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Care & Handling of Surgical Instruments
The proper care and handling of your valuable surgical instruments will improve
their longevity and function. Choose a protocol appropriate for your environment
from the cleaning techniques below.
I. RINSING
Immediately after use, rinse instruments under warm or cool running water to remove all
blood, body fluids and tissue. Dried soils may damage the instrument surface and make
cleaning very difficult. Do not use hot water as this will coagulate proteinous substances.
II. 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
A. Ultrasonic Cleaning
This is the most effective cleaning method. Ultrasonic cleaning is the result of
cavitation. The vibrating sound waves create micron-size bubbles in the solution that
grow with the alternating pressure. When they reach a resonant size, the bubbles
implode creating a force that dislodges dirt and particles, even in the smallest of
crevices. The use of an ultrasonic detergent greatly improves the rate of cavitation as
opposed to plain water.
1. Mix enzymatic (Enzol — WPI part number 7363), or other neutral pH or mild
alkaline detergent (Alconox — WPI part number 13740) per manufacturer
recommendations.
2. Use deionized water, if available.
3. Run ultrasonic cleaner for several minutes to degas the solution and obtain
correct temperature.
4. Place instruments in open position into the ultrasonic cleaner. Do not allow
instruments with sharp blades to touch other instruments. All instruments
must be fully submerged.
5. Do not place dissimilar metals (stainless, copper, chrome plated, etc.) in the
same cleaning cycle.
6. Instruments should be processed in the cleaner for 5 to 10 minutes.
7. Rinse instruments with water to remove ultrasonic cleaning solution and any
remaining soils.
8. Dry instruments thoroughly with a clean towel. This minimizes the risk of
corrosion and formation of water spots.
9. Use spray lubricant (WPI part number 500126) in the hinges to improve
function of instrument.
B. Automatic Washer Sterilizers
Follow manufacturer’s recommendations. Lubricate instruments after last rinse cycle
and before sterilization cycle.
C. 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 instruments carefully and, if possible, handle them separately
from general instruments.
4. Inspect all 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 part number
500126) in the hinges to improve function of instrument.
D. Soaking
Large, non-delicate instruments can be soaked in a corrosion inhibiting detergent
(Alconox — WPI part number 13740) when other cleaning methods are not practical.
Rinsing and drying after soaking is recommended.
III. STERILIZING
A. 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 part number 500126) should be used.
Do not use WD-40 oil or other industrial lubricants.
2. Instruments may be autoclaved individually or in sets.
a. 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.
b. Instrument Sets—Unlock all instruments and sterilize them in an open
position. Place heavy instruments on bottom of set (when two layers are
required).
3. Never lock an instrument during autoclaving. This will prevent the steam
from reaching and sterilizing the metal-to-metal surfaces. Furthermore, heat
expansion during autoclaving can cause cracks in hinge areas.
4. Do not overload the autoclave chamber, as this may also hinder steam
penetration.
5. Place a towel on bottom of pan to absorb excess moisture during autoclaving.
6. At the end of the autoclave cycle (before the drying cycle) unlock autoclave
door and open it no more than a crack (about 3/4"). Run dry cycle for the
period recommended by the autoclave manufacturer. If the autoclave door is
opened fully before the drying cycle, cold room air will rush into the chamber,
causing condensation on the instruments. This will result in water stains on
instruments and also cause wet packs.
B. 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.
IV. STORAGE
Instruments should be stored in a clean and dry environment until use.
V. STAIN GUIDE FOR STAINLESS STEEL
Although stainless steel is corrosive resistant, it can still rust and/or stain if handled
improperly. To determine if a discoloration is rust or just a stain, erase the discoloration with a pencil eraser. If there is pitting in the metal under the discoloration, it is corrosion.If the discoloration is removed, it was just a stain.
Stain color Cause:
Brown/Orange- High pH
Dark Brown -Low pH
Bluish/Black -Reverse plating due to mixed metals during cleaning process
Multicolor -Excessive heat
Light/dark colored spots- Water droplets drying on the surface
Black -Contact with ammonia
Gray -Excessive use of rust remover solution
Rust -Dried on blood or biodebris
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