Infection Control: How Clean Is Your Water?

H2O quality plays a significant role in instrument reprocessing.

My hospital’s sterile processing department is responsible for turning around 1,500 instrument trays a day, and we take every measure possible to ensure these critical instruments are handled correctly and properly sterilized to protect patients from harm by limiting the risks of surgical site infections (SSIs). This includes keeping a close eye on the quality of the water we use. Water impurities can stain instruments and even inactivate your disinfectants.

Focus areas

If you’re concerned your water quality isn’t up to par, the first thing you’ll need to do is learn how to spot potential problems quickly and efficiently. Here are a few of the common impurities in water and the impact they can have on the decontamination process:

• Calcium and magnesium. The hardness of your water is determined by the amount of calcium or magnesium dissolved in it. Calcium and magnesium are often called hard water deposits or scale, and appear as a white film on the surface of instruments or the inside of washing equipment.

• Chloride. Excessive amounts of chloride can give a salty taste to water and can corrode pipes, pumps and plumbing fixtures.

• Sediment. These tiny clay particles can develop from rusty pipes. If your facility’s water system and pipes are old, you may start to notice staining on your instruments when they come out of the washer and sterilizer. Sediments in the water can break down the passive layer of your instrumentation, shortening its lifespan and longevity.

• The pH level. The alkalinity or acidity level (pH) of water can cause pitting or corrosion of your surgical instruments as well.

We had our water tested about a year ago when our water quality was still good, but trending in the wrong direction. So we are now using deionized water during the final rinse in all our instrument washers, which is recommended for use with all concentrated instrument cleaners and approved disinfectants. I heard about a surgical facility that installed a deionized water system but didn’t replace the copper piping with PVC piping. Deionized water eats through copper piping, your instrumentation and the chamber of your equipment because it changes the composition of the water. As a result, the facility had to uninstall their equipment and purchase new sterilizers, a task that took ample time and money.

Start here

If we start to get complaints from the surgeons or the surgical team that, for example, OR scissors are dull, the first thing we do is look at the tray. With the help of our tracking system, we check to see how often that tray is used. If it’s used regularly, then it is only natural for a pair of scissors to start to dull. If the tray hasn’t been used in three months, however, that’s a clue to look deeper into the issue.

The next thing we look at is how clean the instruments look and how they feel when coming out of the washer. If there’s a lot of spotting, the instruments are stiff when we open and close them and they are dull, we would call our equipment manufacturer to come in and help us. They will test the chemistry of the soap, the amount of soap we are using at the sink for soaking and rinsing as well as the titration in our washers to make sure that it’s appropriate per gallon. Lastly, we look at our steam. If our steam is extremely hot, it will linger in the chamber a little longer, which can stain the instruments.

Poor water quality will limit your equipment’s ability to effectively clean the instruments, while also increasing the likelihood that these critical surgical tools become brittle and damaged.

Alternate explanations

If you notice your instruments are coming out of the sterilizer with spots, don’t immediately assume it is because of poor water quality. There might not be enough —  or too much — soap being injected into the washers, or perhaps the titration is off. Another way an instrument can start to develop spotting is if the proteins stay on the instrument for too long. Once the operating room is finished with a surgical case, it is imperative that staff spray or wipe down the instruments before sending them to our department.

Part of the process

The sterile processing department is the backbone of any healthcare facility because the team is engaging in some of the most important work to help keep patients free from SSIs. There are so many critical steps and factors that aid in an SPD’s ability to properly clean, prepare and sterilize surgical instruments that it’s easy to lose sight of the major role water quality plays in the process.

Left unchecked, however, problems in this area could greatly impact your equipment’s ability to effectively clean the instruments, while also increasing the likelihood that your instruments will become brittle and damaged and need to be repaired and replaced on a much more frequent basis. OSM