Maintenance & Cleaning: As a medical professional, you want to ensure the utmost quality and integrity of your surgical instruments at all times. You also want to protect your considerable investment in these high grade medical devices.
The cost of replacing surgical instruments is far greater than the cost of maintaining them. For this reason, a comprehensive maintenance program is extremely important.
Proper Care and Scheduled Preventative Maintenance: Proper care of surgical instruments begins with appropriate cleaning. This guide discusses various methods of washing, sterilizing, and cleaning all types of instruments. Proper care also means off-site maintenance of instruments on a regular basis for sharpening and adjusting. There is no standard schedule; maintenance will be determined by frequency of use. A general rule of thumb for busy practices is to schedule maintenance every six months. Instruments which may require more frequent sharpening and adjusting include:
Scissors Needleholders Bone cutters Hemostats Osteotomes Rongeurs Chisels Bone curettes Knives Punches
The Look and Feel of New Instruments: Most professionals will recognize that new instruments feel different. Newer devices ten to be harder, with a stiffer feel to them. That's because as instruments age, they soften with use and cleaning. With proper care, these devices can last a lifetime. It's important to realize, however, that even the highest grade instruments will experience at least minimal wear and softening over time. Remember that new instruments are designed to be stiff at the onset of use. The idea is to keep this wearing to a minimum with proper cleaning and a scheduled preventative maintenance program.
Enemies of Surgical Instruments: In addition to giving tips on the care and cleaning of instruments, this guide will discus several enemies of surgical instruments. Blood, tissue, and surgical residue are the primary causes of pitting, staining, and discoloring of instruments. Water and moisture also have damaging effects. Allowing any of these elements to dry or soak on your instruments will cause undesirable stains. Other enemies include washing instruments with inappropriate solutions such as dish or laundry soap, bleach, disinfectants, and non-approved solutions. Cold soaking also causes damage.
To properly care for your instruments, it is important to use approved methods of cleaning, and to understand the causes of undesirable effects such as staining. Surgical instruments are manufactured from 300 and 400 series stainless steel. While this material rarely rusts-- it does stain, despite its name. Stains appear as an orange or brown discoloration. The idea is to ensure proper care to limit these stains.
Causes of Corrosion (Staining, Pitting, and Marking): Surgical Residues Blood, pus, and other secretions contain chloride ions which lead to corrosion, most often appearing as an orange-brown color. If left on the instruments for any extended period of time (1-4 hours), the instrument will mark and stain, especially if these residues are allowed to dry. Therefore, always clean and dry every instrument thoroughly after use. Only sterilize a clean instrument. The most damaging procedure is to allow dried-on debris to become baked-on stains in the autoclave. The temperature of the autoclave (250°-270°) will cause chemical reactions that can make the stain permanent. Remember, an autoclave does not clean; it will only sterilize.
Tap Water Even tap water can stain an instrument. Tap water contains a high concentration of minerals which can be seen as a fine deposit on the instrument surface. Rinsing with distilled water eliminates such deposits. Water with high mineral counts left to sit on an instrument can cause unattractive stains. Therefore, it is important to dry your instruments immediately and thoroughly
Cleansers The cleansers and cleaning agents you use could also be a cause of corrosion. Strong substances, as well as those containing a chemical make-up of acid or alkaline-based solutions can lead to pitting and staining. Wash instruments with a neutral pH soap (between 7pH - 8pH) for optimal results. Anything higher may damage the instrument and is not necessary. Do not use Betadine® Solution, dish soap, laundry soap, or surgeons hand scrub. These products will cause spotting and corrosion. Using an instrument cleaning brush is a good idea, especially for jaw serrations, teeth, and hinged areas.
Cleaning After Surgery: The washing process should begin within 10 minutes after surgery, even if sterilization will take place much later. Washing instruments within a few minutes of surgery is your best defense against corrosion, pitting, and staining.
Use only approved solutions. Non-approved solutions are any that do not specifically state on the label that uses include surgical instruments, stainless steel, and sterilization.
Approved solutions are specially designed for surgical instruments and the sterilization cycle. Their product labels will state this use.
Sterilization: All surgical instruments must be sterilized prior to surgery to prevent infection. But even sterilization can leave contaminants behind if instruments are not properly cleaned. To prevent this, sterilize instruments with the ratchets open. This allows for better steam penetration. Plus it prevents the box locks (hinge area) from cracking.
If using a pan or tray, we recommend perforated. This will also enable better steam penetration, and aids in more effective drying as well. For efficiency place heavy instruments at the bottom and lighter, more delicate instruments on top.
If sterilizing in paper or plastic pouches, do not stack pouches on top of one another during sterilization. When possible, use a spiral metal letter holder as a standing aid. This will permit proper steam flow.
Ultrasonic Cleaning: A method of cleaning that is growing in popularity is ultrasonic cleaning. This method is, by far, the most efficient and effective available today. Its ease of use and superior efficiency is quickly making ultrasonic cleaning the preferred choice for today's surgeons. In fact, ultrasonic cleaning is 16 times more efficient than hand-cleaning. Place instruments in the ultrasonic unit for 10-15 minutes and use a neutral pH solution. Here are a few more tips for ultrasonic cleaning:
- Before placing into the ultrasonic unit, clean instruments of all visible debris by washing them in an approved instrument cleaning solution. - Don't mix dissimilar metals (such as aluminum and stainless) in the same cycle. - Make sure instruments have plenty of room. Don't overload your ultrasonic cleaner. - As with all types of cleaning, open all instruments so ratchets and box locks are fully exposed to the cleaning process. - Upon completion of the cycle, remove instruments immediately, and rinse them. - Dry thoroughly with a towel, ensuring that no moisture is left on the instruments.
The use of water in an ultrasonic cleaner is not recommended. A neutral pH ultrasonic cleaner solution, when properly mixed, effectively reduces the surface tension of the solution and increases the ultrasonic cavitation process.
The solution should be changed at least daily, or sooner if the solution appears dirty or murky.