The way it works is sand grains are almost always smaller than the fish waste (and smaller things always "boost" larger things above them) and it packs down better than gravel so the stuff never slips under the sand like it can between cracks in gravel or other larger substrate so it collects on top.
Some of it may get trapped under the sand if you have bottom dwellers but at the same time they'll also dig it up so it works out fairly well that nearly all of it is on the surface.
Crayfish can help some though I've never kept any or heard of how well they maintain sand. Snails, depending on the species, are great for sand. Malaysian Trumpets dig through sand, keeping it loose and aerated and eat some of the waste (depending on what there is) and other snails will eat other kinds of waste. Shrimp also help clean up some kinds of waste.
The only downside with Crays are they can be predatorial and go after small fish, especially those that sleep on the substrate at night.