Orthopedic Drill Chuck Cleaning Methods and Cleanliness Inspection Methods

Wu Keping, The Fifth Affiliated Hospital of Sun Yat-sen University

Hospital IntroductionThe Fifth Affiliated Hospital of Sun Yat-sen University

is located near the beautiful Xiangzhou Lake around

the mountains and rivers. It is not far from Macao. It

boasts convenient transportation by sea and air with

ports and international airport. It’s responsible for

educating the doctors and postgraduates and

undergraduates. Meanwhile, it has been embarking on

multiple technical programs at national and provincial

and municipal levels. The Zhuhai Medical Tech

Research Center has developed over 200 new

technologies since its establishment in 2003.

CSSD Introduction

There are two CSSDs in our hospital. The first one is in the first floor of Medical Technology Building and is responsible for processing the reusable medical devices for clinical departments. The second one is located in the Fifth floor for the processing the instruments for the operating rooms. In total, we have 30 staff, including 1 associate chief nurse, 1 supervising nurse, 6 nurses and 22 technicians. The CSSDs are well laid-out with complete equipment for cleaning, disinfection, packaging, sterilization and monitoring. We are the training center in Guangdong. We’ve hosted 13 education sessions since 2009. The trainees come from 76 hospitals in Guangdong, Guangxi, Hainan and Sichuan. We provided education on collecting, cleaning, inspection, packaging, sterilization and distribution and we also have trainings in the management of equipment and medical devices and team building. We’ve been promoting the implementation of three national standards and regulations and policies, which has been beneficial for the development of CSSD in Guangdong and other areas.

敷料间

Layout of CSSD in the Fifth Floor of Medical Tech Building

Layout of CSSD in the Fifth Floor of Medical Tech Building

BackgroundDuring surgeries, the orthopedic drill chucks revolve at high speed and

generate differential pressure between inside and outside and heat. As a result,

blood, bone marrow and bone tissues can be easily stuck in the narrow

crevices and bearing and become dried. The sleeves of chucks and bearings

can’t be dismantled and it’s difficult for complete cleaning. In order to solve

these problems, we started to use different revulsion methods during the

cleaning of chucks to improve the cleaning efficacy from Feb. to Jun. 2014. It

has proved effective and the followings are the details.

• 2.1 Experimental group: according to the requirements in China national standard WS310.2-2009: Annex B (B.1 Manual cleaning), the purified water was used for cleaning. The chuck was completely under water during flushing, washing, rinsing and final rinsing. The power was turned on for 2 seconds and turned off for 2 seconds. It was repeated for 30 times. During this process, water was kept out of motor.

• 2.2 Control group: according to the requirements in WS310.2-2009: Annex B (B.1 Manual cleaning), the purified water was used for cleaning. The chuck was completely under water during flushing, washing, rinsing and final rinsing. The chuck was manually rotated for 30 times.

After cleaning, the instruments were lubricated at a dilution ratio of 1:100. Air gun was used to dry the crevices. Then the instruments were dried in the drying cabinet for 20 minutes at 90℃. The bearing of drill chuck was lubricated and completely dried.

Experimental Methods• 2.3.1 Visual inspection: check the cleanness of surfaces and serrations of chucks

with naked eyes and magnifying lamp for blood, debris, water scale and other residual and rust.

• 2.3.2 Occult blood test: for swabbing the surfaces, drop some sterile water on the chucks and wait for 10 seconds before swabbing it with Jieli test strips. After the color-blocks are wet for 1 minute, check the result in natural light. For sampling under water, immerse the chucks in the 50ml sterile water. Turn on the power for 2 seconds and turn it off for 2 seconds. Repeat the process for 30 times. Put the test strip under water for 2 seconds and check the result. If the test strip changes color wholly or partially, it is the positive result, which means cleaning fails. No color change is the negative result and it means cleaning passes.

• 2.3.3 ATP bioluminescence method: for swabbing the surfaces, wipe the surfaces of chuck with ATP sampling swab and check the reading. For underwater sampling, turn on the power for 2 seconds and turn it off for 2 seconds. Repeat the process for 30 times. Put the swab under water for 2 seconds and check the reading. Based on the manufacturer’s instructions for use, the cleanness qualifies if RLU (relative light unit) is lower than 45 and it fails if RLU is larger or equal to 45.

Cleanliness inspection methods

Group Surface swabbing Underwater swabbing

No. of qualified Pass rate (%) No. of qualified Pass rate(%)

Test group 25/30 83.33 23/30 76.47

Control group 26/30 86.67 2/30 6.25

Table 2: ATP bioluminescence test results of cleanness of drill chucks

Group Surface swabbing Underwater swabbing

No. of qualified Pass rate (%) No. of qualified Pass rate (%)

Test group 26/30 86.67 25/30 83.33

Control group 28/30 93.97 2/30 6.25

Table 1 Occult blood test results of cleanness of drill chucks

Table 1 Occult blood test results of cleanness of drill chucks

Table 2: ATP bioluminescence test results of cleanness of drill chucks

Conclusion4.1 Challenges in cleaning the orthopedic drill chucks

• There are two challenges in cleaning the orthopedic drill chucks. One is that the drill runs and stops constantly and instant differential pressure is generated in the process. A large amount of blood and bone tissues are drawn inside the crevices and bearing. The heat makes the contaminants easily dried and difficult to clean. The other is that the drill chucks can be dismantled to the minimum due to the complex structure. The narrow crevices and bearing can be scrubbed with brushes. Therefore, it’s very difficult to thoroughly clean them with normal cleaning methods.4.2 Impacts of different cleanness inspection methods on the results

• For the complex instruments, such as drill chucks, visual inspection alone often leads to false negative results. It will be more accurate by combining occult blood tests and ATB bioluminescence methods.

4.3 Impacts of different sampling methods on results• To swab the surfaces can hardly reach the crevices and

bearing of chucks. So these parts can’t be effectively sampled. The underwater sampling can flush out the residuals inside the bearing. Therefore, the latter is objective and accurate in sampling.4.4 Improve the cleaning quality by turn on the drill under water

• By turning on and off the drill under water, strong negative differential pressure can be formed in crevices and bearing so that water can contact these parts during flushing and washing. By doing so, the cleaning quality can be improved.

Conclusion About the authors

Wu Keping Associate chief nurse, 31 years of experience in nursing. Head nurse of CSSD of the Fifth Affiliated Hospital of Sun Yat-sen University, chairman of committee of CSSD Professional Board of Zhuhai Nursing Association, member of standing committee of CSSD Professional Board of Guangdong Nursing Association, deputy supervisor of Guangdong Nursing Education Center in CSSD