All the surgical instruments are very delicate and expensive; care of instruments must be proper and should be on utmost priority and utmost importance.
CAUSES OF DAMAGE OF INSTRUMENTS
Instruments may be damaged due to (Figs 1.1A to D):
- Contact corrosion caused due to preparation on brass rack.
- Discoloration caused due to impurities in water vapor/steam.
- Breaking due to stress corrosion caused by chlorides.
- Spots resulting from improper pre-rinsing or washing.
- Deposition due to caustic solution containing chlorides, effect of prolonged immersion in saline.
- Encrustation of blood due to improper washing or rinsing.
- Pitting due to chlorides.
- Crevice corrosion caused due to destruction of natural passive coating of steal due to mechanical/chemical destruction.
- Water spots due to high mineral content in water.
- Encrustations due to non removal of organic residues because of improper cleaning.
- Fretting corrosion caused due to insufficient treatment with Lubricating oil.
There are certain recommendations for prevention of corrosion of surgical instrument like:
Specifications for Buying
- Choice of material; does it fit the requirements?
- Certificate of quality from the manufacturer. (CE-certificate of excellence)
- Choice of surface finish.
Storing of Instruments
- Avoid any corrosive fumes/chemicals in storage area.
- Avoid area of high moisture to store instruments.
- Brand new instruments should be stored separately.
- Appropriate Racks/Containers should be used to store instruments.
Usage
- Clean the instruments after every use.
- Avoid prolonged exposure to saline.
- Sterilize used and unused instruments.
Preparation for Disinfection and Cleaning
- Check the correctness of the delivery.
- Returning of instruments from OT should be proper.
- Dry instruments should be returned in dry condition.
- Returning instruments in wet condition - Instruments should be immersed in non corrosive combined disinfecting-cum-cleaning solutions.
- All hinges/retches of instruments should be released. Break part instruments should be dismantled.
Re-using the Instruments
- Dismantle and immediately immerse used and soiled instruments, completely in a pre disinfection bath.
- Use containers which are hermetically sealed during the process of thermal disinfection and cleaning. It is done at 93°C for approximately 10 min. For heat sensitive material chemothermal disinfection is done at 60°C for approximately 10 min.
Pre-disinfection
- Use cold water only. Water over 45°C leads to coagulation of proteins and causes cleaning problems.
- Epidemic Hygiene Aspect- disinfection first followed by cleaning.
- Follow exposure times/dilution parameters/concentration level as recommended by the manufacturer for optional cleaning/disinfection, pH value of 4.5 to 9.5 is recommended for cleaning and disinfection solutions.
- Ultrasonic cleaners may be used in case of stubborn stains/encrustations.
Washing
- Periodically test the water for its chloride/silicate and mineral content.
- Use of enzyme based detergents is recommended and instructions for dilutions as recommended by the supplier should be followed. If powdered products are being used-particles should be dissolved.
- Final rinsing should be done in demineralized water.
Drying
- Instruments should be dried immediately after rinsing/washing.
- Use of air pistol is recommended whereever possible.
- Use lint free paper cloth to wipe.
Care of Instruments
- Ensure that all instruments are clean.
- Check functionality of individual instruments.
- Separate the instruments which are not functioning correctly/show signs of corrosion/wear and tear.
Maintenance of Instruments
- Periodically lubricate hinged/retched instruments and instruments with joints, with lubricating oil.
- If required, inspect instruments with carbide tips for wear and tear, replace tip, if required.
- Always maintain correct organization of instruments in terms of size/old or new/large bulky instruments/micro delicate instruments.
Conditions for Sterilization
- Do not overload instrument trays with more than 10 kg.
- Do not mix old instruments with new ones.
- Micro and delicate instruments should be placed in secure containers.
Sterilization
- If all necessary steps prior to sterilization have been followed- Proceed.
- Use demineralized water if possible/quality of water/steam is very important.
- Excessive chlorides can set in corrosion in instruments (levels of chlorides should be less than 120 mg/lit equivalent to 200 mg/l of NaCl).
- Optimal loading of trays prevents formation of condensates.