Surgical Instrument Care and Handling

RINSING

Immediately after use, rinse surgical and dental instruments under warm or cool running water to remove all blood, body fluids and tissue. Dried soils may damage the surgical and dental instrument surface and make cleaning very difficult. Do not use hot water as this will coagulate proteinous substances.

CLEANING TECHNIQUES

Time, temperature, and agitation play important roles in the cleaning process.

Time — the efficiency of cleaning chemicals is often time dependant

Temperature — higher temperature cleaning solutions result in better cleaning

Agitation — whether manual or ultrasonic, it is helpful in loosening the soil on the surface of the instrument

Automatic Washer Sterilizers

Follow manufacturer’s recommendations. Lubricate surgical and dental instruments after last rinse cycle and before sterilization cycle.

Manual Cleaning

1. Use stiff plastic cleaning brushes. Do not use steel wool or wire brushes.

2. Use only neutral pH detergents. If not rinsed properly, low pH detergents may breakdown the stainless protective surface and cause black staining. High pH detergents may cause surface deposits of brown stains, which can interfere with the smooth operation of the instrument.

3. Brush delicate surgical instruments carefully and, if possible, handle them separately from general instruments.

4. Inspect all dental and surgical instrument surfaces to ensure they are visibly clean and free of stains and tissue. Inspect each instrument for proper function and condition. Scissor blades should glide smoothly  and the blades must not be loose when in closed position. Check that forceps tips are properly aligned. Hemostats and needle holders should not show light between the jaws, they should lock and unlock easily, and the joints should not be too loose. Check needle holder jaws for wear. Examine cutting instruments and knives to be sure their blades are sharp and undamaged.

5. Rinse instruments thoroughly under running water. While rinsing, open and close scissors, hemostats, needle holders and other hinged instruments to ensure that hinge areas are also rinsed.

6. Dry instruments thoroughly with a clean towel. This minimizes the risk of corrosion and formation of water spots. Use spray lubricant (WPI # 500126) in the hinges to improve function of instrument. 

Soaking

Large, non-delicate instruments can be soaked in a corrosion inhibiting detergent (Alconox — WPI #13740) when other cleaning methods are not practical. Rinsing and drying after soaking is recommended.

STERILIZING

Autoclaving

1. Lubricate all instruments that have any metal-to-metal action such as scissors, hemostats, needle holders, self retaining retractors, etc. Surgical instrument lubricants (WPI #500126) should be used.NOTE: Do not use WD-40, oil or other industrial lubricants.

2. Instruments may be autoclaved individually or in sets.

• Individual instruments—Disposable paper or plastic pouches are ideal. Use a wide enough pouch (4” or wider) for instruments with ratchet locks (such as needle holders and hemostats) so the instrument can be sterilized in an open (unlocked) position.
• Instrument Sets—Unlock all instruments and sterilize them in an open position. Place heavy instruments on bottom of set (when two layers are required).

Cold Sterilization

Most cold sterilization solutions require a 10-hour immersion to render instruments sterile, but this prolonged chemical action may be more detrimental to surgical instruments than the 20-minute autoclave cycle. If the instruments need only to be disinfected (basically clean), cold sterilization is acceptable since disinfection will take place in only 10 minutes.
But to render the instruments sterile (with absolutely no living organism surviving), autoclaving is recommended.
For instruments with tungsten carbide inserts (needle holders, scissors, tissue forceps), do not use solutions containing benzyl ammonium chloride which will destroy the tungsten carbide inserts.