Instruments Care during Cleaning, Sterilizing and Storage
Guidelines for handling instruments during cleaning, sterilizing and storage:-
CLEANING
A – Water Cleaning:
Submerge instruments into a solution of water and neutral pH (7) detergent.
Do not use water cleaning method for instruments made of Carbon steel. Only stainless steel and semi stainless steel made instruments are recommended cleaning in water. If there is no other option, apply oily lubricant on surface after cleaning in order to save the surface from corrosion and store in dry place.
B – Ultrasonic Cleaning:
Place instruments in open position into the ultrasonic cleaner (make sure to expose the joints and unreachable areas completely or as best as you can). During cleaning sharp instruments like Scissors, Shears, Razors, Cutters, etc. make sure that blades do not touch other instruments.
All instruments need to be fully submerged in ultrasonic solution. Instruments should be processed in the ultrasonic cleaner for the full recommended cycle time (refer to manufacturers recommended cycle time), usually 5 to 10 minutes. The lid cover of ultrasonic unit should cover the machine during operation to avoid splashing. Change the solution weekly – or as often as ultrasonic solution manufacturer recommends.
Do not clean sharp cutting instruments (with razor sharp edges) in ultrasonic solution. The hot burning solution will possibly damage the razor sharp cutting edge, and the instruments need re-sharpening. If ultrasonic cleaning is necessary, the instruments may need re-sharpening for optimum performance.
C – Automatic Washers:
Please follow manufacturers’ recommendations.
I. Rinsing:
Immediately after surgery, rinse instruments under Luke warm, not hot, running water. Rinsing should remove most blood, body fluids and tissues.
II. Disinfecting:
a – Avoid blood and other proteins from sticking on to instrument surfaces, an enzymatic cleaner bath or soak should be used on all instruments. After soaking for a minimum of 10 minutes, rinse instruments under running tap water.
b – Immerse instruments completely in an EPA approved disinfectant for another 10 minutes to 15 minutes. Then rinse again.
c – Neverexpose stainless steel or any other type of instruments to bleach or other corrosive chemicals for the purposes of disinfection. Exposure to bleach will result in severe pitting of your instruments and will void all manufactures’ warranties.
D – Manual Cleaning:
Ultrasonic cleaning works best for instruments with hinges, locks, joints and other moving parts. If ultrasonic cleaning is not available, or in some cases ultrasonic cleaning can damage the instruments (Sharp cutting instruments with razor shape edges), please observe the following steps in order to clean the instruments securely: –
a – Use a durable cleaning brush. Do not use steel wool or wire brushes. Stainless steel wire brushes may be used for instruments with serrated areas or on bone files burs or on stained areas in knurled handles.
b – Use only neutral pH (7) detergents because if instruments are not rinsed off properly, low pH detergents, acidic – 6 pH or less, will cause breakdown of stainless protective surface (pitting) and black staining High pH detergents, alkaline – 8 pH or more, will cause surface deposit of brown stain (phosphates) which will also interfere with smooth operation of the instruments, Most brown stains are not rust – but merely a high pH surface (phosphate) deposit and can be easily removed with any good instrument stain remover.
c – Brush delicate instruments carefully and handle separately from general instruments.
d – Make sure all instrument surfaces are clean and free from stains, tissue and other deposits.
e – After scrubbing, rinse instruments thoroughly under running water- During rinsing, open and close jointed instruments such as forceps, hemostats (also called a hemostatic clamp, arterial forceps, or peans), needle holders, scissors, and all other jointed instruments. Make sure the jointed areas are rinsed clean.
AFTER CLEANING
a – Inspect each instrument for proper working condition and that all are visibly free from stains or deposits.
b – Check all instruments to make sure that: Scissors glide smoothly and that they are not loose when in the closed position. Test scissors to be sure they do not hang up. – Tissue forceps are properly aligned and that the teeth line up. Needle holders closed in the first ratchet position should not show light between beaks when held up to the light. Make sure hemostats and needle holders lock and unlock easily, and that joints are not too loose. Check for wear on jaw surfaces. – Suction tips are clean inside. Cleaning vAm or brushes should be used to clean out inside. Water should be clear when run through the suction tip.
AUTOCLAVING
a – Lubricate all instruments which have metal to metal joints such as forceps, scissors, hemostats and needle hovers. Any good surgical lubricant can be used.
b1 – Individual instruments:
Disposable paper or plastic pouches are Ideal. Make sure you use a big enough pouch for instruments with joints (heliostats, forceps, needle holders, scissors) to be sterilized in the completely open position (not just unlocked – but open as far as the instrument can open). – Closed or locked instruments will cause cracked hinges and other defects during autoclaving because of heat expansion and voids manufacturer’s warranty. – If you use towels to wrap instruments, make sure the towels are free from detergents or detergent residue as this can stain instruments.
b2 – Instrument Sets:
Sterilize all instruments in their completely open position. Place heavy instruments on bottom. Instruments that are looked during autoclaving will not be sterile. Steam cannot reach into the metal to metal surfaces. Do not overload autoclave chamber as steam will not be able to penetrate properly.
Place towel on bottom of pan to absorb excess moisture. This will help prevent the chances of getting wet packs.
Caution:
For most portable or table-top autoclaves, at the end of the autoclave cycle, but before the drying cycle, unlock and just crack the door open a 1/4″. Then run the dry cycle according to manufactures’ recommendations. Do not open the door completely, as this will cause the cool room air to enter the chamber and cause condensation. This will cause wet packs and water stains on instruments.
Make sure autoclave filters and chambers are cleaned consistently. Check daily for residue in the bottom of the chamber. Clean the chamber immediately 9 residues are found as the residue will just deposit on instruments during autoclaving.
COLD STERILIZATION
Most cold sterilization solutions take a minimum of 10 hours to render instruments sterile. This prolonged exposure to chemical action can be mom harmful to instruments than the usual 20 minute autoclave cycle.
Check manufacturers’ specs to determine if the instruments need to be disinfected or sterile. Disinfection can be achieved within 10 minutes or more of soaking.
Caution:
Instruments with Tungsten Carbide inserts (these instruments are identified with gold handles), we do not recommend the use of cold sterilization solutions containing Benzyl Ammonium Chloride as this will deteriorate the Tungsten Carbide inserts.
