Cleaning Guide

    1. General Instructions

Instruments should be used during surgery for their intended purpose exclusively. Misusing instruments will lead to damage that is usually not repairable. A he­mostat, for example, that is used to clamp tubing can come out of alignment and quickly break. Instruments should never be exposed to Hydrochloric acid, Aqua region, dilute Sulfuric acid, Iodine, or Ferric chloride. Because these chemicals are highly corrosive to stainless steel and will cause serious damage despite the passivity protective surface. In addition chloride content substances should be kept away from instruments when­ever possible, such as Aluminum chloride, Calcium chloride .........etc. Instruments should be rinsed immediately follow­ing contact with any of these substances. Rinse instruments that have been exposed to blood and saline solutions before these substances dry, because blood will cause a stain that is difficult to remove, and saline solutions are highly corrosive. The box-lock portion of instruments must be kept clean and free of debris. A buildup of substance in this area will cause instruments to become stiff and eventually break. Use solutions with a pH as near 7.0 (neutral) as possible in cleaning, sterilization and rinsing of instruments. Distilled water is recommended, because it is free of many compounds which exist in ordinary water. These substances alone cause stains and when tap water is combined with some detergents it will form insoluble deposits on the instru­ments. During manual cleaning, avoid the use of steel wool, wire brushes and highly abrasive detergent cleaners. These will damage the instrument's protective surface and lead to corrosion. Thorough rinsing must follow ultrasonic cleaning in order to remove suspended particles. Never autoclave dissimilar metals together, i.e.., titanium, silver etc. Follow manufacturer's specifications when using automatic washer-sterilizers. Before instruments are wrapped for storage they must be thoroughly dry. Remaining moisture, particularly in box-locks may result in corrosion that will weaken the instrument and lead to breakage during use. The use of water-soluble instrument lubricant is recommended. This will help keep a clean box lock mov­ing freely and will aid in protecting the entire surface from mineral deposits. Avoid loading retractors and other heavy items on top of delicate and hollow instruments.

2. Disinfection

A- Preparation

• Instruments should be disinfected and cleaned immediately after use.
• Corrosive caustic agents and medicines- used in operations and for medical treatment- (e.g. silver nitrate, iodine preparations, and albotyl and mercury components) substances have to be removed immediately.
• Instruments must not store in physiological saline solutions as prolonged contact, otherwise causes pitting and rust.
• Handle and deposit instruments carefully after use. Undue "dropping" can cause damage to the instrument, for example hard metal tips on scissors may be chipped or small, delicate clamps can be deformed.
• Hinged instruments (such as scis­sors, clamps, and gouge forceps) have to be opened.
• Instruments should never be left overnight before cleaning as the risk of causing permanent damage increases with the length of time between use and prepa­ration.

B- Manual disinfecting and cleaning

For manual preparations, instruments have to be immersed into a combined disinfecting and cleaning solu­tion with proven disinfecting effect with the following precautions:

• The instructions of the manufacturer have to be strictly followed regarding concentration, temperature and induction time.
• Use fresh disinfecting and cleaning solutions ev­ery day. The following problems may occur due to using the same solutions for too long:
  • Risk of corrosion due to soiling.
  • Risk of corrosion due to increasing concentration caused by evaporation.
  • Decrease if disinfecting effect due to excessive dirt concentration.
• After chemical disinfection and cleaning, the instruments must always be rinsed well under running water. Any residue has to be removed manually (no metal brushes, no scouring agents). In order to avoid water spots, a final rinsing with demineralized water is recom­mended. Finally, the instruments have to be dried immedi­ately. 
  Drying with a pneumatic-air pistol is particularly safe and effective and should therefore be given preference over any other drying method.
• For cleaning, it is recommended to use lint free soft cloths, plastic brushes or cleaning pistols.

C- Ultrasonic treatment

Ultrasonic treatment is particularly suitable for cleaning instruments of high-grade steel. Furthermore, ultrasonic treatment is a suitable method to effectively remove encrustations.
In order to achieve optimum efficiency of the ultrasonic treatment, please observe the following:

• Fill the bath to the markings.
• Add a suitable cleaning and/or disinfecting agent to the water
• Temperature above 40oC promotes degassing and cleaning.

No protein coagulation occurs at higher temperatures if suitable cleaning agent is used. When using disinfecting and cleaning agents make sure that the concentration and temperatures are correctly maintained. Instruments have to be completely covered by the cleaning solution. Non-immersed instruments will not be cleaned. Hinged instruments, e.g. scissors, have to be opened Only trays which do not affect the ultrasonic treatments should be used.

• Large and bulky instruments such as lead hands or kidney trays must be placed in such a way that there are no wave shadows or inactive zones. Place such items either vertically or put them on top of the other instruments.

After ultrasonic treatment, the instruments have to be thoroughly rinsed either manually or by machine. Rinsing has to be performed with clear water of at least drinking quality or, better still, with demineralized water in order to avoid water spots.
The instruments should then be thoroughly dried.

3. Inspection

• After each cleaning, the instruments have to be macroscopically clean, i.e. free of visible protein remnants and other contamination.

Prior to functional inspection, surgical instru­ments with movable parts should be cooled down, thus avoiding metal friction leading to corrosion. Before car­rying out functional inspection, oil any instrument with joints, ratchets or threads. Instruments with non-traumatic tooth have to be specially inspected, and, if necessary, manually re-clean the non-traumatic tooth. Worn out or damaged instruments should be removed for repair or replacement. Corroded instruments should be discarded immediately as these can cause con­tact corrosion even on a perfect surgical instrument.

• Ensure that the instruments function as they should or not. Fine and delicate instruments are inspected under the magnifying glass. *In order to avoid damage during transportation, place the instruments in specially designed racks or use special holding devices to prevent them from slipping.
• Faultless surgical instruments should not be packed together with instruments having damaged sur­faces.
• Older instruments with chipped chromium and/or nickel coating may cause discoloration or corrosion on high-grade surgical instruments. It is, therefore, recom­mended to discard such instruments or pack them sepa­rately.