Proper Care Of Surgical Equipments

A surgical instrument is a specially designed tool or device for performing specific actions of carrying out desired effects during a surgery or operation, such as modifying biological tissue, or to provide access for viewing it. Over time, many different kinds of surgical instruments and tools have been invented. Some surgical instruments are designed for general use in surgery, while others are designed for a specific procedure or surgery.

The operating theatre is one of the most important areas within a hospital or other healthcare facility. The majority of hospitals will have at least one operating theatre which can be used by various surgical specialties to perform elective and emergency procedures.So the usage of proper equipment is necessary for the safety of patients. Here we are discussing some techniques used for proper care and treatment of surgical equipments.

1.Instrument Care

This includes cleaning,disinfecting and Sterilising. Cleaning removes dirt, debris and biological material from surgical instruments. You can clean surgical instruments manually or mechanically using water and detergents or an enzymatic cleaner. Thoroughly clean your instruments, because debris that remains on instruments can interfere with further disinfection/sterilisation.

Disinfection can be broken down into three tiers: low level disinfection (LLD), intermediate level disinfection (ILD) and high level disinfection (HLD). LLD eliminates all vegetative bacteria (except tubercle bacilli), lipid viruses, some non-lipid viruses and some fungi in less than 10 minutes. ILD destroys tubercle bacilli, mycobacteria, lipid enveloped and some non-lipid enveloped viruses and fungus spores. In addition to killing these microorganisms, HLD can also kill bacterial spores, though not in a high number.

Sterilisation destroys all microbial life. Some chemical sterilants can be used as HLD disinfectants when used for shorter exposure periods. Dry heat or autoclaving are the preferred method of sterilising surgical instruments.

2.Cleaning

The first step in properly cleaning your surgical instruments is to rinse off all blood, bodily fluids and tissue immediately after use. Dried soils may damage the instrument surface and make cleaning more difficult. Rinse your instruments in cool water. Hot water can cause proteinous substances to coagulate.

Manual Cleaning

If a mechanical cleaning method is unavailable, manual cleaning may be necessary. Likewise, if instruments are easily damaged, complex (requiring disassembly) or have small lumens, they may need to be cleaned manually.

When cleaning your instruments manually, wear heavy-duty rubber gloves, a plastic apron, eye protection and a mask. Use only neutral pH detergents.If your instruments are not rinsed properly, low pH detergents may break down the protective surface of stainless steel instruments and cause black staining.

Use soft plastic cleaning brushes to scrub the instruments. Do not use steel wool, wire brushes or other abrasive materials that could scratch the finish or dull your instruments. Visually inspect your instruments to ensure they are free of stains and tissue. Check each instrument for proper function and condition.

2.Mechanical Cleaning

Ultrasonic cleaning is the most effective cleaning method, because of its cavitation. As the sound waves vibrate through the cleaning solution, they create microscopic bubbles, which grow as the pressure in the unit changes. Eventually the bubbles implode. The bursting bubbles effectively dislodge debris, even in the most difficult to reach places. A neutral pH detergent improves the effectiveness of the cleaner, because it increases the number of bubbles. Before you begin, fill the ultrasonic cleaner with deionised water and detergent according to the manufacturers directions. Run the cleaner for several minutes to allow the temperature to equilibrate and to remove any gases from the solution.

3.Disinfection

Both thermal and chemical methods are available for HLD. As a general rule, surgical instruments are not susceptible to heat, making boiling the preferred method for disinfecting. Boiling instruments in 100 degree Celcius water for at least one minute kills all microorganisms, except for a few bacterial spores. Boiling does NOT sterilise equipment.

Bring the boiler to a rolling boil. Submerge open instruments in the boiling water. When the water returns to the boiling point, turn the heat down to a gentle boil. A rolling boil could damage instruments as they bounce around in the boiler. After one minute, remove the instruments from the water using a set of disinfected tongs. Allow the instruments to dry and lubricate the hinges. Do NOT leave boiled instruments in the water as it cools, because they could be re-contaminated. Discard the water when you finish disinfecting your instruments.

Sterilisation

Sterilisation kills all microorganisms and spores. Autoclaving (saturated steam under high pressure) is the most common method for sterilising surgical instruments, however, dry heat and chemical sterilants (ethylene gas, hydrogen peroxide gas plasma, etc.) can also be used.

Cold Sterilisation

Soaking surgical instruments in most cold sterilants requires 10 hours to sterilise them. This can be detrimental to fine instruments. If disinfection is required (and not sterilisation) a 10 to 90 minute soak in a cold sterilant may be all that is required. When using instruments with tungsten carbide inserts (needle holders, scissors, forceps), avoid using solutions with benzyl ammonium chloride.