How to Choose the Right Brush
Manually cleaning surgical instruments is an important step in the process of readying them for the next surgery. Instrument cleaning brushes come in all sizes and bristle types: there are curved ones, straight ones, fat ones, skinny ones, stainless-steel-bristled ones, and acrylic-bristled ones. But with so many choices, how do you pick the right brush to clean your instruments? Here are a few things to consider.
The first is the size and shape of the brush needed. Some brushes have a more general purpose and work well for many instruments, while others are tailored for specific types of instruments. Are you scrubbing the outside of the instrument, or do you need to clean an enclosed area like a lumen? Cleaning a lumen requires a narrow, more specialized brush; cleaning the outside of an instrument usually involves a wider, more general brush. If cleaning an interior space, is it rigid or flexible? Is it curved or straight? There are brushes for each of these.
Toothbrush-style brushes are great for cleaning the exteriors of instruments. They are simple in shape and come in a variety of widths and lengths that can be matched to the instrument. There are double-headed ones that give you two different brush-head or bristle sizes, as well.
They also come with either nylon bristles, that won’t damage the exteriors of delicate instruments, or metal bristles, which can be used to clean serrated areas or burrs on stainless steel instruments. Some double-headed ones come with two different bristle materials (e.g., nylon and stainless steel).
Channel brushes are made to clean lumens. Standard ones are straight, with even-depth bristles, and come in many widths and lengths. Fan-tip channel brushes are similar to standard ones but include a fan-shaped group of bristles on the tip to clean the closed end of some lumens. For a gentler clean, acrylic-tipped channel brushes are like fan-tip brushes but are less likely to damage the lumen’s interior. Tapered channel brushes have at least one tapered end to fit tapered lumens and can have a fan of bristles at the end.
If the instrument you’re cleaning has a tube or curved shaft, there are flexible and curved channel brushes. Heavy-duty channel brushes are good for cleaning more durable instruments and their ports. They also have bacteria-resistant bristles.
In addition to these generalized brushes, there are other, more specialized brushes like the heavy-duty wire burr brushes used to clean rough-edged instruments (burrs, saws, etc.) and the double-ended brushes created to clean bone reamers.
Consider the type of bioburden you are cleaning from the instrument as well as the delicacy of the instrument. Metal wire bristles can easily scrub dried-on soils but also can damage softer materials, such as soft metal, rubber, and soft plastic. They can cause scratches where pathogens can hide under biofilm and avoid sterilization.
When cleaning lumens or hoses, the right size channel brush will clean all sides—too large and the bristles will fold; too small and they won’t clean evenly. Measuring the inner diameter of the lumen or hose will tell you the correct size to use. In addition to diameter, you’ll need to measure the length of any lumen to get a brush that can reach the entire length of the channel. There are pull-through brushes for cleaning hoses.
Instrument instructions for use (IFU) may contain specific brush size recommendations that should be followed. Brush IFUs may contain recommendations for which size and type of instruments the brush cleans best.
As a final note, if a brush is not labeled for single use, it must be cleaned after each use. It is generally up to your department to determine how a “use” is defined.