Best Practice Begins With Appropriate Instrument Cleaning

By now, it should be widely understood that surgical instruments can’t be successfully sterilized if they haven’t been thoroughly cleaned first. Unfortunately, it’s a crucial step that continues to challenge many sterilize processing professionals.

1. Don’t let blood dry-Starting the decontamination procedure within 20 minutes after surgery prevents blood from drying and is your best defense against corrosion, pitting and staining. If more time is required, keep instruments moist by placing a wet towel over the equipment. The use of spray-on wetting agents (enzymatic- or detergent-based) is also an efficient way to manage instruments moist.

2. Know the adversary – Water and moisture of any type, especially blood, surgical residues and chloride-based solutions are harmful to stainless steel equipment and are the primary causes of staining and pitting. Other adversaries include surgeon’s hand scrub, household solutions, bleach, iodine-type solutions, general disinfectants, and even briny.

3. Use the right solutions – Only use solutions that have been specifically designed for use on surgical equipment for washing, disinfecting and lubricating. Their product labels will state the intended use on the label. Only solutions with a neutral pH (between 7pH and 8pH) are recommended.

4. Ultrasonically clean– Ultrasonic cleaning is the most efficient technique for cleaning difficult-to-clean areas such as box locks, hinge areas, and serrations. Ultrasonic cleaning employs millions of microscopic collapses produced from sound waves to barrage and pull away debris from the surface of the equipment. Recommended for use in automatic washers and ultrasonic machines when instruments have been pre-cleaned. Hemolytic detergent removes blood and soil, then rinses spot-free, leaving no residue

5. Use the right brush– In addition to mechanized washing, it is essential to use instrument cleaning brushes to assure instruments are adequately cleaned before sterilization. When brushing lumened or annulated equipment, it is important that the brush exit the distal end fully too effectively push out any debris (and then pull back through).

6. Lubricate– A simple, profitable way to maintain instruments and maintain against rusting is to lubricate them with a water-based, neutral pH lubricant after every cleaning cycle, before sterilization. Be assured you are not utilizing a mineral or silicone-based lubricant as these will interfere with sterilization.

7. Troubleshoot stains- The following stain trouble-shooting guide will assist you determining and further prevent instrument staining.

• Brown/Orange Stains – Most brown/orange stains are not rust. This stain color is the result of high pH surface deposits caused by any of the following: chlorhexidine usage, improper soaps, and detergents, cold-sterilization solution, baked-on blood, soaking in saline, or utilizing laundry soap.
• Dark Brown/Black Stains – Low pH (less than 6) acid stain. Maybe caused by incorrect detergents and soaps and/or dried blood.
• Bluish-Black Stains – Reverse plating may appear when two various types of metals ultrasonically proceed together. For eg., stainless steel equipment processed with chrome instruments may cause a stain color reaction. Liability to saline, blood or potassium chloride will cause this bluish-black stain to appear.
• Multi-Color Stains – Extreme heat caused by a localized “hot spot” in the autoclave.
• Light and Dark Spots – Water spots from permitting instruments to air-dry.
• Bluish-Gray Stains – Cold sterilization solution being utilized outside manufacturer guidelines.
• Black Stains – Probable exposure to ammonia.

8. Sterilization– Ever sterilize with the ratchets open. This reduces stress and prevents the box lock/ hinge field from crashing, and promotes better steam penetration. If utilizing a pan or tray, we recommend one with perforations.
Delivering on consistent and compliant sterilization procedures throughout a complex organization is not simple—especially when there hasn’t been mistake or accountability for these procedures before. Making assured that instruments used in surgery are optimally cleaned needs the expertise, quickness, and willingness to the defender for change in the face of resistance.


How Medical Surgical Instruments Should be Cared & Handled?

The most essential considerations in continuing the life of an instrument are relevant use, careful handling, and proper cleaning and sterilization. Every instrument is designed for a special purpose. Utilizing it for an unexpected purpose is an assured technique of damaging an instrument. Examples of misuse include securing surgical cloaks or opening a medicine vial with an instrument designed to hold tissue.

Cleaning, Disinfecting and Sterilizing are the three stages of instrument care.

Cleaning removes dirt, rubble and biological material from medical surgical instruments. You can clean surgical equipment’s manually or mechanically utilizing water and detergents or an enzymatic cleaner. Do thoroughly clean your instruments because rubble which remains on instruments can prevent the instrument from further disinfection/sterilization or can corrupt the research data. Cleaning is the first step toward sterilization and sometimes it is all that is needed.

Disinfection can be damaged down into three categories: low level disinfection (LLD), intermediate level disinfection (ILD) and high level disinfection (HLD). LLD wipes out all vegetative bacteria (except tubercle bacilli), lipid viruses, some non-lipid viruses and some fungi in less than 10 minutes. ILD consumes tubercle bacilli, bacterium, lipid draped and some non-lipid draped viruses and fungus spores. In addition to killing these microorganisms, HLD can also kill bacterial spores, though not in a great number. The CDC recommends a 90 minute soak at 25°C.

Sterilization consumes all microbial life. Some chemical sterilizer can be utilized as HLD disinfectants when utilized for shorter risk periods. Dry heat or autoclave are the favored method of sterilizing operating room instruments.


Cleaning-The first stage in perfectly cleaning your medical surgical instruments.Dip off all blood, physical fluids and tissue instantly after use. Dried soils may damage the equipment surface and make cleaning more difficult. Dip your instruments in cold water. Hot water can cause proteins items to coagulate. If coveted, soak your surgical instruments in water with an enzymatic detergent. The detergent assists to soften the proteins and break down oils. Then, the equipment may be cleaned manually or automatically in a washer or ultrasonic bath.

Disinfection -Both thermal and chemical techniques are available for HLD (High Level Disinfection). As a common rule, surgical instruments are not affected to heat, making boiling the favored method for disinfecting. Boiling instruments in 100°C water for at least one minute kills all microorganisms, except for a few bacterial spores. Boiling does not sterilize instrument.

Bring the boiler to a rolling boil. Submerge open equipment’s in the boiling water. When the water returns to the boiling point, turn the heat down to a pleasant boil. A rolling boil could harm instruments as they rebound around in the boiler. After one minute, remove the instruments from the water utilizing a set of disinfected forceps. Permit the instruments to dry and lubricate the pivots. Do NOT leave boiled equipment’s in the water as it cools, because they could be re-contaminated. Abandon the water when you complete disinfecting your equipment.

To eliminate lime buildup on boiled equipment, use distilled water for boiling or add a little amount of white marinade to the boiler before you process your medical surgical instruments.

Chemical disinfection can be utilized when equipment’s will be harmed by heat. Some chemicals that may be treated include glutaraldehyde 2% for 20 minutes, hydrogen peroxide 6%–7.5% for 20–30 minutes, per-acetic acid 0.2–0.35% for 5 minutes and ortho-phthalaldehyde (OPA) for 5–12 minutes.

Sterilizations -Sterilizations kills all microorganisms and spores. Autoclave (saturated steam under high pressure) is the most common technique for sterilizing surgical equipment’s, however, dry heat and chemical sterilizer (ethylene gas, hydrogen peroxide gas plasma, etc.) can also be utilized.

Dry Heat

Dry heat may also be used to surgical equipment. Instruments can be protected in aluminum foil or fixed in sterilization plates before putting them in the oven. Refer to the manufacturer’s directions to heat the oven. Equipment 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

Permit the instruments to cool to room temperature inside the oven and store them as defined above.

Surgical instruments are a main financial investment in every surgical facility, and procedures should be in place to secure this investment. The life of a surgical instrument is reliant upon the way it is utilized and the care it receives.

Contact for queries at +91-9205156857 or write to us for more information at info@bhumikasurgicals .com