1. 7.6 Cleaning
a) Items should be pretreated with an initial cold water rinse with running tap water or an initial soak in cool water and/or a clinical-soil-dissolving pretreatment product (e.g., an enzymatic cleaner or pH neutral detergent).

2. Water Quality Recommendation VII
Water quality is affected by the presence of dissolved minerals, solids, chlorides, and other impurities and by its acidity and alkalinity.
Minerals can cause deposits, scale, or water spots.
Excessive chlorides can cause pitting.
The pH level affects the performance of enzymatic and detergent agents.
Untreated water quality fluctuates over time, varies with geographic location and season, and can affect the outcome of cleaning actions. (buildup of iron and calcium)
VII.a. The final rinse should be performed with treated (eg, distilled, reverse osmosis, filtered) water

3. Water Quality 7.6 Cleaning
b) After pretreatment, devices should be cleaned according to the manufacturers’ IFU.
c) Devices should be thoroughly rinsed. If a basin is used, the rinse water should be changed after each use.
The final rinse (mechanical or manual) should be with purified water (e.g., distilled, or RO water). See TIR34 for recommendations on the use of critical water.

4. AAMI TIR34:2014 Water for the reprocessing of medical devices
Utility Water (tap water)
Critical Water
A multistep process may include:
carbon bed,
softening,
deionization (DI),
reverse osmosis (RO), and/or
distillation
Final Rinse (mechanical & manual)
Steam Generation

5. TIR 34 Annex G
Typical presentation of water quality issues during the reprocessing of medical devices
Observed problem
Examples of causes
Recommendations
Poor water quality can lead to a variety of problems during device reprocessing. Some of the more common problems are described in Table G.1
Sue, You have our permission to use this as requested. If possible, please use the following credit: Reprinted with permission from AAMI TIR34:2014, Water for the reprocessing of medical devices. Copyright AAMI. Further reproduction prohibited. Thanks and Merry Christmas! -Joe Joseph A. Bremner Director, Technical Publishing & Marketing AAMI N Fairfax Drive  Suite 301 Arlington, VA USA ________________________________________ From: sue Klacik Sent: Tuesday, December 23, :15 AM To: Joseph Bremner Subject: Permission Request Hi Joe,   I hope you holidays are going well. I'm writting to request permission to use a page from  "Table G.1—Examples of observed problems during device reprocessing that can be caused by poor water quality" from the newly published "AAMI TIR34:2014 Water for the reprocessing of medical devices" for the IAHCSMM conference this year and for other presentations to CSS or Surgery organizations.  My presentation will inform the audience of this newly published document.  I am requesting to use one page from Annex G to demonstrate on the power point presentation the valuable information contained in this TIR. I appreciate your consideration in this matter.   Wishing you and your family a happy holiday season,          Sue Klacik
Reprinted with permission from AAMI TIR34:2014, Water for the reprocessing of medical devices. Copyright AAMI. Further reproduction prohibited

6. Instrument stains? Rust breeds rust

12. How to make the change?
Infection Prevention: Shared Responsibility Collaborative coordinated process Multidisciplinary Risk Assessment IP RM SP
Endo OR MD
Adm
IFUs
Mfg

14. References
Guideline for cleaning and care of surgical instruments. In: Guidelines for Perioperative Practice. Denver, CO: AORN, Inc; 2019.
ANSI/AAMI ST79:2017 Comprehensive guide to steam sterilization and sterility assurance in health care facilities. Arlington, VA: Association for the Advancement of Medical Instrumentation; 2017.
ANSI/AAMI ST58: Chemical sterilization and high-level disinfection in health care facilites. Arlington, VA: Association for the Advancement of Medical Instrumentation; 2013
AAMI TIR34:2014 Water for the reprocessing of medical devices

15. References con’t
CDC Guideline for Disinfection and Sterilization in Healthcare Facilities
AST. Standards of Practice for the Decontamination of Surgical Instruments Standard of Practice I - The cleaning of instruments should begin during the surgical procedure to prevent drying of blood, soil and debris on the surface and within lumens. Available at: Accessed 4/17/2018
The Joint Commission, Standards FAQ Details, Instrument Reprocessing – Point-of-Use and Pre-Cleaning Expectations. Available at Accessed 4/17/2018

16. Questions?