When working in any environment where surgical instruments are required, knowing how to clean and care for them properly is vital. For midwives and small centers on a budget, we have some great tips for getting back to the basics for sterilization.
The best part about proper care of your instruments is that it will increase their life expectancy significantly. Even the highest quality stainless steel instruments, from brands like Miltex, are vulnerable to wear and tear if not cared for properly. Here are some important pointers to always keep in mind when caring for your instruments. Print this list off, keep it close-by or tucked into your equipment bag for easy access.
Keeping It Clean
1. Rinse or soak instruments in sterile water immediately after use with an enzymatic detergent. Never let soiled instruments dry before cleaning. Dried body fluids and tissue cause pitting and staining on the metal. Enzymatic detergents are great for breaking down the organic residue on instruments to make washing them with detergent easier.
Instruments should never be soaked in saline or sodium hypochlorite (bleach). Chloride ions are highly corrosive and can eat away at the finishes and metal on your instruments.
2. If you don't have the time to rinse or soak your instruments right after use, wrap them in a cold damp towel.
3. When choosing your cleaning detergent or disinfectant, select an option with a pH between 7 and 10. Detergents with a pH that is higher than 7 are generally more effective when it comes to removing organic debris like blood, feces or fat.
Never use antimicrobial solutions that are used for skin antisepsis when cleaning your instruments.
Remember, when in doubt, check the manufacturer's instructions for the type of detergent to use. Here are some characteristics of an ideal detergent:
- Minimal suds or foaming
- Rinses off easily
- Can disperse organic debris
4. When using an instrument cleaning brush, keep this in mind: stainless steel brushes are designed to clean instruments with serrations, rasps, files and burs, while nylon brushes are excellent for cleaning instruments without scratching or harming delicate surfaces. Don't use abrasive scouring pads that can damage the finish of your instruments.
5. Rinsing is imperative after cleaning because any residual detergents or disinfectants that are not properly rinsed off can reduce the efficacy of the sterilization process.
Got It Clean? Make It Sterile
1. Before sterilizing your instruments, you want to make sure they are dried thoroughly.
2. Lubricate your instruments well with water-soluble lubricant.
3. There are a variety of options available for sterilization: heat or steam autoclaves, steam sterilizers, pressure cookers or conventional ovens.
4. If you are sterilizing with an autoclave, always use distilled water because tap water can discolor and damage the metal of your instruments.
5. Regardless of the method you use, it is imperative to wrap the instruments securely for sterilization. You can use self-sealing sterilization pouches, sterilization tubing, and for larger instruments use sterilization wrap or surgical towels. Everything needs to be secured with sterilization tape, except for the self-sealing pouches.
6. Remember to unlock and open any ratchets during high-pressure autoclaving, because the pressure may break them if they cannot move flexibly and openly.
7. Surgical towels are your best friend when it comes to instrument cleaning and sterilization. These 100% cotton towels can be used as a sterile surface for instruments where sterilizing a surface may not be possible (think home births, emergency births and midwives working in developing countries); they can be used as a damp wrap for instruments you can't clean immediately; use them to dry your instruments; and use/re-use them to wrap your instruments for sterilization.
Taking It Back To Basics - Oven Sterilization
If investing in a medical sterilizer or autoclave is not an option, you can always use an oven. Here are some simple steps for effective oven sterilization.
1. Set your oven to 225 degrees.
2. Place a pan of boiling water at the bottom of the oven.
3. Put your wrapped instruments on a clean rack - do not place them directly onto the oven rack.
4. Ovens range in temperature so watch the process carefully. If using sterilization pouches and the oven gets too hot, the pouches may burn.
5. When steam is generated, you know the sterilization process is in progress.
6. Use a clean utensil to remove the sterilized instruments and once cooled, place into a sterile towel or paper bag to store for future use.
*Note: sterilization tape will not change color in an oven as it is designed to do in an autoclave or sterilizer.
Proper instrument care may take a bit of time in the moment, but the long-term rewards are worth it.
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Written By: Samantha Darling for Cascade HealthCare Products
Cascade HealthCare Instrument Care: http://1cascade.com/c/10893/surgical-instrument-care-sterilization
Miltex Instrument Care: http://1cascade.com/c/10899/miltex-instrument-care-products
All American Medical Sterilizers: http://1cascade.com/c/10880/all-american-portable-sterilizers
Sterilization Products: http://1cascade.com/c/10564/surgical-instrument-sterilization-products