INSTRUMENTS CARE GUIDELINE
Note: Under given Instrument care tips are general explanation, local regulations or hospital protocols may differnt from these recommendations.
We recommend following guideline of cleaning, sterilizing and maintaining instruments.
Personal safety must be ensure during reprocessing of instruments.
Fully trained personal must be perform these processes.
At the time of this procedures safety cloth, gloves and eyewear should be worn.
Sharp instruments always place separate in container.
Do not process different metal like stainless steel, Copper, silver, chrome /gold plated together.
Also not use a sponge basin as any residue from normal saline solution can cause corrosion to develop over a period of time.
A) Ultrasonic Cleaning:
Ultrasonic cleaning procedure is an effective process of cleaning instruments, especially instruments with hinges, locks and other moving parts.
Take following steps during ultrasonic process.
- Instruments must be fully submerged.
- Clean maximum 5 to10 minutes.
- Place instruments in open position in ultrasonic cleaner.
- Keep separate, avoid over-crowding instruments.
- Sharp instruments (scissors, knives, chisel etc) keep separately.
- Use a lid to avoid splashing.
- Keep joints open and ratchets unlocked.
- Place heavier instruments at the bottom of the basket.
- Cleaning of aluminum items by ultrasonic is not recommended.
- Rinse instruments with water to remove cleaning solution.
B) Automatic Washer / Disinfector:
- Use only distilled water.
- Use only low foaming and non-ionizing cleaning detergents.
- Keep joints open and ratchets unlocked.
- Items with concave surface must be placed face down to prevent pooling of water.
- If possible, flush clean all items with tubal structure.
- Electro-medical instruments must not be processed in washer/disinfectors.
- Make sure instruments are lubricated after last rinse cycle and before sterilization cycle.
D) Manual Cleaning:
If ultrasonic or automatic washer/disinfectors are not available, manual cleaning process should be done in a basin or sink but only for micro and delicate instruments.
Please observe the following steps:
- Use stiff nylon autoclavable cleaning brushes.
- Always brush away from the body and avoid splashing.
- Do not use steel wool or wire brushes except special steel wire brushes for instruments.
- Scrub thoroughly until dust has been removed.
- Pay particular attention to serrations, knurling, hinges, ratchets and tubes.
- Rinse thoroughly making sure surfaces is visibly free of stains or tissues.
- A good peracetic acid based instrument cleaner can help remove stains.
- Clean delicate instruments separately to avoid damage.
- After cleaning, sort and dry instruments using hand dryer or drying cabinet.
- Low pH (acidic less than 6 pH) detergents break down stainless protective surface, resulting pitting and black staining.
- High pH (alkaline more than 8 pH) detergents can cause brown stains (phosphate deposits) that can interfere with the function of instruments.
Most brown stains are not rust and are easily wiped with lightly oiled cloth.
- Electro-medical instruments must be cleaning very carefully to avoid damage to the coating.
Inspect each instrument carefully after cleaning. To use a magnifying glass or microscope will be helpful to detect faults which not visible to the naked eyes.
- Scissors blades should glide smoothly all the way (they must not be loose when in closed position).Test by cutting thin gauze or surgical glove material three quarters of length of blade. Scissors should cut all the way to the tips, and not hang up.
- Forceps have properly aligned teeth and ratchets.
- Hemostats forceps and Needle Holders must not allow light through the jaws when closed in first ratchet position (hemostats may show a small opening half way in from the closed tip) lock and unlock easily and joints should not be too loose. Check Needle Holders for wear on jaw surfaces.
- Suction tubes or instruments with tubal structure are clean inside.
- Biopsy Punches, punch a clean hole into tissue paper.
Retractors must function properly.
- Cutting instruments like knives have the sharp undamaged edges.
- Joints are not loose or crack. Also they are not dry and stiff.
- There is no sign of breakage on any part of the instruments.
Note: Damaged instruments must be taken out of service immediately for repair or disposal.
Sterilization is done to preserve the substance for a long time without decay.
Sterilization kills all microorganisms and spores. Autoclaving (saturated steam under high pressure) is the most common method for sterilizing surgical instruments; however, dry heat and chemical sterility (ethylene gas, hydrogen peroxide gas plasma, etc.) can also be used.There are several methods however we recommend boiling and steam sterilization
A) Preparation for Sterilization:
Before of sterilization be Ensure that:
- Ensure instruments are fully clean, dried and lubricated.
- Instruments must not contain detergent residue.
- Do not put rusted instruments in autoclave, it can transfer rust to other instruments.
- Place instruments in sterilization trays or wrapped in paper before autoclaving.
- Use only a non-silicon water-soluble lubricant, not industrial type.
- Sterilize Instruments either individually or in sets.
- Place all instruments in unlocked position to avoid breakage.
- Avoid to overload chamber.
C) Steam / Autoclaving Sterilization
Arrange the instruments, sterilization trays or packs in the autoclave without stacking them. The steam must circulate freely inside the autoclave. Follow the manufacturer’s directions for adjusting the time, temperature and pressure of the autoclave cycle. Process the instruments as under.
- Unwrapped instruments at 121°C for 20 minutes at 15 PSI above atmospheric pressure or at 134°C for 3–4 minutes at 30 PSI above atmospheric pressure.
- Wrapped instruments at 121°C for 30 minutes at 15 PSI above atmospheric pressure or at 134°C for 15 minutes at 30 PSI above atmospheric pressure.
When the autoclaving cycle is complete and the pressure reaches zero, open the door a centimeter or two to allow the steam to escape. Run the drying cycle as recommended by the autoclave manufacturer until all the instruments are dry. It should take about 30 minutes. Using sterile tongs, remove all the instruments, trays and packages. Allow them to cool to room temperature before storing.
Unwrapped items must be used immediately or may be stored in covered, dry, sterile trays for up to a week. Store wrapped packages in a warm, dry, closed cabinet. Instruments remain sterile as long as the wrap is dry and intact.
With most portable table top Autoclaves, at the end of the autoclave cycle before the drying cycle unlock the door and open it about 6-7mm. 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 afterwards as recommended by the manufacturer.
DRY HEAT STERILIZATION:
Dry heat may also be used to sterilize surgical instruments. Instruments can be wrapped in aluminum foil or placed in sterilization trays before putting them in the oven. Refer to the manufacturer’s directions to heat the oven. Instruments can be heated to any of the following to be considered sterilized:
- 180°C for 30 minutes
- 170°C for 1 hour
- 160°C for 2 hours
- 149°C for 2.5 hours
- 141°C for 3 hours
Allow the instruments to cool to room temperature inside the oven and store them as described above.
Susceptible to a small number of bacterial spores, so a high level disinfection is suitable for semi-critical items. These items include anesthesia equipment, some scopes (endoscope) and temperature probes.
Non-critical items do not come into contact with mucous membranes but touch intact skin. Equipment like blood pressure cuffs, surgical beds and stereotaxic frames are considered non-critical. They must be thoroughly cleaned, but will not require sterilization. A low level disinfection may also be used.
- Follow instructions of equipment manufacturer.
- Do not use alkaline corrosive detergents.
- COLD STERILIZATION:
- Use only CE Marked products.
- Do not use bleach (sodium hypochlorite.
- Do not cold disinfect aluminum instruments, electro-medical instruments and instruments with tungsten carbide inserts.
- Use only cold sterilization of highest standard that take a short time. Most cold sterilizations take up to 10 hours which is detrimental to the instruments.
- Do not use a multi-day use disinfectant because organic residue collected in the solution after every immersion will not render instruments truly disinfected.
- Multi-day use disinfectant can also damage or stain instruments surface.Not only this,it can also cause corrosion to instruments that are processed in the same solution afterwards. Finally, So remember what the following terms mean:
- STERILE is an absolute term (no living organism survives).
- DISINFECTED basically clean. Some organisms may survive. Always choose a proper method of sterilization to get instruments in the required condition for use.
Included. Boxes are anodized aluminum and wire baskets are stainless steel. All necessary accessories are also available.
Corrosion in joints, cavities, serrations
Baked on blood,debris and residue
left during sterilization.enin wraps
containing residue of caustic
Carefully clean and rinse affected areas
with soft bristle brush. Check with the
laundry to make sure lenins are rinsed
Rust Deposit on surface.
Sterilizing instruments of different
metals in the same cycle.
Sterilize non-ferrous metal instruments
separately from stainless steel.
Rust colored film.
Chemicals in the detergent or
excessive amounts of iron or other
minerals from the local water
Use distilled or demineralized water.
Surface rust can be removed by light
buffing or an application of metal
Brownish Stain or deposit of chromium
Contamination from un-clean
Use distilled or demineralized water to
cycle through the autoclave.
Bluish Gray Stains.
Use of cold sterilizing solutions
beyond recommended time
Follow manufacturer's guidelines. use
distilled water and rust inhibitor.
Presence of ammonia in the
cleaning compound or in autoclave
Use distilled or demineralized water
to cycle through the autoclave.
Exposure to blood, saline solutions,
potassium chloride and other acids.
Detergents with Low pH
(acidicless than 6 pH) or High pH
(alkaline more than 8 pH)
Use only CE Marked detergents with
neutral pH (7). Clean and rinse
thoroughly. Use distilled or
Light and dark colored spots or moisture
remaining on the instruments within the
sterile wrapped packs.
Water droplets condensing on the
instruments and evaporating very
slowly, usually traced to a high
mineral conten to in the water
supply. Excessive moisture in
autoclave during sterilization and
termination of cycle.
Ensure instruments are fully dried.Use
distilled water only. Make sure that
autoclave chamber is clean and check
for leak in gaskets or valves to stop
condensation. At the end of the
autoclave cycle before the drying cycle
unlock the door and open it about
6-7mm. Then run the drying 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