Procedure for Cleaning

Procedure Recommended for Cleaning, Maintenance & Sterilization of Surgical Instruments

Rinsing 

Immediately after surgery, rinse instruments under warm or hot running water to remove most blood, bodily fluids, and tissue residue. 

Disinfecting  

Protecting Medical Personnel During Cleaning: 

1. Soak instruments in an enzymatic cleaner bath for at least 10 minutes to prevent blood and proteins from adhering to their surfaces. After soaking, rinse thoroughly under running tap water.
2. Fully immerse instruments in a PA-approved disinfectant for a minimum of 10 minutes, then rinse again.
3. Avoid using bleach or similar chemicals on stainless steel instruments, as they can cause severe pitting and void the manufacturer’s warranty.

Cleaning  

Submerge instruments in a neutral pH (7) detergent solution mixed with water. 

Ultrasonic Cleaning 

– Place instruments in an open position in the ultrasonic cleaner, ensuring sharp tools like scissors and blades do not touch other instruments. 

– Completely submerge instruments and process them for 5–10 minutes or as recommended by the manufacturer. 

– Cover the ultrasonic cleaner during operation to avoid splashing. 

– Do not clean different metals (e.g., stainless steel and copper) together in the same cycle. 

– Replace the cleaning solution as per the manufacturer’s instructions. 

– Rinse all instruments thoroughly with water after ultrasonic cleaning to remove any residual solution. 

Automatic Washing and Sterilization 

– Follow the manufacturer’s guidelines carefully. 

– Lubricate instruments both before and after the sterilization process. 

Manual Cleaning 

If ultrasonic cleaning is unavailable, follow these steps: 

1. Use stiff nylon brushes for cleaning, and avoid steel or wire brushes unless specifically designed for certain areas like serrated edges or stained surfaces.
2. Use neutral pH detergents only. Low pH detergents can cause pitting and black staining, while high pH detergents may leave brown deposits. Remove stains with a specialized stain remover.
3. Handle delicate instruments separately to avoid damage.
4. Inspect instruments for proper alignment, functionality, and cleanliness. Ensure cutting tools are sharp and free of damage, and confirm the proper operation of retractors and hinged instruments.
5. Rinse thoroughly under running water, ensuring all hinged areas are clean.

After Cleaning 

Allow instruments to air dry completely before storing them in a clean, dry area. 

Autoclaving 

1. Lubricate all instruments with metal-to-metal action (e.g., scissors, hemostats) using a water-soluble, non-silicone surgical lubricant.
2. Sterilize instruments individually or in sets.

   – For individual instruments, use disposable pouches at least 4 inches wide for tools with ratchet locks, ensuring they remain unlocked during sterilization to avoid damage from heat expansion. 

   – For sets, place heavier instruments at the bottom and sterilize all tools in an open position. Avoid overloading the autoclave. 

3. Use a towel in the sterilization tray to absorb moisture and prevent wet packs.
4. At the end of the autoclave cycle, open the door slightly before the drying cycle to prevent condensation and water stains.
5. Regularly clean autoclave chambers and filters to maintain efficiency.

Cold Sterilization 

– Cold sterilization solutions typically require 10 hours to render instruments sterile. Prolonged exposure can damage instruments more than a 20-minute autoclave cycle. 

– For disinfection, a cold sterilization soak of 10 minutes or more is sufficient. 

– Avoid cold sterilization solutions containing benzyl ammonium chloride for instruments with tungsten carbide inserts (gold-handled tools), as they may degrade these components. 

Key Distinctions: 

– Sterile: Free of all living organisms. 

– Disinfected: Clean but not completely free of microorganisms.