1. Chemicals in the Cleaning Process
Introduction of Myself and Ecolab.
Hendrik Graae
Account Manager - Healthcare

2. Chemicals in the Cleaning Process

3. Importance of Cleaning
You cannot Sterilise anything that has not been CLEANED
You cannot Disinfect anything that has not been CLEANED
Hence CLEANING is the most important step in the Sterilisation process for any Reusable Medical Device!
Explain the Factors of Cleaning.
Care must be taken with any Chemistry

4. The factors of Cleaning
Universal Solvent
Time
Temperature
Chemical Action
Mechanical Action
Each different process will vary in regard to the above factors.
You should consider all of the above when considering improving a particular process
It is possible to compensate for a deficiency or in one area by increasing the action of one or more of the other parameters.
You should “validate” a process whenever you change any of these.
PROCEDURE

5. The factors of Cleaning
Universal Solvent
Time
Temperature
Chemical Action
Mechanical Action
Manual
Automatic
Ultrasonic
Prewashing >40°
Washing <55°
The melting temperature varies for different proteins, but temperatures above 41°C will break the interactions in many proteins and denature them. This temperature is not that much higher than normal body temperature (37°C), so this fact demonstrates how dangerous a high fever can be.
Heat can be used to disrupt hydrogen bonds and non-polar hydrophobic interactions. This occurs because heat increases the kinetic energy and causes the molecules to vibrate so rapidly and violently that the bonds are disrupted. The proteins in eggs denature and coagulate during cooking.
Medical supplies and instruments are sterilized by heating to denature proteins in bacteria and thus destroy the bacteria.
PROCEDURE
Alkalis
Enzymes
Neutralisers
Rinse Aids

6. We need to use specific chemicals for specific processes.
A Process Agent
Pretreatment Agents
Detergents
Disinfectants
Neutralisers
Rinse Additives
Specialty Products
Explain the Factors of Cleaning.
We need to use specific chemicals for specific processes.

7. Pretreatment Agents
Pretreatment agents may be detergents or anti-microbial.
They are products which are applied to the Reusable Medical Devices prior to a manual, or automated cleaning process
Pretreatment agents are used when there will be a delay in reprocessing.
They should keep the soils aqueous and begin the cleaning process.
They can be foam sprays or wet disposal products

8. Detergents
Using detergents restricts contamination of a medical product to a degree necessary for further reprocessing or application.
Detergents are employed for both manual and automated reprocessing procedures.
A basic distinction is made between:
pH-neutral detergents with/without enzymes
mildly alkaline detergents with/without enzymes
alkaline detergents with/without tensides

9. Manual Detergents
The primary component of a manual detergent is the surfactant.
Surfactants provide the following effects
- Reduced water tension.
- Wetting/soil Penetration –particularly hydrophobic soils such as fats/proteins.
- Wetting of dried soils- Breaking bonds that attach soil to a surface.
- Emulsification of non soluble soils
- Soil suspension and dispersion.
Surfactants are SURFACE ACTIVE AGENTS or TENSIDES
Surfactants are usually very foamy, de-foamers are added to manual detergents for a lower foam profile.
For safety and visibility always add detergents to water after filling the sink.
Wetting agents reduce the surface tension of water, allowing it to spread on the waxy surface coating soil particles and into the pores in the soil. Wetting agents consist of molecules that are attracted to water on one side and to waxes on the other.

10. Detergents in the Washers
Each of the 5 factors can significantly influence the mechanical cleaning process.
Contrary to what the name suggests mechanical cleaning relies more on chemical action and temperature than a manual process.
The traditional basis for machine (mechanical spray) detergents is ALKALINITY
Increasingly the CSD industry is moving to neutral, enzymatic or low alkalinity detergents for batch, index and cart washer disinfectors.
Neutral Enzymatic detergents are selected as they have superior material compatibility over traditional Alkali’s

11. Alkaline Detergents
Alkalinity in machine detergents provides the following benefits
- Strong alkali aids removal of protein.
- Protein solubility increases as pH increases.
Alkalinity promotes peptizing of protein chains into water soluble fragments
- Alkalinity aids dispersion of fats and caustic alkalinity may promote saponification.
- Alkalinity neutralizes acid soils.
Saponify –To convert a fat into soap with Alkali
Peptization is the process responsible for the formation of stable dispersion of colloidal particles in dispersion medium aka water the universal solvent.
A colloid is a mixture in which one substance of microscopically dispersed insoluble particles is suspended throughout another substance.

12. Solubility of Protein
100 50 2 4 6 8 10 12
% of Protein Removed pH

13. Alkaline Detergents
Material compatibility is a significant issue with high caustic detergents.
Highly alkaline detergents are incompatible with many materials of construction
Aluminium
Anodised surfaces
Copper
Serious OH&S issues with Dangerous Goods - Class 8 caustic detergents.

14. pH of different chemical programs

15. They are special Ninjas designed to take out certain baddies!
Why Enzymes?
Certain Enzymes are designed to only digest certain substrates.
They are special Ninjas designed to take out certain baddies!
Cellulose is a molecule found in the cellular structure of almost all plants. It is made up of carbon, hydrogen, and oxygen, and it is considered to be the most abundant organic (carbon-based) compound in the world.
Protease
Lipase
Amylase
Cellulase

16. Enzymatic detergents

17. Examples in Australia are
Disinfectants
Disinfectants are employed both for manual and - preferentially - automated reprocessing to provide final disinfection for thermolabile medical products, such as flexible endoscopes. Disinfectants contain germ-killing agents and combinations of such agents. They reduce the number of viable micro-organisms on a surface to a level suitable for further handling or use.
Examples in Australia are
ORTHO-PHTHALALDEHYDE (CIDEX OPA) and Peracitic Acid used in Endoscope reprocessing

18. Neutralisers
Acidic substances based on citric acid or phosphoric acid which can be added to the initial rinsing water in automated reprocessing following alkaline cleaning in order to neutralize alkalinity and enhance rinsing of the detergent.
Neutralisers can also help in the breaking up of inorganic substances in water ie lime scale caused by water hardness.
Water hardness is the amount of dissolved calcium and magnesium in the water. Hard water is high in dissolved minerals, both calcium and magnesium.

19. Rinse Additives
Rinse aids are added to the final rinsing water in a automated reprocessing procedure to achieve more effective, faster drying.
The active agents in the rinse aids reduce the surface tension of the rinsing water and so minimize adhesive residual moisture.

20. Care Products
Care products for reusable medical devices with metallic friction surfaces which need lubrication are made of paraffin or other mineral oils and emulsifiers.
Instruments should be cleaned before the lubricant is applied. Cleaning, particularly ultrasonic cleaning, removes lubricants from RMD’s. Lubricants decrease friction between working surfaces. Unless otherwise specified, lubricants should be water soluble to allow steam penetration during sterilization; oil-based products cannot be penetrated.
There are a number of reasons that stiffness can occur in instruments. This maybe due to: exposure to saline solutions or inadequate cleaning, in these cases, stiffness will not necessary be corrected by lubrication.

21. Ultrasonic Cleaning Detergent: Neutral or low alkaline detergent
Contain surfactants (tensides) for wetting
Low foam
Enzymatic products are well suited.
Ultrasonic cleaning uses cavitation bubbles induced by high frequency pressure (sound) waves to agitate a liquid. The agitation produces high forces on contaminants adhering to Reusable Medical devices. This action also penetrates blind holes, cracks, and recesses.
The cleaning solution contains ingredients designed to make ultrasonic cleaning more effective. Reduction of surface tension increases cavitation levels, good wetting agents (surfactant) will help penetrate and hold the soil in solution.
Solutions are mostly used warm, below 45 °C to prevent protein coagulation.

22. What impacts Detergent performance?
Water Quality

23. Consequences of increased water hardness include:
Water marks / lime deposits on equipment (Salt on equipment!)
Scale / lime deposit on machines.
Impairs cleaning efficiency - increases surface tension of water (decreases detergent ability to wet/penetrate soils)
Reduces detergency - reduction soil load capacity - disperse less soil.
Combines with some soils  insoluble.

24. Chemical safety Treat all chemicals with Respect.
Wear Personal Protective Equipment whenever handling Chemicals.
Safety Data Sheets.

25. Thank you.