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Instruments Care


RECOMMENDE STEPS IN CLEANING, STERILIZATION & MAINTENANCE OF SURGICAL INSTRUMENTS

1. HOLDIN/PRESOAK

It is important never to hold instruments in a dry container, which allowsblood and debris to dry onto instrument surfaces and makes cleaning more difficult. If rinsing and decontamination processes are not immediately available, pre-treat instruments or hold in a neutral holding/presoak enzymatic solution after patient use but before actual cleaning. Prep EnzymeFoaming spray for pre-cleaning of soiled instruments and scopes. Simply spray on instruments until ready for rinsing and disinfection. Also, use neutral pH all purpose multi- enzyme concentrate is ideal for instrument presoaking and pre-cleaning. As soon as possible, rinse, disinfect and clean as follows:

2. RINSING

Immediately after surgery, remove organic materials by rinsing instruments under warm (not hot) running water. Rinse should remove most blood fluids and tissue. Do not process metals (stainless, copper, chrome plated, etc.) together. Alwayswear safety protection gear.

3. DISINFECTING

To protect medical personnel from contamination during cleaning, immerse instruments completely in an EPA approved disinfectant for approximately 10-20 minutes. Always closely follow manufacturers' recommended disinfecting time and solution preparation and instruction. Then rinse again.

CAUTION:

Disinfected instruments areNOT STERILE. Never expose stainless steel instruments to bleach or other corrosive chemicals to disinfect. Exposureto bleach may result in instruments pitting and will void all manufacturer guarantees.

4. CLEANING

All blood dried body fluids and should be completely removed from the instruments prior to sterilization. Several methodsare available.

A. Soak:

An enzymatic cleaner bath (soak) or a solution of water and neutral pH (7) detergent are effective in removing organic material from instruments. Use distilled (demineralized) water if possible. Instruments should be fully submerged for at least 10 minutes. Do not let "sharp" (scissors, knives, osteotomes, etc.) running water to remove solution. Change solutions frequently.

B. Ultrasonic Cleaning:

Most instruments manufacturers recommend ultrasonic cleaning as the most effectiveway to clean surgical instruments, particularly thosewith hinges, box locks and other moving parts. All instruments must be fully submerged in open position. Use distilled (demineralized) water if possible. Make sure that "sharp" blades do not touch other instrumentsto prevent possible surface scratching and also be sure dissimilar metal instruments areseparated. Process instruments for full recommended ultrasonic cleaning cycle. Change solution frequently or as often as the manufacturers recommends. Rinse instrumentswith water to remove the cleaning solution, can be safety usewith all ultrasonic unites.

C. .Automatic Washer sterilizer:

follow manufacturers' recommendations but ensure instruments are lubricated after the last rinse cycle and before the sterilization cycle

CAUTION:

Needle holder and forceps may check if sterilized with ratchet in closed position.Manual Cleaning: if ultrasonic cleaning is not available, observe the following steps. Use stiff nylon cleaning brushes. Do not use steel wool or wire brushes except specially recommended stainless steel wire brushes for instruments serrated areas, bone or on stained areas of knurled handles. Use only neutral pH (7) detergents such. If not rinsed off properly, low pH (acidic less than 6 pH) detergents break down the stainless protective surface resulting in pitting and/or back staining. High pH detergents (alkaline morethan 8 pH) which can also interferewith the smooth operation of instruments. Most brown stainsare not rust and are easily removed with stain remover. Brush delicate instruments carefully, and if possible, separatethem from general instruments. Make sure instruments surfaces are visibly clean and free from stain and tissue. Stain Remover can help remove residue stains. This is also a good time to inspect each instrument for proper function and condition. Check scissors' blades to ensure proper function. Blades should glide open and closed smoothly. Test cutting performance at 3/4 length of the bladewith the following recommended materials. Scissorsshould cut all the tips. Recommended cutting test

materials:

Fine/Delicate scissors: Surgical gloves Medium scissors: Single layer of stocking/cast netting Large/utility scissors: Double layer of stocking/cast netting. Check forceps (pickups) for proper jaw alignment. Teeth must meet properly – without catching. Check hemostats and needle holders to ensure jaw tipsclose in first ratchet position and entire jaw should close in third ratchet position. Check instruments for loose hinges and verify that they lock and unlock easily. Suction tube should be clean inside. Test Biopsy Punches by punching aclean hole in 3-6 mil thick poly-bag material. If poly-bag material is not available, use tissue paper. Retractors should function properly. Cutting edge instruments and knives should be sharp and free of damage. After scrubbing, rinse instrumentsthoroughly under running water. While rinsing, open and close scissors, hemostats, needle holder and other hinged instruments to make sure the hinge areas are rinsed out and no debris remain.

5. AFTER CLEANING

Separate dissimilar metals prior to sterilizing/autoclaving. If instruments areto be stored, let them air-dry and storethem in a clean and dry environment.

6. AUTOCLAVING

A. Lubricate all hinged instrumentswhich have any “metal to metal” action, at the screw or box lock. A non-silicone, water-soluble surgical lubricant is recommended. Do not use industrial oils and lubricants.

B. Sterilizer instruments either individually or in sets. o Individual Instruments: Disposable paper or plastic pouches are ideal. Make sure to use awide enough pouch for instrumentswith ratchet locks so instruments can be sterilized in an open (unlocked) position. Instruments locked during autoclaving can experience cracked hinges(box lock) or other problems because of heat expansion. If wrapping instruments, make sure thetowel does not contain detergent residue, which can stain instruments. o Instruments Sets: Unlock all instruments and sterilize in an open position. Place heavy instrumentson the bottom of sets (when two layers are required). Do not overload the chamber because an air pocket may form that hinders steam penetration.

CAUTION:

With most portable tabletop autoclaves, at the end of the autoclave cycle and beforethedrying cycle, unlock the door and open it no morethan crack, about 1/4” (6.4mm). Then run the dry cycle for the period recommended by the autoclave manufacturer. If the autoclave door is fully opened before the drying cycle, cold room air will rush into the chamber causing condensation on the instruments that may result in water stains or causewet packs. Make sureautoclave filters and chambers are cleaned as recommended by the manufacturer. Stain Remover is effective in removing stains and cleaning the autoclave chamber. If you have any unusual staining on your instruments after sterilization, obtain our InstrumentsCare Instruction or contact to your local Towne representative.

7. CHEMICAL/COLD STERILIZATION

Most chemicals/cold sterilization solution renders instruments sterile only after 10- hour immersion. This prolonged chemical action can be more detrimental than usual 20-minute autoclave cycle. If the instruments need to be "disinfected" only, a chemical/cold sterilization soak is acceptable, as disinfection in using bleach (paragraph 3). Sterile- an absoluteterm (no living Organism survives) Disinfected-basically clean. Some organisms may survive..