CHAPTER 23 Care of Instruments
Surgical instruments are designed to correct physical problems that require surgery. When a good-quality surgical instrument is used for the right job, that instrument should last a lifetime. That life can be extended if, during that use, it is cleaned and maintained properly.
All instruments should be checked for roughness or pitting of the surface. All instruments with moving parts should be checked for smoothness of engaging and disengaging and for proper meshing of the jaws. If two parts of an instrument are held together by a screw, the screw should be tight. If any such defects exist, they facilitate corrosion, rusting, and staining.
Soiled instruments must be cleaned as soon as possible after use. Within 10 minutes, blood or tissue left on an instrument starts to break down the instrument’s surface. This causes the instrument to become stained, pitted, or rusty. If instruments cannot be cleaned within that time frame, they should be kept moist by being placed in a wet towel; however, they should not be soaked, because that only hastens the breakdown of instruments.
The scrub brushes used should be designed specifically for medical instruments. Too hard a bristle can cause damage and fail to get into the cracks and crevices that exist in individual instruments. The instruments should be opened and placed in the cleaning solution. Each instrument must be scrubbed, with attention to the grooves in the jaws, the box locks, and the joints. Then they should be rinsed in water and dried thoroughly, again with attention to the box locks and joints. The moving parts, such as joints, box locks, and ratchets, should be lubricated, using a lubricant that is specially designed for surgical instruments and is steam penetrable.
Many elements contribute to the breakdown of instruments. The top three are tap water, surgical wraps, and moisture.
Surgical wraps also cause instrument breakdown. Most detergents are alkaline based, and most washing machines do not rinse well enough to remove the metallic ions that remain in materials. The instruments are wrapped in these fabrics and placed in an autoclave that produces steam, which vaporizes these metallic ions and deposits them onto the surgical instruments. For this reason, an autoclave should be cleaned on a weekly basis to prevent the buildup of minerals and metallic ions. Surgical wraps should be sent through two rinse cycles. It is also advisable to avoid overloading the washing machine when cleaning surgical wraps.
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