Veterinary teaching hospitals and clinics constantly seek ways to improve efficiency while maintaining the highest standards in surgical instrument preparation. Ensuring veterinary surgical instruments are properly cleaned and sterilized is vital for preventing surgical site infections (SSIs) and maintaining the highest standards of care. Cleaning these instruments presents challenges. However, recent advancements in cleaning and organization systems have led to significant innovations, streamlining the cleaning process and enhancing overall efficiency while reducing costs. The scope of the problem Improper cleaning and sterilization of veterinary surgical instruments can contribute to SSIs. While there are no formal methods for reporting, SSIs have been shown to occur in 0.8 to 18.1 percent of veterinary surgical patients.1 According to a study published in Veterinary Clinics of North America: Small Animal Practice, a questionnaire of veterinarians revealed that only half had written standard operating procedures for hospital cleaning.2 This lack of standardized cleaning protocols can lead to inconsistent cleaning practices and higher contamination risks. Data from the Canadian Veterinary Journal reveals 13 percent of surgical instruments in a small sample subject to cold, sterile solutions showed signs of opportunistic pathogens and other bacteria.3 Further, the importance of water quality in decontamination of surgical instruments has become more clear in recent years.4 These statistics highlight the ongoing challenge of ensuring effective instrument cleaning in veterinary practices. Key challenges Several challenges complicate the proper cleaning of veterinary surgical instruments: Surgical instrument design. Most veterinary surgical instruments have hinges and multiple crevices where debris can accumulate. These areas are difficult to clean thoroughly, increasing the risk of contamination. Resource constraints. Many veterinary clinics operate on tight budgets, limiting access to advanced cleaning technologies, such as ultrasonic cleaners or automated washers. Lack of training. Inadequate staff training on proper cleaning and sterilization techniques, such as the use of detergents and correct cleaning methods, exacerbates the issue. Inadequate protocols. Unlike in human healthcare, veterinary practices often lack standardized cleaning protocols to ensure consistent cleaning effectiveness. Innovative solutions Addressing these challenges requires a multifaceted approach combining training, technology, and standardized protocols. Historically, veterinary clinics and teaching hospitals relied on time-consuming methods for instrument cleaning, such as brushing each surgical instrument individually, placing them one by one into ultrasonic cleaners, rinsing, drying, lubricating, and organizing them into surgical packs. This traditional approach, while effective, demands significant time and effort. Innovative cleaning systems can now revolutionize how surgical instruments are cleaned and the order of the workflow. Although surgical instruments most commonly are separated at the end of the cleaning cycle, a new approach separates soiled instruments as the first step. Each surgical instrument is separated onto custom-fabricated stainless-steel racks precisely calibrated to allow instruments to be easily put onto and taken off of the rack when they are fully open (Figure 1). Having all soiled surgical instruments fully open is necessary for the best cleaning. Figure 1. Photo courtesy Scrub Racks All racks are etched with the instrument’s name and a number for its placement on the rack board—every hook on the rack board is also etched (Figure 2). The specific order on the board for each surgical instrument is determined by the order in which the instruments are picked for packs. Figure 2. Photo courtesy Jason Jamerson, Louisiana State University The racks, holding each surgical instrument fully open, allow all soiled instruments on the rack to be brushed simultaneously from all angles (Figure 3). Since each rack can hold dozens of instruments, hundreds of tools can be cleaned far more efficiently. Figure 3. Photo courtesy Scrub Racks The entire rackful of brushed and rinsed surgical instruments is then placed into a large ultrasonic cleaner that can hold more than 100 instruments when fully loaded. These racks allow for best cleaning by having the surgical instruments fully open and facing downward during ultrasonic cleaning (Figure 4). Figure 4. Photo courtesy Scrub Racks Additionally, the racks allow close inspection for residual biomatter, ensuring all instruments meet standards. Heather Dean, DVM, Assistant Professor of Clinical Skills at the Louisiana State University (LSU) School of Veterinary Medicine, emphasizes the importance of efficient instrument preparation: “Efficient preparation and cleaning of surgical instruments are critical to maintaining high standards of care in our program. These racks hold each surgical instrument fully open for best cleaning and easier inspection.” This more streamlined approach helps improve organization, offer faster drying and lubricating, reduce time and labor, and standardize the cleaning process while allowing better inventory management. Finally, because each rack is held on a board in an order specified by each clinic for the easiest and fastest picking of surgical packs, this approach can save time and effort when building surgical packs. Impact on hospitals and clinics These advanced systems and considerations are particularly beneficial in high-volume environments, such as veterinary teaching hospitals and veterinary clinics performing multiple surgical procedures. Facilities managing from a few hundred to thousands of surgical instruments daily can customize racks for specific instruments, ensuring consistency and speed during the cleaning process. Veterinary clinics, especially those performing high-quality, high-volume spay/neuter, have also embraced these innovations. Wendy Wolfson, DVM, Associate Professor of Shelter Medicine and Surgery at LSU, works closely with high-volume spay/neuter clinics and emphasizes the importance of efficient instrument management in such settings. “Clinics are constantly looking for ways to reduce labor costs and increase productivity and standardization without sacrificing quality of care,” says Dr. Wolfson. “These more efficient ways of cleaning dozens of instruments at once allows clinics to achieve both goals, improving operational efficiency and minimizing time spent on instrument cleaning.” Advanced cleaning systems can help minimize or even save labor costs while maintaining high standards of care. By reducing the time and effort required for instrument preparation, clinics can allocate resources more effectively, improving patient outcomes and overall operational efficiency. Craig Alberty, DVM, owner of Associated Veterinary Services, a high-quality and high-volume clinic in Baton Rouge, La., shares, “This innovation for cleaning instruments saves approximately three hours of labor each day delivering better results and saving money.” Additional considerations Implementing standardized cleaning protocols. Veterinary practices should consider using guidelines, such as those recommended by the American Animal Hospital Association (AAHA). Protocols can include pre-cleaning, manual cleaning, and automated washing steps. Investing in modern cleaning equipment. Although budget constraints are a reality, clinics can benefit from cost-effective technologies, such as organizing racks and tabletop ultrasonic cleaners. Studies show ultrasonic cleaning is the most effective method to removing biomatter compared to manual cleaning alone.5 Comprehensive staff training. Regular training sessions to educate staff about proper cleaning and sterilization techniques are a good practice. Incorporating visual aids, hands-on workshops, and routine competency assessments can enhance learning outcomes. Using enzymatic detergents. Research indicates enzymatic detergents are significantly more effective at breaking down organic material than standard detergents. Clinics should consider using detergents specifically designed for surgical instrument cleaning.6 Routine inspection and maintenance. Before sterilization, instruments should be inspected for cleanliness, damage, and functionality. Regular maintenance, including sharpening and realignment, ensures optimal instrument performance.7 Setting a new standard Modern systems for cleaning and organizing surgical instruments represent a significant leap forward in veterinary medicine. Whether in teaching hospitals or private clinics, these solutions can help improve organization, reduce time and effort, enhance standardization and consistency, and saves vital resources. By adopting these advanced methods, veterinary professionals can focus more on delivering exceptional patient care, setting a new standard in efficiency and quality. Copey Pulitzer is the founder and Chairman of the Board of Low Cost Animal Medical Center, a high-volume spay/neuter and wellness clinic in New Orleans. He is also the inventor of the patented Scrub Racks System, which he devised to help his clinic be better organized, and save time and money during surgical instrument preparation. References Improve Veterinary Practice; Infection control in the surgical environment. Retrieved from: https://www.veterinary-practice.com/article/infection-control-surgical-environment Traverse M, Aceto H. Environmental cleaning and disinfection. Vet Clin North Am Small Anim Pract. 2015 Mar;45(2):299-330, vi. doi: 10.1016/j.cvsm.2014.11.011. Epub 2014 Dec 30. PMID: 25555560; PMCID: PMC7114656. MWI Animal Health; The importance of sterilization for surgical tools. Retrieved from: https://www.mwiah.com/our-insights/the-importance-of-sterilization-for-surgical-tools Infection Control Today, 2009 Retrieved from: https://www.infectioncontroltoday.com/view/water-instrument-processing Beni, HH., Shafiei, Z., Ghadami, A. Comparative Study of the Manual, Automated, and Ultrasonic Surgical-Instrument Cleaning Methods. Journal of Iranian Medical Council July 2022; Volume 5 Issue 3 Cortés AMC, Salazar MTJ,Villegas MAD, García JHG (2017) Effectiveness of Enzyme Detergents in Cleaning Medical Devices in Critical Use Conditions. J Mol Cell Biochem. Vol.1 No.1:2 Infection Control Today, 2011.Retrieved from https://www.infectioncontroltoday.com/view/best-practices-proper-instrument-maintenance.
