Most surgical healthcare facilities own tens or hundreds of thousands of dollars of surgical instrumentation. In order to maintain the value of that inventory and ensure optimal performance in the operating room, instruments must be handled, cleaned and stored properly in a consistent maintenance program. Fairgozzi Surgical Instruments are Premium Quality products that are intended to undergo repeated sterilization cycles, but their lifecycle depends on the meticulous execution of such a program.
Fairgozzi Surgical makes the following recommendations regarding instrument maintenance to enhance the performance and service-life of instrumentation. The following is not meant to be a comprehensive guide to instrument care, cleaning and/or maintenance, but rather a set of general recommended guidelines. For further detail, please view Fairgozzi Surgicals Instrument Care Guidelines. For an even more comprehensive guide, please refer to one of the many reference books available on the market. Failure to follow generally accepted instrument care and maintenance procedures will shorten the service life or instrumentation and may invalidate the manufacturer instrument warranty.
- • Remove debris from surgical instruments with a sponge and sterile water during procedures to prevent drying on of blood and tissue
- • All instruments should be placed in a distilled water bath immediately after a procedure and before leaving the operating room
- • If a bath is not possible, place the instruments into an instrument tray and cover with a towel moistened with sterile water immediately after the procedure. Foam and spray products, specifically intended to pre-treat surgical instruments, are available to keep the soiled instruments moist, as substances like blood and bodily fluids can be highly-corrosive when allowed to dry.
- • Instruments should be rinsed, disinfected and cleaned as soon as possible thereafter to prevent formation of bio film
2. Pre-Cleaning: Soak & Rinse
- • Place instruments in a neutral presoak enzymatic solution designed for surgical instruments or a solution of distilled water and neutral detergent
- • Separate instruments of dissimilar metals and ensure sharp tips do not come in contact with each other
- • Prepare the enzymatic soak and use per the enzyme manufacturers recommendations, paying special attention to instructions for correct dilution, temperature and soak time
- • Immerse instruments fully in the solution in the open, unlocked and/or disassembled position
- • Remove instruments from the enzymatic soak after the time period recommended by the enzymatic solution manufacturer and rinse them thoroughly with distilled water, removing any remaining organic material
3. Cleaning & Disinfecting
- • All instruments taken from a procedure tray should be cleaned in either an ultra-sonic cleaner or automatic washer sterilizer using a neutral detergent (pH of 7), or an enzymatic cleaner bath. Regardless of the cleaning method chosen, all instruments should be free from blood, body fluids and tissue prior to sterilization. It is important to remember that disinfected instruments are not yet sterile.
Ultrasonic Cleaner Recommendations
· o An ultrasonic cleaner is widely regarded as the most effective way to clean surgical instruments; in particular it is best for removing soil from hard to reach surfaces such as grooves, crevices, hinges, box locks, and other moving parts, etc.
· o Follow the recommendations of the ultrasonic manufacturer regarding cycle times, detergents, proper placement of the instrument tray and conditioning (“degassing”) of the cleaning solution
· o Use distilled water for best results
· o Instruments should be cleaned in the open (unlocked) position – open or disassemble as necessary
· o Separate dissimilar metal instruments during cleaning
· o Do not let sharp instruments touch each other during cleaning
· o Change solutions frequently, per the manufacturers recommendations
· o Rinse instruments with water after cleaning to remove all remnants of the cleaning solution. This final rinse should be with softened or de-ionized water to better remove detergents and avoiding pitting and staining.
· o All visible residues should be removed at this point
Automatic Washer Sterilizer Recommendations
· o Follow the instructions of the automatic washer-sterilizer manufacturer (wash and rinse times, appropriate detergents, etc.)
· o Some automatic washer sterilizers include a lubrication phase that is built into the cycle – if not, ensure instruments are lubricated per the guidelines in step 4 prior to sterilization.
· o When ultrasonic cleaning is not available, manual cleaning may be used as secondary option
· o Use distilled water for best results
· o Instruments should be cleaned in the open (unlocked) position while ensuring sharp instruments dont touch each other
· o Using a small, clean, soft-bristled hand-held brush, remove soil and organic material from all surfaces of the instrument while fully immersed in the solution. Never use abrasives like steel wool, and only specifically-designed wire brushes should be used on particular areas of the instrument (serrations, files, etc.).
· o Remove the soil from the ratchets, jaws, tips, box locks, and/or hinge mechanisms. The box lock and hinge portion of an instrument must be thoroughly cleaned after each use.
· o Instruments should be fully submerged for the period of time recommended by the manufacturer of the cleaning product
· o Thoroughly rinse instruments by immersing in water and wiping with a clean, soft cloth
· o Change solutions frequently, per the solution manufacturers recommendations
- • An instrument lubricant (often referred to as instrument milk) that is compatible with the method of sterilization to be used is recommended before instruments are sterilized
- • Ultrasonic cleaners remove all agents. Thus, instruments cleaned with an ultrasonic cleaner must be lubricated routinely after cleaning and before sterilization.
- • Some lubricants must be diluted in a solution and used by dipping instruments in the open position, while others may be applied directly into box locks, hinges and other moving parts. Follow the manufacturers instructions for proper use.
- • Proper application of lubricants to joints will keep them moving freely and aid in protecting the entire instrument surface from mineral deposits. Lubrication will prevent metal-on-metal friction, sticking and corrosion, as well as preserve the smooth function of the instrument.
- • Before instruments are wrapped for sterilization, they must be thoroughly dried. Wet instruments wrapped for sterilization are likely to come out of the sterilizer wet and prone to contamination.
- • Moisture, particularly in box locks and hinges, may result in corrosion that will weaken the instrument and lead to breakage.
- • Sterilize instruments in the open (unlocked) position
- • Lubricant should not be wiped off instruments prior to autoclaving
- • Prepare instrument sets for sterilization using a wrapper, pouch or rigid sterilization container that is appropriate for the method of sterilization to be used
- • Do not overload the sterilization chamber as air pockets may form and prevent steam contact during sterilization
- • The sterilizer manufacturers instructions for cycle parameters should be followed with regard to exposure temperature and time
- • Ensure autoclave filters and chambers are cleaned regularly as recommended by the manufacturer
- • Inspect all instruments thoroughly prior to each use, paying particular attention to the following:
- • Smooth instrument motion
- • Condition of moving parts, including tips, box locks, ratchets and cutting edges
- • Blade sharpness and cutting ability
- • Box lock and ratchet security
- • Security of screws during instrument operation
- • Tip and/or jaw alignment
- • Meshing of serrations and/or teeth, w/ no catching
- • Missing parts or obvious signs of wear
- • Under no circumstance should an instrument identified to be functioning improperly after inspection be returned to service prior to repair
8. Handling & Storage
- • Avoid overloading of trays
- • Protect all sharp tips with tip protectors
- • All instruments should be air-dried prior to storing
- • Place heavier instruments on the bottom of the tray
- • Store in a clean and dry environment
9. General Recommendations
- • Each instrument is designed to perform a specific function, such as cutting, grasping, dissecting, retracting, etc. Instruments should only be used for their designated surgical purpose by trained personnel. It is the responsibility of each healthcare facility to ensure the personnel responsible for transport, cleaning, storage and use of instruments are trained properly.
- • All instruments should be routinely inspected and maintained by a qualified repair technician
- • Avoid processing dissimilar metals together
- • Always wear safety protection gear when handling instruments
- • Novo Surgical instruments are supplied non-sterile and must be cleaned, lubricated and sterilized prior to initial use
- • Do not use bleach or other corrosive chemicals to disinfect, treat or clean instruments. Only EPA-approved substances designed specifically for use with stainless steel surgical instruments should be used.
- • Only use chemical/cold sterilization solutions for instruments approved for such a process
- • Chemical/cold sterilization should never be used for instruments with tungsten carbide inserts.