5 Tips to Maintain Your Surgical Instruments

by Raynetta Stansil Independent Healthcare Consultant

Surgical instruments are incredibly important for hospitals and health centers around the country. As tools that are used day in and day out, they represent a significant investment hospitals must make to take care of their patients.

Surgical instruments must be maintained in good working order at all times. This leads to better patient care as well as cost savings by increasing the tools’ lifespan. The following five tips serve as guidelines to extend the life and utility of surgical instruments.

1. Cleaning and Reprocessing

Proper cleaning and reprocessing of instruments prevents contamination in the operating room. These tasks also ensure that no bioburden is left on the instruments. For example, precleaning with enzymatic spray will remove blood and bodily fluids that would otherwise result in staining and rapid deterioration.

2. Inspection

Immediately following a thorough cleaning and reprocessing process, a visual inspection is necessary to ensure that everything has been properly cleaned and decontaminated. You will need to check for:

Cleanliness
Corrosion
Defects
Missing parts or loose set pins
Proper alignment
Smooth cutting edges

3. Testing

After a visual inspection, it is best to test instruments and their functionality. Each surgical instrument comes with specific uses, meaning that each instrument will need its own function test protocol to ensure proper working order. This post lends specific testing protocols for a variety of instruments:

Scissors

Hold scissors as a surgeon would. Open scissors half-way and close on test material or glove. Cut should be smooth and even to the tip, without snagging.
Open the scissors and drop one handle gently. The scissors should engage with tension at ½ to ⅓ closure point.

Rongeurs

Cut a 3x5 index card, business card or material of similar weight.
Two-thirds of the cutting edges of a bone rongeur must cut the test material smoothly, without tearing. Bite should be clean without snagging or tearing (except Pituitary Rongeurs).
Pituitary Rongeurs should make an even, uniform impression on the test material.

Osteotomes

Using a plastic testing rod or dowel, or a plastic syringe barrel, place osteotome at 45° angle.
Cutting edge should not “slip” but engage evenly on the rod.

Needle Holders

The jaws of the needle holder should come together at the tips, without having to apply closing pressure on the first ratchet.
Close jaw to one ratchet and ensure that light can’t be seen through the jaws.
Close jaw to one ratchet onto test material (e.g. aluminum foil). Check for outline of jaw and impressions of serrations (if present).
Open the needle holder and drop one side of handle gently. It should be ½ to ⅓ closed.

Clamps

Close the clamp on the first ratchet and hold it up to the light while continuing to close the ratchet. No light should be seen passing through the jaws, with the exception of vascular clamps.
As with the needle holder, drop one side of the handle gently. It should be ½ to ⅓ closed.

Vascular Clamps

To test the atraumatic “teeth”, fill a zip lock bag with water.
Close the clamp at one corner of the bag to test if the liquid is protected from flowing into the clamped corner.
Remove the clamp and check that there are no holes or perforations.

Forceps

Toothed forceps should engage evenly when being closed. Teeth should be sharp and equally sized.
When closing or opening thumb forceps with a guide pin, the pin must slide centrally into the guide hole and the pin must not jam or rub.
Most ratcheted instruments should open completely and hold test material at each step of the ratchet (with the exception of vascular clamps).

Curettes

Test sharpness on a plastic rod or dowel or syringe barrel, as with the osteotome.
Assure the cutting edge is clean, smooth, and intact.

4. Handling and Storage

Many surgical instruments are delicate, for instance those used in ophthalmology, and require utmost care in handling and storage. This minimizes both breakage and contamination. For example, an endoscope must be properly stored vertically in a dry environment after endoscope reprocessing to prevent bacterial growth that can lead to bacterial transmission and nosocomial infection.

5. Instrument Repair

Due to the normal wear and tear of use, even the best cared-for surgical instruments will need to be repaired or serviced at some point of their life. This is especially true if the instruments are frequently used. Some instruments that are used daily may actually need to be refurbished once a year to preserve efficiency, rather than simply maintaining them. For others, it is important to set up a regular inspection schedule to ensure they are functioning properly.

If an instrument’s efficiency seem to be faltering, it is best to get it repaired immediately rather than wait for it to stop working altogether. Even though such an instrument may still function, it will not work to its full capacity, which may lead to accidents. For the best results, instruments can be sent to a professional repair service, who will have the right tools and replacement parts. For example, organizations like Surgical Solutions can provide certified technicians who can take over endoscope repair.

Final Thoughts

Any medical center needs surgical instruments that are always working to their full capacity. Any lapses in maintenance may lead to inefficiencies that have the potential to affect the whole organization. For instance, an improperly cleaned instrument may lead to a surgical site infection (SSI) that places a costly lawsuit in the hospital’s hands. The five tips above can help prevent this from happening.