Properly cleaning surgical instruments, that is to say returning them to the level of cleanliness and sterility required for them to be used in another surgical procedure, is a multi-step process. Simply running them through a sterilization cycle is not enough. Prior to sterilization, the instruments must be pre-treated and cleaned to remove harmful and often infectious bioburden. This bioburden (blood, mucous, proteins, fat and other residue), which adheres to use surgical instruments, not only presents the risk of cross-contamination, it can also cause serious damage to the expensive instrumentation itself.

The effective breaking-down and removal of bioburden and other soils from instruments prior to sterilization is crucial to attaining appropriate sterility. Fortunately, there is no shortage of instrument cleaning and care solutions designed to maximize the effectiveness of the initial cleaning process and protect the instruments from the damage causes by water and bioburden. Here are some of the latest offerings from the leaders in the industry.

STERIS’s Prolystica Ultra Concentrate products protect instruments from water damage.
Ruhof Healthcare (Mineola, NY) is an innovator and leading manufacturer of innovative solutions and individualized services designed to meet almost any decontamination and material management challenge. Their extensive line of instrument cleaning and care products includes enzymatic detergents, rust and stain removers, instrument lubricants, rust inhibitors, autoclave cleaners, surface disinfectants and more. One Ruhof product in particular, Endozime® AW Triple Plus instrument cleaning solution, features a unique formulation of protease, amylase, lipase, carbohydrase and proprietary enzymes with A.P.A. (Advanced Proteolitic Action) and rust inhibitors. A.P.A. greatly increases protein enzyme activity to provide a faster more thorough penetration into hard-to-reach places on surgical instruments and scopes. Endozime AW Triple Plus also has biological additives that speed the process of liquefaction and solubilization, facilitating enzymatic action and contributing to the product’s effectiveness.

Another innovative Ruhof product is Prepzyme® X.F., which provides a thick, long lasting enzymatic foam that keeps soiled instruments moist and begins breaking down blood, fat, carbohydrates, starches and protein prior to decontamination. This instrument prep foam makes cleaning easier and helps speed up turnaround time by preventing bioburden from drying on the surface of instruments. The applicator spray tip is designed to reach into cannulas and lumens, providing a deeper more thorough cleaning. Prepzyme X.F. is an alternative to water-based solutions that can cause rust after prolonged soaking of instruments.

Spectrum Surgical’s Spectra-Scrub is a powdered stain remover that restores luster to stainless steel instruments.
STERIS Corporation (Mentor, OH) offers a complete line of solutions for instrument cleaning needs including enzymatic presoaks and cleaners, neutral pH and compatible, low alkaline detergents, high alkaline/acid rinse combinations, instrument lubricants, and the new Prolystica™ Ultra Concentrate cleaning system. STERIS instrument cleaning chemistries are formulated with the highest quality ingredients and designed for maximum effectiveness of manual or automated washing processes. They are also designed to work

The Prolystica Ultra Concentrate cleaning formulations provide superior cleaning of blood, mucous and even the most challenging fatty soils associated with orthopedic procedures. They work effectively in all types and qualities of water and have less effect on washer pressure. This means that the mechanical power of the water in high-impingement automated washing systems is not impeded and that more tough soils will be removed from the instruments during each automated washing cycle. This reduces the risk of forming biofilm. The Prolystica Ultra Concentrate products are also formulated to protect instruments from the damaging effects of water. Whether water is purified, deionized, hard or soft, it can be damaging to instruments and equipment, corroding a variety of metal substrates (including stainless steel) and causing oxidation to occur. These formulas include corrosion inhibitors to prevent pitting, oxidation and corrosion.

Spectrum Surgical offers a full line of instrument care solutions for stainless steel surgical instruments.
Spectrum Surgical Instruments Corp. (Stow, OH) offers a full range of instrument care solutions specifically designed and approved for use on stainless steel surgical instruments. These solutions are intended to prep and treat surgical instruments throughout the cleaning process up to final sterilization. The first solution in the product line is Spectra-Moist™, a fast, safe and easy to use spray-on cleaner that prevents blood from drying. This solution begins the cleaning process immediately after surgery, helping to save instruments from the harmful chloride ions found in dried-on blood. This triple-action, detergent-based product has a fresh floral scent and comes in a 32-ounce spray bottle.

Also included in Spectrum’s line of instrument care solutions is Spectra-Lube™, a bacteriostatic, water-based, spray-on lubricant, and Spectra-Scrub™, a powdered stain remover. Spectra-Lube replaces potentially messy milk baths, eliminates the risk of contamination and puts lubrication directly where the user needs it. It, like Spectra-Moist, comes in an easy-to-use 32-ounce spray bottle. Spectra-Scrub powdered stain remover is designed to remove stains and restore the luster to stainless steel instruments quickly and effectively. All of these solutions are safe, require no special handling and have no harmful fumes or unpleasant odors.

Kimberly-Clark Pre-Cleaning Detergent Spray helps keep devices moist and begins to breakdown bioburden.
Getinge USA (Charleston, SC) offers alkaline, acidic, neutral, aluminum-safe alkaline and enzymatic cleaners in normal concentration and super-concentrated forms, for both machine and manual cleaning. They also offer high quality maintenance products, such as ready-to-use foaming enzyme spray, instrument brightener, stainless steel polish and ethylene oxide and steam permeable lubricants. The Getinge instrument detergents are designed to be used on a wide variety of medical devices and in a broad range of cleaning situations.

A long time leader in decontamination technology, Getinge was first to market a full line super-concentrated liquid products. The benefit from the super-concentrates is less container waste, more convenient package sizes and more cost-effective cleaning. They also offer one of the few aluminum-safe alkaline cleaners available on the market. This allows a facility to use the power of alkalinity to remove tough residue without compromising the surfaces of either stainless steel or aluminum.

Cardinal Health (Dublin, OH) offers a full line of detergent products that can be used on a wide range of surgical instruments including stainless steel, flexible and rigid scopes, soft metal instrumentation and plastics. The detergents contain specialty-chelating agents that are compatible with enzymes. These chelating agents effectively tie up hard water minerals so they are not deposited onto instrumentation. This avoids staining and binding of instrumentation and allows for the compete removal of any hard water films which may harbor soils. In addition, Cardinal’s cleaning solutions are phosphate-free and biodegradable. They optimize the performance and life expectancy of instruments resulting in cost savings, operational efficiency and patient safety focus.

Kimberly-Clark Multi-Enzyme Detergent removes all soils to ensure proper disinfection.
Another company that provides cleaning solutions, as well as other instrument care products, is Miltex, Inc. (York, PA). Their EZ-Zyme All Purpose Enzyme Cleaner is a neutral pH, multi-enzyme concentrate that can be used for pre-soaking instruments or in ultrasound and evacuation systems, while their neutral pH, phosphate-free Surgical Instrument Cleaner can be used for both manual or ultrasonic cleaning. Also available is the Instrument Prep Enzyme Spray, a ready-to-use foaming spray specifically designed to pre-clean instruments. The spray prevents bioburden from drying and adhering to instruments, making it ideal for use in areas where immediate instrument cleaning is not possible or practical. For an added convenience and to complement their cleaning solution line, Miltex also offers an Instrument Care System Kit which includes an informative 25-minute instrument care video designed to help practitioners and staff properly care for instruments, one bottle of spray lube, instrument cleaner, stain remover and an assortment of nylon and stainless steel brushes.

Kimberly-Clark Health Care (Roswell, GA) offers their Pre-Cleaning Detergent Spray and Multi-Enzyme Detergent to provide benefits that can help simplify a facility’s cleaning process and reduce the risk of cross-contamination. The Kimberly-Clark® Pre-Cleaning Detergent Spray, in a convenient 24-ounce bottle, begins the process of breaking down bioburden on contaminated, reusable medical devices and keeps the devices moist through the first step of the cleaning process. The Kimberly-Clark® Multi-Enzyme Detergent, in a one-gallon pump bottle and five-gallon refill, helps to ensure that surgical instruments and devices are clean before being disinfected or sterilized by penetrating and breaking down the most common contaminants, such as proteins, fats and carbohydrate-based soils. The synergistic formulation of enzymes plus detergent works quickly within a range of water temperatures. In addition, its low-foaming property makes it appropriate for manual cleaning and for use in small washers.