How to Load Washer Racks in Sterile Processing

Efficient washer rack loading helps ensure that medical instruments are thoroughly cleaned and ready for the next step in reprocessing. Understanding best practices for rack loading and using the appropriate rack and related accessories helps deliver efficient and consistent cleaning from your automated washer/disinfector.

This article explores various washer racks and available accessories, provides guidelines for proper washer rack loading, and offers tips to help deliver your washer's expected throughput while minimizing rework.

COMMON MISTAKES IN WASHER RACK LOADING

STERIS Clinical Education Specialists have learned from Customer feedback over the years that rack loading is not often taught or understood well by newer technicians. Later in this article, we will review proper loading techniques to help avoid these common mistakes. Some common errors can occur, which prevents the washer/disinfector from properly cleaning devices:

Overloading the Rack: This prevents effective cleaning as the cleaning solution may not reach all device surfaces
Improper Placement of Instruments: Incorrect placement can lead to shadowing, where parts of instruments are not exposed to the mechanical cleaning process. It's best to avoid stacking trays or placing items directly over other items. Disassembling multi-layer instrument sets and placing each layer separately on the rack shelves can also help prevent shadowing.

Not Using the Correct Rack or Accessories: Using the wrong rack or not using necessary accessories can result in inadequate cleaning. Specialty devices, such as minimally invasive surgical devices or containers, require specialized racks that ensure full washing coverage. STERIS Washer Racks come with hose connections for lumens, enabling the washer to flush cleaning solutions through devices. Not using the correct accessories or washer racks could cause the need for re-work and washing devices.

Ignoring Manufacturer's Instructions: Not following the device manufacturer's instructions for use (IFU) can lead to improper cleaning and potential damage to instruments. Properly disassembling devices and using validated cleaning chemistries helps ensure optimal cleaning performance.
Failure to Inspect and Maintain Racks: Dirty or damaged racks can impede cleaning. Check for free rotation of spray arms and remove any debris daily. Replace any damaged components as per the manufacturer's recommended maintenance schedule.
Incorrect loading sequence: Unbalanced loading of a washer rack can affect the rack's stability and cleaning efficacy, potentially causing items to move around during washing

EXAMPLES OF IMPROPERLY LOADED WASHER RACKS

Instruments that are not organized appear to have been "tossed" into the tray, causing possible shadowing
Instruments on stringers should be placed with the bar laying down flat and the instrument tips pointed upward for optimal washing
All ring-handled instruments should be on a large stringer and placed in an open position

The silicone mat should not be in the tray
The right side appears overloaded, with instruments lying on top of each other

Lids are left on trays, which have layered instruments inside. Trays should be separated.
The technician did not load from the bottom up, placing the largest/heaviest on the bottom

Device IFU is likely not followed as these broach instruments should be secure in their holders or on a separate tray
Devices should be spread out to be cleaned properly and prevent shadowing

Although the devices are correctly loaded, the number of instruments in this basket likely causes it to exceed 25 lbs
Excessive loading can cause instruments not to be cleaned properly. The best practice would be to reduce the volume of instruments in this basket.

STANDARDS AND GUIDELINES FOR LOADING WASHER RACKS

While standards and guidelines around washer/disinfectors exist, many do not specify how to load a washer rack beyond instructing users not to overload it. Key standards that mention washer/disinfector loading include ANSI/AAMI ST79:2017 & 2020 Amendments, the CSA Z314-18 National Standard of Canada, and the EN ISO 15883 series used primarily in Europe. The Healthcare Sterile Processing Association (HSPA) also provides guidance in the 9th edition of the Sterile Processing Technical Manual, guiding technicians on proper preparation and providing tips for proper loading of racks.

While these resources can provide useful information on best practices, these standards do not provide step-by-step instructions on how to load a washer rack properly, but for good reason. Each washer load will be unique, with varying instruments and accessories from multiple sets. This variability leaves technicians responsible for determining how to best arrange the devices for the load they're working on. Understanding best practices is the first step to proper washer rack loading.

TIPS FOR MEDICAL WASHER RACK LOADING SUCCESS

When technicians load a washer rack, various instruments from different sets are loaded onto the same washer rack load. Best practices for loading washer racks involve:

Preparing Instruments

Remove items that impede washing – Items like chemical indicators, container filters, tray liners, and paper items should not be included in washer loads as they can clog the washer recirculation system. Solid rubber and silicone mats should also be removed to allow water to flow freely through all instrument sets and levels of the washer rack. Silicone mats should be washed separately from instrument sets.
Instruments should be disassembled per the device IFU, and all small parts should be removed and placed into a closed basket designed for use in a washer/disinfector. Be sure to follow all cleaning instructions provided by the instrument manufacturer.
Hinged instruments must be opened to access the box lock so the cleaning solution can reach all crevasses
Multi-level trays should be opened and separated to be washed as individual trays and all lids removed

Loading the Instruments Into Washer Racks

Load from the bottom up – Placing heavier and larger items on the bottom shelves and lighter items on top. Loading from the bottom up helps to ensure stability and proper chemistry exposure.
Avoid "shadowing" to ensure exposure of all instrument parts to cleaning and disinfection processes. Using trays with mesh bottoms and sides allows fluids to reach all surfaces and drain away effectively.
Use positioning accessories – Accessories such as instrument stringers or washer rack inserts, to help position the instruments or utensils. These aids can also prevent instruments and utensils from shifting during the cleaning process.
Don't overload racks - Overloading racks can prevent effective cleaning and may require re-washing of instruments. Spray arms of the washer and washer rack should be able to move freely. Instruments that are sticking up or sticking out through the mesh basket must not impede the washer spray arms. Ensure enough space between items for the cleaning solution to reach all surfaces.
Consider set weights – A tray with more than 25 lbs. would be challenging to sterilize in steam sterilization properly - if it's too heavy for the sterilizer, why would this work for the washer? This simple rule can help avoid overloading too many instruments into one mesh tray. Washer/Disinfectors also have total cycle weight limits, often around 130 lbs. for the complete load, including racks and accessories.
Connect available hoses to lumened and cannulated devices – Some technicians may be unaware these hoses could be connected to help flush cleaning solutions through lumened devices such as suction tubes. This step helps ensure the removal of debris from the interior of these devices and helps prevent the need to repeat the decontamination reprocess.

Additional Considerations for Washer Racks

Loaner trays must be separated – Although loaner sets should be kept together, many of these multi-tray sets are layered and must be separated. Remember, all parts of devices should be accessible by washer solution and spray arms.
Regular maintenance of racks is crucial for optimal performance – Inspect and maintain racks regularly, checking spray arms for free rotation and removing any debris that may impede cleaning. Ensure that tubing, filters, and any other components requiring replacement at regular intervals are part of the preventative maintenance schedule.

Before putting a washer rack into service for the day, running an empty rack on a cycle with a VERIFY^® All Clean Test Washer Indicator tests the performance of your automated washer/disinfector process and instrument cleaning chemistry functionality to help ensure cleaning is done effectively.

For example, STERIS was called into a facility over concerns with washer performance – the VERIFY All Clean Washer Indicator was failing. Upon inspection, the spray head of the washer rack had not been properly cleaned. After removing the spray head and cleaning, the washer passed the cleaning indicator test and was put into service for the day. If this test was not performed regularly, the users may be unaware that the wash rack was not performing cleaning completely.

TOP WASHER RACKS & ACCESSORIES

Multi-Level Racks	RAS 12 Racks	Container Racks

Used to hold instrument trays, general and special purpose trays during processing. Some multi-level racks, such as MIS or Ophthalmic racks, are required for specialty inserts.	Designed to process select reusable da Vinci^® X/Xi and S/Si* robotic instruments in AMSCO 7052HP and AMSCO 7053HP washers equipped with the RAS Cycle. Learn More Here	This rack insert holds sterilization containers, lids, and filters. Using an insert like this ensures the container and its pieces are cleaned and stay in place during the washing cycle.

General Purpose Racks	Insert for Ophthalmic Instruments
	$Ophthalmic I\nstrument Rack$
Various racks are used to hold basins, bowls, operating room shoes, bed pans, and more. General purpose racks are an essential accessory to help ensure items are properly positioned to be cleaned, and water can drain away during drying.	Designed to process Ophthalmic Instruments and requires a 3-level Base Rack to attach to. Comes with bimanual irrigation and aspiration handpiece holders, Phaco and micro tweezer instrument holders, and jets for cannulated instruments.

Multi-level racks are essential for high-volume processing of general instrumentation. They come with two to five shelves, each equipped with rotating spray arms, making them versatile for different instrument sizes. For example, a 2-level rack design offers a 15 ¾" clearance on the bottom level that can accommodate bowls, basins, and surgical trays. Conversely, a 5-level rack for the same washer disinfector would have a 3" clearance for each shelf accommodating 10 standard trays but not bowls or basins.

Specialty racks, such as minimally invasive surgical (MIS) racks and ophthalmic racks for eye surgery devices, ensure that delicate instruments are securely held and thoroughly cleaned. Container racks hold container system bases, lids, and large procedural basins and bowls. Additionally, STERIS provides rack inserts for accessories like basins, bowls, and operating room shoes, as well as hoses to connect to lumened devices, ensuring thorough cleaning of internal channels.

MAXIMIZE YOUR WASHER LOADING

Proper washer loading is essential for maximizing cleaning efficiency and ensuring that medical instruments are ready for the next step in processing. By leveraging the right accessories and washer racks, sterile processing departments can enhance their workflow and reduce the need for re-washing. STERIS offers a variety of products to help achieve these goals, ensuring devices are cleaned properly and efficiently.

EXPLORE STERIS WASHER RACKS AND ACCESSORIES HERE

*da Vinci^® is a registered trademark of Intuitive Surgical, Inc.