While many Central Sterile Supply Department technicians may not recognize their role as instrument "investigators," that’s nonetheless a befitting description. After all, each device that enters and exits the CSSD must be carefully assessed and meticulously scrutinized to ensure that it is clean, sterile, well-functioning, and safe for patient use. Such was the message delivered at IAHCSMM’s 2010 Annual Meeting by Rick Schultz, president and CEO of Spectrum Surgical Instruments, during the aptly titled technical update session "CSI: Central Sterile Investigation."

Schultz, who is notoriously passionate about CSSD education, particularly as it relates to instrument care and maintenance, provided a wealth of practical, user-friendly information to a roomful of attendees. His overall message targeted all stainless steel instruments found in the CSSD, regardless of their manufacturer.

Schultz wasted no time uncovering some common instrumentation-related mistakes and misconceptions. Among his first messages, which seemed to strike a chord with attendees: Instruments are only new for one day. Stainless steel, however durable it may be, also harbors some lingering misconceptions.

"The man who invented stainless steel lied. It’s really ‘stained-more steel,’ he explained, adding that hands, water and elements present in the OR all affect stainless steel. "The art of processing is controlling that."
While instruments can quickly become dull and fail to function as they did upon first use, Schultz assured attendees that all scissors, needle holders and orthopedic instruments are designed to be restored. The sharper the scissors, the better, Schultz reasoned, because surgeons don’t have to apply as much pressure when they are sharp.
"It’s the difference between being proactive and reactive. It’s not what you spend on instruments. It’s what you save by maintaining them," he reasoned. "Either you choose to spend a smaller amount or you will be spending a larger amount – that’s a fact of instrumentation."
Dried-on blood and bioburden is a big problem that must be addressed, and can be easily remedied with the use of enzymatic sprays (tap water and a towel also work wonders for keeping instruments moist – and it costs nothing), according to Schultz. He added that the OR and other departments must be educated on the importance of not allowing instruments to dry prior to hitting the decontamination area. "It’s their job to keep instruments moist after use. Once it dries, it’s very difficult to clean."

Among some of Schultz’s other instrument care tips shared with attendees:

• Much like tread on tires, all needle holders wear out with use. Only buy gold-handled needle holders because they will last longer, grip better and can be rejawed. The 18-carat gold is a visual reminder that they contain tungsten carbide. "When you wear out non-gold handled needle holders, party’s over. You can’t rejaw them."

• Needle holders (and scissors) will wear out at the tip. Even if the rest of the instrument looks like new, it won’t matter. "If the tip is worn, that’s bad."

• Test ratchets, but only when you field a complaint. Put it on the first click and tap on the work surface. Turn it over and do it again. If it springs open, alignment is in order.

• Look at the hinged area of hemostats and look for cracks and bioburden. "The larger the crack, the longer it has been there."

• Ensure that teeth are present on tissue forceps and inspect the spaces between teeth for the presence of tissue.

• Check the screw hinge of scissors for cracks and bioburden, and also for breaks on the tips.

• Don’t over-sharpen scissors. If you have gold-handled scissors, which stay sharper longer, ask the repair vendor if they require sharpening and avoid just placing them in an automatic preventive maintenance schedule. "Once you grind off the carbide, you’re done."

• Only test scissors with the right hand and never place the thumbs all the way through the handles. Use red testing material for larger scissors and yellow for smaller ones. Ensure that the scissors cut all the way through to the tip, which is the most important part.

• Pick two days (i.e., Tuesday and Thursday) to test for scissor sharpness. Only pull scissors that come in on the trays that day. In time, you’ll make significant headway, but it doesn’t have to be done all at once.

• Black-handled (super-cut) scissors are the sharpest scissors available, but they dull the fastest, so they must be addressed promptly. Black rings indicate that the scissors have a knife edge. Serrations on scissors prevent slippage. These scissors may be sharpened and serrations may be added back in. "Don’t believe otherwise."

• Take photos to document damage and improper practice (i.e., dried blood on instruments coming from the OR, cracks on instrument hinges, damaged tips, missing teeth). "A picture is worth a thousand words."

• Once a month, do an inservice with an instrument training box. Assemble what you want your staff to learn. Place Pakistani instruments in the box so staff can feel/tell the difference. Include dull, damaged or otherwise malfunctioning instruments and show staff what to look for and how to properly test their efficacy.

• Let teammates know the price of instrumentation. This will help them better understand the importance of proper care and maintenance.

• Outfit each work station with lubrication, test material, magnifiers, and tip protectors (micro and ophthalmic instruments contain small teeth that can only be viewed under a microscope).

• An ultrasonic washer is stainless steel instruments’ best friend because it cleans 16 times better than handwashing. Ensure that the ultrasonic washer is working properly. If water is moving, that’s good news. Put a piece of foil in the water and turn on the ultrasonic for ten minutes. "If the foil is shredded and beaten up, the ultrasonic is working."