Best Practices for Proper Instrument Maintenance

ICT spoke with Derek Lashua, marketing director for Spectrum Surgical Instruments Corp., about the challenges of surgical instrument handling and repair.

Q: What are the top issues sterile processing personnel are contending with when it comes to instruments? What are you seeing the most of in the repair process?

A: When it comes to surgical instruments and continually shrinking budgets, proper care, instrument education, testing, inspection, cleaning, and preventive maintenance should all be hot topics when it comes to saving your facility money. A well-educated staff that knows how to efficiently identify problem areas before problems arise will improve customer service, ensure the safety of the patient, and help insulate your instrument budget.

Commonly used items that our repair offices see the most of are, not surprisingly, items that are actually designed to be serviced. Instruments such scissors, needle holders, Kerrison rongeurs, bone cutters and laparoscopic instruments are all instruments that can be sharpened, repaired, and restoredand should be, under regularly scheduled maintenance programs. The cost to properly maintain instruments is far less than the cost of buying a replacement item. Having a well-educated staff that knows what to look for and when to send an item out for repair is also key. Partner with your instrument vendor to find out what they offer in the way of educational programs and preventive maintenance programs that include the review of all sets and detailed reporting of their findings. Maximize your vendor to maximize savings.

Q:What are the worst enemies of surgical instruments and why must sterile processing department (SPD) personnel be aware of the need to handle these instruments with care?

A: The worst enemy of surgical instruments continues to be blood, tissue and bioburden. Blood contains chloride ions that will damage stainless steel instruments if not removed within a reasonable amount of time (generally within 20 minutes) after surgery. If this isnt possible, the practice of covering instruments with a moist towel or employing a spray-on moisturizing solution will help. The use of solutions that are not specifically designed for use on surgical instruments creates another worst-enemy scenario. Items such as surgeons hand scrub and a broad assortment of household cleaning/housekeeping cart solutions, such as bleach, will damage stainless steel. Proper instrument care solutions employ pH levels that are neutral, meaning they have a pH level of 7 to 8. Gaining a general understanding of pH levels is important when it comes to instrument cleaning solutions. When using solutions that are not neutral pH, a thorough rinsing may help.

Additionally, when it comes to the handling and transporting delicate and high-cost specialty items such as rigid endoscopes, these items require an extra level of care. The use of protection devices such as proper fitting cases, tip protectors and protective sleeves are a wise, low-cost investment.

Q: Can you re-emphasize why it is so important for proper cleaning to be performed before the next steps in reprocessing, which are disinfection and sterilization?

A: Let me re-emphasize the mantra, If its not clean, it cant be sterile. The use of ultrasonic cleaning and cleaning brushes, in addition to mechanized cleaning, cannot be emphasized enough. The use of cleaning brushes will allow you to effectively brush out hard-to-clean areas of instruments such as lumens/cannulas, box lock areas and hinges. These areas most-often trap surgical residues and will invariably experience problems such as cracking, pitting, staining, and rusting. Ultrasonic cleaning is also a very effective method of cleaning the areas of instrument that are typically difficult to clean such as scissor hinges and hinge areas/box locks of needle holders and hemostats. Ultrasonic cleaning employs a process called cavitation, which, through sound waves, creates millions of microscopic bubbles that burst and pull debris away from the surface of the instrument. Ultrasonic cleaning has been proven to be 16 times more effective than washing by hand, alone. Another low-cost and effective way to prolong the life of your instruments is to apply instrument lubricant after cleaning, prior to sterilization. Important: use only a water-based lubricant. Do not use a mineral oil or silicone-based lubricant as these will interfere with sterilization.

Q: How critical is it for SPD personnel to know what they are looking at (in terms of stains, damage, etc.)

A: Again, the importance of a well-educated staff cannot be stressed enough. Call your instrument vendor today to find out what kind of educational programs they offer in the way of instrument testing and inspection certification to further educate your staff. Coordinate a program within your facility that regularly tests and inspects instruments for sharpness, proper function, staining and potential flaws. Learn to identify potential problem areas before they become major issues. Surgeon satisfaction will improve. Patient safety will increase. Hospital liability will decrease.

Q: What are some suggestions for proper quality assurance after instruments have gone through the reprocessing stage?

A: Some simple yet effective instrument testing and inspection steps for proper quality assurance are:

The use of scissor testing material. Simply make three smooth cuts through test material, cutting all the way to the distal tip. Scissors MUST cut at the tip! This is the area that portion of the blade that is used the most by a surgeon. Red scissor test material is used for scissors measuring 4.5 inches to 12 inches in length. Yellow scissor test material is used for smaller scissors measuring 3.5 inches to 4.5 inches in length.

Test ratchets for proper function. To test ratchets of hemostats and needle holders, engage/lock the instrument on the first ratchet. Lightly tap the rings on a hard, level surface. If the ratchets spring open, the instrument is in need of alignment and should be removed from service. Contact your repair vendor.

Inspect needle holders for jaw wear. Inspect the jaws of needle holders, especially at the distal tips for a smooth area. This is the area where a needle is held and is the area that will wear first. If the needle holder is identifiable by gold ring handles, the Tungsten Carbide jaws can be replaced. Remove the item from service and contact your repair vendor.

Conduct insulation testing of laparoscopic instruments. To test laparoscopic insulation, visually inspect the entire shaft for any nicks or cuts. Next, pull back on the insulation where the insulation meets the insert. If the insulation slides back and creates a gap, the instrument is in need of re-insulation.

Inspect all instruments for visible debris and validate cleaning process. Utilize a clean pipe cleaner or brush to validate cleaning process and inspect for signs of debris.

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