Surgical Instrument Washers
Ultrasonic Surgical Instrument Cleaner 
Surgical Instrument Detergent Enzyme Cleaners
Surgical Instrument Washer Detergents 
Surgical Instrument Detergent Concentrates
Surgical Instruments that were cleaned in a Surgical Instrument Washer with automated Ultrasonic Cleaner Solution using a combination surgical instrument cleaner : "evaluation of Surgical Instrument Washer with automated Ultrasonic Cleaner Solution confirmed that the efficacy of disinfection was 100%". "All surgical instruments and utensils tested were sterile at the completion of the process."
Surgical Instrument Washer  Ultrasonic Cleaner Solution
Provide the Prerequisite for Sterilizing Surgical Instruments and Utensils
The Proper Sequence of Treatments
The Proper Sequence of Treatments of cold water pre-wash, ultrasonic cleaning, detergent washing, final rinse(s), and hot air drying treatments of a Surgical Instrument Washer with automated Ultrasonic Cleaner Solution using a combination enzymatic enzyme detergent surgical instrument cleaner, will provide the prerequisite for: safe handling, disinfecting, and sterilizing of surgical instruments.
John Temple
John Prohonic
Product Development
Summary :Surgical Instrument Washers Ultrasonic Cleaner Solutionare designed to clean all surfaces thoroughly, thereby providing the critical prerequisite for the safe handling, disinfecting, and the sterilizing of surgical instruments. 
Critical cleaners, usually referred to as Washer Decontaminators Washer Disinfectors, perform pre-wash, ultrasonic (optional), detergent washing, purified water elevated temperature rinsing, lubrication and high temperature drying in such a manner as to provide thoroughly clean, stain free and lubricated medical devices. Surgical Instruments cannot be sterilized (be sterile) unless all exposed surfaces are properly cleaned, prior to sterilization, to remove soil (debris, bioburden) and properly rinsed to prevent staining.1,2,3  Not all Washer Decontaminators Washer Disinfectors provide adequate pre-rinsing, pre-cleaning, purified water rinsing, and thereby render higher rejection rates of processed surgical instruments. 4,5.
Surgical Instrument Washers Ultrasonic Cleaner Solution Secure Performance
The proper sequence of treatment and the correct choice of time, temperature and the components used are necessary to render surgical instruments that are critically clean, safe to handle, and have the prerequisite for sterilization. 6,7,8.
Washer Decontaminators Washer Disinfectors employ a cold water pre-wash to remove gross debris.  This removes proteins and lipids, preventing them from being baked onto devices during the high temperature treatments to follow. 9, 10.  Then, the ultrasonic process creates millions of micro implosions to loosen and free debris from lock boxes, hinge pins, serrations and other difficult-to-access surface areas. 
The Washer Decontaminators Washer Disinfectors detergent wash then applies high flow low pressure water with a cleaning concentrate (at ~ 135 degrees F) in such a manner as to evenly reach all areas of the load and strip bioburden from the surgical instruments.  The elevated temperature (at ~ 194 to 209 degrees F) purified water final rinse secures the biocidal process, removes mineral deposits from prior cycles and lubricates the instruments. The high temperature (at ~ 158 to 230 degrees F) dry cycle presents heated, forced air which dries each device.  The critical cleaned medical devices are now clean, safe to handle, have the prerequisite for sterilization, and are properly prepared for further reprocessing. 
Surgical Instrument Washer Ultrasonic Cleaner Solution - Complete Removal of Pathogens
The Washington University School of Medicine at Washington University Medical Center examined the performance of a properly designed Washer Decontaminator Washer Disinfector (CESCO washer Decontaminator Model 520) and found that it removed all organisms from the surgical instruments tested.  11
The Surgical Instrument Washer with automated Ultrasonic Cleaner Solution was tested for its ability to complete remove pathological organism from surgical instruments.
Pure cultures of the following organisms were grown on appropriate agar plates:

1. Staphylococcus aureus;
2. Pseudomonas aerations;
3. Escherichia coli;
4. Bacillus species

Kelly clamps, tweezers and scissors wee placed on these plates of organism, taking care to ensure that all serrated edges were packed with all the organisms.  Each contaminated instrument was then dipped into the tube of Thiogycolate medium before being placed in all the washer baskets.  The instruments were then processed through the complete Washer Decontaminator Washer Disinfector cycle.  At the end of the drying cycle, the instruments were allowed to cool and then dipped into another tube of Thioglycolate medium.     
Results
All tubes of the Thioglycoate medium tested before the wash grew the appropriate organism within six to 18 ours after testing.  All tubes tested at the end of the wash showed no growth after 14 days of incubation. This Washer Decontaminator Washer Disinfector removed all organisms from the instruments. 
Surgical Instrument Washer with automated Ultrasonic Cleaner Solution 
Efficacy of Disinfection 100%
Another evaluation of Washer Decontaminators Washer Disinfectors confirmed that the efficacy of disinfection was 100%.  In this study, L.P. Jette and N.G. Lambert used two test methods.12   One method (N) was to test the effect of heat only within the disinfection process and the other test method (G) was to test the efficacy of both heat and washing.  Each method gave reproducible results and confirmed the efficacy of the Washer Decontaminator Washer Disinfector.
Surgical Instrument Washer with automated Ultrasonic Cleaner Solution 
Critical Cleaners Will Work for You
Washer Decontaminator Washer Disinfector Critical cleaners demonstrated the ability to completely remove pathological organisms with effective repeatability.  There operation is automatic, reliable, labor saving and easy to use.  Central Processing departments rarely find the need to manually treat devices and report an  exceptionally low rate of rejected devices. 

Conclusion
The Proper Sequence of Treatments of cold water pre-wash, Ultrasonic Cleaner Solution, detergent washing, final rinse(s), and hot air drying treatments of a Surgical Instrument Washer with automated Ultrasonic Cleaner Solution using a combination enzymatic enzyme detergent surgical instrument cleaner, will provide the prerequisite for: safe handling, disinfecting, and sterilizing of surgical instruments.

References
1. Peggy Ryan, RN, “Concepts of Cleaning Technologies and Processes,” Journal of Healthcare Material Management, (Nov./Dec. ’87), pp. 20-27.
2. Marimargaret Reichert, RN, “processing Reusable Medical Devices, “Journal of Hospital Material Management, p. 40.
3. Training Manual for Central Service Technicians, American Society for Central Services Personnel of the American Hospital Association, (Chicago, IL, 1986), p. 69.
4. Ryan, op. cit.
5. Training Manual for Central Service Technicians, op. cit.
6.  Ryan, op. cit.
7. Interview with Charles A. Reed, Washington University School of Medicine, Washington University Medical Center, Dec. 1985.
8.  L.P. Jette’and N.G.Lambert, “Evaluation of Two Hot Water Washer Disinfectors for Medical Instruments, “ Infection Control Hospital Epidemiology, Vo.1 9, No. 5, (1988), pp. 194-199.
9. Training Manual for Central Service Technicians, op. cit.
10.  Ryan, op. cit.
11.  Ryan, op. cit.
12. L.P. Jette’and N.G.Lambert, op.cit.

NOTE:
Surgical Instrument Washers used in this research study were manufactured by CESCO, Mercersburg PA. Although these Surgical Instrument Washers  are not currently available. The studies demonstrate the propensity for Surgical Instrument Washers to deliver optimal cleaning results.

The surgical instrument cleaners used in these studies are currently available in the form of the all-in-ONE combination enzymatic enzyme detergent surgical instrument cleaners. A critical component for optimal cleaning is using the best possible "surgical instrument cleaners". Recent European studies have illustrated and concluded that combination enzymatic enzyme detergent surgical instrument cleaners are more effective than conventional surgical instrument cleaners. The research was initiated to deactivate prions deactivating prions within the objective to prevent CJD (Creutzfeldt-Jakob Disease).
Surgical Instrument Washers
Ultrasonic Surgical Instrument Cleaner 
Surgical Instrument Detergent Enzyme Cleaners
Surgical Instrument Washer Detergents 
Surgical Instrument Detergent Concentrates
After being cleaned in a Surgical Instrument Washers using a combination
surgical instrument cleaner:
“All surgical instruments and utensils tested were sterile at the completion of the process.”

ABSTRACT
Paper accepted for presentation at APIC: 
Eighteenth Annual Conference and International Meeting
Nashville Tennessee

Surgical Instrument Washers
Ultrasonic Surgical Instrument Cleaner 
Surgical Instrument Detergent Enzyme Cleaners
Surgical Instrument Washer Detergents 
Surgical Instrument Detergent Concentrates

Oral Presentation 
Validation of the microbial safety of surgical instruments and utensils following automated cleaning by a Surgical Instrument Washer (Tunnel Washers with Ultrasonic Cleaners) – Thermal Disinfection. A. Drake, RN and L. Ayers, MD., The Ohio State University Hospitals, Columbus, Ohio, 43210

The application of universal precautions to instruments/utensils handling became an issue in the selection of replacement decontamination equipment for Central Sterile supply at our hospital.  The new technology of an automated thermal disinfection Washer Decontaminator Washer DisinfectoSurgical Instrument Washers (Tunnel Washers with Ultrasonic Cleaner Solution) r (CESCO TM, Mercersburg, Pa.) offered increased protection to our reprocessing staff due to decreased handling but raised concerns about the efficacy of thermal disinfection as opposed to traditional washer sterilization. Because of the limited scientific documentation of this new technology, a study was undertaken to establish the microbial safety of finished products and to identify any feature or function failure which could adversely affect outcome. The sequence of treatments for the Surgical Instrument Washers (Tunnel Washers with Ultrasonic Cleaners) progress from flush/rinse, sonic bath, wash, rinse, lubricant/deionized water (DI) sprays to drying at 240°  F. for 4 minutes.  The Washer Decontaminator Washer Disinfector Surgical Instrument Washers (Tunnel Washers with Ultrasonic Cleaner Solution) was challenged with selected instruments and utensils that are considered to be very difficult to clean.  Included were 30 each  of stainless steel non-perforating towel clips and stainless steel and glass medicine cups.  Each item was rinsed with a 10 5ml  suspension of Staphylococcus aureus, Pseudomonsaeruginosa, Enterococcus fecalis and Candida albicans in nutrient media and then dried. The instruments wee processed in the Surgical Instrument Washers (Tunnel Washers with Ultrasonic Cleaner Solution) 3 separate loads during times of high volume operation.  All products were tested for sterility.  Ten separate cultures were taken of the final rinse solution of instrument lubricant and de-ionized water prior to the drying cycle.  A separate culture was taken of the instrument lubricant fluid.  All instruments and utensils tested were sterile at the completion of the process.  The final rinse, however, was heavily contaminated with the saprophytic bacteria Flavobacterium  sp., Pseudomonas (P.) picketti and P. rubrisubalbicans.  The source of the contamination was determined to be resin gel in the DI tank and not the instrument  lubricant.  The contamination can be eliminated by the addition of a 0.22 u filter to the DI line.  Our findings support the practice of validating all features of new technologies that may compromise the expected final outcome.  The Surgical Instrument Washers (Tunnel Washers with Ultrasonic Cleaner Solution) Washer Decontaminator Washer Disinfector is a valid replacement for the conventional washer-sterilizer.
Ann Drake
John Temple
Product Development

NOTE:
Surgical Instrument Washers  used in this research study were manufactured by CESCO, Mercersburg PA. Although these Surgical Instrument Washers are not currently available. The studies demonstrate the propensity for Surgical Instrument Washers to deliver optimal cleaning results. The surgical instrument cleaners used in these studies are currently available in the form of the all-in-ONE combination enzymatic enzyme detergent surgical instrument cleaners. A critical component for optimal cleaning is using the best possible "surgical instrument cleaners". Recent European studies have illustrated and concluded that combination enzymatic enzyme detergent surgical instrument cleaners are more effective than conventional surgical instrument cleaners. The research was initiated to deactivate prions deactivating prions within the objective to prevent CJD (Creutzfeldt-Jakob Disease).
Surgical Instrument Washers
Ultrasonic Surgical Instrument Cleaner 
Surgical Instrument Detergent Enzyme Cleaners
Surgical Instrument Washer Detergents 
Surgical Instrument Detergent Concentrates
Surgical Instrument Washers
Ultrasonic Surgical Instrument Cleaner 
Surgical Instrument Detergent Enzyme Cleaners
Surgical Instrument Washer Detergents 
Surgical Instrument Detergent Concentrates 
Neutral pH  and "free-rinsing" for residue free Surgical Instruments
Surgical Instrument cleaning and conditioning.
The most effective Eye Surgical Instrument Cleaning Conditioning Concentrate.
ONE product for cleaning surgical instruments.
ONE application for cleaning surgical instruments.
Apply it ONCE. It's all you need for cleaning surgical instruments.
Lower Surgical Instrument Cleaning COSTS. Break down and remove bioburden clean and condition the surface all-at-ONCE. The easy FOAM-it  is formulated for "free-rinsing-purity".
This is especially important when cleaning Surgical Instruments. Surgical Instruments rinsing clean. Your cleaner surgical instruments will look newer and perform longer.
Cut the cost of cleaning Surgical Instruments.
Cut the clutter of cleaning Surgical Instruments.
Surgical Instrument Detergent Cleaners
Surgical Instrument Detergent Concentrates
Surgical Instrument Detergent Concentrates
easy FOAM-it
Surgical Instrument Cleaners
& Conditioners
Cleaning Surgical Instruments with Neutral pH 
and "free-rinsing" Cleaners
all-in-ONE 
Surgical Instrument Cleaners
& Conditioners
Surgical Instrument Cleaners
for lower cost,
fast and effective cleaning.
Surgical Instrument Detergent Cleaners
Surgical Instrument Detergent Cleaners
Surgical Instrument Detergent Cleaners
Surgical Instrument Detergent Cleaners
Surgical Instrument Detergent Cleaners
Surgical Instrument Detergent Cleaners
Direct from the Scican factory to you.
Countertop Sterilizers 
Table top Sterilizer
unwrapped sterilizer Table top Sterilizer  9 minute cycle
Table top Sterilizer and Countertop Sterilizer
wrapped sterilizer Table top Sterilizer 17.5 minute cycle
sterilizing surgical instruments between procedures.
Table top Sterilizers
Table top Sterilizers  
Flash Sterilizer Cycle
Flash Sterilizers  
Direct from the Scican factory to you.
Countertop Sterilizers 
Table top Sterilizer
unwrapped sterilizer Table top Sterilizer  9 minute cycle
Table top Sterilizer and Countertop Sterilizer
wrapped sterilizer Table top Sterilizer 17.5 minute cycle
sterilizing surgical instruments between procedures.
Table top Sterilizers
Table top Sterilizers  
Flash Sterilizer Cycle
Flash Sterilizers  
Surgical Instrument Care Cleaning Care of Surgical Instruments Importance of Cleaning Surgical InstrumentsMallard Medical Surgical Instrument Cleaners and Surgical Instrument Washers, for the highest quality Surgical Instrument Care.
Mallard Medical Surgical Instrument Cleaners and Surgical Instrument Washers, for the highest quality Surgical Instrument Care.
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Mallard Medical Surgical Instrument Detergent Enzyme Cleaners and Surgical Instrument Washers deliver the surgical instrument cleaning outcomes that you and your surgical instrument deserve.
Surgical Instrument Washer Detergents 
Surgical Instrument Detergent
Surgical Instrument Detergent
Surgical Instrument Workstations,
Prep and Pack Tables and Work Sinks
Surgical Case Carts: conventional Surgical Case Carts, and
Case Carts that create space
Surgical Instrument Detergent
Surgical Instrument Case Carts
Surgical Instrument Decontamination Work Sinks
UPS-1
Surgical Instrument Detergent
4 Enzyme Lubricant  Cleaners
Surgical Case Carts
UPS-1 Surgical Instrument Detergent Cleaners
Surgical Instrument Detergent Cleaners are packages as:
UPS-23 Surgical Instrument Detergent Enzyme Cleaners - 23 oz., 12 per case
UPS-1   Surgical Instrument Detergent Enzyme Cleaners - 4 gallons per case with 1 pump
UPS-5   Surgical Instrument Detergent Enzyme Cleaners - 5 gallon
UPS-15 Surgical Instrument Detergent Enzyme Cleaners - 15 gallon
UPS-30 Surgical Instrument Detergent Enzyme Cleaners - 30 gallon
UPS-55 Surgical Instrument Detergent Enzyme Cleaners - 55 gallon 
Ultrasonic Surgical Instrument Cleaner
Instrument-Washers-1