How much do you have invested in surgical instruments? $1,000? $10,000? $100,000? More? Good instruments are not only expensive, they are also delicate objects any surgery lover should treat with care and respect. How about the rest of your team? Do they treat your investment with care and respect? Do they know exactly what to do once they find a pile of bloody instruments in the sink? Here is a 10-step process to become a perfect instrument caretaker. 1) Soaking Surgical instruments are like dishes: the longer they dry out in the sink, the harder they are to clean. Fortunately, there are presoak sprays and enzymatic cleaners that can start the cleaning process for you. The box locks or hinges of all instruments should be kept open during the soaking phase. If you do not have time to take care of instruments in a timely fashion—say less than 10 minutes—never let them soak in water. Instead, spray them, and cover them with a wet towel. 2) Rinsing Rinsing instruments clears them of gross debris. Ideally, this should be done with distilled water. Tap water will do, but be aware that chlorine and minerals damage instruments. 3) Scrubbing Blood damages instruments. No matter how clean instruments look at this stage, debris and blood clots are still in the tiny nooks and crannies and hinges. Scrub them with a soft nylon brush (never metal) under running water with good lighting. 4) Ultrasonic Cleaning The ultrasonic cleaner should contain an ultrasonic solution diluted with distilled water, per the manufacturer’s recommendations. Ultrasonic cleaning is reportedly 16 times more efficient than manual scrubbing. But it should not replace it. It will remove tiny debris invisible to the human eye. Cover it with a lid to prevent aerosols generated during the cavitation process. In addition, the lid reduces the noise created during the ultrasonic cycle. Instruments should be placed in a basket, rather than simply being “thrown in the tank,” which can reduce the cleaning power and damage the tank. (See more tips below under "Ultrasonic Cleaner Secrets.") 5) Rinsing Rinsing instruments clears them of the tiniest debris that are now in the ultrasonic solution. Ideally, this should be done with distilled water. Tap water will do, but remember that chlorine damages instruments. 6) Drying Instruments should never be allowed to air dry in order to avoid water spots, which can lead to stains and rust. Instruments should again be kept opened (box locks open). They are placed on a towel. Use a second towel to gently pat them dry. 7) Inspecting This step is often skipped, but now is probably the best time to inspect instruments; they are clean, dry and lubricant free. Pay close attention to every surface of each instrument. Notice any cracks or chips. Make sure the tips of instruments such as needle holders and hemostats line up nicely, and that their jaws are not worn off. Brownish stains can be removed with a stain removal powder and a brush. The sharpness of scissors can be tested by cutting into a special latex sheet. 8) Lubricating A lubricating solution should be used at this point. There are two options: soaking (for 30 seconds) or spraying instruments. Either way, all moving parts should be lubed: hinges, box locks, screws, ratchets, etc. The box locks should again be kept open. Instruments are air dried or blotted dry with a towel. Lubrication helps prevent stains and rust, while allowing smoother use of your instruments. Be aware that a “milk” bath can harbor bacteria if the solution is not changed regularly (at least weekly, depending on your case load). 9) Wrapping All instruments should be double wrapped in appropriate material. Huck towels or hand towels are not appropriate. Use only paper or cloth specifically designed to wrap instruments. Larger and heavier instruments should be on the bottom of packs or trays, and lighter, more delicate ones on the top. A sterilization strip is placed inside the pack. Sterilization tape is used on the outside. The tape has three important pieces of information written with a permanent marker: the type of instrument or pack, the date, and the initials of the wrapper-upper. Being able to read your handwriting is a nice bonus. 10) Sterilizing Don’t overlook the autoclave. Instruments need “breathing room” for the steam to move around them during the sterilization cycle. Use racks and shelves to allow enough space between packs or pouches. Ultimately, the proof is in the pudding. If the outer layer of your packs or pouches is wet, either the drying cycle is inappropriate, or packs and pouches were too tightly packed. Allow instruments to sit undisturbed until the cycle is finished, or items are completely dry. Pouches should never be stacked on top of each other. They should be placed vertically, in a rack, or horizontally, with the paper layer up (so steam can evaporate). Once all these steps have been accomplished, sterile instruments need to be stored appropriately. You may not think of storage as an important step in the care of instruments, but it conditions their sterility after all this work. Dr. Phil Zeltzman Instruments in an ultrasonic cleaner. Ultrasonic Cleaner Secrets How does an ultrasonic cleaner work? Ultrasound waves are generated. They create microscopic vacuum bubbles. When they implode near instruments, they remove debris. How do you know your ultrasonic cleaner is working properly? You can simply observe “sonic waves” at the surface of the water. Or you can run this fascinating and fun experiment: place a piece of aluminum foil and run a full cycle (10 minutes). If your machine works, the foil should be covered in tiny holes. Ultrasonic Cleaner Quick Tips ✔ Change your ultrasonic cleaner fluid and “milk” bath at least weekly. ✔ Do it more often depending on how busy you are or if the fluids appear dirty. ✔ Post a calendar to ensure compliance
