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Driving sterilization best practice starts with proper instrument cleaning

By now, it should be widely understood that surgical instruments can’t be successfully sterilized if they haven’t been thoroughly cleaned first. Unfortunately, it’s a crucial step that continues to challenge many sterile processing professionals. Read on for the top ten tips for effective surgical instrument cleaning from Derek Lashua, marketing director, Spectrum Surgical Instruments Corp., Stow, OH.

1. Don’t let blood dry. Beginning the decontamination process within 20 minutes after surgery prevents blood from drying and is your best defense against corrosion, pitting and staining. If more time is needed, keep instruments moist by placing a wet towel over the instruments. The use of spray-on wetting agents (enzymatic- or detergent-based) is also an effective way to keep instruments moist.

2. Know the enemies. Water and moisture of any kind, especially blood, surgical residues and chloride-based solutions are harmful to stainless steel instruments and are the primary causes of staining and pitting. Other enemies include surgeon’s hand scrub, household solutions, bleach, iodine-type solutions, general disinfectants, and even saline.

3. Use the right solutions. Only use solutions that have been specifically designed for use on surgical instruments for washing, disinfecting and lubricating. Their product labels will state the intended use on the label. Only solutions with a neutral pH (between 7pH and 8pH) are recommended.

4. Ultrasonically clean. Ultrasonic cleaning is the most effective method of cleaning difficult-to-clean areas such as box locks, hinge areas and serrations. Ultrasonic cleaning employs millions of microscopic implosions produced from sound waves to burst and pull away debris from the surface of the instrument. This energy, combined with the surface tension provided by a low-suds ultrasonic cleaning solution will clean instruments 16 times more effectively than manual cleaning alone.

5. Use the right brush. In addition to mechanized washing, it is important to use instrument cleaning brushes to ensure instruments are effectively cleaned before sterilization. When brushing lumened or cannulated instruments, it is important that the brush exit the distal end completely to effectively push out any debris (and then pull back through).

6. Lubricate. An easy, cost-effective way to maintain instruments and defend against rusting is to lubricate them with a water-based, neutral pH lubricant after every cleaning cycle, before sterilization. Be sure you are not using a mineral or silicone-based lubricant as these will interfere with sterilization.

7. Troubleshoot stains. The following stain trouble-shooting guide will help you identify and further prevent instrument staining.

8. Sterilization. Always sterilize with the ratchets open. This reduces stress and prevents the box lock/ hinge area from cracking, and promotes better steam penetration. If using a pan or tray, we recommend one with perforations.

9. Promote teamwork. The sterile processing department works in concert with the operating room. Arrange for the two departments to meet on a routine basis to discuss and identify problem areas.

10. Communicate with your vendor. Contact your instrument vendor and inquire about education and preventative maintenance programs offered.

Driving sterilization best practice starts with proper instrument cleaning