Cleaning Catalog

8/14/2019 Cleaning Catalog

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Sontec Instruments

7248 South Tucson WayEnglewood, CO 80112(303)790-9411(800)821-7496Fax(303)792-2606

Everything you ever wanted toknow about surgical instruments

AND A LITTLE BIT MORE...

A guide to ensure you, that every time you need an instrument to work properly, it Does .


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In 1937 the author first realized the importance

of checking surgical instruments in the operating room. In

those days most of the surgeons owned their own instru-

ments. Problems were many for the Operating Room

supervisors because the number of surgical instruments

surgeons had was limited. Surgeons were forced to bor-

row from each other to complete their sets, especially

when some of their instruments were set aside for repair.In an average hospital it was not uncommon to

have 20 to 25 surgeons each owning his personal instru-

ments. It was necessary for Operating Room supervisors

to receive the surgeons permission prior to having his

instrument repaired. If a surgeon worked in several hos-

pitals in a city, his instruments had to be transported from

one hospital to another. In emergencies, the OR supervi-

sor had to improvise to make up sets, and much dissension

occurred among doctors as to who had borrowed their

instruments.

George Pencer taught many nurses the technique

of checking instruments, and in hospitals of 200 beds or

more , he would actually set up portable repair equipmentallowing the repair and sharpening of instruments without

removing them from the hospitals.

Since 1937 many advance in the quality, repair,

and ownership of surgical instruments have taken place.

But we feel this handy check list, reviewing the care and

maintenance of surgical instruments, should still prove

helpful for all members of the surgical team.

Forceps and Hemostats

A surgeon faces a most irritating and frequently

frustrating problem when a forcep or hemostat does not

function properly. In most cases, this can be avoided if a

surgical nurse knows how to check and test these instru-

ments correctly before including them in the surgical sets.

Forceps are probably abused more than any other

instrument. Experience indicates that breakdown of high

quality forceps is often the direct result of their misuse.

They are most frequently misused in orthopedic surgery.

Here they are often applied to steinman pins, bone plates,

screws, and nails-usually when pliers are not avail-

able. They also are used to clamp large sponges, tubing,

needles, etc. The smaller the misused forcep, for example

a Mosquito or Kelly, the greater the damage. As the jaws

of a forcep are overloaded, inevitably misalignment of thejaws occurs and reduction of tension in the shanks. Thus,

the instruments effectiveness is greatly impaired. When

this situation occurs in a Kelly or similar type instrument,

the forcep will not hold tissue securely: therefore, fail-

ing to accomplish the job for which it was intended. If a

surgeon continues to use the instrument, further damage

at an accelerated rate will result. For example: when the

jaws of a Allis clamp do not align, the teeth will not mesh

properly, and they will break or wear very rapidly. When

the jaws of an Ochsner forcep do not align and a surgeon

continues to use it, the tooth on the male jaw usually

breaks off. Thus, not only is the instrument destroyed, but

pieces of the tooth may be lost in surgery.

How to test a forcep for jaw alignment

Start with a visual test. Close the jaws of the for-

cep lightly. If the jaws overlap, they are out of alignment. On forceps with serrated jaws, observe to see if the teeth

are meshing properly. Holding the shanks of the forcep in

each hand , with the forcep open, try to wiggle the instru-

ment. If the box lock has considerable play, and if it very

loose, this will cause jaw misalignment. If this occurs, the

instrument is faulty and should be repaired.

Forceps and Hemostats which spring open

It is extremely annoying to a surgeon, and hazardous to the

patient, when a forcep or hemostat springs open; especially

when clamped on a duct or a large vessel, such as a kidney

pedicle. Operating room nurses have surely seen this hap-pen.

The above problem is usually caused by forcep

misalignment, worn ratchet teeth, or by lack of tension at

the shanks. As ratchet teeth are subject to constant metal

to metal wear, they are the fastest wearing parts of a for-

cep. By constant strain of closing and opening the instru-

ments, there is continues friction and wear; in particular

on the first ratchet tooth. Therefore, when a surgeon takes

a large bite with the forcep and locks it on the first ratchet

tooth, a small jar of any kind may cause it to spring open.

How to check the ratchet teeth on instruments

Clamp the forcep on the first tooth only. When

clamped, the instrument should produce a sounding snap.

After the instrument is locked on the first ratchet tooth,

take and hold the instrument at the box lock; then tap the

ratchet teeth portions of the instrument lightly against a

solid object (a weighted vaginal retractor is ideal). If the

instrument springs open, it is faulty and should be re-

paired.

How to check the tension between the shanks

Close the forceps lightly. When the jaws touch,there should be a clearance of1/16" or1/8" between the

ratchet teeth of each shank. Such clearance provides ad-

equate tension at the jaws when closed.

For a forcep to work effectively and efficiently,

the jaws must align and meet exactly; the serrations should

mesh correctly; the shanks should be flexible and resilient

to compensate for a larger bite. The ratchets must hold.

The forceps, when closed, must not spring open. The

ratchet teeth should slide over each other smoothly when

opening and closing. In short, the forceps should open and


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3close easily, permitting the surgeons to work rapidly and

efficiently.

Orthopedic Instruments

Chisels, osteotomes, and gouges in constant use

need sharpening and honing at frequent intervals. If they

are accidentally misused, such as on a steinman pin, bone

plate, or screw, the edges become dull and nicked. In thesecases, the instrument should be sharpened immediately.

Your author has been told that it is difficult for a surgeon

not to occasionally encounter a pin, a bone plate, or a

screw with an osteotome; particularly when it is neces-

sary to remove an old plate which has some bone growth

around it. In such a situation , it is prudent to have an older

or special osteotome or chisel available for the surgeon. In

the regular course of cleaning and sterilization, care must

be exercised not to hit the edges of the chisels, gouges, and

osteotomes against each other or other instruments. Such

jostling not only dulls the edges of the instruments, but it

can also chip or dent the sharp edges.

Visual test for checking orthopedic instruments

Check for nicks and burrs on edges on chisels

and osteotomes. On bone cutting forceps and double

action ronguers, one should again check to see whether

the jaws align. If the screws at the fulcrum are slightly

loose, the jaws inevitably become misaligned; conse-

quently damage occurs to the jaws when the instruments

are used. Frequently, a bone cutting forcep or ronguer is

used to cut wire or a pin. To preclude this practice, it is

very important to have wire cutter or pin cutter available

to the surgeon. Orthopedic instruments are very expensive;therefore, they merit exceptional care.

Tonsil Instruments

Adenotomes

The proper fitting of the adenotome blades is a

problem. An adenotome blade should slide smoothly in the

channels of an adenotome. When closed the blades should

not overlap the adenotome. If overlapping does occur,

the blade is too long and could be hazardous in use. If the

blade is to short , it will not close completely, causing tear-

ing of tissue rather than a clean cut.

Check the blades. Be sure they slide smoothlyand close so that no visible light can be seen between the

tip of the blade and the adenotome. When ordering new

blades, send your adenotomes to your surgical instrument

repair company and have the blades fitted to each adeno-

tome. This is very important because no two adenotomes

are alike, even though they may be the same size. Also,

be sure to have each blade stamped or lettered with the

same code number as the adenotome. For instance, if the

adenotome is coded 1-A, the blade should be coded 1-A.

This identification procedure insures a proper fitting blade

for each adenotome.

Tonsiltomes

If blades do not close properly, the sluder presents

the same problem as ill-fitted adenotomes. In checking,

be sure the blade slides close, so that no light is visible be-

tween blade and tip of tonsiltome. Also, the blade should

not extend beyond the tip of the tonsiltome.

Tonsil Snares

On tonsil snares, Tydings and Eves type, one

should inspect the tip of the cannulas. Tonsil snare wires

have a tendency to wear grooves into the tips of the can-

nulas, thus causing the wire to stick or catch and not pull

through the cannula completely. If the wire sticks, it will

have a pulling and tearing effect on the tissue instead of

a clipping effect. If grooves are visible in the tips of the

cannulas, the instrument should be repaired.

Eye Instruments

Cataract Knives, Keratomes

It is very important to know how to test a cataract

knife correctly. Once the eye surgeon penetrates the con-

junctiva of the eye with a cataract knife only to discover it

will not cut, he is in trouble.

A small buckskin is the proper device for de-

tecting a faulty knife. This item is a must for testing eye

knives. To make the test, lay the handle portion of the eye

knife across the palm of your hand. Do not touch it with

your fingers. Hold the buckskin drum in your other hand.

Then, push or slide the knife blade through the buckskindrum while it still rests in you palm. The blade should

penetrate the drum as though it were passing through

butter. If it sticks or has a tearing effect, then the knife is

in need of repair. The same procedure is used for testing

Keratomes.

Extreme care should be taken in handling all eye

instruments. Too much emphasis cannot be given to this

matter. During cleaning and sterilization, caution must be

taken to prevent the instruments from touching each other.

Metal to metal contact should never be permitted. Eye

instruments, even at best, can stand improvement.

There are a number of other fine eye cutting

instruments which are too numerous to mention in thisarticle; however, the same procedure of care should be

followed on them as on the cataract knives previously

discussed.

Scissors

Scissors, especially Mayo operating and Metzen-

baum dissecting, which do not cut on the tip of the blades

can cause surgical havoc. Not only should a dissecting,

or an operating scissor, cut tissue on the tips, but it is also


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4 needle holder. It is the only instrument involving constantmetal to metal contact. Many times when pliers are not

available, especially to orthopedic surgeons, needle hold-

ers are used on screws, pins, bone plates, etc.

How to test a Needle Holder

The test is very simple. First, clamp the needle

in the jaws of the needle holder. Then, lock the instrument

on the second ratchet tooth. If the needle can be turned

easily by hand, the instrument should be set aside for re-

pair. When the instrument is new, it will hold securely onthe first ratchet tooth for a considerable time.

Needle Holders, such as a Crile Wood, Derf, or

Halsey used in plastic surgery, should hold at least 6-0

suture. Eye needle holders, such as a Castroviejo or Kalt,

should hold 7-0 suture.

Lubricating surgical Instruments

Ordinary oil or mineral oil is not permeable by

steam and should never be used on surgical instruments.

Neither should it be used for oiling the screw lock on scis-

sors or the box-lock on forceps.

Extensive test have shown that oil will harborbacterial spores in box-locks even though the instruments

are autoclaved. Common lubricating oil acts continuously

as a collector of dust and dirt. The problems caused by

indiscriminate oiling if instruments are matters of grave

concern.

The development of a lubricant calledInstru-

ment- Milkresulted in a dramatic break through in the

science of instrument maintenance. After theInstrument-

Milkdip is applied, the instruments are autoclaved. The

lubricant's unique characteristics permit complete steril-

ization of both lubricant and instrument while lubricating

qualities are fully retained.

A knowledge of the operating and the testing

characteristics of surgical instruments can substantially

benefit many segments of the nursing profession. In-

struments which are kept in optimum conditions by

periodic testing, at least monthly, and which are repaired

as required, produce multiple profitable gains. Surgeons

save time and are able operate with unerring precision.

Operating Room supervisors abide in an atmosphere of

satisfaction which comes from doing an important as-

signment exceptionally well. Subsequently they develop

and enjoy increased rapport with surgeons and gain their

respect. Hospitals save money be keeping their surgical

instruments in optimum condition. As with the mainte-nance of most technical equipment, the best maintenance

is the cheapest. In consequence, the patient gains the most

from the increased potential for a completely successful

operation.

important that the scissor blades glide over each other

smoothly. Only a correctly ground scissor with properly

set blades can provide this action. The precise setting of

the blades is very important. To achieve this state involves

a highly skilled procedure. And it takes an exceptionally

skilled craftsman with years of experience to grind and set

blades correctly.

Various types of scissors are made for different

types of use. It is important, therefore, that the surgeonhas the proper scissors available to him. Light, fragile

scissors, such as eye scissors with fine blades, should be

meticulously guarded against misuse. For the surgeon to

work quickly and methodically, an eye scissor must have

a particularly smooth and delicate action and cut on the

tips of the blades. Dissecting scissors are made for the ac-

curate cutting and dissection of tissue. The tips and edges

of the blades of these scissors should not be used for any

other purpose. If a dissecting scissor, especially a Metzen-

baum, is used for cutting heavy sutures or catgut, not only

will the edge be dulled, but there will be a tendency for the

blades to separate thus causing the scissors to loosen and

lose their effectiveness.

Suture scissors should be available to the surgeon

for cutting sutures. Wire of any kind should never be cut

with scissors. A wire cutter should be available for this

purpose. A scissors should be used only for its intended

purpose.

Sharpening surgical scissors is a highly skilled

procedure. Very often when scissors are incorrectly

ground by a incompetent repairman, the blades become

overheated. Consequently, they loose their temper, and

the edge of the scissors is caused to soften. This situation

practically ruins a scissor because the blades will not hold

their edges and must be repeatedly sharpened. Constantsharpening, in turn, causes the tips to eventually become

pointed and sharp . In addition , the fact that they do not

close properly makes the instrument useless for dissecting.

How to test a scissor for maximum efficiency

All operating Mayo and Metzenbaum scissors

should cut four layers of gauze at the tips of the blades.

Smaller scissors less than 4" in length should cut at least

two layers of gauze at the tips. Additionally, eye scissors

should have a delicate touch when cutting. The Mayo

and Metzenbaum scissors should cut with a fine, smooth

feel and a minimum amount of pressure by the blades.Check the action the scissors; it should not be too tight or

too loose. Check the tips (points) of the scissors. Are

they too sharp? Are there burrs on the tips of the blades,

especially on the Mayo and Metzenbaum scissors? When

the scissors are closed, are the tips of the blades open? A

scissor should both cut on the tips and feel very smooth

when cutting.

Needle Holders

No instrument receives greater abuse than a


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5face upon which a continuous layer of chromium oxide

may form. Surfaces which may not be effectively polished

are usually the first to show corrosion. Thus, knurled

handles or handles with milled grooves may rust , while

the remainder if the instrument is unaffected. Even the

satin-like, dull finish used to reduce glare is somewhat

more prone to surface corrosion than highly polished sur-

faces. This surface corrosion will not penetrate deeply and

usually may be removed by scrubbing with a brush and anabrasive soap. Instruments with surface corrosion can be

repolished and passivated by the manufacturer to new con-

dition. Usually, the surface corrosion does not reappear

under proper maintenance thereafter.

A more distressing type of corrosion is that which

takes place on blades of knives, in box-locks or between

the blades of scissors. In these cases the function of the

instrument may be impaired. The most common causes of

this type of corrosion are as follows:

Inadequate cleaning and drying immediately

after use.The use of corrosive sterilizing solution or toolong exposure to sterilizing solution.

The use of faulty autoclave.

Probably the single most important consideration

in the care of surgical instruments is cleanliness. Any

foreign material either organic or inorganic on the surface

of hardenable stainless steel is likely to promote corrosion.

Thorough cleaning is more difficult than is realized by

some surgical nurses. This was shown by investigation

of Allegheny Ludlum Steel Corporation to determine the

specific cause of corrosion on certain surgical instruments.

A microscopic examination revealed foreign material scat-tered over the surface of these instruments. Also chlorides

were found in the corrosion products. These findings

indicate that the instruments had not been thoroughly

cleaned or rinsed. A good soap and rubbing is required.

Often a soft brush is needed. Such as the Whisk'R Brush

available from Sontec Instruments. Finally the instrument

should be disassembled after use, thoroughly cleaned, and

thoroughly dried before they are reassembled. Instruments

of this type will corrode if they are stored with trapped

moisture.

A convenient method of removing corrosion

products from inaccessible places is to soak the instrument

in a mixture of equal parts ethyl alcohol and aqueous am-

monia. After contact with this solution for about twelve

hours, the corrosion products may be rinsed or lightly

brushed away. This procedure is particularly useful in

freeing box-locks which have frozen because of corro-

sion. Box-locks present a problem due to a tendency to

retain sterilizing solutions and moisture; furthermore, the

intersurfaces are not polished.

Sterilizing solutions are a likely source of the

chloride found in the corrosion products. Certain qua-

CORROSION OF STAINLESS STEEL SURGICAL

INSTRUMENTS

Corrosion of stainless steel surgical instruments

is a constantly recurring problem to both the surgeons and

the instrument maker. The surgeon is justly chagrined

when he finds rust on his delicate hand made instruments.

The blame is likely to fall on the instrument maker when

no other cause is apparent. However, corrosion is not

uniformly observed. In some hospital corrosion of stain-less steel instruments is rarely seen, while in others, each

sterilization produces a coating of corrosion. The purpose

of this paper is to explore some of the causes of corrosion

and to indicate what is being done by the user to minimize

corrosion.

There is a need for some explanation as to the

choice of stainless steels used for fabricating surgical

instruments. Also a question may arise as to why stainless

steel should rust under any circumstances. In the usual in-

dustrial situation a manufacturer's choice of raw materials

is guided by economics. He must balance desired physi-

cal properties against costs. This is not the case in the

manufacture of hand made surgical instruments. Here, raw

material costs are insignificant compared to labor costs so

that only metallurgical properties are considered.

A wide range of metallurgical properties are of-

fered by the class of metals called stainless steel. These

metals have iron and chromium in common, but contain

carbon, nickel, sulfur, tungsten, manganese, molybdenum

and many other elements. It is chromium which imparts

the stainless quality; and in general, the more chromium

present in the alloy, the more resistant it is to the cor-

rosion. Carbon reduces the corrosion resistant effect of

chromium, but it is necessary to produce hardness. Hard-

ness is a prime consideration in instruments that requireextremely sharp edges or accurate jaw approximation. It is

a unhappy circumstance that there are only a few stainless

steel alloys which may be hardened sufficiently to be used

in the manufacturer of delicate surgical instruments. These

alloys are low in chromium content and high in carbon

content. They belong to the broad class known as stainless

steel, but are the least corrosion resistant of the group.

In order to minimize corrosion of these harden-

able stainless steel alloys, special handling is required

by the processor. A properly made instrument will have

passed through two processing steps which increase its re-

sistance to corrosion. In one of these steps, calledpassiv-

ation, the instrument is treated with nitric acid. This dis-solves away any particles of carbon steel which may have

been ground in during processing. All tools necessary for

fabricating are of necessity made of carbon steel (regular

steel). The nitric acid bath also promotes the formation

of a surface coating of chromium oxide. The formation

of the chromium oxide coating is usually considered the

mechanism by which chromium produces resistance to

corrosion in stainless steel.

Polishing is the second processing step which

reduces corrosion. Polishing removes sites of possible

corrosion attack by producing an extremely smooth sur-


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6ternary ammonium chlorides make good cold sterilizing

agents as they have very strong germicidal properties as

well as being detergents.

The detergent property results from the molecular

structure which contains a large organic group and an ionic

portion. Such compounds are inherently corrosive due

to the presence of the chloride ion. These materials are

usually compounded with rust inhibitor which is effective

for only a limited time. When cold sterilizing solutionsare used, they must be replaced frequently. If corrosion

still persists, the solutions should be prepared with distilled

water.

Corrosion during autoclaving will take place

if (1) the autoclave is not operating properly, (2) cor-

rosive materials are in contact with instruments or (3)

tap water instead of distilled water is used to generate

steam. Autoclaves in which a large amount of corrosion

takes place should be inspected for leaking valves. Such

autoclaves may not be drying the instruments adequately

or may even be drawing corrosive matter back from the

drain. The source of the trouble may be as remote as the

laundry. Cloth used to wrap instruments to be autoclaved

may contain residual detergents, bleaches or starch. These

compounds can promote corrosion at the operating tem-

peratures of the autoclave.

The best material now available for the manu-

facturer of surgical instruments is a hardenable stainless

steel. With this material, extremely fine points, sharp

edges and durable sets may be fashioned into instruments.

However, in obtaining hardness, some resistance to corro-

sion is sacrificed. Special handling by the manufacturer

as well as the user indicated. In order to reduce corrosion

, instruments must be thoroughly cleaned and dried, and

they must not be given prolonged exposure to sterilizingsolutions. Care should be taken that no corrosive materials

are introduced into the autoclave and that the autoclave in

functioning properly. Whenever the autoclave is suspect,

distilled water should be used. When corrosion does occur

in stainless steel instruments, it is usually of superficial

nature. This surface corrosion may be removed by soaking

in a solution of alcohol and ammonia or by repolishing by

the manufacturer.

Instruments used in speciality surgery are the

products of a few highly skilled craftsmen. At their finest,

these instruments reflect not only craftsmanship but a high

degree of artistic ability in design and styling. When such

instruments are give the very special care which they de-serve, they will retain their beauty and function for many

years.

utilizes proper technique during the use, care, and handling

of its surgical instruments.

Manufacture

Metallurgical research has enabled instrument

makers to produce accurate, long lasting surgical instru-

ments. The steel used in most O.R. instruments is a 400

series alloy which has several useful properties. It can

be brought to very sharp cutting edge and will hold thisedge through continuous use. In addition, it has a high

tensile strength enabling it to maintain precisely set jaw

approximations. The metal is often referred to as stainless

because of its corrosion resistant qualities. A chromium

content of 11.5-18% gives the steel some of its stainless

characteristics. However, a manufacturing step known as

passivation actually provides the instrument with its corro-

sion resistance properties. Passivation, which follows the

final polishing steps, is a chemical bath which creates an

oxidized layer on the surface on the instrument. Through

routine hospital use and exposure to the air this oxidation

process continues, effectively maintaining and even build-

ing up a barrier to most stains and corrosive elements.

Maintenance Procedures

Designed and crafted to exacting specifications,

instruments will perform for a reasonable number of years

when the following steps are observed:

Instruments should be used during surgery for

their intended purpose exclusively. Misusing instruments

will lead to damage that is usually not repairable. A he-

mostat, for example, that is used to clamp tubing can come

out of alignment and quickly break.

Certain compounds are highly corrosive tostainless steel and will cause serious damage despite the

passivated protective surface. Instruments should never be

exposed to Hydrochloric acid, Aqua regia, dilute Sulfuric

acid, Iodine, or Ferric chloride. In addition the following

substances should be kept away from instruments when-

ever possible:

Aluminum chloride

Ferrous chloride

Barium chloride

Mercury chloride

Bichloride of Mercury

Potassium Thiocyanate Carbolic acid

Potassium permanganate

Calcium chloride

Sodium Hypochlorites

Dakin's solution

Stannous chloride

Chlorinated limeInstruments should be rinsed immediately follow-

Every hospital owns many thousands of dollarsworth of surgical instruments. The care and maintenance

these instruments receive is critical to their performance

during surgery and to the cost containment effort of each

hospital. Having made the investment in a quality product,

the hospital can expect several years of use if the staff


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7ing contact with any of these substances.

It is important to rinse instruments that have

been exposed to blood and saline solutions before these

substances dry. Blood will cause a stain that is difficult to

remove, and saline solutions are highly corrosive. Instru-

ments should be placed in a basin of sterile distilled water

immediately following use.

The box-lock portion of instruments must be kept

clean and free of debris. A buildup of substance in thisarea will cause instruments to become stiff and eventually

break. Manual cleaning should remove all visible residue,

and it is essential to keep the box-locks open during any

automated cleaning procedure.

When cleaning, sterilizing and rinsing instru-

ments, it is important to use solutions with a pH as near

7.0 (neutral) as possible. Distilled water is recommended

rather than tap water 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 instru-

ments.

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. Manual cleaning will be most effective

with a solution of distilled lukewarm water and a neutral

pH detergent. This should be followed by a two stage

rinse of distilled water, first warm then cool.

The use of an ultrasonic cleaner is highly rec-

ommended. Avoid overloading the tank and always use

a detergent created for the use with these machines in the

suggested proportions. Thorough rinsing must follow

ultrasonic cleaning in order to remove suspended particles.

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

Follow manufacturers specifications when using

automatic washer-sterilizers. Use a freerinsing , low-

sudsing detergent with a neutral pH (7.0), and do not alter

prescribed cycle times. A high-sudsing detergent may

clean effectively but often leave residual deposits on the

instruments. Again, do not autoclave dissimilar metals

together.

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. The most

effective method of drying instruments are in a dry heatoven, a sonic energy oven, or a hot plate.

The use of water-soluble instrument lubricant is

recommended. This will help keep a clean box lock mov-

ing freely and will aid in protecting the entire surface from

mineral deposits. Note that ultrasonic cleaners remove

all lubricants which will result in stiff box locks; hence

this maintenance procedure should routinely be done after

ultrasonic cleaning and before autoclaving.

An effort should be made to protect sharp cutting

edges and fine working tips during all maintenance pro-

cedures. Such as tip covers by Medi Spec. Avoid loading

retractors and other heavy items on top of delicate and

hollow instruments.

Inspection is a vital part of proper care and main-

tenance. Instruments in need of repair will not perform

accurately in surgery and breakage is likely to occur.

Worn ratchets, loose box locks and misaligned tips can

be repaired at a fraction of the cost of new instruments.

Contact Sontec Instruments for information regarding acost effective instrument repair program.

Spots and Stains

It is common for instruments to become stained

or spotted despite the best effort of the manufacturers and

the hospital staff. In nearly all cases these problems are the

result of minerals being deposited upon the surface of the

instruments. Adhering to proper technique during cleaning

and sterilizing procedures will prevent most staining oc-

currences. However, they will not disappear on their own.

The following section identifies the various instrument

related problems hospitals may encounter.

Brown Stains

Detergents containing polyphosphates may dis-

solve copper elements in the sterilizer. This results in

copper being deposited on the instruments by an electro-

lytic reaction. The hospital may try a different detergent

or check the quantities used. Usually a dull blue or brown

stain is simply a buildup of oxidation on the surface. This

film is harmless and will actually protect the instrument

from serious corrosion.

Blue Stains

Are usually the result of cold sterilization tech-

niques. It is important to prepare the solution according

to exact proportions and to change the solution when

recommended. Serious corrosion may occur if the solu-

tion is used past the manufacturer's time limit. The use of

distilled water and rust inhibitor in the solution will help

retard discoloration.

Black Stains

May be the result of contact with ammonia.Many cleaning compounds contain ammonia and it will

remain on the instruments unless they are well rinsed.

A black stain may also be the result of amine deposits

traced to the steam in the autoclaves. Solutions contain-

ing amines are often used to clean the steam lines. It is

necessary to follow steam line cleaning procedures with a

cycle of distilled water to remove all traces of amines from

the autoclave system.

Light or Dark Spots


8/26

8

Are the results of slow evaporation of water

condensed on the instruments. What often remains is a

mineral deposit which is related to the mineral content of

the water. Using distilled water for sterilizing procedures

will help to eliminate the formation of these residual

spots. It is also important to follow manufacturer's specific

autoclave operating instructions. Spots may result, for ex-

ample if the autoclave doors are opened before the steam

is completely vented. An additional cause of spotting can

be traced to the instrument wraps. During laundering pro-

cedures it is vital that detergents are thoroughly rinsed out

and that the final rinse is prepared so that the wraps are left

with a pH between 6.8 and 7.0 This will inhibit spotting

during steam sterilization.

Rust Deposits

It is very unlikely for surgical grade steel to rust.

What appears to be rust is usually residual organic matter

in box locks or mineral deposits which have been baked

onto the surface of the instrument. Localities where the

water has a high iron content, for example, an iron depositwill result in a metallic film on the instrument. This is not

the fault of the instrument and can be prevented with the

use of distilled or demineralized water during cleaning

procedures.

Important Information

The use of neutral pH detergents is vital to the

maintenance of surgical instruments. Contact with acidic

or alkaline solutions will remove the instruments protec-

tive barrier of chromium oxide, often leading to corrosion,

pitting or breakage. There is no guarantee if the instru-

ments are continually exposed to acidic solutions pH4 andlower or alkaline solutions pH10 and higher.

Conclusion

The most effective method of dealing with

instrument problems is to prevent them from occurring.

The use of distilled water, careful preliminary cleaning,

using neutralized pH solutions, following manufactur-

ers instructions, visual inspection, will all help to keep

instruments performing accurately and cosmetically free

of troublesome stains. It is important to act quickly should

a problem arise. Delay will compound the problem and

irreparable harm may result.

PREPARATION FOR DISINFECTION

AND CLEANING

Disinfection of soiled instruments not only helps

to preserve the instruments themselves, but also serves

to protect those persons responsible for their transporta-

tion and cleaning. Wherever possible, instruments should

be disinfected and cleaned immediately after use. Any

soiling left to dry will make eventual cleaning much more

difficult and could result in damage to the instruments. If

necessary, instruments should be taken apart, allowing the

disinfectant to cover all surfaces.

For disinfection of the instruments either humid

heat or chemical disinfection can be used. Humid heat is

preferable providing the instruments are suitable for treat-

ment in this manner.

Occasionally, corrosive caustic agents and

medicines (e.g. silver nitrate, iodine preparations, albotyl

and mercury components) are used in operations and for

medical treatment. Remnants of these substances have to

be removed immediately.

Under no circumstances must instruments bestored in physiological saline solutions as prolonged con-

tact causes pitting and rust.

Undue "dropping" can cause damage to the

instrument, hard metal tips on scissors may be chipped or

small, delicate clamps can be deformed. In order to avoid

this, carefully handle and deposit instruments after use.

To avoid encrustation and corrosion, in case of

removal in dry conditions and return to CSSD, the instru-

ments must immediately be subject to machine treatment.

For this treatment, deposit the instruments on suitable

trays, e.g. perforated sterilizing trays. For effective clean-

ing, hinged instruments have to be opened(such as scis-

sors, clamps, gouge forceps).Instruments which are subject to machine treat-

ment have to be immersed into a combined disaffecting

and cleaning agent.

For removal in wet conditions and return to

CSSD use only noncorrosive agents in prescribed concen-

trations. Water alone is not sufficient. The instruments

have to be fully covered by the solutions.

Instruments should never be left overnight

before cleaning as the risk of causing permanent damage

increases with the length of time between use and prepa-

ration.

Handles and cables for HF-surgery have to be

prepared like surgical instruments.Microsurgical instruments require special prepa-

ration and for this reason have to be deposited on racks

or suitable holding devises. Dental materials, such as

filling materials, adhering to dental instrument have to be

removed directly after use. Otherwise there is the risk of

hardening and/or corrosion.

Rotating dental instruments such as burrs, drills,

and grinding tools, have to be separated and stored in spe-


9/26

9cial containers or holding devices; such instruments have

to be prepared separately.

If possible, surgical motors have to be dismantled

in to their components immediately after use; follow the

instructions of the manufacturer. Surfaces of the various

parts have to be wiped with a lint free cloth, impregnated

with a disinfecting and cleaning agent, or sprayed with a

disinfection spray in order to avoid blockage and encrus-

tation.Simple tools can be prepared like surgical instru-

ments.

Tubing sets for cooling liquid and spray nozzles

have to be rinsed immediately with water from the rinsing

bottle and checked for leakage (visual control, see chapter

"inspection").

Prior to preparation, rigid endoscopes have to be

dismantled according to the manufacturer's instructions.

Optical equipment has to be placed in special containers.

In case of flexible endoscopes , the insertion part

has to be wiped with a lint free cloth immediately after

use. The cloth should be soaked in instrument disinfectant

which should contain either a suitable detergent compo-

nent or a cleaning intensifier suitable for disinfectants.

In order to avoid encrustations and blockage, the

extraction channel and any other additional channels have

to be rinsed with the same solution, The air/water channel

has to be rinsed with water from the rinsing bottle.

Prior to further processing, the leak test has to

be carried out according to the instructions of the man-

ufacturer. This allows for the detection of leaks and

perforations in good time and avoids expensive subsequent

damage caused by the penetration of fluids.

A damaged endoscope together with a fault

description has to be returned immediately to the manu-facturer.

Cleaning and disinfecting of endoscopes should

preferably be done in automatic machines.

Dismantle elastic instruments and breathing sys-

tems according to the manufacturers instructions. Cones,

sealing surfaces, thread connections and valve plates have

to be carefully handled and protected against mechanical

damage.

Prior to preparations, completely remove breath-

ing line from the absorbers. Data readers have to be

prepared only according to the manufacturer's instructions.

Manual disinfecting and cleaning

For manual preparations, instruments have to be

immersed into a combined disinfecting and cleaning solu-

tion with proven disinfecting effect.

The instructions of the manufacturer have to be

strictly followed regarding concentration, temperature

and induction time. Special attention has to be paid to the

manufacturer's instructions with regard to material com-

patibility of instruments not made of high-grade steel.

Use fresh disinfecting and cleaning solutions ev-

ery 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 increasingconcentration caused by evaporation.

Decrease if disinfecting effect due to

excessive dirt concentration.

Instruments with a narrow lumen (tubings, cannu-

lae) or with cavities are generally difficult to prepare. One

must, therefore, take care that the passages are free and

that the inside is completely in contact with the solutions.

If powdered products are used, completely dis-

solve the powder first. Only then should one immerse the

instruments since undissolved particles may lead to clog-

ging of the narrow lumen and discoloration of the instru-

ments.

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 recom-

mended. Finally, the instruments have to be dried immedi-

ately.

Water on the surfaces of elastic instruments made

of rubber or plastic may cause white spots to appear which

can only be removed by drying.

If after manual cleaning , instruments are chemi-

cally disinfected instead of being sterilized, a separate

disinfectant has to be used.

The instruments then must be rinsed thoroughly

with sterile demineralized water.If pneumatic air used for drying, make sure that

the air flows through a sterile filter.

Preference should be given to manual preparation

of microsurgical instruments as they are very sensitive to

mechanical damage. Even then, damage is possible, e.g.

when removing blood encrustations, the main causes for

damage are:

Metal brushes

Scouring agents

Too much exertion

Dropping or knocking

For cleaning, it is recommended to use either

lintfree soft cloths, plastic brushes or cleaning pistols.

Drying with a pneumatic-air pistol is particularly safe and

effective and should therefore be given preference over

any other drying method.

In general, dental instruments can be prepared

like surgical instruments. Instructions for preparation of


10/26

10

dental instruments, recommended for separate treatment,

are given as follows.

Hand pieces and angled hand pieces as well as

turbines must not be immersed. The outside is either

cleaned with a cloth or sprayed with disinfectant. Only the

methods specified by the manufacturers have to be applied

for internal cleaning and care.

As a result of the material used, rotating dental

instruments have to be placed in special disinfecting and

cleaning solutions. In order to avoid corrosion, the instru-

ments, after quick rinsing, have to be dried at once and

treated with corrosion protecting agent suitable for steril-

ization. In the case of ceramic-bonded or plastic-bonded

grinding tools, one must first check whether the disin-

fecting and cleaning agents are suitable agents for these

instruments. Unsuitable agents may destroy the bonding

materials.

Root canal instruments are sensitive to me-

chanical damage and, therefore , have to be prepared

separately. Root canal instruments with color-anodized

handles will loose their color codes when attacked byalkaline solutions.

The various components of the surgical mo-

tor line have to be externally cleaned with lint-free cloth

impregnated with disinfecting and cleaning agents. Soft

brushes can also be used. When spraying the surfaces with

disinfection spray, wipe the parts afterward with a cloth.

Under no circumstances should these components be im-

mersed. Any penetrated liquid has to be removed immedi-

ately by turning the aperture upside down.

Simple tools can be prepared like surgical instru-

ments. Rigid endoscopes have cavities and channels which

are difficult to clean. Careful preparation of these instru-

ments requires:

Removing the seals/washers

Opening the stop cocks

Dismantling according to the manufacturer'sinstructions.

When immersing the endoscope into the cleaning

and disinfection solutions, make sure that all air bubbles

escape from the cavities by moving the instrument to and

fro or by holding it in a sloped position thus guaranteeing

complete wetting of the surface.

Do not use metal brushes or scouring agents, butonly swabs, cleaning guns and brushes with natural or

plastic bristles.

Use a wooden applicator with cotton wool soaked

in alcohol to gently rub off any dirt on windows or glass

surfaces, otherwise use a neutral detergent (hand washing

liquid).

Prior to preparation take off valve and caps from

flexible endoscopes, thus guaranteeing thorough clean-

ing and flushing of the channels. For cleaning, put the

endoscope in the container filled with instrument disin-

fecting and cleaning agent and make sure that the surface

is thoroughly wet.

Clean the channels with the brush belonging to

the system followed by flushing with the cleaning solution.

For this purpose some manufacturers offer a hand pump.

Take particular care when cleaning the distal end (optical

system, Albarran lever etc.).

Immediately after this pretreatment abundantlyrinse the instrument inside and outside with water. Then

place the flexible endoscope into the container with

instrument disinfecting solution so that all channels are

filled. The hand, 1.c. pump can now be used. Take care to

disinfect the extraction nozzle. Soaking time and solution

concentration have to be strictly observed according to the

instructions of the manufacturer.

After chemical disinfection, thoroughly rinse all

surfaces and channels leaving no residues. To avoid water

spots use demineralized water. Additional sterile filtration

of the water prevents undesired recontamination.

Dry the outside of the flexible endoscope with

a lint-free cloth. Drying the channels should be done ac-

cording to the manufacturer's instructions by using a hand

pump, light source and suction pump or by means of com-

pressed-air of max. 0.5 bar. Undesired recontamination is

prevented when sterile and filtrated compressed-air is used.

Elastic instruments with lockable cavities, such as

bellows and breathing masks, have to be cleaned and dis-

infected in closed conditions thus avoiding the penetration

of liquid into the cavities.

To avoid damage on diaphragms and functional

parts of the breathing system, no compressed air should be

used for cleaning. Machine preparation allows disinfec-

tion, cleaning, after rinsing and drying without having theinstrument handled.

Machine disinfection and cleaning

Machine preparation is usually done in the case of

a dry return to CSSD. When wet removal to CSSD is the

case, then either a low-foam producing disinfectant has to

be used or else the instruments have to be thoroughly pre-

washed as foam development in the machine can consid-

erably influence the cleaning results. This also applies for

instruments having to be pretreated either in a splashing

or by ultrasonic treatment because they are soiled. (e.g.

owing to dried-on blood and secreta or remnants of fillingmaterial).

The temperature of the inflowing water should

not exceed 45o

C as higher temperatures lead to protein

coagulation and cause cleaning problems.

Disinfection can either be performed chemother-

mally or thermally.

When using cleaning agents combined disin-

fecting and cleaning agents on it is recommended to

strictly follow the instructions of the manufacturer regard-


11/26

11ing induction time, concentration and temperature.

Using the correct dosage rate does not only

guarantee a perfect disinfection and cleaning result but

also the most careful treatment of the material. If alkaline

detergents are underdosed (false economy) there is a risk

of pitting, which can be avoided at pH-values over 10.5.

When acid detergents are used, corrosion may occur due to

the chlorides in the water. This can be prevented by using

demineralized water. With machine cleaning, special at-tention has to be paid to the following:

Hinged instruments have to be opened, thusguaranteeing thorough cleaning in the joint.

Do not overload the perforated trays so that allinstruments can be well rinsed.

A thorough internal flow has to be guaranteedwith instruments having long, narrow cavities

(tubing, cannula, breathing systems). Use

special inserts.

Place instruments in such a way that theycannot damage each other.

Place large and bulky instruments properly onthe ray thus avoiding "shadows" on other

instruments

Color-anodized aluminium instruments maylose their color and thus their coding function if

normal machine preparation methods are used.

Remnants from the cleaning phase have to be

totally removed in the subsequent rinsing procedures as

otherwise spotting and/or discoloration may occur. Ad-

ditional use of suitable neutralizing agent improves the

rinsing results.For final rinsing a temperature of 70-90

oC has

proved to be best.

Should corrosion occur on surgical instruments

due to bad water quality, then the rinsing temperature

should be limited to 70-75oC. Corrosion, water spots and

discoloration will be avoided when using demineralized

water for final rinsing . No temperature limit must then be

observed.

When the machine operation is done without dry-

ing, then the goods have to be removed from the machine

immediately after the program has finished. If drying is

not sufficient, repeat it.

Machine preparation for microsurgical instru-ments is possible if the instruments are held in place in

reliable and safe manner, e.g. racks.

Dental instruments can be treated like surgical

instruments for machine preparation. Pay special attention

to the following:

Probes and other delicate instruments have toplaced in racks or holding devices to be pro-

tected against damage.

Rotating instruments like burrs, drills, milling

cutters and grinding tools are suitable for

machine preparation only to a limited extent.

Preference should be given to an ultrasonic bath.

Root canal instruments should also be cleanedin an ultrasonic bath.

Hand pieces can be prepared in a machine onlyif recommended by the manufacturer; special

holding devices are, however, necessary.Immediately after the end of the machine

program remove any moisture using a mainte-

nance spray recommended by the manufacturer.

Mouth mirrors may be dull due to machinetreatment which will shorten their life

span.

With the exception of simple tools and acces-

sories, machine preparation for disinfecting and cleaning

is not possible for the components of the surgical motor

line.

Rigid endoscopes have to be dismantled for ma-

chine preparation according to the manufacturer's instruc-tions. Seals/washers have to be removed and stop cocks

opened.

Machine preparation should only be done if

recommended by the manufacturer for this procedure (e.g.

optical equipment). In order to avoid damage, secure the

parts safely and make sure that the insides of all cavities

are thoroughly flushed.

Flexible endoscopes can only be processed in

special automatic machines. Standard disinfecting and

cleaning machines are not suitable. If endoscopes are

disinfected prior to machine preparation, only use a low-

foam product as foam which develops in the machine will

deteriorate the cleaning and disinfecting results.

Prior to further processing, the leak test has to be

carried out according to the manufacturer's instructions.

This allows for the detection of leaks and perforations in

good time and avoids expensive damage caused by the

penetration of fluids.

There are machines in which a leak test is incor-

porated either before or while the program is activated. A

leaking endoscope has to be returned to the manufacturer

together with a fault description.

Standard alkaline cleaning agents may cause

damage to the endoscopes, therefore, use only those

products recommended as suitable by the manufacturer.Chemo-thermical processing should not exceed a tempera-

ture of 60oC.

During machine preparation, make sure the

endoscope is secured and that all external surfaces and the

inside of all channels are thoroughly and reliably flushed.

Final rinsing should be performed with sterile

demineralized water. If, for technical reasons, this is not

possible, at least water of drinking quality must be used.

Subsequent to final rinsing, machine drying should be pos-

sible. Prior to storage, thoroughly dry the endoscopes.


12/26

12Elastic instruments with lockable cavities, such as

bellows, breathing masks etc. have to be cleaned and dis-

infected in closed conditions thus avoiding the penetration

of liquid into the cavities. To avoid overstretching of the

edge of the mask, remove the nipple prior to preparation,

press out some air and replace the nipple.

Elastic instruments, made of PVC for example,

with low temperature resistance have to be disinfected,

cleaned and dried at max. 65o

C.Care has to be taken with rubber instruments

because imperfectly removed residues of cleaning agents

lead to irreversible damage by subsequent drying and ster-

ilization. The surface of the material depolymerizes and

gets sticky. Latex-coating dissolves under blistering.

Especially serious are residue not completely

flushed out of functional parts of the breathing system.

Furthermore, all parts have to be completely dry as rem-

nants of moisture may lead to functional troubles.

Elastic instruments may not be dried above 95oC;

higher temperatures considerably shorten their life span.

Functional parts of breathing systems are

specially designed by the manufacturers of either units.

Preparation can, therefore, only be performed according to

the manufacturer's instructions.

Ultrasonic treatment

Ultrasonic treatment is particularly suitable for

cleaning instruments of high-grade steel. Delicate instru-

ments (microsurgical instruments, dental instruments) can

be carefully and thoroughly cleaned by ultrasonic treat-

ment.

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 when

preparing a bath:

Fill the bath to the markings.

Add a suitable cleaning and/or disinfectingagent to the water

Temperature above 40oC promotes degassingand cleaning.

No protein coagulation occurs at highertemperatures if suitable cleaning agent is used.

When using disinfecting and cleaning agents

make sure that the concentration and tempera-tures are correctly maintained.

Even with a properly prepared bath, faults can

arise. These can be avoided by observing some principle

rules:

Instruments have to be completely covered bythe cleaning solution. Non-immersed instru-

ments will not be cleaned.

Hinged instruments, e.g. scissors, have to be

opened

Only trays which do not affect the ultrasonictreatments should be used.

Large and bulky instruments such as lead handsor 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.

An excessively dirty solution in the ultrasonicbath decreases the cleaning effect and increases

the risk of corrosion. Depending on the frequent

cies of use, the solution has to be renewed at

regular intervals.

Ultrasonic treatment times of approx. 3 minuteshave proved to be efficient for cleaning at

frequencies of at least 35 KHz.

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 inorder to avoid water spots.

The instruments should then be thoroughly dried.

To avoid damage, microsurgical instruments have

to be deposited on special racks.

In order to avoid destruction of surfaces and

soldering seams on dental instruments, no acid cement

remover should be added to the ultrasonic bath.

Hand pieces and turbines are not suitable for

ultrasonic cleaning.

As a result of the material used, rotating dental

instruments have to be treated with special disinfecting

and cleaning agents. Prior to ultrasonic treatments place

them on special holding devices to avoid contact damage

between the instruments (e.g. by sharp cutting edges, dia-

mond grain). After a quick rinsing under running water

followed by immediate drying, rotating dental instruments

have to be treated with a corrosion protecting agent suit-

able for sterilization.

Mouth mirrors can be damaged by ultrasonic

treatment.

Under no circumstances use ultrasonic treatments

for components of the surgical motor line, with the excep-

tion of simple tools and accessories.

Ultrasonic treatment is only allowed for those

parts of rigid endoscopes which are suitable for this proce-dure according to the manufacturers's instructions (e.g. no

optical systems).

Flexible endoscopes are not to be treated in an ul-

trasonic bath. Accessories, such as valves, caps, bite rings,

and forceps are suitable for ultrasonic treatment.

Elastic instruments are not suitable for ultrasonic

treatment as ultrasonic waves have no effect on elastic

surfaces.

Functional parts of the breathing system can also

not be prepared in an ultrasonic bath.


13/26

13

Care and maintenance

Instruments with joints or ratchets have to be

treated with suitable lubricating agents during the clean-

ing process.

These lubricating agents prevent the friction of

metal on metal and preserve smooth function of the instru-

ments, thus avoiding corrosion by friction. Furthermore,constant use of such agents prevents "sticking" of the

hinged parts.

The care agents can either be applied manually or

during the final rinsing in the machine.

In any case it is indispensable that threads, joints

etc. difficult to access are directly treated with each prepa-

ration.

Dental instruments have to be cared for like

surgical instruments with the exception of the following:

Hand pieces, angular hand pieces as well as

turbines have a very complex internal design.Therefore, they have to be treated with special

agents in accordance with the instructions of the

manufacturer.

Immediately after drying, treat all rotatingdental instruments (drills, burrs) with a

corrosion protection agent, suitable for steriliza-

tion in hot air or steam.

Motor lines have to be lubricated and maintained

with agents recommended by the manufacturer. Hand

pieces which are not watertight have to be sprayed with

special care agents for inside cleaning and lubrication.Apply a few drops of special oil into the supply

channel of pneumatic surgical motor. To distribute the oil

inside , run the motor for a few seconds with compressed-

air. Proper lubrication and maintenance of the motor

line is of great importance, therefore, the manufacturers

instructions must be followed.

Rigid endoscopes must be lubricated.

However, joints and non maintenance-free stop-

cocks may have to be treated with special oil or special

grease according to the manufacturer's instructions.

The only necessary maintenance on flexible endo-

scopes is to treat the valves with silicon oil before inserting

them into the valve housing. Do not spray them with car

agents as the propellent gases will damage the instruments.

Only silicon oils and grease-free gels should be

used as lubricants. Agents containing vaseline or paraffin

cause swelling or softening of rubber parts.

Refrain from treating elastic instruments and

breathing systems with lubricants prior to sterilization.

Special care and maintenance measures are prescribed by

the manufacturer, should the need arise.

Elastic instruments of silicon rubber may not be

treated with silicon because of swelling which makes them

inoperable. Under no circumstances use paraffin agents

for rubber and latex instruments; this prevents them from

swelling up.

Inspection

After each cleaning, the instruments have to be

macroscopically clean, ie. free of visible protein remnantsand other contamination.

Prior to functional inspection, surgical instru-

ments with movable parts should be cooled down, thus

avoiding metal friction leading to corrosion. Before car-

rying out functional inspection, oil any instrument with

joints, ratchets or threads.

Instruments with non-traumatic toothing have to

be specially inspected, and, if necessary, manually reclean

the non-traumatic toothing.

Worn out or damaged instruments should be

removed for repair or replacement. Corroded instruments

should be discarded immediately as these can cause con-

tact corrosion even on a perfect surgical instrument.

Stains on surgical instruments are due to improper

preparations. Cause of such stains or spots can be:

Insufficient mechanical or manual cleaning.

Unsuitable cleaning, disinfecting and careagents.

Failure to observe the dosage instructions forcleaning, disinfecting or care agents.

Remnants of cleaning and disinfecting agents-insufficient rinsing.

Poor water quality.Residue in the sterilizing steam, when steamquality is not accordance with recommenda-

tions.

Remnants of medications, marking pens orchemo-indicators.

Procedural faults e.g. not cleaning brand-newsurgical instruments prior to sterilization.

These and other causes for spots on surgical

instruments show the complexity and difficulty of the

problems dealt with here. To facilitate tracing and finding

the cause for such stains, it is recommended to cooper-ate with competent manufacturers. By making use of the

company's service, you will not only take advantage of

their practical experience but their well-equipped laborato-

ries as well.

To avoid permanent damage, instruments with

remnants on the surface have to undergo a special treat-

ment. The method of treatment is adapted to the cause of

the stain. In order to avoid damage and subsequent corro-

sion due to metal friction, under no circumstance use metal

brushes or metal sponges to remove stains. More details

about causes of stains and corrosion are given in chapter


14/26

14

12.

Each surgical instrument is designed for a specific

purpose. Inspection has to be carried out to ensure that

they function as they should. If any doubt, a reliable man-

ufacturer can advise you on suitable inspection methods.

Especially 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 toprevent them from slipping.

Faultless surgical instruments should not be

packed together with instruments having damaged sur-

faces. Older instruments with chipped chromium and/or

nickel coating may cause discoloration or corrosion on

high-grade surgical instruments. It is, therefore, recom-

mended to discard such instruments or pack them sepa-

rately.

Handles, cables and cables for neutral electrodes

for HF-surgery have to be checked for faultless function.

(Caution: defective contact). It is compulsory to

sort out defective parts.

Prior to sterilization the surgical motor line with

accessories should undergo a functional inspection accord-

ing to the manufacturer's instructions.

Units operating with compressed air should be

checked for leaks and be given a functional inspection.

Any leakage will be audible or can be found by immersing

the hose into water.

For checking the exhaust channel additionally

connect the pneumatic surgical motor to the compressed-

air hose. With the motor running, leaks can be best

detected in the water.

Simple tools are inspected as general surgical in-

struments. In order to avoid damage during transportation,store the tools in special racks or place them in suitable

holding devices to prevent them from slipping.

The leak test for tubing sets for cooling liquid

can be carried out by means of a clamp and a large syringe

filled with water. Fill the tubing with water; close one end

with the clamp, and insert and empty the filled syringe in

to the other end.

In case rigid endoscopes are used, check the ad-

ditional instruments for HF-surgery for absolutely perfect

installation. Exchange damaged parts.

Surfaces of electrodes/loops must be free from

encrustations which can be removed with fine abrasive

powder. Take care that neither insulation nor clips getdamaged or deformed.

To avoid damage to optical systems, clean them

carefully with a swab, moistened with alcohol. If this does

not remove the clouding return the part to the manu-

facturer for inspection. Damage can be avoided by using

wooden or plastic applicators, metal is not suitable.

Optical wave guides and fibre-optic cables have to be

checked for optical fibre breaks. To find this out, take one

end of the fibre optic cable, hold it against the light and

then look into the other end. Little black spots indicate

breaks in the fibres. A large number of breaks reduces the

light output. Such fibre optics as well as endoscopes with

surface damage and surface deformation should be sent for

repair.

Normally, clouding of the optical system on flex-

ible endoscopes can be removed by using a wooden appli-

cator (not metal) soaked in alcohol. If this does not help,return this instrument to the manufacturer for inspection.

Optical fibre breaks in the optical wave guide can

be seen by holding the proximal end against the light and

looking into the distal end. Quite a number of breaks con-

siderably reduce the light output. Such damaged instru-

ments have to be returned to the manufacturer.

Endoscopes with visible external damage (e.g.

deformation in the insertion part or on the supply tube,

overstretched angled rubber) have to be returned to the

manufacturer.

Flexible endoscopes are best dried while sus-

pended and should be stored unfolded. Locks and feed-

reels should be loosened. The transportation case should

be used for storage.

Prior to every use, check all functions of the

endoscope. Use only silicon oils or greaseless gels as

lubricants. Under no circumstances should vaseline or

lubricants containing paraffin be used as these cause soft-

ening or swelling.

Breathing systems have to be inspected according

to the manufacturer's instructions.

Elastic instruments have to be inspected ac-

cording to their function and range of use. The most

important inspections are:

Bellows have to be undamaged and airtight

Filling system of the bellows must not show anyleakage.

Lumina of catheters and probes have to be free.

Connections have to meet functional safety.

There should be no changes of design, e.g.radius of curvature of tracheal tubes.

Elastic instruments with faults or damage have to

be replaced. Frequent problems are

Dissolvation (blister forming)

Cracked surface

Sticky surface

Hardenings

Porous surface

Discoloration


15/26

15

To prevent premature failure, take care that elastic

instruments are stored in a dry place without being kinked

or overstretched.

Sterilization

General

Sterilization conditions as well as units have to bein conformity with valid quality standards.

Follow the sterilization instructions of the

manufacturer. Sterilizing accessories as well as sterilizing

packings have to meet the requirements of the both the

instruments as well as the sterilizing method used.

Autoclaving

Normally, autoclaving is performed with satu-

rated water steam at 134oC. In special cases a temperature

of 121oC can be used for a longer time.

Sterilization procedure has to be standard suitably

for the goods to be sterilized. Sterilizing packings have

to meet the valid standards with regard to quality and ap-

plicable to the procedures selected.

Steam used for sterilization has to be free from

any contamination and should neither impede the process

nor do damage to the sterilizer of the goods to be ster-

ilized. In order to guarantee this, meet the recommend-

ations of pr EN 285 regarding the quality of the water in

the tanks as well as the condensate, 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 stresscracking 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.

The loading weight of perforated trays filled with

instruments should not exceed 10kg.

After sterilization, instruments have to be stored

dry until used again. Instruments as well as the inner

covering of sterilized goods have to be absolutely dry after

having cooled down to room temperature.

Excessive condensate production during ster-

ilization is avoided by observation of the recommended

maximum weight for loaded perforated trays. Drying is

facilitated by wrapping the perforated trays into a clothwithin the container or external paper packing.

If heavy sets are unavoidable, the instruments

should be distributed among several perforated trays. In

addition, special measures may be necessary for drying.

In general, dental instruments can be autoclaved

like surgical instruments. When separate treatment for

dental instruments is necessary, obey to the following

instructions.

Rotating dental instruments (e.g. burrs ormilling cutters) can be autoclaved.

Hand pieces should, wherever possible, beautoclaved at 134

oC, due to the shorter

induction time.

Check whether turbines are suitable for autoclaving with the manufacturer.

For mouth mirrors, refer to manufacturer'sinstructions.

All components of the surgical motor line, meant

for sterile application, can be autoclaved at 134oC. Refer

to the manufacturer's instructions. Special instructions of

the manufacturer have to be observed for storage during

sterilization.

Hoses for compressed-air have to be protected

against pressing during sterilization.

Apart from the optical system with rigid endo-scopes, all endoscope parts (insert, trocar, trocar sheath,

shaft, mandrel) have to be separated from each other and

can then be sterilized like other surgical instruments.

Sterilizing instructions from the manufacturer have to be

observed for optical systems. Optical systems suitable

for autoclaving should be processed at 134oC instead of at

121oC due to the shorter thermal stressing.

Flexible endoscopes are not autoclavable due

to restricted temperature compatibility. If necessary, use

gas sterilization. Instruments used for endoscopy, such as

clamps, catheters etc. may be autoclaved.

Elastic instruments with and without bellows

made of silicon and natural latex are suitable for auto-

claving. Due to the shorter thermal stress, preference is

given to a processing at 134oC. Items of thermo-materials

(plastic) may only be autoclaved if recommended by the

manufacturer.

When elastic instruments are autoclaved, take

care that the cavities, e.g. edge of mask, bellows are open

in order to avoid damage due to changes in pressure.

Prior to sterilization, cavities closed with valve

(e.g. bellow catheters) have to be sucked free of air and

water by means of a syringe.

Functional parts of breathing systems can be

autoclaved at max. 134

o

C. Cavities must not be closed inorder to avoid damage to the valves.

Hot-Air Sterilization

When surgical instruments are hot-air steril-

ized, please take care to load and operate the sterilizers

properly. To ensure safe sterilization, the temperature

should not be below 180oC but should not exceed 200

oC as

this may cause structural changes leading to irreversable

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


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16for 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.

Dental instruments can generally be sterilized like

surgical instruments. When separate treatments for dental

instruments is necessary, obey to the following instructions:

Temperature should not exceed 180oC whensterilizing hand pieces.

Turbines are not suitable for hot-air sterilization.

Burrs and milling cutters must not be sterilizedat a temperature exceeding 180

oC in order to

avoid softening.

The sterilizing of mouth mirrors has to becarried out in accordance with the manufacturers

instructions.

Components of the motor line are only partly suit-

able for hot-air sterilization, due to the various materials

used.

Rigid endoscopes are not suitable for hot-air ster-

ilization.

Flexible endoscopes are not suitable for hot-air

sterilization.

Elastic instruments are not suitable for hot-air

sterilization. Breathing systems are not suitable for hot-air

sterilization.

Gas Sterilization

Gas sterilization should only be used when no

other method is suitable.

Components of motor line should only be gas ster-

ilized when explicitly recommended by the manufacturer.

Optical systems of rigid endoscopes may be gas

sterilized, however, follow the instructions of the manu-

facturer.

Flexible endoscopes can be gas sterilized at a tem-

perature limit of 60oC. Use higher temperatures only when

indicated by the manufacturer.

For gas sterilization, the flexible endoscope is

packed in a transparent sterilizing hose allowing a curva-

ture diameter of at least 30cm. It is very important to make

sure that the venting cap is adapted to the supply connectoras otherwise irreversible damage will occur.

To ensure protection against mechanical dam-

age, the sealed flexible endoscope is put into a wire basket

belonging to the gas sterilizer. Again, pay attention that the

curvature diameter is not less than 30cm.

Goods sterilized with ethylene oxide require suf-

ficient airing times before being used again. Depending on

the goods sterilized and on available airing conditions, such

airing times can differ considerably. Reliable airing times

can be given only by the manufacturer of endoscopes.

After airing, flexible endoscopes should be stored in an

extended position.

Elastic instruments of thermolabile plastic are not

autoclavable but can be gas sterilized if the manufacturer

gives instructions about a suitable procedure.

Elastic instruments of rubber and functional parts

of breathing systems do not have to be gas sterilized; use

autoclaving.

Treatment of brand new instruments

Packings of brand-new instruments have to be

removed and instruments have to be stored in dry rooms,

open to air. Temperature fluctuations may otherwise lead

to condensation within the plastic packing and thus cor-

rosion.

Under no circumstances store instruments in

cupboards or rooms where chemicals are kept which can

produce corrosion vapors.

Prior to first use, brand-new instruments have to

be prepared. First remove any protective caps or foils.

Cleaning, rinsing, lubrication, inspection and sterilization

have to be carried out according to the procedures previ-

ously described.

Prior to the first preparation, microsurgical instru-

ments have to be placed in racks or holding devices to

avoid damage.

Elastic instruments have to be kept in their

original packing and stored in a dry, cool and dark place.

When ordering supply, please keep in mind that in addition

to wear through use, elastic instruments are prone to aging

even when in storage.

Functional parts of the breathing system fre-quently contains valves or membranes which can get

sticky when stored for a longer period. Such valves or

membranes have to be tested and operated before being

put to use.

Special information

By following these instructions properly, thereis no difference in the preparation of instru-

ments with a mirror finish or matte surface.

These instructions do not refer to disposable

items Instruments and cables with optical waveguides

can generally be prepared like surgical

instruments, if the manufacturers have not given

other instructions. Only hot-air sterilization and

ultrasonic baths cannot be used.

Fibre-optic cables should not be bent, nor coiledtoo tightly.

Cables and handles for HF-surgery can be


17/26

17machine prepared and are autoclavable.

For all other preparation processes, refer to the

instructions of the manufacturer.

Water for preparation

Instruments must have certain characteristics

in order to fulfill their function (e.g. cutting ability ofscissors, clamping force of clamps and forceps). Only a

very limited number of steels meet these requirements.

Unfavorable water composition can, therefore, have a

detrimental effect on such steels. Consequently, the qual-

ity of water must be taken into account when planning the

sanitary installations.

Ordinary water contains dissolved salts. The

amount of salts contained varies depending on the water

purification process. Evaporation of water leaves remnants

of salty encrustations (lime). Of all water components,

chlorides have to be regarded as the most potentially dam-

aging because in higher concentrations they cause pitting

on instruments.

The relationship between chloride content in the

water and pitting are not predictable in some cases.

In general, the danger of chloride induced pitting

rises with:

Increasing chloride content

Increasing temperature

Decreasing pH-value

Longer induction time

Rougher instrument surface

Insufficient drying

Experience shows that with a chloride content up

to approx. 129mg/1 (corresponding to 200mg/1 NaC1=

sodium chloride) the possibility of pitting is low but rises

rapidly with increasing chloride content.

Low concentration of other components can cause

brown, blue, grey-black, or rainbow colored discoloration.

Such discoloration can be caused by contact with the ele-

ments iron, copper, manganese, magnesium and silicon in

the water. Generally, there is no corrosion. By immersing

or rubbing the instruments with suitable products contain-

ing acid (follow the instructions of the manufacturer) such

decolorization can be removed to a great extent. In addi-tion to the natural water components, sometimes there are

rust particles in the water. Almost always, such rust comes

from corroded piping systems. When preparing the instru-

ments, such rust particles deposit on the goods and cause

rust spots (extraneous rust) followed by corrosion.

Make it a basic rule to use demineralized water

for final rinsing.

Even when using an ion exchange for demin-

eralization, tarnishing can occur due to penetration of

silicic acid. The remedy is in-time regeneration of the

exchanger-consult an expert.

Materials

When producing surgical, microsurgical, and

dental instruments, the manufacturer will use the materials

most suitable for the purpose for which the instrument is

intended.In most cases, the demands for high elastic and

toughness, good cutting ability and high wear resistance,

together with best possible corrosion resistance can only

be answered by using metal materials for surgical instru-

ments. Therefore, stainless and hardenable chromium

steels with a chromium content of approx. 13% are used.

Instrument characteristics, such as smooth and homo-

geneous surface, a matte or mirror finish, and a hardened

condition can be achieved with steels. The user has to

observe, however, that these instrument steels, listed in na-

tional (DIN) and international (ISO) standards, are gener-

ally resistant to chemical and thermal stress as occurring in

doctor's practices and hospitals, but are, on the other hand,

very sensitive to stress corrosion and chloride induced pit-

ting.

Apart from the hardenable stainless chromium

steels, non-hardenable chromium steels with modified

chromium content and rust and acid resistant chromium-

nickel steels are used. The use of the latter steels is limited

to certain instrument types due to restricted mechanical

properties.

For the manufacturer of rigid and flexible endo-

scopes of all kinds, chromium steels are hardly taken into

consideration. Due to the application technique and design

of the endoscopes, the greatest variety of mater

Documents

Cleaning Catalog