Why how you load them and set your cycle matters in your ultrasonic cleaner

Are you loading soiled instruments into your ultrasonic cleaner haphazardly? Are your lumened and robotic instruments getting properly flushed? Once your instruments are properly loaded in the correct trays, are they being washed on the right cycle? Are you following the manufacturer’s instructions for use (IFUs)?

Ultrasonic cleaners are designed for loosening and removing biofilm and soils from all sorts of surgical instruments. They are an important part of any sterile processing department (SPD). But the instruments must be loaded into the correct trays in the right way to be thoroughly cleaned. 

Nonlumen instruments

Ultra Clean’s ultrasonic systems can clean nonlumen and lumen instruments and most can clean da Vinci® robotic instruments as well. Nonlumen instruments can be cleaned in Ultra Clean’s standard tray, lumen tray, or a wire mesh tray with a minimum of ½ cm2 spacing (there must be openings on the sides and bottom for the ultrasonic waves to get through). 

Placing the instruments in a tray without the proper openings will prevent them from being properly cleaned. Hinged instruments must be fully open to allow the ultrasonic waves to clean inside the joint. Also, if two instruments are touching, the cavitation created by the ultrasonic waves is blocked from those areas, leaving them soiled. If only nonlumen instruments are being cleaned, the ultrasonic wash cycle should be set to a nonlumen cycle to avoid an error from unnecessary irrigation.

Lumen instruments

Cleaning lumen instruments requires connecting them to irrigation that cleans the inside of the lumen as well as the outside of the instrument. Ultra Clean’s standard lumen trays have a manifold at either end with irrigation ports. One end of an irrigation hose is connected to the instrument, while the other is connected to a port on the manifold. This allows the detergent solution to circulate through the instrument.

Two tray organizers fit across the width of the tray and support the instrument’s lumen, keeping it from touching any lumen instruments next to it or nonlumen instruments in the bottom of the tray. Instrument tips must be open to allow the circulating detergent solution to flush out of the lumen. Lumen instruments, with or without nonlumen instruments in the same tray, should be set to a lumen wash cycle so that irrigation takes place.

Robotic instruments

Robotic instruments require special trays and connectors to receive the proper irrigation during the ultrasonic wash. Ultra Clean has ultrasonic cleaners that can process da Vinci S®/Si®, Single-Site®, X®/Xi®, and SP® instruments. Like the lumen trays, the robotic trays have two manifolds. Each style of instrument has a different adapter to connect it to irrigation. Again, the instrument tip must be open to be properly cleaned. The ultrasonic wash cycle should be set to a robotic cycle, which is a set 15 minutes for da Vinci instruments.

Ultrasonic cleaners are an important part of the medical device cleaning process, but they cannot properly clean instruments that are not in the correct trays or are not loaded into the trays properly. If the wash cycle is set incorrectly, the machine may stop working and sound an alarm and may not clean the instruments thoroughly enough. If, after cleaning, your instruments are still testing as soiled, check your loading and wash cycle selection to be sure you are following the operator’s manual or IFU.