Spray n' Wash Spraying used trays with enzymatic cleaner immediately after use helps prevent damage. Inspect instruments before returning them to service.

Just because surgical instruments are made of stainless steel doesn't mean they'll never stain. A lack of attention to care and handling at the point of use and during the decontamination process can result in surface marking, discoloration and corrosion. This damage renders instruments unfit for use in the OR. Follow these rules to make sure your surgeons can depend on their instruments.

Point of use pre-cleaning
Instrument damage often begins at the point of use. Blood, pus and other body fluids contain chloride ions that, with prolonged exposure, will corrode a stainless steel surface. It doesn't take long. Surgical residue can easily mark or stain an instrument, especially if it's allowed to dry.

This damage is preventable if OR staff conduct point of use pre-cleaning throughout and immediately after each case. As instruments are used, wiping their surfaces and flushing their lumens with sterile water will remove debris before it has a chance to dry.

Nurses and techs can also give reprocessing a head start by making sure that instruments stay damp when they're sent to central sterile. Covering trays with wet surgical towels is a good idea, but spraying the instruments down with an enzymatic cleaner is even better. The cleaner (which is also available as a gel) not only keeps the tray's contents wet, but also prevents bioburden from eating away at them. Gross contamination just rolls right off.

One thing that surgical staffers must never do, though, is wipe instruments down with or immerse them in basins of saline solution. As a compound of sodium and chloride, the solution can corrode stainless steel in 30 minutes. The worst instrument corrosion I've ever seen was on items left in a pan of saline for an hour. The pitting was already visible.

Diligent decontamination
Cleaning surgical instruments between 30 minutes and 1 hour after use is the best defense against marking, staining and pitting, but in a busy, multi-OR facility, that's not always possible. That's why point of use pre-cleaning is so critical: because sometimes when used instrument trays are sent down to decontamination, they have to wait in a queue.

The first thing a conscientious sterile processing tech does when the tray arrives on the dirty side of the room is spray it with enzymatic cleaner, whether it needs it or not. Perhaps the OR staffer just gave it a little spritz in the interest of saving money on supplies. But you need to be heavy-handed with the spray, not like you're spritzing your hairdo. Maybe it's an expensive product, but you have to ask whether you'd rather spend money on preventive care or on replacing damaged instruments. Plus, you can rest assured that when the tray reaches the head of the queue, it's still protected.

Even with the enzymes at work, manual cleaning is still an essential step in decontamination. Instruments must be completely disassembled and thoroughly scrubbed with the right size and type of brush before they're run through the washer-decontaminator. You can only sterilize instruments that are clean, and any dried-on debris of blood, body fluid or fatty deposits can become baked-on permanent stains in the autoclave. A helpful hint: When our reprocessing techs are working at the sinks, they scrub the instruments beneath the surface of the water, so as to avoid aerosolizing any contaminants.

Following manufacturers' instructions — both instrument manufacturers' instructions with regard to their specified cleaning agent, and cleaning agent manufacturers' instructions with regard to the amounts and concentrations to be used — is imperative. To maintain instruments' quality, do not deviate from the manufacturer-specified product, typically a neutral pH soap. Overly acidic or alkaline solutions can damage instruments. I recall the sterile processing tech who poured bleach (a chlorine compound) into a sink full of instruments with the intent of disinfecting them while they were cleaned. You're killing the bacteria, all right, I told the tech, and you're killing the instruments, too.

When manually cleaning, keep the "Goldilocks effect" in mind. Using too much cleaner, like using too little, won't deliver optimal results. Human error can play a part — your 1 oz. might not be my 1 oz. — and since the cleaning agents we use are low-sudsing, it's easy to overdo it. We've installed a dosimeter that siphons the correct amount of cleaner from its jug into the sink, enabling precise proportions of cleaner to water every time.

A closer look
Even the most carefully reprocessed instruments may occasionally show spotting, discoloration or corrosion. After the washer-decontaminator completes its cycle, inspect instruments for damage as they're being reassembled and arranged into their trays for sterilization. We use magnifying lenses mounted at the work tables to read the serial number etched into each instrument in order to return it to its proper tray, but these magnifiers also give us a high-powered view of the instrument's surface and any stain, crack, pitting or other damage it may have sustained.

It's an important step in the reprocessing process. We don't want an instrument in which damage has started, which can carry the risk of bacteria into surgery or which isn't otherwise usable for surgery, to end up in the tray. So it's in our hands to remove it from circulation for repair or disposal.

We also contract with a repair company, whose truck visits once a week. The service reps inspect all of our instrument trays according to a timed maintenance schedule, checking for damage, testing functionality, and sharpening and lubricating as needed. Since our ortho trays are used the most, they get the most frequent inspections.

If you take care of your instruments between uses, you'll experience fewer issues at the surgical field. But don't underestimate the value of starting off on the right foot by buying instruments forged from durable materials. The $21 scissor made of German-grade stainless steel is going to stand up to a lot more use than the $6 made-in-Pakistan scissor, and the manufacturer known for top-quality instruments will deliver a more durable product than the company that fills your mailbox with sale booklets. For tools you'll be reusing again and again, look for longevity and keep your sterile processing staff in the loop when you're weighing the purchase.