Surgical instrument care Flashcards
Define ASEPSIS
Free from pathogenic microorganisms
Define ANTISEPSIS
Use of an antiseptic to eliminate pathogenic organisms
Define STERILISATION
The process to eliminate al pathogenic microorganisms, with the exception of bacterial spores. Achieved through extremes of heat or chemicals
Define BIOBURDEN
The number of contaminants found living on a particular non sterilised surface or device
Define BIOFILM
A layer of mucilage, usually found on flat surfaces. Shields potentially harmful material, such as spores (removed through mechanical scrubbing)
What material are surgical instruments commonly made from?
Either surgical stainless steel, tungsten carbide, chromium plated carbon steel, or titanium
Describe tungsten carbide
Very hard wearing but expensive - often added as inserts to instrument handles to improve strength.
Describe surgical stainless steel
An alloy (mixture of metals) of chromium (12-20%) nickel (8-12%) and molybdenum (0.2-0.3%).
The chromium gives shine, is resistant to scratches and corrosion and good for cleaning; the nickel has a smooth, highly polished finish; the molybdenum gives strength
Describe chromium plated carbon steel
More cost effective than other options but will rust much more quickly. It can also ‘pit’ which is where tiny holes are causes by organic material, and cleaning solutions
Describe titanium
Very lightweight, often matte finish (to reduce glare), and very strong. Often used in ophthalmic kits
What are some commonly used surgical instruments?
- forceps
- scissors
- retractors
- scalpel handles
- dissecting forceps
- needle holders
- drape clips/towel clamps
What are some types of haemostat forceps?
Haemostat forceps stop blood flow. Types include:
- Rochester peans
- Spencer wells
- Halstead mosquito
- Kellys
- Crilles
- Dunhills
What type of blades are on haemostat forceps?
They may be cutting or clamping
What is a box junction?
A type of junction on an instrument where one half of the instrument goes through the other; they are not simply joined by a screw
What are some types of scissors used for surgery?
- Mayos
- Metzenbaum’s
- Paynes
- Vigo
- Dissecting
- Carless
- Castroviejo (micro precision scissors)
What are some non surgical scissors?
- Lister bandaging scissors
- Littauer suture scissors
- Heaths suture scissors
What are the main types of retractors?
Retractors may be self retaining or handheld
Name some specific retractors
Hohman’s and Langenbeck are both handheld
Gelpis are an example of self retaining retractors
What side blades fit on to a size 3 scalpel handle?
Size 10 -15
What side blades fit on to a size 4 scalpel handle?
Size 20-25
What are some types of dissecting forceps?
- Lanes
- Treves
- DeBakey
- Adson Browne
- Spay
All of these may have a plain, or rat tooth
What is another name for needle holders?
Needle drivers
What are some types of needle holders?
- Mayo Hagar (no cutting edge)
- Olsen Hagar (have a cutting edge)
- Gillies
- McPhails
Often identifiable from the hashtag pattern on their clamps
What is distinctive about needle holders?
They often have a hashtag pattern on their blades
What are the two types of drape clips?
Backhouse towel clamps
Jones cross action
What is important to look out for when inspecting instruments?
- retained soil/debris
- damage to the ratchets
- sharpness of cutting blades
- alignment
- cracked box junctions
- pitting
What is the method for testing if a set of forceps is damaged?
Close the jaws lightly - there should be no overlap and no light should be able to be seen through them. With the ratchet on each tooth, tap it gently on the edge of a surface, and
What is the method for testing if a set of needle holders is damaged?
Clamp a needle in the jaws of the needle holders and lock the ratchet on the second tooth. The needle should be very difficult to rotate by hand
What is the method for testing if a set of scissors is damaged?
They should easily cut a 4 layer gauze with their tip - the cut should be smooth along the whole of the cutting edge
What is cleaning, in relation to surgical instruments?
The single most important step in making a medical device ready for reuse
What are some basic principles of washing instruments?
- use a cool water rinse to remove gross debris (cool water prevents coagulation of blood)
- an enzyme detergent soak may be required to remove fat or protein sediments
- a detergent compatible with the make up of the instrument should be chosen
What cleaning detergents can contribute to metal erosion in surgical instruments?
Dish or laundry soap, bleach (sodium hypochlorite) and other non approved solutions
When should instruments be cleaned after surgery?
As soon as possible following surgery. All instruments in the pack should be cleaned, even if they were not used
What is the first stage of cleaning for hinged instruments?
The jaws should be opened and the instrument soaked in a mild detergent or enzymatic cleaner
What are some different enzymes that may be in enzymatic instrument cleaners?
Proteases (break down proteins)
Amylases (break down starches)
Lipases (break down fats)
How does an ultrasonic instrument cleaner work?
Ultrasonic cleaners are much more efficient than manual cleaning. They use high frequency sound waves that pass through the instrument and cause microscopic bubbles. The bubbles don’t pop, they implode (cavitation) which creates a vacuum, sucking any dirt or debris off the instrument.
As with manual cleaning, instruments should be opened before cleaning, rinsed afterwards, lubricated (once per week, only in the moving parts) and allowed to air dry, ideally on an incontinence sheet or similar, not a towel.
Define CAVITATION
The process of bubbles imploding in an ultrasonic instrument cleaner, sucking the dirt and debris off in a vacuum
How often should hinged instruments be lubricated?
Once per week, and only on the moving parts
What is the ideal surface for instruments to air dry on?
On an incontinence sheet, or other absorbable surface, ideally not on a towel due to the likelihood of fibre transfer
What are some factors that affect the efficacy of sterilisation?
Adequate cleaning, bioburden, pathogen type, protein, biofilm accumulation, lumen length/diameter, restricted flow in the machine, device design and construction
How does cleaning instruments affect sterilisation?
Failure to adequately clean instruments results in higher bioburden, protein load and salt concentration
How does a bioburden affect sterilisation?
It is the number of microorganisms that are living on a non sterilised surface - an instrument must be completely free from microorganisms for sterilisation to be effective
How does pathogen type affect sterilisation?
Spore forming microorganisms are most resistant to sterilisation
How does protein affect sterilisation?
Residual protein decreases the efficacy of sterilisation - this should be removed by manual cleaning
How does biofilm accumulation affect sterilisation?
Reduces the efficacy of sterilisation by impairing exposure of the sterilant to the microbial cell
How does lumen length/diameter affect sterilisation
Both impair sterilant penetration - may require forced flow to allow sterilisation
How does restricted flow affect sterilisation?
It will limit the contact that the sterilant has with microorganisms
How does device design and construction affect sterilisation?
Materials used may affect compatibility with different sterilisation processes and affect efficacy. Design issues such as screws and hinges will also affect this
What are tip protectors?
Often rubber ends placed over the end of an instrument to protect the tip during sterilisation - vet wrap and gauze can also be used
What is gold standard for packing instruments and kits?
Double bagging, with the date of package and sterilisation written on
What should be written on the end of an autoclave pack before sterilisation?
The date packed and sterilised, the date of expiry, the contents of the pack, and ideally the initials of the person who packed it
What are some common rules for packing surgical kits?
- use a thin tipped sharpie for labelling
- label the package before packing it
- pack same number of swabs per pack
- ratchet handles should be loose
- double bag as it is gold standard
- place TST at the deepest part of the kit
- check package for any perforations before use
How long does a pack stay sterile if double bagged?
96 weeks
What is the method for folding reusable gowns for sterilisation?
- Gowns are sterilised folded inside out. Place on a clean flat surface, so the outside of the gown is facing up
- Fold the arms and the ties to the centre
- Fold in each side, to the centre, twice until the gown is long - ensure all the ties are tucked in
- Concertina the gown so that the inside of the neck sits on the top. The gown can now be double wrapped and sterilised
How should packed instruments and kits be stored?
They should be protected from contamination and moisture - they should be stored away from theatre in a dust free, dry environment, out of direct sunlight and at an ambient temperature
What way should single instruments be placed into autoclave bags?
With the handles at the end of the bag with the ‘ears’ so when opened, the surgeon is presented with them first
What are some different types of packing equipment used for autoclaving?
Reusable autoclave bags, indicator tape, disposable bags, paper drapes, reusable drapes, autoclave trays
What are autoclave bags?
Reusable, usually made of nylon. Can be reused up to 50 times. Expensive, come in varying thicknesses and can make custom sized bags
What is indicator tape?
Used to indicate change in temperature/ sterilisation
What are disposable autoclave bags?
Peel and seal bags. Regularly used for autoclaves and ethylene oxide chambers
Describe a paper drape
Used for kit wrapping, come on a roll
Describe a reusable drape
Can have fenestrations, reusable but can fray and cause contamination
Describe autoclave trays
Used to place instruments directly onto, without the need for bags. Autoclave is turned on and then removed by the surgeon.
