At times the washers used by Hospital Reprocessing Departments are called "washer sterilizers", referring to the type of washers that were used prior to an industry wide change in surgical instrument washer technologies initiated by CESCO. Click Here to go to the APIC Abstract. Washer sterilizers were replaced by washer disinfectors (surgical instrument washers and washer decontaminators) due to the ineffective cleaning outcomes and slow turnaround time of the washer sterilizers. Washer Decontaminators, Washer Disinfectors are a valid replacement for the conventional washer sterilizer.
Click Here to go to the APIC Abstract.
Related References:
Cost Benefit Analysis Comparing Washers versus Manual Cleaning.
Hand washing medical devices presents a risk the the healthcare workers.
Washer Disinfectors can avoid the risks associated with hand washing surgical instrumentsWasher disinfectors can reduce the costs of cleaning surgical instruments. Studies demonstrate that Washer Disinfectors using a 4 enzyme detergent disinfector can deliver the: complete removal of all pathogens and surgical instruments sterile at the completion of the process. Properly designed Washer Disinfectors deliver the Proper Sequence of Washer Treatments that include a combination of mechanical and chemical treatments. After being cleaned in Washer Disinfectors that include using a combination 4 enzyme detergent Surgical Instrument Cleaner: evaluation of Washer Disinfectors confirmed that the efficacy of disinfection was 100%. All surgical instruments and utensils tested were sterile at the completion of the process. Click Here to go to the APIC Abstract
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APIC Abstract, Paper accepted for presentation at APIC: 
Eighteenth Annual Conference and International Meeting
Nashville Tennessee, Oral Presentation
Validation of the microbial safety of surgical instruments and utensils following automated cleaning by properly designed Surgical Instrument Washers, Washer Decontaminators, Washer Disinfectors. A. Drake, RN and L. Ayers, MD., The Ohio State University Hospitals, 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 Surgical Instrument Washer, Washer Decontaminator, Washer Disinfector, (TW)(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 Proper Sequence of Treatments of the Surgical Instrument Washer with an Ultrasonic Cleaner Solution Treatment progress from cold water prewash at <110 F initial flush rinse elevated to 135 degrees F (optimal for enzyme cleaning activity), to detergent wash with elevating temperature from 135 to 209 degrees F (optimal for detergent cleaning activity), to final rinses, to lubricant/deionized water (DI) sprays, to hot air dry cycle at ~ 158 to 230 degrees F  for 4 minutes.  The Surgical Instrument Washer, Washer Decontaminator, Washer Disinfector, 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 Washer, Washer Decontaminator, Washer Disinfector, 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. Surgical Instrument Washers, Washer Decontaminators, Washer Disinfectors are a valid replacement for the conventional washer sterilizer.
Ann Drake
John Temple, VP of Marketing and Product Development, CESCO
Product Development
The Washer Disinfector Proper Sequence of Washer Treatments includes a series of mechanical and chemical treatments. 
The mechanical Washer Disinfector treatments include:
  • cold water pre-wash,
  • ultrasonic cleaning,
  • detergent wash,
  • purified water rinses, and
  • hot air drying.
The  chemical Washer Disinfector treatments include:
  • combination of 4 enzyme cleaners,
  • surfactant detergents,
  • surface conditioners, and
  • lubricants. 
It is a recognized risk of exposure to unidentified microorganisms that reprocessing personal endure during the decontamination, reprocessing, and cleaning of surgical instruments. Our goal is to minimize the amount and degree of reprocessing personal exposure to this risk and provide reprocessed surgical instruments that are:
  • clean safe to handle,
  • safe for patient care,
  • have received the prerequisite for sterilizing surgical instruments, and
  • are decontaminated, cleaned, safely prepared, and sterilized at the lowest cost.
The goal of cleaning-reprocessing surgical instruments is to deliver Surgical Instruments that are safe for the Reprocessing Staff to handle and have received the prerequisite for disinfecting and/or sterilizing surgical instruments.
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The Goal Purpose of an Surgical Instrument Washers The purpose of an Instrument Washer is to deliver surgical instruments that are clean and safe to handle for reprocessing and are clean so that they can be sterilized. Surgical instruments that are not clean cannot be sterilized. Surgical Instrument Washers properly prepare surgical instruments for sterilization by Terminal Sterilizers. Clean is the Prerequisite for Sterilization. Studies have demonstrated how properly designed Tunnel Washers, Surgical Instrument Washers Decontaminators, Washer Disinfectors are able to deliver optimal cleaning using a combination of automated mechanical treatments and chemical treatments. Enzymatic Enzymes Detergents Conditioners and Lubricants in ONE  cleaning concentrate. After being cleaned in a properly designed Tunnel Washer, Washer Decontaminator, Washer Disinfector using a combination enzyme detergent cleaning concentrate: evaluation of Washer Decontaminators Washer Disinfectors confirmed that the efficacy of disinfection was 100%. All instruments and utensils tested were sterile at the completion of the process.
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After being cleaned in a Surgical Instrument Washer delivering the Proper Sequence of Washer Treatments, including ultrasonic cleaning and a combination enzyme detergent cleaning concentrate: evaluation of Surgical Instruments confirmed that the efficacy of disinfection was 100%. All instruments and utensils tested were sterile at the completion of the process. 
Properly Designed Surgical Instrument Washers
Provide the Prerequisite for Sterilization
John Temple 
John Prohonic
Product Development
Summary : Properly Designed Surgical Instrument Washers are designed to clean all surfaces thoroughly, thereby providing the critical prerequisite for the safe handling, disinfecting, and the sterilizing of surgical instruments. Surgical Instrument Washers perform pre-wash, ultrasonic 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. 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.
Design Secures Performance when:
  • Cleaning Surgical Instruments hand washing,
  • Cleaning Surgical Instruments automated washer decontaminators,
  • Cleaning Surgical Instruments washer disinfectors,
  • Cleaning Surgical Instruments washer sterilizers.
The Surgical Instrument Washer 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. Surgical Instrument Washers 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. 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 Surgical Instrument Washer 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. 
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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. Surgical Instrument Washers were 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 when:
  • Cleaning Surgical Instruments hand washing,
  • Cleaning Surgical Instruments automated washer decontaminators,
  • Cleaning Surgical Instruments washer disinfectors,
  • Cleaning Surgical Instruments washer sterilizers.
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.
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Surgical Instrument Washer Efficacy of Disinfection 100%
Another evaluation of Surgical Instrument Washers 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. Cleaning Surgical Instruments using automated washer decontaminators, Cleaning Surgical Instruments using washer disinfectors, and Critical Cleaners. Surgical Instrument Washers 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.  The Surgical Instrument Washer, cold water pre-wash, ultrasonic cleaning, detergent washing action, final rinse and drying treatment of a properly designed Washer Decontaminator Washer Disinfector Critical Cleaner will provide critical cleaning, the prerequisite for safe handling, optimal disinfecting, and sterilizing of medical devices. The goal of cleaning (decontaminating reprocessing) surgical instruments is to deliver Clean Surgical Instruments that are safe for the Reprocessing Staff and have received the prerequisite for disinfecting and/or sterilizing surgical instruments. It is a recognized risk of exposure to unidentified microorganisms that reprocessing personal endure during the decontamination, reprocessing, and cleaning of surgical instruments. Our goal is to minimize the amount and degree of reprocessing personal exposure to this risk and provide reprocessed surgical instruments that are clean: safe to handle, safe for patient care, and are cleaned (decontaminated reprocessed) at the lowest cost. The optimal decontamination cleaning-reprocessing of surgical instruments will secure the prerequisite for disinfecting surgical instruments and/or sterilizing surgical instruments, deliver surgical instruments that are safe to handle, and reduce reprocessing costs. Surgical Instrument Washers using the with all-in-ONE enzymatic enzyme detergent surgical instrument cleaners used in this research study were manufactured by CESCO, Mercersburg PA.
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Product Support: 1-509-747-5027
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Studies demonstrate that Washer Disinfectors can deliver the complete removal of all pathogens from surgical instruments and surgical instruments that are sterile at the completion of the process. Washer Disinfectors deliver the Proper Sequence of Washer Treatments that include a combination of Washer Disinfector mechanical and Washer Disinfector chemical treatments. After being cleaned in Washer Disinfectors that include using a four enzyme Washer Disinfector Detergent, the evaluation of Washer Disinfectors confirmed that the efficacy of disinfection was 100%. All surgical instruments and utensils tested were sterile at the completion of the process. The Surgical Instrument Washer  Proper Sequence of Washer Disinfector Treatments includes a series of mechanical and chemical treatments. The mechanical treatments include: cold water pre-wash, ultrasonic cleaning, detergent wash, purified water rinses, and hot air drying.
Washer Disinfectors chemical treatments include a combination of four enzyme washer disinfector cleaners, washer disinfector detergents, washer disinfector surgical instrument surfactant surface conditioners and washer disinfector surgical instrument lubricants.
The all-in-ONE Surgical Instrument Detergent Enzyme Lubricant Cleaners are packaged as:
UPS-23  easy-FOAM-it Pre wash Surgical Instrument Detergent Enzyme Cleaners, 10 per case,
UPS-1   Washer Disinfector Detergent Enzyme Lubricant Cleaner 4 gallon jugs per case,
UPS-5   Washer Disinfector Detergent Enzyme Lubricant Cleaner 5 gallon jugs,
UPS-15  Washer Disinfector Detergent Enzyme Lubricant Cleaner 15 gallon jugs,
UPS-30  Washer Disinfector Detergent Enzyme Lubricant Cleaner 30 gallon jugs, and
UPS-55  Washer Disinfector Detergent Enzyme Lubricant Cleaner 55 gallon jugs. 
Scroll down for the applications of how each size is typically used.