Cleaning Precautions
The following are the cleaning precautions you should keep in mind:
- Time, temperature, and agitation are essential for instrument cleaning.
- Avoid harshly soaking the tools in hot water, alcohol, disinfectants, or antiseptics, and do not soak the tools for more than two hours.
- Use soft materials or paper cloths, water spray guns, or soft plastic brushes made of nylon.
- Do not use steel wool, wire brushes, pipe cleaners, or abrasive detergents to remove residue.
Manual Cleaning and Soaking
Instruments should be cleaned immediately after use. When cleaning the instruments manually, be careful with the tips to avoid damage. Moreover, after rinsing the instruments with distilled or demineralized water, choose a cleaning and disinfecting solution suitable for the instruments. It is recommended to use neutral pH detergents to avoid corrosion, pitting, and breakage. Furthermore, you should use small, hand-held nylon (not steel) brushes to clean the instruments while immersed in the solution. This will remove the soil from the tools and enhance patient care.
Ultrasonic Cleaning
Ultrasonic cleaning is the most effective method for cleaning surgical instruments from deep surfaces. In this procedure, the sound waves from the ultrasonic device create bubbles in the solution that dislodge dirt and particles, even in tight spaces. Following are the guidelines we recommend during ultrasonic cleaning:
- Place the instruments in an open position to avoid sharp tools from touching other instruments, and do not pile them up.
- Use a free-rinsing, low-sudsing detergent with a neutral pH (6.0 - 8.5).
- Do not use this method for delicate and micro instruments to avoid damage.
- Never place dissimilar metals, such as stainless steel, copper, etc., in the same cleaning cycle.
- Follow the manufacturer’s specifications for automatic washer-sterilizers.
Rinse and Dry
When the ultrasonic cleaning process is completed, ensure that the instruments are cleaned with distilled, pyrogen-free water to remove all traces of debris and cleaning agents. After thoroughly rinsing the instruments, allow them to air-dry before storing. Additionally, use a soft, absorbent towel or cloth to dry the external surfaces.
Lubrication
After properly cleaning the instruments, lubricate all the joints and movable parts, such as boxlocks and hinges, regardless of their surface coatings. This lubrication should be done after the ultrasonic cleaning and before sterilization for complete care and maintenance of the tools. Furthermore, do not rinse the instruments after this step.
Sterilization - Autoclaving
Sterilization is an essential step in cleaning and maintaining surgical instruments. Autoclaving, also known as steam sterilization, is the most common method to sterilize instruments. In this method, the instruments are sterilized with steam that comes from distilled water and is free of all impurities. The instruments can be autocalved individually or in sets, but in the open and unlocked position. Instruments may be packaged in rigid containers or those cleared for use in sterilization. Packaging should ensure the sterility of instruments until they are opened for use at the sterile field and permit the removal of contents without contamination.
However, try not to put too many instruments in at once, as this may hinder steam penetration. We recommend placing a cloth or towel on the bottom of the pan to absorb moisture. Additionally, ensure that the close has no residue of detergents and is pH neutral.
Here are the recommended steam sterilization parameters to achieve a Sterility Assurance Level (SAL) of 10-6:
Independent laboratory testing conducted according to ISO 17664, has validated the following sterilization parameters. | |||
Sterilization Method | Temperature | Exposure Time | Dry Time |
High Vacuum Steam (Pre-vacuum) | |||
Wrapped | 270ºF (132ºC) | 3 minutes minimum | N/A |
Independent laboratory testing, referencing FDA (21CFR Part 58) Good Laboratory Practice Regulations have validated the following parameters. | |||
High Vacuum Steam (Pre-vacuum) | |||
Unwrapped in containers Perforated stacked/unstacked Solid unstacked | 270ºF (132ºC) | 3 minutes minimum | 20 minutes |
Gravity Steam | |||
Unwrapped in containers Perforated unstacked | 250ºF (121ºC) | 4 minutes minimum | 20 minutes |
Gravity Steam | |||
Wrapped in cassettes | 250ºF (121ºC) | 45 minutes | 20 minutes |
Ethylene Oxide (EtO) | |||
Unwrapped in containers Perforated unstacked Solid unstacked | 131ºF (55ºC) | 30 minutes | 60 minutes (minimum) Concentration: 725 mg/l Humidity: 70% Aeration time: 8 hours minimum |