12 Tips for Instrument Care and Cleaning


If you take care of your instruments, they'll take care of you.

Benjamin Franklin was right: “An ounce of prevention is worth a pound of cure.” Pretty sure Mr. Franklin wasn’t talking about caring for surgical instruments, but we do know that taking these 12 preventive steps will pay dividends down the road.

1 Pre-enzymatic treatment. Make sure your staff gives your instruments a pre-enzymatic treatment immediately after use in the OR. As you know, blood is corrosive to surgical instruments.

“We use enzymatics to make sure the blood remains wet on those surgical instruments until they can get cleaned,” says Mark Voigt, director of sterile processing at CentraCare Health in St. Cloud, Minn. “If blood is allowed to dry, it can cause that pitting and rusting. It could be so bad that you have to replace the instruments, and that’s costly.”

2 Preventive maintenance program. Make sure you’re on a good preventive maintenance program. There are a lot of repair companies out there that will come to your facility and set up a program to have routine checks — for example, sharpening blades and making sure clamps are lined up properly — that will help instruments from becoming damaged beyond repair.

TOP HEAVY A heavy heart retractor placed on top of delicate cardiovascular instruments can cause damage.   |  Mark Voigt/CentraCare Health

Think about your car. If you’re good to it, it’ll be good to you. If you change the oil every 3,000 miles, you could get more than 100,000 miles from the car. But it you abuse your car, you’re likely to have problems. It’s the same with your instruments. Modern-day surgical instrumentation is becoming even more complicated, especially in robotics. And it’s way more expensive to fix than it used to be.

“That’s why it’s imperative to make sure your equipment is working appropriately,” says Mr. Voigt.

3 Transport with care. You can damage instruments while transporting them. Make sure that your sterile processing department is packaging your instruments in a way that follows the manufacturer’s IFU. But that’s not all. Make sure that instruments aren’t being jostled during handling, particularly in the transport cannister.

“We see even more damage to instruments from the OR on the way to our decontamination area,” says Mr. Voigt. “I don’t think anybody is trying to intentionally damage instruments, but they’re being pushed to go faster and faster to turn the room over. Sometimes it’s just kicking the can down the road.”

Sometimes a handful of instruments are just pushed into a rigid container after a procedure and the tips of scissors, tissue forceps or needle holders — all delicate instruments — can fall into small holes in the rigid containers and get bent, damaged or broken.

“It’s the end of the case, they’re hurrying and they’re putting instruments into a rigid container,” says Mr. Voigt. “Damage can occur when you place heavier instruments on top of delicate instruments.”

To prevent that at CentraCare Health, Mr. Voigt has conversations with the OR team on a regular basis. If he sees something like that happening, he records it and reports it back through a process improvement method.

4 Segregate. Segregate your sharps from your delicate instruments. You can put them in separate containers or use a surgical towel to separate the sharps from the delicates (with the delicates on top), says Mr. Voigt.

5 Use vacuum sterilization. Switch from gravity to vacuum sterilization — when it’s compatible with the device’s IFU — to improve the efficiency of sterilization and cut down on the time that instruments are exposed to steam. With gravity, steam comes from the top and pushes steam through the instruments. Using vacuum pushes the steam more forcefully through the trays. It penetrates more efficiently and gets into the nooks and crannies of the instruments and does so in less time.

For example, the dental drills used at Omaha (Neb.) Surgical Center — which have a lot of moving parts — were locking up because of being sterilized over and over. They often needed to be repaired or replaced.

“Our dental drills needed to be sterilized for 15 minutes in gravity. By switching to vacuum, we were able to cut that down to 4 minutes,” says Melissa Sawyer, CST, assistant OR manager at Omaha Surgical Center. “Now, they’re just not exposed to the high temperatures as long. That seems to have made the repairs less frequent and extended the life of the instruments.”

6 Lubricate when necessary. When appropriate, lubricate all your instruments to cut down on repairs. Omaha Surgical Center does a lot of pediatric dental restorations, in addition to eyes, gynecology and colonoscopies. The center was having issues with the drills not spinning because the motors were repeatedly getting stuck. To solve that problem, the center made it protocol that every time a drill came back to the instrument room, it was lubricated with an oil before sterilization — but only the dental drills. Many of the manufacturer’s IFUs for other drills recommend that they not be lubricated.

7 Pare your instrument trays. Decrease the number of instruments in your trays and limit the trays to only those instruments being used for the procedure. This reduces multiple unused instruments from being exposed to sterilization over and over. At Omaha Surgical Center, the eye trays used to contain around 25 instruments, some of which weren’t being used but still had to be sterilized because they were brought in for the procedure.

“We took out those instruments that were only used occasionally and put them into peel packs and placed them in ‘cataract extras,’ little slots in our cupboards in each OR,” says Ms. Sawyer. “We cut it down to 12 instruments, so there were fewer instruments to clean every time.”

WATCH THE TIPS Wire baskets can damage the tips of instruments if not placed properly in the basket.   |  Mark Voigt/CentraCare Health

8 Use protective rubber mats. Place a reusable rubber mat in all your eye trays to protect the delicate instruments from being damaged in the trays. Instruments rolling around in the trays can sometimes get bent. The mats can be sterilized at the same time as the instruments, further protecting the instruments from getting damaged, says Ms. Sawyer, who adds that when you cut down on the number of instruments used for a procedure, you can also buy smaller trays that come with the mats.

9 Properly staff your SPD. It might be unusual for eye surgery centers to have 2 central supply technicians working at the same time, but that extra personnel investment has been cost-effective for the Main Line Surgery Center in Bala Cynwyd, Pa.

“Our turnover is so quick that we need to have 2 people that know what they’re doing to turn those instruments over,” says Claire Welliver, RN, nursing director at Main Line Surgery Center. “And we don’t have a large number of repairs because of that.”

It starts with the staff at the center. Everybody is trained on taking care of instruments. When a new person starts, they’re trained on instrument care, and then annually there are competencies for the staff on instrument care. In addition to the 2 central supply techs, nurses and other techs are rotated into processing to cover for days off and vacations.

10 Gentle on the diamond blades. Use a diamond blade chamber cleaning system instead of a brush to reduce repairs on diamond blades.

DELICATE DIAMOND Expose the diamond blade from its handle, then push it into the cleaning sponge and rinse.   |  Mark Voigt/CentraCare Health

A reusable diamond blade is made from diamond and is extremely sharp. Some doctors use disposable blades to make an incision in the eye and that costs money. Omaha Surgical Center does 20-plus cataract cases a day, and each one of those disposable blades can cost from $15 to $20. The one-time purchase of a diamond blade, for around $1,000, that can be reused every time can save quite a bit of money for those surgeons who do a lot of cases.

But you have to be careful when cleaning a diamond blade. Otherwise you risk wasting your one-time upfront cost. There was a time when techs at Omaha Surgical Center cleaned diamond blades by hand with a brush. But the forceful brushing caused the blade to chip and sometimes dislodge from its handle, says Ms. Sawyer. They decided the delicate diamond blade needed a gentler touch when cleaning. As you can see in the photo to the left, they now clean diamond blades using a sponge system with cleaning solution. How it works: You expose the diamond blade from its handle, then push it into the cleaning sponge and rinse. Techs wash and rinse the blades twice, all by hand, which Ms. Sawyer says has cut down on damage to the blades.

11 Have adequate inventory. Trying to get by with an insufficient inventory of instruments can lead to shortcuts when cleaning instruments.

At Main Line Surgery Center, they can do 60 cases in a day, approximately 8,000 cases a year. The 4 ORs are running at full capacity with cataract patients.

“Having the 2 central supply technicians and a lot of inventory saves repair money and saves time because we get to do more cases,” says Ms. Welliver. “I’m doing what I need to do to keep the flow going and to make sure we have the right instrumentation. It’s also an infection control issue. Can you afford an infection? I don’t think so.”

12 Devise a handoff sheet. After a case, everybody goes into hurry-up mode because they want to get the room turned over as quickly and safely as possible. That could cause problems for getting the instruments back to sterile processing without damaging them. To prevent that from happening, you can use a handoff sheet like the one they designed at UConn Health Center in Farmington, Conn.

SAFE SEPARATION An easy way to protect instruments from unnecessary damage is to use a surgical towel to segregate the delicate from the sharp instrumentation.   |  Mark Voigt/CentraCare Health

It’s a quick, 1-minute document where the OR tech lists the surgeon, the room, the time, the technician and what instrument is damaged. The 8 line-item handoff sheet asks questions like:

  • Did you separate your delicates?
  • Did you separate your sharps?
  • Did you spray down with enzymatics?
  • Are there any instruments that have to go out for repair, or that have to be turned over?

“We get the sheets with the case cart and if there is a problem, we have that information to refer to,” says Peter Daigle, supervisor of sterile processing at UConn Health Center. “We know who did what, so we can correct the problem if it happens again. Doing this helps the instruments not get damaged in transport. It’s a preventive approach to saving money and it’s worked out good for us.”

You can also use a tagging system to note if an instrument has been damaged and needs to go out for repair. At UConn Health Center, the OR tech writes things like “This item is damaged” or “Send out for repair” on the tags — providing as much detail as possible for sterile processing — then attaches them to the instrument in question. Sterile processing then writes up the specifics of the problem before sending the instruments out for repair. OSM

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