Automated Washer User Survey

Thank you for participating in this Survey about usage and validation of your Automated Instrument Washer.

Please Indicate the brand and model of washer(s) in use by your Department:

Are your washer(s) tested for cleaning efficacy?

Yes No

If yes, please indicate the frequency of testing:

If yes, please indicate the method(s) for testing (indicate all that apply):

Independent Testing Lab

In-house Test

The Washer Manufacturer/Distributor

Please indicate the method by which the cleaning effectiveness of the washer is monitored:

Please indicate which of the following steps are routinely taken prior to use of the Washer

Enzyme Pre-soak Ultrasound cleaner Scrubbing by Hand

Please Indicate the Capabilities of the primary Washer in your Department

Enzyme Wash	Ultrasound
Multiple Detergent Selection	Instrument Lubricant
Drying Cycle

Please indicate the maximum water temperature of your washer

Do you capture and record with every cycle:

Temperature of the Water Yes No

Temperature of the Air Yes No

Water Pressure Yes No

Hardness of Water Yes No

Conductivity of the Water/Aqueous Solution Yes No

pH Level of Water/Aqueous Solution Yes No

Volume of Water/Aqueous Solution Yes No

Please provide the target level for the most common wash cycle performed:

Alkaline (pH) Level:

Water Temperature:

Quality Grade of Water:

Drying Cycle:

Would you be interested in a daily test that could provide independent confirmation that your washer is getting instruments clean?

Yes No

At your option, please provide information about yourself and your Healthcare Facility

Name:
Department:
Hospital:
City & State	,
Number of Hospital Beds
Number of Surgical Cases per Day

Thank you again for your time and effort in filling out this survey.