General information about Automatic cart washer at CSSD

2. The amount of sterile containers, carts & trolleys used in hospitals has increased
significantly due to the centralization of sterilization services.
The cleaning of these carts trolleys is usually done either;
Manual
Automatic or
Manual & Automatic
The washer area houses the
equipment that receives soiled
carts, washes them, and delivers
them to the Clean and Sterile
Storage Room.

3. In general carts Wash in CSSD can be done :
Manual
Water pressure driven between 2 to 6 bar up to 50°C
Dosing of detergents should be automatic.
Wall mounting kit,
Cleaning gun, 15m
Length hose with stainless steel ½” to ¾”connection kit
Automatic
An automatic mechanical cleaning equipment that helps
reduce microbial contamination and renders items safe
for staff to handle
Using both technique
In this case the manual carts wash area is serves as a
back-up to the automated cart washer

4. ANSI/AAMI defines a cart washer as “mechanical cleaning equipment
that helps reduce microbial contamination and renders items safe for
staff to handle and for patients to use.”
A medical automatic cart washer (also referred to as a cage, utensil, or
utility washer) “is a heavy duty, large capacity, hydro-spray washer/dryer
designed for use in CSSD to clean, sanitize, and dry surgical cases, general
purpose carts, racked utensils, and utility items used in health care
facilities.”
Reference
http://www.lynxpg.com/WebModules/ServiceCategories/dtl_Machines.aspx?MacID=18
The cart washer “is a high capacity mechanical washer/disinfector
intended for use in the efficient washing, low-level disinfection, and drying
of utensils, carts, and other miscellaneous reusable items used in the care
of patients
The automatic cart washer may seem like a simple machine, but it plays a
vital role in reducing the occurrence of hospital-acquired infections

5. This area provides a means to clean case carts, as well as ridged instrument containers.
Workflow Should allow direct access to SPS receiving, storage and dispatch area, for case cart
assembly, and indirect access to preparation and assembly area for return of rigid instrument
containers

7. Space : approx. 11.1 m2
Ceiling Height: 2700 mm
Lighting: 30 FC
Power : as per Manuf.
HVAC:
o Minimum Total Air Changes 10
o Room Air Exhaust Required:
Yes, 100%
o Exhaust: : “Wet Exhaust”
o Room Air Return Permitted: No
o Room pressure: Negative (-)
PLUMBING & Water Supply
o Hot & cold water : Yes - as per
manuf. Requirements
o Sanitary Drain : Yes - as per
manuf. Requirements
o Reagent Grade Water: Yes - as
per manuf. Requirements

8. These factors affect the facility’s ability to produce items that are safe to handle and use. As the washing
provides only low-level disinfection, so it is very important that the process works every time and that a back-
up plan exists in case of failure . Major variables that affect the performance of an automatic cart washer are:
Water quality
Hard water can cause spotting and block the spray jets
Poor quality water will cause the use of more cleaning solution than needed.
pH level not compatible with the cleaning solution will lead to solution’s effectiveness will be
compromised.
Temperature
The heat play vital role in disinfection & pre-rinse and cleaning solution activity
Cleaning solution
Use of original manufacturer recommended cleaning solutions is essential
Solutions must be mixed properly and administrated at the right concentration and temperature to be
effective
Reference : Stephen M. Kovach, Proper Use of the Medical Automatic Cart Washer March 2009

9. Loading
Cart washer not to be loaded above the recommended capacity
Item to be distributed to receive proper cleaning from all sides
Avoid crowding the cart with items
Cycle selection
washers must have multifunctional programs with the capability
to allow users to modify a cycle to meet their particular needs
Mechanical issues
Most of the automated process are related to the proper function
of the pumps, spray action, and features such as tilting during cleaning.
Training
The proper use of the cart washer depends on the training provided to the user.
This training should review the following:
Hospital guidelines for use of the medical automatic cart washer.
Contents of the cart washer manual
Explanation of the various cycles -- when to use them and on which equipment
Loading of equipment
Preventative maintenance as outlined by the manufacturer
Relevant safety issues

10. Safety
Safety is a broad issue involving staff, patients, and the hospital work environment.
Safety concerns & measures must be considered, implemented & verified during
planning replacement stages.
Vapor and moisture that escape from the washer (even one with an exhaust fan) can present problems for
the sterile storage area ( avoid to locate the exit door direct /near sterile storage items/area)
Emergency shut-off buttons to be provided in an easy reachable place from both side of the washer.
Staff must wear the proper personal protection equipment when working with the cart washer.
Departments need a back-up plan for cleaning when automatic washer is out of order (second washer or
manual cleaner gun.
Each medical facility should have a written back-up policy and procedure, which should be reviewed by both
Infection Control and Risk Management.

11. Process verification
This involves three components.
Staff documentation .
Staff need to observe, record and report how the machine functions.
verification tests .
The use of some independent means to check:
o water quality,
o equipment function, and
o water temperature.
P.P.M ( Periodic Preventive Maintenance) & C.M ( Corrective Maintenance)
The adherence to the preventative maintenance schedule prescribed by the equipment manufacturer, and
preforming this maintenance by a qualified trained person play vital role in safety, effective machine operation
and life span of the washer. The P.P.M should be documented (including the changed parts used during P.P.M)
C.M also must be performed by on time by qualified trained person, parts used should be original and all
acclivities in C.M must be documented and reported.
The washer performance after P.P.M and C.M should be checked, documented & reported.

12. in the market different configurations and sizes are available of carts/trolleys for auto
washers . The selection of any should be fully comply with the selected automatic cart
washer type /model and the recommended by the manufacturer.

13. The cart washer can be installed on the floor (with a small ramp for an easy loading/
unloading of the trolleys) or into a 150mm (5.90”) pit for floor level loading.
If a Tilting rails is used , then it allows water to drip for a faster drying phase.
The longitudinal tilting of the rails, at the end of the cycle, makes the unloading of
carts easier.

14. Integration will support CSSD team managers, providing them with
customized solutions to reach the highest productivity level for every layout
configuration in new or refurbishment projects.
The integration can be achieved if the following are considered ;
Compact Carts /Trolleys
Multipurpose Carts / Trolleys
Multipurpose washer
Use of thermal & chemical resources
Adjustable chamber depth / Washing chamber capacity
Min required space for installation
Easy installation and maintenance

15. In some Healthcare facility it has been observed that;
Medical automatic cart washers are being used inappropriately to clean
surgical instruments;
Cart washers are erroneously perceived as able to provide high level
disinfection;
Staff are not receiving yearly in-service training.
Running /Operating the automatic cart washer with less or more capacity
than the recommended
lack of QA/QC tests and records before and after the cart washing process.
Use of a non recommended by the manufacturers Detergents / Solutions.
Poor service / maintenance programs (P.P.M & C M) , which lead high down
time, low system life time.

16. Efficient Operation of the Automatic Cart Washer
To help prevent infections, all equipment (carts, wheelchairs, stretchers, baskets, etc.) must be disinfected
between uses according to the Spaulding classifications. Automatic cart washer must function to its full ability
in accordance to these classifications.
Proper servicing and maintenance
Staff can reduce the amount of downtime for the washer if they well trained & understanding the
reasons for failures
Preforming the quality process to monitor the washer’s function. Monitoring also makes staff more aware
of their cleaning process.
The medical automatic cart washer is an effective tool in reducing the incidence of hospital acquired
infections. As does any piece of equipment, the cart washer must be used by properly trained staff,
maintained according to the manufacturer’s instructions, and monitored to verify that it is working properly.