Only a very limited number of
stainless steel types can satisfy the requirements asked for by the user
of surgical instruments. Due to their special alloy, high-grade steels
used for surgical instruments are characterized by the fact that they form
specific passive layers as a protection against corrosion. These
protective layers can, however, be damaged by external influences which
will harm the instruments.
Only to a limited extent are
high-grade steels resistant to the attack of aggressive waters, e.g. with
a high cloride content. In particular, chloride ions can cause pitting or
even stress corrosion cracking.
Users of our instruments can be
assured that we are taking great care at the selection of the correct
steel types and the steel processing.
To maintain the value of the
instruments, the user must provide continuous expert care and correct
preparation.
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. The instruments should be taken apart, if necessary, 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 treatment in this
manner.
Under no circumstances must
instruments be sored in physiological saline solution as prolonged contact
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 the instruments after use.
To avoid encrustation and corrosion,
in case of removal in dry condition and return to the CSSD, the
instruments must immediately be subject to machine treatment. For this
treatment, deposit the instruments on suitable trays, e.g. perforated
sterilizing trays. For effective cleaning, hinged instruments have to be
opened (such as scissors, clamps, gouge forceps).
Instruments which are subject to
machine treatment have to be immersed into a combined disinfecting and
cleaning agent. For removal in wet condition and return to CSSD use only
non-corrosive agents in prescribed concentrations. Water alone is not
sufficient! The instruments have to be fully covered by the solution.
Instruments should never be left
overnight before cleaning as the risk of causing permanent damage
increases with the length of time between use and preparation.
For
manual preparation, instruments have to be immersed into a combined
disinfecting and cleaning solution with proven disinfecting effect.
The
instructions of the manufacturer have to be strictly followed regarding
concentration, temperature and induction time.
Use
fresh disinfecting and cleaning solutions every day. The following
problems may occur due to using the same solution for too long:
-
risk of corrosion due
to soiling
-
risk of corrosion due
to increasing concentration caused by evaporation
-
decrease of
disinfecting effect due to excessive dirt concentration
Instruments with a narrow lumen (tubings, cannulae) 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
solution.
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 recommended. Finally, the instruments
have to be dried immediately.
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 prewashed as foam development in the machine can considerably
influence the cleaning results. The temperature of the inflowing water
should not exceed 45°C as higher temperatures lead to protein coagulation
and cause cleaning problems. Disinfection can either be performed
chemothermally or thermally.
Attention has to be paid to the following:
- hinged
instruments have to be opened, thus guaranteeing thorough cleaning in the
joint
- do
not overload the perforated trays so that all instruments can be well
rinsed
- a
thorough internal flow has to be guaranteed with instruments having long,
narrow cavities (tubing, cannulae, breathing systems). Use special
inserts.
Remnants from the cleaning phase have to be totally removed in the
subsequent rinsing procedures as otherwise spotting and /or discolouration
may occur. Additional use of a suitable neutralizing agent improves the
rinsing results.
For
final rinsing, a temperature of 70-90°C has proved to be best. Sterile and
demineralized water should be used.
Ultrasonic treatment is particularly suitable for cleaning instruments of
high-grade steel. Attention should be paid to the following points:
- Fill
the bath up to the markings
-
Add a suitable
cleaning and/or disinfecting agent to the water.
- Temperature
above 40°C promotes degassing and cleaning.
- When
using disinfecting and cleaning agents make sure that the concentration
and temperature are correctly maintained.
-
Instruments have to be
completely covered by the cleaning solution.
-
Hinged instruments, e.g. Scissors and clamps.... have to be opened.
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 in
order to avoid water spots.
The
instruments should then be thoroughly dried.
The
following proposals have to be observed:
Sterilization conditions as well as units have to be in conformity with
valid quality standards. Follow the sterilization instructions of the
manufacturer.
Autoclaving
-
Temperature 134°C
-
Hinged instruments
like scissors, clamps have to be opened
-
The loading weight of
perforated trays filled with instruments should not exceed
10 kg.
Hot-air
sterilization
-
Temperature 180°C
-
Not suitable for rigid
and flexible endoscopes.
