to users that mistakenly think the items are, in fact, disinfected. Sodium hypocholrite can be extremely damaging to medical devices, and I would recommend it be limited to extreme cases such as CJD instruments that can not be discarded and burned.

Warm regards,
Pete Bobb

Dear Maliwan,
I received the following answer concerning your question from Dr. Urs B. Rosenberg, author of several articles about disinfection e.g. " Thermal Disinfection - the A₀ concept and the Biological Background" published in "Zentral Sterilisation" 2/2003.
Kind regards, Josy Holdener

Dr. Rosenberg's comments:
Immersing instruments in a disinfectant solution prior to cleaning

Advantage:

• Reduces the potential risk of infection for the technicians and the risk of contamination of the surroundings.

Disadvantages:

• Potential fixation of (proteinaceous) soil, particularly by aldehydic and alcoholic disinfectants
• Corrosion of instruments when using sodium hypochlorite

What to do?

• Do not reprocess sharps (needles and scalpels)
• Wear protective attire (gloves, apron, face shield or goggles to protect you from infectious agents and/or disinfectant solutions)
• When using a disinfectant, ask provider about data on blood fixation/dissolution characteristics. (We actually have a suitable product but since I don't know in which country you are located, I can't tell you whether the product is available for you. You can contact me via e-mail: )
• If not using a disinfectant, disinfect sink and surrounding with a surface disinfectant after termination of cleaning.

Dear,

The AKI red brochure: "Proper maintenance of Instruments" (see on the EFHSS Education page, 3. Articles, Periodicals, Online publications) gives a lot of information on causes of problems with instruments.

Good luck,
Wim Renders

p.s.
- In France a predisinfection is obligatory (see on the EFHSS Education page, Sterilization Basics: Le cycle de stérilisation).
- Sodium hypochlorite will ruin your instruments!!