Okay, so did you look at page 105? Look, there's a little table on page 105, right? Right there on the bottom. What does it say?
I asked you to find me the temperatures, the humidity, and air exchanges. Decontamination area, temperature is 60 to 65 Fahrenheit, or 16 to 18 degrees Celsius. And please, please, please remember both numbers.
Celsius and Fahrenheit. Preparation and packaging area, we went up to 68 to 73 degrees Fahrenheit, which is 20 to 23 degrees Celsius. And sterile storage was 75 degrees or lower, or 24 degrees Celsius or lower.
Humidity for decontamination was 30 to 60 percent. Ditto for preparation and packaging. And less than 70 percent. in sterile storage. You know, this is not entirely correct because the humidity level in sterile storage must not fall below 30% humidity.
And the reason for that is that if the humidity level falls in decontamination area, in sterile storage area below 30%, your wrapping and packaging materials become dried up and brittle. When that happens, the... instruments inside are compromised because cracked and brittle material lets stuff get into the package make sense do we want that no so that's what i wanted you to look up okay if i didn't touch upon uh the ultrasonic cleaner and um and um um mechanical washer i'm going to do that now so Now, we talked about water extensively, right? Do I need to repeat anything about water right now?
No, I don't. Okay, good. And so let me talk about the ultrasonic cleaner and the mechanical washer. So last time we stopped short and we stopped short of discussing the final decontamination steps.
and we finalized in talking about manual cleaning, right? So now we should talk about mechanical cleaning. And the mechanical cleaning begins with ultrasonic.
In reality, the ultrasonic cleaner is not given enough credit. It is a hugely important and necessary piece of equipment that we must have in our possession, fully operational and in good shape. And we must use it extensively. Some people skip this process.
They consider it a pain, but it's not. So ultrasonic cleaner is part of mechanical decontamination. The main word, so this is your thought progression.
From ultrasonic cleaner, we have to look at the word cavitation. So ultrasonic cleaner works on the principle called cavitation. What is cavitation? Cavitation is the formation of tiny imploding bubbles.
is atrocious. That's why I speak every word that I write. So, a formation of tiny imploding bubbles.
What is an implosion? Well, it's like an explosion. Except an explosion goes, boom, outside. And implosion goes, inside. Effect is kind of similar.
So, what does that mean? form hundreds of thousands, maybe millions of tiny bubbles that implode around the dirty instrument. That implosion creates vacuum. Vacuum is used in your vacuum cleaner. And what does it do?
It sucks up the dirt, right? So, implosion, cavitation, formation of imploding bubbles that create a vacuum. And this vacuum... vacuum sucks off dirt particles.
from the instruments it is especially important with instruments with lumens the ones that you use a brush to clean inside so an instrument with lumen right so what is it it's like it's like a pipe right so these bubbles go inside and they implode within and whatever little pieces of chunks of dirt are stuck over here, these little bubbles, when they implode, they're going to suck off these dirt particles from within, the ones you missed with your brush. Because there's no way to get everything out with a brush. You do the best that you can. you can. But these hundreds of thousands of tiny bubbles inside that narrow space will suck off the dirt particles.
And in reality, that's all as far as the ultrasonic cleaner is concerned. Except a couple of things. The ultrasonic cleaner also uses enzymatic detergent.
And if we're using enzymatic detergent in a bath of water, that means the water must be of certain temperature. And while they don't tell us or specify what that temperature is, that temperature must be comfortable. Because if the water is too cold, the enzymes go to sleep if the water is too hot the enzymes are cooked in either case it doesn't work has to be warm and comfortable okay now when you When you use the ultrasonic cleaner and you create all these bubbles, you also create gases within the tank.
These things need to be removed or degassed. So, ultrasonic cleaner must be cleaned. And also, the word cleaned is synonymous with the word degassed.
Daily. By daily, we mean every shift. Will you see it down in a hospital?
Absolutely not. No one does this. Should they do it?
Absolutely. Once you get there, you will do it. Does this make sense? Can I erase?
No problem. I'm just itching to shoot the board with my trusty cleaner. All set?
Last but not least, for the pièce de résistance, we have the final step in mechanical decontamination. And that would be... what's that thing? Mechanical washer.
Logic, just like we did with ultrasonic, ultrasonic used cavitation, mechanical washers use a principle called impingement. The meaning of the word impingement means to knock off. And I'm going to demonstrate for you what that means.
I want you to see this. This is like a super-duper demonstration of what impingement is. Now, I have put on my hand, let's pretend for a moment, The moment that my hand is a surgical instrument, and on it, that little piece of paper, is a dirt particle that was left over from manual washing, from ultrasonic, but this, you know, really pesky little guy got left behind. So we're going to use a stream of water, under high pressure and temperature, to knock off this guy. So here is what it is.
That's impingement right there. You see that? Ready? Set? Did you see that?
That poignant presentation? So. So that was a demonstration of impingement.
We use high pressure and high temperature water jets to knock off... Oh my god. Last sentence from here. Making instruments safe to handle with bare hands. So in other words, as I open my mechanical washer on the clean side, The door opens, I receive my tray of instruments, and I take them out and I handle them with my bare hands.
I'm putting together a gigantic leap of faith that the guy or the gal on the other side of the glass did the proper... manual cleaning. They brushed everything out.
They used enzymatic detergent. They cleaned everything with their nylon brushes and sponges and enzymatic detergent. Then, after doing that, they put it in the ultrasonic where these bubbles...
imploded the living daylights out of all the bubbles inside, the lumens and everything else, and they sucked off all the dirt particles from the instruments on top. Then I put them in the right way. I put them inside the mechanical washer, and the impingement process took care of the rest of the business.
And even though I can't use this for surgery, at least, at the very least, it's safe for me to handle with bare hands. Can I get an amen? now how many times do you think yours truly witnessed the amount of stuff that comes in you take out a suction catheter or or something from the mechanical washer and out comes out a whole goop of pus blood and whatever else they've been sucking out right onto your ungloved hand At that moment in time, you want to open the pass-through window, reach into the guy that's doing the decontamination work, and grab him by the throat and say, My bare hands, man.
Folks. Sterilization is a process. Cleaning, decontamination, sterilization.
Without one, there is no two. Without two, there is no... no three.
If I take my undecontaminated equipment and put it in the magic box that we call sterilizer, it's not going to sterilize anything. It's just going to cook. Cook. Let me tell you something. If you don't reach in to the other side of the glass and choke somebody, I have personally seen surgeons, better yet, their nurses from the operating room, run back to sterile properties.
department with these instruments looking to track down the people that quote-unquote sterilized their equipment for the surgery the patients on the table the patients already out with anesthesia the sterile field has been set up do you know how long it takes to prepare a surgical suite for the operation how long does it take for the patient to get laid out get completely totally covered up only to receive your package from sterile processing put it on the sterile field unwrap it the doctor says scalpel The surgical scrub technician or nurse looks in there and says, Holy cow, doctor, there are bone fragments in here. That's when the doctor reaches in, takes out the mallet from there, and some kind of a saw, and goes to your department, looks on the name of the package and says, Where's Steve? Steve's name is on the pack. I was about to slice the patient open. We already administered anesthesia.
I got to tell you something. Do you know what it means to administer anesthesia? That means that your likelihood of not waking up are higher than dying from the surgery.
When you go for surgery, they make you sign all sorts of consent forms in which you say, I agree to die. All for the benefit of sleeping through this. Yeah, I mean if you ever gone for surgery, they have you sign a stack this big and all it says is that I agree to die in your hands and I will not sue if I don't wake up.
So they just put this poor bastard, uh, uh, this poor person, uh... out of his misery. They're out there receiving all sorts of happy juice. Machines are going, beep, beep, beep. The gas is going, fff, fff, fff.
They just took... him a half hour 45 minutes to lay everything out just so nicely and the doctor ready to go scalpel i'm ready to go and they find bone fragments from a previous case why because somebody didn't clean in decontamination the other person didn't look when it came out from the mechanical washer and the third person who was rapping didn't give a hoop about what the other two didn't see and didn't do Well, I'm here to tell you when this sort of thing happens, heads do roll. There's only so...
Your name's in the package. And you know what? Whose name's in the package?
The guy that took their wrapped package that somebody else already did and simply put it in the sterilizer. That's the guy that's responsible. You put it in the sterilizer.
The person who's not responsible at all, his or her name appears in everything. I mean, how am I supposed to know? They give me a package, say, hey, Steve, put it in the sterilizer.
I say, all right, I put my name in the package. Steve? May 20th, whatever, 3 p.m., I'm going to put this in the sterilizer, press the button, boom. Okay, I sterilized it.
I certify that when this thing comes out, I have reasonable assurance of sterility inside that package. But I didn't see anything inside that package. But I'm the first guy that they tracked down. And then they're going to look and say, who was in decontam that day? Was it Bob or was it Mary?
Bob said, I stepped out for lunch. Somebody else did that when I was there. I said, who wrapped this package? Well, I don't know. I think it went on table number three.
Who worked table number three? No, the only name that appears there is yours, the guy who pressed the button. Sounds like injustice, doesn't it?
And that's the whole point. Everybody rotates and circulates through the department. Someday your name is going to be on there, and you're going to be in decontam, and you're going to be, you know, wrapping, you're going to be inspecting, blah, blah, blah.
Everybody's responsible. Everybody gets it. Except the manager. The manager will make sure and find the guilty party and will fire whoever deserves to be fired. But I got to tell you, having seen these doctors fly out of the...
It's like Satan. Satan, and rightfully so. Okay? They fly out because if they were to put that in... If they didn't notice inside the OR that there were bone fragments or other stuff from the previous patient and they stuck it in the other patient, who's responsible?
It's not us. Now it's... the doctor. If the guy or the gal, the surgical tech or the nurse didn't notice this and says, doctor says scalpel, they give you a scalpel and the doctor says okay, let's go. At that moment, it's already too late.
The infection is in. Resulting in serious illness or death. Folks, you have to understand sterile processing department is the most important department in the entire hospital.
the only source of revenue, serious revenue for the hospital is the operating room. All the other departments don't bring in any money. Only surgery brings in real money on a daily basis. If you don't provide high quality instruments to your doctor, they will leave to a different hospital where they will operate. If you don't turn the equipment over in its proper time, they're screwed.
If they're screwed, the hospital is screwed. If the hospital is screwed, the patients are screwed. and you are out of a job. Make sense?
At some point in time, very soon, you will be compensated as real professionals. Right now, we're like in the middle ground. But I'm here to tell you, a couple of years from now, the money is going to be real. The respect will be real.
But only once people stop making these stupid mistakes inside there. If you don't clean, you can decontaminate. If you didn't decontaminate, you did not sterilize.
There is a lot of people out there is no way to sterilize anything that's contaminated or just dirty. These machines, they don't perform miracles. We all have to work within the realm of science, chemistry and physics, time, temperature, pressure, if we're dealing with high temperature sterilization. But you can't sterilize anything if you have a chunk of meat from a different patient still sitting on that piece of equipment. It just doesn't work that way.
Make sense? All right, I'm done with my little rant. Let me find what else to talk about.