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THE RELEVANCE OF THE HEALTH CLEANING PROCEDURE FOR
HEALTH
Junia Angélica Ferreira Bedone1
Celaine Kelly Ribeiro Gonçalves2
Diana Couto de Araújo3
Abstract: Objective: The purpose of this work is to recognize studies that address the importance of
the procedure for cleaning health products, in order to provide a critical observation to practitioners in
the corresponding areas. Method: This article was carried out through an integrative bibliographical
review. The research materials were: articles from the Google Scholar portal on this theme in the
period of 2022. The research is a bibliographical review, which concerns a structured study developed
with based on material published in articles on the Google Scholar portal. Results: The cleaning
procedure, being reported as a main period in the treatment of PPS, was recognized in 4 studies,
as being the indispensable process that makes the products safer to handle and prepares them for
disinfection or sterilization. Five articles researched procedural audits, cleaning, and two articles on
device and resource properties. Conclusion: With that intention in mind, the panorama elaborated for
this study provided an overview of the reasons related to the cleaning procedure that can inuence the
disinfection and/or sterilization phase and can provide support for institutes interested in performing
self-medication cleaning. Assessment of PPS management structures and procedures.
Keywords: CME. Health Products. Cleaning procedures.
1 Nurse, graduated from the University Center of East of Minas Gerais - Unilestemg. Acts as a
technical consultant at Sispack Medical. Regular student of the MBA course Material Management
and Sterilization.
2 Nurse, graduated from Paraná College - FAPAR. Acts as a technical consultant at Sispack Me-
dical. Regular student of the MBA course Material Management and Sterilization.
3 Biologist, graduated from the Federal Rural University of Pernambuco-UFRPE, Postgraduate
in Science Teaching. Nurse, graduated from the Olinda Higher Education Foundation-Funeso, post-
graduate in a surgical block, CME and SRPA.
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INTRODUCTION
Primarily, the instruments applied in the health area are made with raw materials that grant
several cycles of cleaning, preparation, disinfection or sterilization repeatedly until they lose their
purpose. This procedure ensures the prevention of the transmission of microorganisms and must be
carried out by a qualied professional (SOUZA et al., 2020).
The health products (PPS) process is pointed out as a means of increasing the guarantees
of products that generally have a high cost for sanitary systems and reducing the environmental
eects they cause, since the reuse of these artifacts reduces the volume of waste dumped into the
environment (SOUZA et al., 2020).
It is important to emphasize that the PPS process is driven by regulatory policies based on
risk management and public health safety; however, it diers from one country to another and can be
more or less restrictive, considering technological, operational, environmental, legal, economic, and
political issues. (ROSEIRA et al, 2016).
In hospital institutions, the PPS are assigned to the Materials and Sterilization Center (CME),
it is the place of “protection of the patient against contamination/cross-infection and other adverse
events related to the materials used in care, above the duty and commitment to adequately meet the
needs of the care units, especially the surgical center” (KAZUKO, 2022).
In this way, the CME, as well as other organizations/institutions processing PPS are
responsible for ensuring the daily ght against infections (HAIs), as any failure in the process
from material admission, cleaning, disinfection, preparation, packaging can endanger the sterility
of the preparations, which in the future corresponds to infectious conditions, either during patient
hospitalization or in an outpatient environment, or oce. (ALVIM, RAMOS; DURÃO, 2019).
The parameters that inuence cleaning are summarized in the Sinner Cycle, which is
represented by a circle where the elements that interfere in the process (temperature, chemical agent,
time and mechanical action) interact in a compensatory way in order to ensure adequate cleaning
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(SMITH, et al., 2012).
Therefore, to perform cleaning, the following are required: water, detergent, mechanical
action, temperature and time.
In the cleaning process, the steps of rinsing and drying the parts are essential and to
completely erase the organic matter of the PPS, in addition to removing deposits, dirt and garbage
from the cleaning agents and consumables applied, regardless of the type of cleaning designated, both
manual and automated (SOUZA, et al., 2020).
This should be carried out rinse with potable water which is intended to remove all residues
from the applied solution/inlet and after proper rinsing. This procedure is signicant because residual
moisture can promote microbial growth, adversely aecting other procedures, such as sterilization,
such as the danger of damage to the material itself. (SOUZA et al., 2020).
Detergents are sanitizers intended for cleaning products and surfaces by reducing surface
tension, composed of synthetic, organic, liquid or water-soluble powders that contain wetting agents
and emulsiers that suspend dirt and prevent the formation of insoluble compounds or foam on the
instrument or surface (BRASIL RDC n.º 15; 2012). In the PSS process, we oer to apply detergents
composed of enzymes, alkaline or acidic, regardless of the seal, as long as they are decently registered
with ANVISA. (OLIVEIRA, MATI, 2017).
The inspection is carried out using image-enhancing lenses, with a magnication of at least
eight times, especially in joints and assembly materials, complemented, when mentioned in some
examples, with commercially available chemical tests (BRASIL RDC n.º 15; 2012).
Visual control is recommended during the cleaning process, but it is also necessary to predict
the levels of organic matter and microbial contamination in the cleaned objects. Chemical tests must
be applied to verify the eectiveness of the cleaning procedure (ALVIM, RAMOS, DURÃO, 2019).
It is essential that the designated area has characteristics in all internal procedures, such as
receiving contaminated PPS, cleaning, preparation, sterilization, storage and distribution. Cleaning is
a critical step in this process for safe disinfection or sterilization. It should be questioned that, when
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there is a type II CME, where there are health products of complex compliance, manual cleaning is
complemented by automated cleaning or other cleaning of proven eciency (BRASIL, RDC n.º 15;
2012).
The purpose of this work is to recognize studies that address the importance of the cleaning
procedure of health products, in order to provide a critical observation to practitioners in the
corresponding areas.
METHODOLOGY
This work was carried out through an integrative bibliographic review elaborated from
published scientic articles, legal and normative documents that subsidize the procedures of hygiene
of PPS in the health area.
The evolution of integrative research occurred in six periods. Identication of themes and
choice of research questions. Selection of publications for the preparation of samples, description of the
pre-selected qualities of the questionnaire, classication of the ndings, observation and representation
of the answers and demonstration of the review reports (MENDES, SILVEIRA, GALVÃO, 2008).
The research materials were: articles from the Google Scholar portal on this topic in the
period of 2022. The research is a bibliographic review, which concerns a structured study developed
based on material published in articles, from the Google Scholar portal.
An elevation was made through the theoretical foundations and it was set out to obtain data
of great consequence for the accomplishment of this work, because primordial origins were sought so
that essential data could be obtained to study the fundamental qualities of the subject.
The standards for the works classied in the bibliographic elevation will be full texts, in
Portuguese and English, with free entry to the aforementioned principles of information. The exception
standards were themes that do not meet the purposes of the work.
Regarding the works found through the Google Scholar portal around the chosen theme, a
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total of 33 articles were found, only 02 of which were in a foreign language and of this amount, 17
articles were chosen as the basis of this study.
It should be noted that in addition to the articles mentioned above to be part of the work,
bibliographic references were also used to compose the entire scientic basis in this work described.
FINDINGS
Among the studies found, most were based on exploratory descriptions, followed by
laboratory studies, articial reviews, and narrative reviews of the literature, all focusing on health
products.
The cleaning procedure, being reported as a main period in the treatment of PPS, was
recognized in 4 studies, as it is the indispensable process that makes productions safer to handle and
prepares for disinfection or sterilization (SOBECC, 2017; ; MATI et al., 2018; ALVIM, RAMOS,
DURÃO, 2019; SOUZA et al., 2020).
Five articles searched for procedural audits, cleanliness audits, and two articles on device
and feature properties. Both in order to predict how the processes and advantages of the cleaning
technique are carried out, and to reinforce the importance of preserving strict monitoring of the
equipment that helps in this procedure, such as thermal disinfectants and the use of detergents.
The requalication and monitoring of equipment, ensuring the eciency of cleaning
procedures, taking into account the prevention of healthcare-associated infections (HAIs), in addition
to patient safety, are issues of global importance (OLIVEIRA, MATI, 2017; SOBECC, 2017; ; MATI
et al., 2018; ALVIM, RAMOS, DURÃO, 2019; SOUZA et al., 2020).
The safety of disinfection after a cleaning procedure was highlighted in four studies, as the
procedure aims to ensure its eectiveness against contamination and microbiological risks (ROSEIRA
et al., 2016; SOBECC, 2017).
The valorization of the use of various varieties of detergents was highlighted in three articles,
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which report pertinent appearances, both for the microbial eects on the cleaning routine and for the
ideal detergent alternative. (OLIVEIRA, MATI, 2017; SOBECC, 2017; MATI et al., 2018).
It was clear in all the materials reviewed that the concern with cleanliness itself is closely
related to the size of the institutions, not only for resources, but for the interest of the professionals
who work there. The lack of physical structure, operational procedures that are eective and the
proper inspection of what is actually being processed are just points in the midst of so many neglected
factors.
DISCUSSION
The implementation of specic legislation for CSD, although it is nationwide and therefore
most of the requirements presented aim at minimum needs for a safe processing of SHCP, also
presents articles that are dicult to apply for many health institutions (BRASIL, RDC n.º 15; 2012).
Complete compliance with the legislation, as well as technological parks with equipment such as
washers, thermodisinfectors, for example, although much desired by MSC nurses, are not always a
reality (MADEIRA et al., 2015)
It was possible to denote that, in order to carry out good care activities, it is essential to
implement a capable and constant treatment with SPF, with special emphasis on cleaning, regardless
of the size of the institution.
It should be noted that we are dealing here with a manual procedure, but the automated one if
so requires. In addition, the products to be used in practice, their selection and suitability and, above
all, the materials/work to be used (POZZER et al., 2019).
It was also seen that cleaning medical equipment is among the 10 most common compliance
errors and the Centers for Medicare and Medicaid Services (CDC) and the Joint Commission
International (JCI) reported that 1/3 of hospitals have deciencies in the reprocessing process.
According to the research, it should be noted that the cleaning stages and their validation
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must follow a standard operating procedure (SOP), prepared with recent mentions and scientic
studies with a high level of demonstration that contribute to the structuring of a well-dened and
practical document, as required by Brazilian legislation.
This should allow the systematization and adaptation of an evaluated routine essential for
the treatment of SPC, in this case, we can say that the practices involved in the treatment sites of SPC
require the quality of internal procedures, especially cleanliness, thus providing indispensable care to
the patient, being a measure that should always be evaluated and standardized in health services, in
order to ensure the success of all periods of the procedures (POZZER et al., 2019; ALVIM, RAMOS,
DURÃO, 2019).
In the specications of RDC No. 15 of 2012 we nd the classication for critical PPS of
intricate conformation, that is, those with a lumen of less than ve millimeters or blind bottom, places,
internals unavailable to direct friction, recesses or valves. Product compatibility is a signicant factor
in the eectiveness of cleaning during operation. The most common obstacles we face in this case are
endoscopes, which are considered more dicult materials to clean, as they have several narrow and
large lumens.
A exible and delicate structure with numerous components, and also the cleaning of
radiosurgery materials, which are complex, high expense and their use is increasingly common in
various surgical specializations.
In this case, these materials can be damaged by certain chemicals and cleaning products,
requiring careful preparation by the team and strict compliance with handling protocols.
Considering this scenario, in the process of cleaning the PPS, with complex conformations,
preference should be given to manual cleaning, whose friction should be with non-abrasive materials
that do not release particles. It is mandatory by this determination to complement it with automatic
cleaning by ultrasonic or other proven device containing cannula connectors and using intermittent
ow technology (SOBECC, 2017).
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CONCLUSION
The study concluded that the treatment of PPS in CSSD involves several times, all of which
require attention, and thus, the hygiene procedure is indispensable for the quality of the treatment of the
material, being a step that can inuence all aspects of the patient. Reasons related to cleanliness such
as cleaning technicians, handling, technicians, equipment and inputs applied, water characteristic and
drying are evaluated and reviewed eectively and continuously to ensure a more eective sterilization
process.
The control and improvement of quality and safety should start from the representation of
health professionals and their managers, directing their work to the organization of processes, with a
view to the prevention of HAI and patient safety.
With this intention, the panorama elaborated for this study provided an overview of the
reasons related to the hygiene procedure that can inuence the disinfection and/or sterilization phase
and can provide support for institutes interested in performing self-medication cleaning. Evaluation
of the structures and procedures of management of the PPS.
The adequacy of the size of the service institution to the de facto classication of
the sterilization sector and with this the acquisition of equipment is a relevant factor, as well as
implementing the standard operating procedure based on cleaning indicators, as a way to comply with
current legislation, since, for all processes that occur within sterilization, Cleaning must contain this
type of traceability.
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