Instrument Care

Tap water should not be used for cleaning surgical instruments as it frequently contains significant quantities of foreign ions that can damage instruments. High concentrations of chlorides, for example, can lead to pitting and stress-related fractures. Also, the presence of minerals in the cleaning water can discolor the instrument. (These discolorations can be removed by using the appropriate cleaning products.) To prevent these problems, it is recommended that only salt-free, demineralized water be used for instrument cleaning.

Preparation for Cleaning:

Instruments should be cleaned immediately after use. If that is not possible, they should be placed in a basin of distilled water or a solution of neutral pH detergent until such time as cleaning is possible. However, instruments should not be stored in aqueous solutions for prolonged periods. If they are placed in a basin prior to cleaning, the basin should be drained and cleaned daily.

Manual Cleaning Suggestions:

Carefully follow all manufacturer’s instructions regarding solution temperatures, soaking times and mixture concentration.

  • If powdered cleaning solutions are used, be sure that the mixture has had adequate time to dissolve.
  • We recommend using a neutral pH cleaner. Products other than neutral pH can result in instrument damage.
  • Change the cleaning solution daily. Evaporation can increase the concentration and cause corrosion. Dirty solutions do not clean as effectively.
  • For manual cleaning, use lint-free, soft textile cloth, paper cloth, soft plastic brushes (toothbrush) or water spray guns.
  • After manual cleaning, instruments should be rinsed twice, first in tap water and then in distilled water. This two-step rinsing will remove any remnants of surgical debris as well as remove any contaminants that may have been in the tap water.
  • After rinsing, instruments should be thoroughly dried. If it is possible, forced air should be used for drying. If that is not possible, gently shake the excess water from the instruments and place them on clean, dry, lint-free towels to dry.

Ultrasonic Cleaners:

  • As in all cleaning methods, the solutions used for cleaning must be prepared according to manufacturer’s instructions. Failure to do so will result in either an acidic or alkaline pH, both of which can cause corrosion and breakage. We recommend using a neutral pH cleaner. Products other than neutral pH can result in
  • instrument damage.
  • Breakage resulting from corrosion is called “stress corrosion cracking.” This usually occurs around the box lock of needle holders and hemostats or on the screws of scissors. It appears as a buildup of what looks like rust. If seen, it should be cleaned away immediately with a soft toothbrush.
  • Place instruments in open position into the ultrasonic cleaner. Make sure that sharp blades such as scissors, knives, osteotomes, etc. do not touch other instruments.
  • All instruments have to be fully submerged.
  • Do not place dissimilar metals (stainless, copper, chrome plated etc.) in the same cleaning cycle.
  • Rinse instruments after ultrasonic cleaning with distilled or deionized water to remove ultrasonic cleaning solution.

Automatic Washer Sterilizers:

Follow manufacturers’ recommendations. Make sure instruments are properly lubricated after last rinse cycle and before sterilization cycle.

Instruments Inspection:

After cleaning is a good time to inspect each instrument for proper function and condition.

Check the following:

  • Scissor blades glide smoothly from open to closed (they must not be loose when in closed position). Test scissors by cutting into thin gauze. Three quarters of the length of the blade should cut all the way to the scissor tips, and not hang up.
  • Forceps should have properly aligned tips.
  • Hemostats and needle holders should not show any light between the jaws. They should lock and unlock easily, and the joints should not be too loose. Check needle holders for wear at the tips.
  • Suction tubes should be clean inside.
  • Retractors should open, close and lock properly.
  • Blades of all cutting edges should be sharp and undamaged.

Steam Sterilization:

  • Complete an “empty” cycle every day prior to sterilizing the instruments. To prevent corrosion damage to the instruments, it is important that the steam be completely free of foreign substances.
  • To avoid excessive condensation, stay with the manufacturer’s recommended load for the sterilizing unit. If heavy sets are unavoidable, instruments should be spread out to reduce the condensation buildup.
  • Care must be taken with delicate scissors to prevent tip breakage.
  • Never Lock an instrument during autoclaving. It will not be sterile as the steam cannot reach the metal-to-metal surfaces. The instrument might develop cracks in hinged areas caused by the heat expansion during the autoclave cycle.
  • Once sterilized, instruments must be dried completely before being stored away. Without proper drying times, “water spotting” can result.

Cold Sterilization:

  • Most cold sterilization solutions render instruments sterile only after a 10-hour immersion. This prolonged chemical action can be more detrimental to the surgical instruments than the usual 20-minute autoclave cycle. If the instruments need to be disinfected only, cold sterilization is recommended since disinfection will take place in only 10 minutes.
  • Keep in mind the difference between STERILE and DISINFECTED: Sterile- an absolute term (no living organism survives); Disinfected- basically clean.
  • Always use the proper sterilization/cleaning technique to render the instrument in required condition for use.
  • Important: For instruments with tungsten carbide inserts such as needle holders, scissors, and tissue forceps we do not recommend use of solutions containing Benzyl Ammonium Chloride. This will destroy the tungsten carbide inserts.

Lubricants and Detergents:

Besides lubricating moving parts, lubricants inhibit rust, corrosion and discoloration.

As part of a regular instrument care program, proper lubrication helps reduce instrument wear. A one-minute soaking prior to autoclaving is adequate to insure protection.

Neutral pH detergents are ideal for surgical instruments. The neutral pH will not damage stainless steel or tungsten carbide inserts. The solution is gentle enough for manual as well as ultrasonic cleaning.

Handling New Instruments:

Follow the procedures outlined previously, clean and rinse new instruments before their first sterilization. Instruments should not be stored in a cabinet with any chemical that produces a corrosive vapor.

Even though instruments are passivated, serious damage can result if there is exposure to any of the following:

  • Hydrochloric acid
  • Iodine
  • Ferric chloride
  • Bleach
  • Dilute Sulfuric acid

Whenever possible, the following substances should be kept away from instruments:

  • Aluminum Chloride
  • Lysol
  • Dalkin’s Solution
  • Barium Chloride
  • Mercury Chloride
  • Ferrous Chloride
  • Bichloride of Mercury
  • Phenol
  • Stannous Chloride
  • Calcium Chloride
  • Carbolic Acid
  • Tartaric Acid
  • Potassium Permanganate
  • Potassium Thiocynate
  • Chlorinated Lime
  • Sodium Hypochlorite

Cleaning and Sterilization Trouble-Shooting Guide:

Problem Casuse Prevention
Spotting
Mineral deposits left
  1. Check operation of autoclave.
  2. Use chloride-free solutions for sterilizing, disinfecting, rinsing, and cleaning. (Distilled or mineral free water.)
Rust (Corrosion)
Film left by steam
  1. Check purity of water supply
  2. If water softeners are used, check for composition.
  3. Purge Steam pipes, especially new installations.
  4. Clean inside of sterilizer regularly according to manufacturer’s specifications.
Rust (Corrosion)
Deposit
  1. Do not mix stainless steel with other metals, especially where there is evidence of defective plating.
  2. Rinse with distilled water (important where tap water may have high metallic content).
  3. Remove debris from box lock.
  4. Dry all instruments thoroughly. Use fulltime cycle (important when instruments are wrapped).
Pitting
Chemical and electronic attack of surfaces
  1. Rinse instruments thoroughly immediately after use.
  2. Avoid long exposure to chlorides and acids.
  3. Do not use detergents having high pH levels.
  4. Do not mix metals in ultrasonic cleaners.
Black to purple stains
Ammonia
  1. Avoid exposure to ammonia in solutions and cleaning compounds.
  2. Rinse instruments thoroughly (distilled water preferred).
Brown stains
Minerals
  1. Check water supply in sterilizer.
  2. Check cleaning compounds and detergents.
  3. Clean inside of sterilizer regularly according to manufacturer’s specifications.
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