Maintain moisture

Immediately after the surgical procedure, place the instruments in an instrument tray/container and cover with a towel moistened with sterile distilled water. Foam, spray or gel products, specifically intended for use with surgical instruments in an impervious plastic bag or container with a tight lid to the documentation environment.

Enzymatic Soak

Immerse fully opened and/or disassembled instruments in an enzymatic solution, specific for use with surgical instruments. Prepare the solution and use per enzyme manufacturer’s recommendations, paying special attention to instructions for correct dilution, temperature and soak time. Flush air from lumens and fill them with enzymatic solution for full contact with this inner surface during the soak time.

Rinse

Remove instruments from the solution after the time period recommended by the enzymatic manufacturer and rinse thoroughly with tap water. Flush lumens until water runs clear.

cleaning Instruments

Choose a cleaning solution appropriate for surgical instruments and follow the manufacturer’s instructions for use. The use of neutral pH detergents is vital to the maintenance of surgical instruments. Contact with acidic or alkaline solution will remove the instruments’ protective barrier of chromium oxide, often leading to corrosion, pitting, and breakage. You may find that depending on the type of soil, a detergent that is a little more or less acid or alkaline may be more appropriate.

Rinse

Thoroughly rinse instruments by immersing in tap water and wiping with a clean, soft cloth. Flush lumens until water runs clear.

Ultrasonic Cleaning and Rinsing

Follow the recommendations of the ultrasonic manufacturer regarding cycle times, detergents, proper placement of the instrument tray, and conditioning (“degassing”) of the cleaning solution, etc. Use an ultrasonic cleaner to remove soil from hard to reach surfaces such as grooves, crevices, lumens, instruments with moving parts, etc., after gross soil has been removed. Open or disassemble instruments as appropriate. Place instruments in a mesh bottom stainless steel instrument tray. Place the tray into the ultrasonic cleaner. Flush air out of lumens and fill them with the ultrasonic cleaning solution (under the solution level in the chamber) for effective removal of soil from that inner surface by the ultrasonic activity.

Final Rinse

Final Rinse should be with “treated water”. Softened or deionized water should be used for the final rinse to better remove detergents etc. Softening water removes calcium and magnesium ions that cause water to be hard. Iron ions may also be removed by this treatment. Deionization removes ionized salts and particles from the water. Excessively hard water can spot or stain instruments and excessive chlorine in water can cause pitting of the instrument. Deionized water is preferred for the final rinse.

Decontaminate Clean Instruments

Once instruments have been cleaned they must be rendered safe for handling, inspection and assembly. They may be steam sterilized without a wrapper or disinfected following the instructions from the instrument, sterilizer and disinfectant manufacturers.

Visual Inspection and Instrument Set Assembly

Visually inspect the instrument for cleanliness and to ensure all parts are in proper working order, as the set is assembled. Inspection is a vital part of proper care and maintenance. Instruments in need of repair will not perform accurately in surgery and breakage is likely to occur. DO NOT USE damaged instruments. Worn ratchets, loose box locks and misaligned jaws can be repaired at a fraction of the cost of new instruments.

Lubricate

The use of an instrument lubricant, that is compatible with the method of sterilization to be used, is recommended before instruments are sterilized. Be certain that the instrument lubricant is diluted and maintained properly, according to the manufacturer’s instructions. This type of lubricant is referred to as “instrument milk” and is usually applied by spraying into the box locks and moving parts or by dipping the opened instruments into a solution. Lubricants that are too concentrated or too heavily applied will result in slippery instruments that will also be mistaken as wet after sterilization. After thoroughly cleaning instruments, proper application of lubricants to joints will keep them moving freely and aid in protecting the surface from mineral deposits. Note that ultrasonic cleaners remove all lubrication; therefore this maintenance procedure should be done routinely after ultrasonic cleaning and before sterilization. Proper lubrication is an integral step in maintaining the long-life of the surgical instrument. Lubrication will prevent the friction of metal on metal and preserve the smooth function of the instrument thus avoiding corrosion by friction. Furthermore, routine use of lubricating agents, on thoroughly clean instruments, will prevent hinged and other movable parts from sticking. Lubrication will aid in protecting the entire instrument surface from mineral deposits.

Drying

Before instruments are wrapped for sterilization or storage, they must be thoroughly dry. If a set of instruments is wet when wrapped for sterilization it is likely to come out of the sterilizer wet. “Wet Packs” are not suitable for use after sterilization because they may be easily contaminated when handled. In addition, remaining moisture, particularly in box locks and hinges may result in corrosion that will weaken the instrument and lead to breakage during use. Prepare instrument sets for sterilization using a wrapper, pouch or rigid sterilization container that is appropriate for the method of sterilization to be used. The Association for the Advancement of Medical Instrumentation (AAMI) and individual sterilizer manufacturers provide guidance for the proper preparation of surgical instrument trays for sterilization. Some sterilizer manufacturers can also provide information regarding wet pack problem solving. See also, Sterilization for the Healthcare Facility, 2nd Edition, Reichert, M.; Young, J., “Wet Pack Problem Solving”, Lee, S. (Frederick, MD: Aspen, 1997).