Surgical Instrument Care
Cleaning Surgical Instruments
Surgical Instrument Cleaners
The primary purpose of cleaning surgical instruments is to remove all inorganic and organic proteinaceous bioburden from the internal and external surfaces of surgical instruments.
The secondary purpose of cleaning surgical instruments is to maintain and improve the “passive Layer” of surgical stainless steel. The passive layer is provided by the manufacturer of the surgical instruments. Proper cleaning of the surgical instrument will maintain and improve this passive layer. (for more information go to: Prevent Surgical Instrument Corrosion ) washer sterilizers, surgical instrument washers.
Stainless steel surgery instruments are made of corrosion resistant high-grade specialty steels. The key word here is “resistant”. Corrosion resistant does not mean corrosion proof. One of the special characteristics of these steels is that the manufacturer forms a "passive oxide layer" on the surface, which protects them against corrosion. This makes surgery instruments as corrosion resistant as possible. It is imperative that you maintain the passive oxide layer to prevent corrosion and maintain your surgery instruments in optimal condition. If this is not done the stainless steel will be more susceptible to corrosion, pitting and stains.This will reduce the life of the surgery instruments and/or render it useless. Initially, all “stainless steel” surgical instruments have the same corrosion resistance. When strength and hardness requirements are important factors for instrument function, corrosion resistance is generally lower. Increasing the corrosion resistance would soften the stainless steel. Manufacturers of surgery instruments and surgical instrument containers recommend the use of neutral pH cleaning concentrates.
Yellow-brown to dark-brown stains or spots on surgical stainless steel instruments are frequently mistaken for "rust". These residue deposits (stains or spots arranged in groups or along edges or in crevices) are usually the instrument being exposed to result of high chloride content. They will lead to pitting of the surgical instrument surface if not removed. (see Avoiding High Levels of Chloride below) Excessively hard water can contain high levels of salt sufficient to cause stains or spots that appear as rust. Boilers used to generate the steam for steam sterilizers, if not cleaned properly, will produce contaminated steam which can deposit minerals onto instruments during the sterilization process.
Virtually all manufacturers of surgical instruments, rigid scopes, flexible scopes, and instrument containers recommend the use of neutral pH Cleaning Concentrates. Do not use high acidic (pH <4) or high alkaline (pH >9) products for disinfection or cleaning, since these can corrode metal, cause discoloration or stress fractures.
Tap water can contain many minerals, which may discolor and stain surgical instruments. It is recommended that de-ionized water be used for the final rinsing to prevent spotting. all-in-one or "combination" cleaning concentrates can be effective in treating unacceptably hard source water and removing hard water encrustation from surgical instruments and equipment. If untreated tap water is used for final rinsing, then the instruments must be dried immediately to avoid staining.
Clean instruments, or apply treatment to prevent the drying and encrustation of debris, as quickly as possible after use. Do not allow blood and debris to dry on the instruments. If cleaning must be delayed, place groups of instruments in a covered container with appropriate enzyme-detergent or apply an enzyme-detergent foam spray to delay drying. The use of pre-soaking enzyme-detergent foam sprays have been shown to reduce the time expended for manual cleaning and render higher quality outcomes. After surgery, open all box locks and disassemble instruments with removable parts. This will limit blood drying on instruments that may cause them to corrode.
Staining and spotting may result if residual chemicals are not completely rinsed from surgery instruments that are subjected to steam sterilization. Following the manufacturer’s recommendations for the proper sequence of treatments (cold water pre-wash, enzyme-detergent wash, purified water rinse/lubrication, and drying) is critical to prevent stains and spots. A Cleaning Concentrates that will avoid spotting are "free-rinsing" or "rinse clean".
Stainless steel is essentially a low carbon steel which contains chromium at 10% or more by weight. It is this addition of chromium that gives the steel its unique stainless, corrosion resisting properties. The chromium content of the steel allows the formation of a rough, adherent, invisible, corrosion-resisting chromium oxide film on the steel surface. If damaged mechanically or chemically, this film is self-healing, providing that oxygen, even in very small amounts, is present. The corrosion resistance and other useful properties of the steel are enhanced by increased chromium content and the addition of other elements such as molybdenum, nickel and nitrogen. Stainless steel has a passive film created by the presence of chromium (and often other alloying elements, nickel, molybdenum) that resists this process. When exposed in air, stainless steels passivate naturally (due to the presence of chromium). But the time required can vary. In order to ensure that the passive layer reforms rapidly after pickling, a passivation treatment is performed using a solution of nitric acid and water.
How is the "passive oxide layer" Manufactured and Maintained
The passive layer or stainless steel is intended to prevent or resist corrosion. The process is called “Passivation”. “Passivation” and Polishing eliminate the carbon molecules form the instrument surface. This forms a layer which acts as a corrosive resistant seal. Passivation is a chemical process that removes carbon molecules from the surface of the instrument. This chemical process can also occur through repeated exposure to oxidizing agents in chemicals, soaps, and the atmosphere. Polishing, by the manufacturer, is a process used to achieve a smooth surface on the instrument. Surgical Instruments are polished because the passivation process leaves microscopic pits where the carbon molecules were removed. Polishing also builds a layer of chromium oxide on the surface of the surgery instrument. Proper cleaning, handling, and sterilization will build up the layer of chromium oxide and protect the Surgical Instrument from corrosion and /or pitting.
Enzyme Surgical Instrument Detergent, and we guarantee it. Surgical instrument Cleaner Endoscope Cleaner Enzyme Detergent Product Usage: The use of Surgical instrument Endoscope Enzyme Detergent Cleaners of various compositions and concentrations is becoming common. Over half of all Surgical instrument Endoscope Enzyme Detergent Cleaners available contain enzymes. The enzymatic enzyme detergent cleaner industry is the largest single market for enzymes, at rate of 25 - 30% of total sales. Details of which enzymes are used within enzymatic enzyme detergent cleaners and the ways in which they are best used, are rarely been published. Surgical instrument Endoscope Enzyme Detergent Cleaner Mis Understandings: Common misunderstandings exist pertaining to the application of Surgical instrument Endoscope Enzyme Detergent Cleaners including the times and temperatures for optimal cleaning outcomes.