Proper Lumen Cleaning & Verification

The Importance of Proper Lumen and Channel Cleaning

Cleaning requires a variety of techniques and attention to detail during the decontamination process performed by the sterile processing department (SPD). Proper cleaning of lumens, crevices, channels and ports can be very time consuming and requires the use of proper cleaning tools such as delicate channel brushes or lumen flushing systems.

Making sure your decontamination staff are provided with the appropriate resources and the cleaning tools that are necessary to properly reprocess your specific inventory is critical. Often specialty devices, like flexible scopes and power equipment will come with cleaning brushes from the manufacturer that are outlined in the instructions for use (IFU). These brushes and cleaning accessories are designed to be used to properly clean that manufacturers specific product. Things like material make up and size considerations are taken into account when these cleaning accessories are provided.

Cleaning Verification

Cleaning verification requires a variety of methods and detailed processing in the preparation areas of the CSSD. Cleaning verification should include primarily a detailed visual inspection as the first initial step in the process. Because our human vision is no where near perfect, we as reprocessing professionals should be using a variety of tools and devices to assist in this inspection process.

Some of the tools and devices that can be useful during inspection and verification include;

• The use of lighted magnification should be included during inspection in both cleaning and inspection. Proper room lighting can also be a huge factor in the success of the inspection process. ANSI/AAMI ST79 Comprehensive guide to steam sterilization and sterility assurance in health care facilities recommends the use of at least 500-1000 lux at a minimum. This is where any additional light sources on the works stations and magnification tools come in handy.
• The use of a digital microscope or camera to magnify the area being inspected, aid the technicians to see things the human eye cannot see, improving the inspection step. These cameras are often USB compatible and affordable.
• For the inspection of lumens and channels, the use of a borescope offers better visibility inside those areas. The interior surfaces can be challenging to clean with a brush and,  as visibility is limited during this process, a borescope will offer a closer look to ensure visible cleanliness has been attained during inspection.
• The use of the flushing technique after washing is quite common during the assembly phase of reprocessing. However, it is important not to add any additional chemicals or solutions to freshly cleaned medical devices prior to sterilization unless approved by the manufacturer and recommended in the cleaning instructions.
•  Lastly, a more objective and sensitive method would include the measurement of the levels of organic soils or microbial growth left on the surfaces with the use of commercially available tests for residual bioburden. There are several validated testing methods available, check out section D.3 of ANSI/AAMI ST79:2017 for resources on this process.

Promise to the Patient

Reprocessing intricate medical devices is a very challenging, technical and skilled task. It is important for all reprocessing professionals to remember to take time during the cleaning phases of decontamination. Ensuring that all surfaces and hard to reach areas are cleaned where you might not be able to visually inspect easily. All instruments that touch patients are contaminated and each one should be cleaned entirely and in accordance with all recommended practices and instructions. We know this takes time, but it is how we guarantee the safety of our teams as well as the safety of the patient's life.