Instruments Care

Recommended Steps in Cleaning, Sterilization & Maintenance of Surgical Instruments

1. Hold in:
It is important never to hold instruments in a dry container, which allows blood and debris to dry onto instrument surfaces and makes cleaning more difficult. If rinsing and decontamination processes are not immediately available, pre-treat instruments or hold in a neutral holding/presoak enzymatic solution after patient use but before actual cleaning. Prep Enzyme Foaming spray for pre-cleaning of soiled instruments and scopes. Simply spray on instruments until ready for rinsing and disinfection. Also, use neutral pH all purpose multi-enzyme concentrate is ideal for instrument presoaking and pre-cleaning. As soon as possible, rinse, disinfect and clean as follows:

2. Rinsing:
Immediately after surgery, remove organic materials by rinsing instruments under warm (not hot) running water. Rinse should remove most blood fluids and tissue. Do not process metals (stainless, copper, chrome plated, etc.) together. Always wear safety protection gear.

3. Disinfecting:
To protect medical personnel from contamination during cleaning, immerse instruments completely in an EPA approved disinfectant for approximately 10-20 minutes. Always closely follow manufacturers’ recommended disinfecting time and solution preparation and instruction. Then rinse again.

4. Cleaning:
All blood dried body fluids and should be completely removed from the instruments prior to sterilization. Several methods are available.

A. Soak: An enzymatic cleaner bath (soak) or a solution of water and neutral pH (7) detergent are effective in removing organic material from instruments. Use distilled (demineralized) water if possible. Instruments should be fully submerged for at least 10 minutes. Do not let “sharp” (scissors, knives, osteotomes, etc.) running water to remove solution. Change solutions frequently. 

B. Ultrasonic Cleaning: Most instruments manufacturers recommend ultrasonic cleaning as the most effective way to clean surgical instruments, particularly those with hinges, box locks and other moving parts. All instruments must be fully submerged in open position. Use distilled (demineralized) water if possible. Make sure that “sharp” blades do not touch other instruments to prevent possible surface scratching and also be sure dissimilar metal instruments are separated. Process instruments for full recommended ultrasonic cleaning cycle. Change solution frequently or as often as the manufacturers recommends. Rinse instruments with water to remove the cleaning solution, can be safety use with all ultrasonic unites. 

Automatic Washer sterilizer: follow manufacturers’ recommendations but ensure instruments are lubricated after the last rinse cycle and before the sterilization cycle

· Needle holder and forceps may check if sterilized with ratchet in closed position.Manual cleaning: if ultrasonic cleaning is not available, observe the following steps. 
· Use stiff nylon cleaning brushes. Do not use steel wool or wire brushes except specially recommended stainless steel wire brushes for instruments serrated areas, bone or on stained areas of knurled handles. 
· Use only neutral pH (7) detergents such. If not rinsed off properly, low pH (acidic – less than 6 pH) detergents break down the stainless protective surface resulting in pitting and/or back staining. High pH detergents (alkaline – more than 8 pH) which can also interfere with the smooth operation of instruments. Most brown stains are not rust and are easily removed with stain remover. 
· Brush delicate instruments carefully, and if possible, separate them from general instruments. 
· Make sure instruments surfaces are visibly clean and free from stain and tissue. Stain Remover can help remove residue stains. This is also a good time to inspect each instrument for proper function and condition. 
· Check scissors’ blades to ensure proper function. Blades should glide open and closed smoothly. Test cutting performance at ¾ length of the blade with the following recommended materials. Scissors should cut all the tips. Recommended cutting test materials: 
· Fine/Delicate scissors: Surgical gloves 
· Medium scissors: Single layer of stocking/cast netting 
· Large/utility scissors: Double layer of stocking/cast netting. 
· Check forceps (pickups) for proper jaw alignment. Teeth must meet properly – without catching. 
· Check hemostats and needle holders to ensure jaw tips close in first ratchet position and entire jaw should close in third ratchet position. Check instruments for loose hinges and verify that they lock and unlock easily. 
· Suction tube should be clean inside. 
· Test Biopsy Punches by punching a clean hole in 3-6 mil thick poly-bag material. If poly-bag material is not available, use tissue paper. 
· Retractors should function properly. 
· Cutting edge instruments and knives should be sharp and free of damage. 
· After scrubbing, rinse instruments thoroughly under running water. While rinsing, open and close scissors, hemostats, needle holder and other hinged instruments to make sure the hinge areas are rinsed out and no debris remain. 

5. After Cleaning:
Separate dissimilar metals prior to sterilizing/autoclaving. If instruments are to be stored, let them air-dry and store them in a clean and dry environment.

6. Autoclaving:
A. Lubricate all hinged instruments which have any “metal to metal” action, at the screw or box lock.
A non-silicone, water-soluble surgical lubricant is recommended. Do not use industrial oils and lubricants.
B. Sterilizer instruments either individually or in sets.
o Individual Instruments: Disposable paper or plastic pouches are ideal. Make sure to use a wide enough pouch for instruments with ratchet locks so instruments can be sterilized in an open (unlocked) position. Instruments locked during autoclaving can experience cracked hinges (box lock) or other problems because of heat expansion. If wrapping instruments, make sure the towel does not contain detergent residue, which can stain instruments. 
o Instruments Sets: Unlock all instruments and sterilize in an open position. Place heavy instruments on the bottom of sets (when two layers are required). Do not overload the chamber because an air pocket may form that hinders steam penetration. 

With most portable tabletop autoclaves, at the end of the autoclave cycle and before the drying cycle, unlock the door and open it no more than crack, about ¼” (6.4mm). Then run the dry cycle for the period recommended by the autoclave manufacturer. If the autoclave door is fully opened before the drying cycle, cold room air will rush into the chamber causing condensation on the instruments that may result in water stains or cause wet packs. Make sure autoclave filters and chambers are cleaned as recommended by the manufacturer.
Stain Remover is effective in removing stains and cleaning the autoclave chamber. If you have any unusual staining on your instruments after sterilization, obtain our Instruments Care Instruction or contact to your local Towne representative.

7. Chemical / Cold Sterilization:
Most chemicals/cold sterilization solution renders instruments sterile only after 10- hour immersion. This prolonged chemical action can be more detrimental than usual 20-minute autoclave cycle. If the instruments need to be “disinfected” only, a chemical/cold sterilization soak is acceptable, as disinfection in using bleach (paragraph 3).

· Sterile- an absolute term (no living Organism survives) 

· Disinfected-basically clean. Some organisms may survive. 
  Always use the proper sterilization/cleaning technique to render the instruments in the required condition for use.

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