Care and Maintenance of Surgical Instruments

Pre-Cleaning

Before proper cleaning of the surgical instruments, some techniques need to be considered as a priority for general pre-cleaning of the tools. This will make the rest of the procedure easier and enhance the instruments’ lifespan. The following guidelines can facilitate the subsequent cleaning of surgical instruments.

• Clean the instrument thoroughly after every use, and keep it moist.
• Do not allow blood and other fluids to dry on the instruments.
• Wash the contaminants with lukewarm or cool water at a temperature below 110°F/43°C.
• Open and disassemble the instruments to expose all parts for the cleaning process.
• Avoid placing ebonized instruments and stainless steel tools together to prevent scratches.
• Use the surgical tools for their intended purpose to avoid damage.

Rinse

To ensure proper cleaning of your instruments, rinse off all the blood and/or bodily fluid immediately after every use. Furthermore, it is suggested to rinse the surgical instruments under warm distilled or demineralized water. Do not use hot water or ordinary tap water to rinse the instruments.

Cleaning Precautions

It is essential to take cleaning precautions to avoid certain practices that can damage the instruments and lead to corrosion. Here are the cleaning precautions you need to take while cleaning the instruments:

• Avoid soaking instruments in hot water, disinfectants, alcohol, or antiseptics to avoid coagulation.
• Delicate instruments require special handling to prevent damaging the tips.
• Soak the surgical instruments for a maximum of 2 hours.
• Never use wire brushes, pipe cleaners, steel wool, or abrasive detergents to remove residue.
• Avoid mixing instruments of different metallic composition.
• Microsurgical, plated, and delicate tools should be cleaned manually, not in an ultrasonic cleaner.

Manual Cleaning and Soaking

We recommend manually cleaning delicate surgical instruments that require careful handling. The following are the tips for smooth and optimum manual cleaning of the instruments:

• Prefer using pH-neutral detergents to prevent corrosion, breakage, and pitting.
• Clean the instruments thoroughly right after use to prevent the formation of biofilms.
• After rinsing, suitable cleaning and disinfecting solutions for instrument care are used.
• Use soft materials or paper cloths, water spray guns, or soft plastic brushes made of nylon.
• Do not use the same cleaning solutions repeatedly; change them daily.

Ultrasonic Cleaning

Ultrasonic cleaning is the most preferred way of cleaning the in-depth surfaces and parts of the surgical instruments. You must ensure that all contaminants are removed from the instruments before placing them into the ultrasonic cleaner for effective results. We recommend you follow the manufacturer’s specifications for the time, temperature, and agitation required for the instruments. Furthermore, the bubbles created in the solution by the sound waves of the device facilitate the dislodging of dirt and particles, even in tight spaces. In addition, we suggest the following:

• Open or disassemble instruments so that boxlocks and ratchets are approachable.
• Use a free-rinsing, low-sudsing detergent with a neutral pH (6.0 – 8.5).
• Avoid placing instruments with sharp blades overlapping with other instruments.
• Do not put dissimilar metals, such as stainless steel, copper, etc., in the same cleaning round.

Rinse and Dry

After the ultrasonic cleaning cycle, you must rinse all tools with distilled, pyrogen-free water to remove all ultrasonic cleaning solution and debris. You should thoroughly dry the tools externally with a soft and clean towel or let them air-dry completely. Moreover, compressed air may be used to aid the drying process. 

Lubrication

The following are the tips to lubricate the cleaned instruments properly:

• Lubricate all joints and movable parts, like boxlocks and hinges, after cleaning the instruments, regardless of their surface coatings.
• Note that ultrasonic cleaners remove all lubrication; therefore, this maintenance step should be done routinely after ultrasonic cleaning and before sterilization.
• Do not rinse the instruments after this step.

Sterilization – Autoclaving

Autoclaving sterilization is the most crucial step in the proper care and maintenance of surgical instruments, where the tools are sterilized with steam that comes from distilled water and is free of all impurities. All instruments should be placed in the autoclave chamber, avoiding overburdening to prevent overlapping and potential damage. We also suggest the following:

• Do not put too many instruments in at once, as this may hinder steam penetration. 
• Place a cloth or towel on the bottom of the pan to absorb or soak up all the moisture. 
• Ensure that the internal surfaces are free from detergent residue and pH neutral.

Moreover, the instruments may be packaged in rigid containers or packaging cleared for use in 

sterilization. Packaging should ensure the sterility of instruments until opened for use at 

the sterile field and permit the removal of contents without contamination. You should also consider that the medical device manufacturer’s exposure times to sterilization temperature may need to be longer than the minimum indicated by the sterilizer manufacturer, but must never be shorter.

Instrument Checkup

It is essential to check the condition of your surgical instruments after they have been properly cleaned, lubricated, sterilized, and stored for their next use. You must consider checking certain things, such as:

• Review the inner and external surfaces of the tool for any irregularities, damage, or staining.
• Check whether the instruments are closing in place.
• If there are any damaged and defective tools, you should discard or replace them.

Storage of Instruments

After the instruments are dried thoroughly, you need to store them in suitable storage racks. They must be placed and secured in a closed, dry, and cool environment. Furthermore, shelving of the instruments should be easily cleaned and allow the free movement of air around the 

stored product. Also, keep the tools with delicate tips with protectors to save them from damage.