surgical instruments market

Maintenance » Maintenance Procedure

1. General Instructions  

1. 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.

2. Instruments should never be exposed to Hydrochloric acid, Aqua regia, 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.

3. 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.

4. 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.

5. 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.

6. 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.

7. Thorough rinsing must follow ultrasonic cleaning in order to remove suspended particles.

8. Never autoclave dissimilar metals together, i.e.., titanium, silver etc.

9. Follow manufacturer's specifications when using automatic washer-sterilizers.

10. 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.

11. 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.

12. Avoid loading retractors and other heavy items on top of delicate and hollow instruments.

 
2. Disinfection and Cleaning  
 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 reclean 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.
 
4. Sterilization  

  

  • In general follow the sterilization instructions of the manufacturer.

Sterilization Methods

 
 1. Autoclaving  

  

  • Normally, autoclaving is performed with saturated water steam at 134°C. In special cases a temperature of 121°C can be used for a longer time.
  • Steam used for sterilization has to be free from any contamination, otherwise rust particles from the conducting system may cause corrosion or a high content of silicic acid may lead to discoloration of the instruments.
  • Due to heating and cooling down during the sterilization process, a surgical instrument with a closed ratchet may suffer from tension stress which causes stress cracking in joints or deterioration of the clamping force. Therefore, such instruments have to be sterilized either in open condition or closed on the first ratchet only.
 
 2. Hot-Air Sterilization  

  

  • When surgical instruments are hot-air sterilized, please take care to load and operate the sterilizers properly.
  • To ensure safe sterilization, the temperature should not be below 180°C but should not exceed 200°C as this may cause structural changes leading to irreversible damage, especially as far as microsurgical instrument are concerned.
  • Instruments with parts of rubber, plastic, or textile as well as plastic-coated instruments and handles for electrodes are not suitable for hot-air sterilization.
  • The general use of lubricating agents should be omitted prior to hot air sterilization. Only oil the joints and ratchets of surgical instruments.
 
 3. Gas Sterilization  

  

  • Gas sterilization should only be used when no other method is suitable i.e. it is not recommended for surgical instrument.
  • Components of motor line, Optical systems of rigid endoscopes and Flexible endoscopes can be gas sterilized.
 
 4. Cold Sterilization  
  It is not recommended for surgical instruments due to the following reasons:
1- Most cold sterilization solutions render instruments sterile only after a 10 hour immersion. This prolonged chemical action can be more detrimental to surgical instruments than the usual 20 minute autoclave cycle, resulting in corrosion and dulling of sharp edges on knives, scissors, hooks, etc.
2- The solutions are not changed as recommended, causing undesirable suspensions, as blood, saline, proteins, medications, detergents, soap, and debris, to circulate forward to new instruments.
3- The instruments generally are not rinsed with deionized (softened) distilled water after being removed from these somewhat corrosive solutions (Cold Sterilization Solutions).
 
 5. With time and use these solutions become ever more corrosive.  

  Treatment of brand new instruments

  • Packing of brand-new instruments has to be removed and instruments have to be stored in dry rooms, open to air.
  • Store instruments in cupboards or rooms where chemicals are kept which can produce corrosion vapors.
  • Remove any protective caps or foils. Microsurgical instruments have to be placed in racks or holding devices to avoid damage.
  • Cleaning, rinsing, lubrication, inspection and sterilization have to be carried out according to the procedures previously described.
  • The cleaning step should never be skipped because residues (e.g. from packing materials or care agents) could lead to the formation of stains or deposits during sterilization.
  • The passive layer of brand-new instruments is necessarily still thin and so these instruments tend to be more sensitive to critical treatment conditions than are older instruments.
 
 
 
 

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Chairman Word
To our country, to the entire world and to the future, we founded lifeCare Surgical. Starting from where others ended, adding the value of 20 years experience in the field of instrumentation. Offering products with the best quality that appreciate health care and doctors needs.