Instrument Cleaning, Repair and Handling

Infection Control Today sought industry input on the issue of instrument cleaning, handling, repair and processing and received several varied responses. The recommendations from these representatives can save facilities thousands of dollars, since a well-cared-for instrument is an instrument that does not need to be replaced frequently. Participants include Dan Dwyer, healthcare sales manager of Raven Labs; Alex Vrancich, vice president and general manager of Spectrum Surgical Instruments Corp.; Jack Kinville, marketing manager for Ruhof Healthcare; and Kathie Fulks, SterilMed education manager. Their responses are below.

ICT: What are the most significant impediments to effective cleaning of instruments?

Spectrum: While in a sterile processing department, it’s not uncommon to see a row of multiple case carts lined up awaiting decontamination. Soiled instruments should not be allowed to sit for long periods, as this allows the blood and other surgical debris to dry and form onto the instruments, which makes cleaning and decontamination much more difficult. Our recommendation has always been to start the decontamination process as soon as possible after a procedure — within 10 to 15 minutes is recommended. Surgery departments can do this by applying wetting agents to the instruments before sending them to the sterile processing department. Wetting agents come in many forms. Some are liquid spray-on detergents, some are foaming enzymatics, but they all achieve the goal of beginning the decontamination process sooner rather than later. This is one of the best things we can do for our instrument sets to improve the cleaning process. If these solutions aren’t available at your facility, we recommend taking a towel dampened with water and draping it over the instruments. This is not as effective as a wetting agent, but at least we are helping to prevent blood from drying.

Ruhof: Proper cleaning of surgical instruments is the most crucial step in instrument care. When proper cleaning protocols are not followed, it can lead to rusting and spotting of instruments and ultimately cross contamination of patients. If a multi-enzyme detergent is not used for disinfection, then you are not able to remove all biofilm. When biofilm is left on an instrument it will break down and start to rust the instrument. While this is visibly noticeable on the surface of the instrument, it can also be detected when box locks and joints don’t articulate well and begin to grind. Also, it is crucial not to let dirty instruments set overnight; this will allow the biofilm to dry onto the surface and will be extremely difficult to remove in the morning. Dried on biofilm is extremely difficult to dislodge manually or in the most capable of washers. Lastly, letting instruments soak in any type of solution over night will rust the instruments.