By Julie E. Williamson
Operating room (OR) and endoscopy suite professionals play a critical role in point-of-use instrument treatment – and the use of enzymatic sprays and detergents can be a powerful tool in the process thanks to their ability to break down clinical soil and make cleaning easier and more effective in sterile processing areas. But many OR, endoscopy and SPD team members aren’t using them consistently and properly and may even lack an understanding of enzymatics’ function and benefits.
During his session from the 2021 IAHCSMM Virtual Conference, Craig Wallace, president of Wallace Sterilization Consulting, shared his knowledge about enzymes – including what they are, how they work and essential factors to consider to ensure they are leveraged to their fullest. He explained how enzymes and enzymatic detergents and the soils on instruments and medical devices fall into the biochemistry category and how biological macromolecules are comprised of building blocks [sugars, the building blocks of carbohydrates; fatty acids, the building blocks of lipids; nucleotides, the building blocks of nucleic acids (DNA and RNA); and amino acids, the building blocks of protein] that join together by a link or bond. Enzymes, on the other hand, are proteins that serve as biochemical catalysts, increasing the rate of a chemical reaction without the enzyme itself undergoing any chemical changes itself. Put simply, as they relate to instrument treatment, enzymatic detergents break down the large molecules in the clinical soil to make it easier to wash away during the decontamination process.
“There are millions, perhaps billions, of reactions in cells and all are catalyzed by enzymes to make those reactions happen more quickly,” Wallace said, adding that enzymes are very specific in their work. Most enzymatic detergents sold today have different enzymes for different soil components: protease, lipase and amylase, which break down proteins, lipids/fats, and carbohydrates, respectively.
How enzymatic detergents work (and ensuring proper use)
SPDs rely on two types of water-soluble cleansing agents: alkaline detergents that use alkaline pH chemistries to break down and solubilize soils, and enzymatic detergents that rely on enzymes’ lytic action to break down and solubilize soils. Enzymatic detergents are complex chemistries consisting of enzymes, stabilizers and surfactants, and they are sensitive. They require the correct temperature, pH and concentration to ensure the enzymes stay intact and effective.
“We need to show them respect by following the instructions for use because there are specific reasons behind those [instructions],” he continued.
Recommended usage and conditions for manual and ultrasonic/automated cleaning methods must be carefully and consistently followed. Many detergents are concentrated and require proper dilution to work effectively. Manufacturer instructions must also be diligently followed to ensure proper temperature ranges (enzymes are sensitive proteins, so “don’t run them too hot,” warned Wallace), and proper temperature must also be maintained in storage areas to prevent the enzymatics from losing their efficacy.
He also stressed the need to check expiration dates with every product used, including enzymatic detergents. They shouldn’t be viewed like simple hand soap in a restroom, he said, explaining that stabilizers, for example, may not work after the expiration date.
“These detergents are chemicals designed to chew up biological macromolecules, so they need to be handled, stored and used properly. Follow IFU closely to ensure the enzyme and surfactant chemistries will safely and effectively clean the instruments and devices,” Wallace said.
Author’s note: Enzymatic detergents/sprays may not be suitable for all instrument/devices, so be sure to closely follow manufacturers’ IFU (when in doubt, contact the device and enzymatic manufacturers). Also, while enzymatic sprays can be powerful tools for point-of-use treatment in the OR and other direct patient care areas, they may not be available in some facilities/departments. In the absence of enzymatic sprays or foaming agents, experts agree it is still important to keep instruments moist at point of use to prevent clinical soil from drying and hardening on devices (which can make it more challenging to remove in sterile processing areas and can jeopardize high-level disinfection and sterilization processes). Simply spraying instruments with water or covering them with a water-moistened towel (not saline, which can damage instruments) can be effective.
– Julie E. Williamson serves as Director of Communications and Editor-in-Chief for the Healthcare Sterile Processing Association (formerly the International Association of Healthcare Central Service Material Management).