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Instruments should be immersed in demineralised or distilled water with enzymatic detergent at a neutral pH, under 45ºC

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Packaged instruments should be stored in a dry, closed and warm place.

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Inspection for proper functioning of the surgical instruments must also be performed prior to sterilization.

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Inspection for proper functioning of the surgical instruments must also be performed prior to sterilization.

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“Best Practice” Procedures Prior to Sterilization of Medical Equipment - Veterinary Infection Prevention and Control - Wiley Online Library

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Washing should remove all the dirt and biological debris from the surface of the materials and should be performed within 30 minutes of the end of the surgical procedures. To prevent blood from drying on the materials we suggest covering them with a damp towel.

The instruments shouldn't be overexposed to physiological saline solutions, since prolonged contact promotes oxidation.

At the beginning of the washing process the material should be rinsed under running water, while opening and closing the instruments. Manual washing should be done with hard plastic brushes, with the instruments immersed in demineralised or distilled water with enzymatic detergent at a neutral pH, under 45ºC, in order to avoid the coagulation of protein substances. We recommend always using new detergents and washing solutions since the overuse increases chemical concentration due to evaporation, favouring the corrosion of the materials and reducing the effectiveness of the disinfection.

Ultrasonic cleaning by cavitation is the most effective cleaning method.

Disinfection can be effectively achieved by immersing the instruments in enzymatic detergent, at neutral pH, for 90 minutes at 25°C. At the end the instruments should be rinsed with demineralised or distilled water and dried with paper towels. Do not use alcohol when cleaning materials.
2. Lubrication
Cleaning may render instrument's joints stiff due to mineral deposits and other impurities in the water system and regular metal to metal friction causes corrosion. Blue recommends applying a spray lubricant to all surfaces and instrument joints after each cleaning cycle.
3. Inspection
Before carrying out the sterilisation inspect each instrument and confirm the correct function of the joints, cleanness and general condition of the material.
4. Sterilisation
Sterilisation is essential to ensure that surgical instruments do not act as pathogen vectors. The most common method is autoclaving.

In the autoclave the instruments must always be in the open position to allow the steam to reach all surfaces. Do not overload the autoclave trays, which would block the steam penetration. The temperature, cycle duration and pressure should be those recommended by the manufacturer.

Regardless of the steriliser class, complete drying of all instruments and implants should be assured to prevent their degradation. The use of dry heat is not recommended for the sterilisation process.

Unpackaged instruments should be used immediately. Packaged instruments should be stored in a dry, closed and warm place.

Cold sterilisation, with prolonged immersion in enzymatic detergents, can impair delicate instruments. Avoid using solutions with benzium ammonium chloride on instruments with tungsten.

Most problems with the instruments can be attributed to one or more of the following causes:

Improper cleaning and drying immediately after use;

Prolonged exposure to sterilisation solution or use of corrosive solution;

Using normal running water instead of demineralised or distilled water in the cleaning and sterilisation processes;

Using non-recommended detergents or lubricants;

Some sort autoclave failure.

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1. Cleaning and Disinfection Washing should remove all the dirt and biological debris from the surface of the materials and should be performed within 30 minutes of the end of the surgical procedures. To prevent blood from drying on the materials we suggest covering them with a damp towel.

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Separate areas for instrument decontamination and packing/sterilisation

Protocols to include managing instruments and equipment from infected cases

Packing- use a standardised approach and deliver training

Drying, avoid strike through

Appropriate storage for sterile instruments and equipment - RCVS knowledge

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Managing infection control in practice- Sterile service considerations Separate areas for instrument decontamination and packing/sterilisation Protocols to include managing instruments and equipment from infected cases Packing- use a standardised approach and deliver training Drying, avoid strike through Appropriate storage for sterile instruments and equipment

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Surgical instruments are crucial for saving animals' lives, but what happens if they're not cleaned properly? Well, that's a nightmare no veterinary professional wants to deal with! Cleaning veterinary surgical instruments is more than just a matter of appearance. It's about safety, precision, and maintaining quality care.

Sterilizing surgical instruments is not rocket science. So, let's discuss the essential practices and methods for sterilizing and cleaning surgical instruments veterinary. By understanding the basic steps and avoiding common mistakes, you can ensure that the tools are always ready for action.

Keep reading!

The Importance of Cleaning Veterinary Surgical Instruments

Keeping Pet Patients Safe

First and foremost, clean instruments are synonymous with healthy pet patients. Here's why:

* Infection Prevention: By ridding tools of harmful bacteria, you're stopping infections before they start.

* Functionality: Properly cleaned instruments work as they're supposed to, allowing for successful surgeries and medical procedures.

Maintaining Professional Standards

* Compliance with Veterinary Sterilization Protocol: Sterilizing instruments is not just good practice; it's the law. Stick to guidelines to stay on the right side of regulations.

* Boosting Reputation: Showing you care about cleanliness helps build trust with patients and other medical professionals.

Risks of Not Cleaning Surgery Equipment Properly

Contaminated instruments can cause so many problems, and the stakes are high. Here's what could go wrong:

Spread of Infections

* Pet Patient Risk: Improperly cleaned instruments can carry bacteria, leading to infections. It's not worth playing fast and loose with someone's health.

* Staff Exposure: Health professionals may also be infected if tools aren't sterilized properly.

Decreased Instrument Longevity

* Wear and Tear: Failing to clean instruments properly can cause them to deteriorate faster. Before you know it, you'll face unexpected expenses to replace them.

* Malfunction During Procedures: This is more than an inconvenience. A malfunctioning instrument can be a matter of life and death during a surgical procedure.

Surgical Instrument Cleaning Steps Veterinary

1. Pre-cleaning: Rinse the instruments immediately to remove visible dirt and debris.

2. Washing: Either manually wash your instruments or use an automatic washer. Your choice should depend on the instruments and the manufacturer's recommendations.

3. Disinfecting: This step is crucial. It involves killing harmful bacteria and making sure your instruments are safe.

4. Rinsing Again: Remove all cleaning solutions and disinfectants to avoid leaving a residue.

5. Drying: A simple step, yet vital. Moisture can breed bacteria, so make sure those instruments are bone-dry.

6. Inspection and Maintenance: Keep a keen eye out for damage and ensure everything works smoothly.

Following these surgical instrument cleaning steps is crucial for ensuring patient safety.

5 Best Practices for Cleaning Veterinary Surgical Instruments

In the medical field, cleaning veterinary surgical instruments is mandatory. It is something that no surgeon wants to mess up. So, let's cut to the chase and discuss the 5 best practices for cleaning all contaminated tools.

1. Follow Manufacturer Guidelines

Every instrument has a particular way it likes to be cleaned. And who knows better than the folks who made it?

* Read the Manual: It has all the details on cleaning that particular instrument.

* Use Recommended Products: Stick to the cleaning solutions and tools the manufacturer vouches for.

2. Pre-Clean Immediately After Use

Time's ticking once you're done using a surgical instrument .

* Rinse It Off: Rinse off any visible debris immediately after use. It's like washing dishes - easier when it's fresh.

* Soak if Needed: Some tools may need a nice soak to remove stubborn bits.

3. Automate When You Can

Let's face it; machines are often better at cleaning veterinary surgical instruments veterinary.

* Utilize Ultrasonic Cleaners: These nifty devices can get into nooks and crannies that hands can't reach.

* Employ Washer-Disinfectors: These machines can be a godsend for that extra layer of cleanliness.

4. Regular Inspection and Maintenance

An instrument that looks clean might not be. You have to make sure it is inspected and maintained regularly.

* Inspect Regularly: Check for wear and tear, discolorations, and other signs of something amiss.

* Maintain Properly: Regular maintenance ensures that everything's working as it should.

5. Train and Retrain Staff

Keeping surgical instruments clean is a team effort.

* Provide Proper Training: Make sure everyone knows the procedures like the back of their hand.

* Offer Refresher Courses: Even old hands can benefit from a refresher now and then.

Recommended Methods for Cleaning Veterinary Surgical Instruments

Cleaning surgery equipment is not as simple as washing the dishes after dinner! When it comes to these life-saving tools, proper methods, precision, and care are critical. So, let's break down the recommended process of cleaning surgical instruments,

1. Manual Cleaning

Cleaning veterinary surgical instruments manually is ideal when the tools have complex structures and machine cleaning is not feasible.

* When to Use: When instruments are delicate or have intricate parts.
How to Do It:
* Wear Protective Gear: Safety first! Gloves and eye protection are a must.

* Rinse: Start with a good rinse to wash away visible debris.

* Scrub: Use soft brushes and manufacturer-recommended detergents.

* Rinse Again: Rinse thoroughly to remove all cleaning agents.

* Dry: Air dry or use clean, lint-free towels.

2. Ultrasonic Cleaning

This is where technology comes into play, using sound waves to clean where hands can't reach.

* When to Use: For instruments with small crevices or hard-to-reach areas.
How to Do It:
* Use an Ultrasonic Cleaner: These machines are specially designed for the job.

* Choose the Right Cleaning Solution: Follow manufacturer guidelines or veterinary surgical instrument cleaning protocol here.

* Rinse and Dry: Rinse and dry the instruments properly after the ultrasonic bath.

3. Automated Cleaning

Machines can take over much of the work, and automated cleaners are becoming more common.

* When to Use: For standard instruments without special cleaning needs.
How to Do It:
* Use a Washer-Disinfector: These machines clean and disinfect all in one.

* Follow Instructions: Different devices have different rules. Stick to the manual.

4. Disinfection

After cleaning veterinary surgical instruments, disinfection ensures that all potential pathogens are eradicated.

* When to Use: Always after cleaning.
How to Do It:
* Choose the Right Disinfectant: Again, manufacturer guidelines are your friend here.

* Follow the Instructions: Disinfectants have specific usage instructions.

Common Mistakes People Make When Cleaning Surgical Instruments Veterinary

Here are some common blunders to avoid:

Skipping Steps

Cutting corners can lead to infections and malfunctions; therefore, stick to the procedure. Remember, it's there for a reason!

Using the Wrong Solutions or Equipment

This mistake leads to damage to instruments and less effective cleaning. That's why it is critical to follow manufacturer guidelines. They know best!

Ignoring Manufacturer's Instructions

Ignoring the manual and veterinary surgical instrument cleaning protocol can shorten the tool's lifespan and reduce efficiency. Those instructions aren't just for show. Give them a read!

Lack of Training

Proper training in cleaning surgical instruments makes all the difference. Lack of training can lead to mishandling of tools and improper cleaning.

Conclusion: Cleanliness Is Next to Healthiness

Cleaning veterinary surgical instruments might seem like a complex chore, but with the correct methods, it's a breeze. Saving lives and providing the utmost care is the responsibility of the healthcare department. So, ensure you sterilize and clean the tools before and after using them.

In addition, veterinary professionals should prefer high-quality surgical instruments that last longer and do not rust and corrode as quickly. offers German-made, quality stainless steel veterinary surgical instruments that are low-maintenance and long-lasting. Contact us today to equip your surgical kit with quality medical instruments.

Frequently Asked Questions

What Are the Top 5 Authorized Surgical Cleaning Agents?

The top 5 ideal cleaning agents are quaternary ammonium compounds (QACs), hypochlorite solutions, accelerated hydrogen peroxide, phenolics, and peracetic acid.

What Agents Are Not Recommended for Cleaning Surgical Instruments Veterinary?

Avoid using HCL/muriatic acid, ammonia, solvents, hard water / pH above 7, detergent-free solutions with enzymes, bleach, Cl-containing compounds, quaternary salts, and abrasive cleaner for cleaning surgical instruments as they can damage them.

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surgical instrument cleaning steps veterinary

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veterinary surgical instrument cleaning protocol

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the process of cleaning surgical instruments

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Best Practices and Methods for Cleaning Veterinary Surgical Instruments

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Cleaning veterinary instruments might seem like a complex chore, but with the correct methods, it's a breeze. Saving lives and providing the utmost care is the responsibility of the healthcare department.

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Biosecurity encompasses everything that is done to mitigate pathogens and protect against the spread of infectious diseases. Cleaning, sanitizing, disinfecting and sterilization each play a vital role in the overall protection of animal, human and environmental health. To address the unique needs in veterinary practices multiple strategies and processes are required to be effective but it doesn't have to be complicated. Approach each cleaning process in the same manner. The number and type of layers is determined by the desired outcome.
Base Layer
Always start with Macro Cleaning any surface by manually removing potential fomites and/or organic material such as feces, urine, gross debris, bedding, gauze pads, surgical instruments, drapes or other items that have the potential to spread germs. Make sure all items are placed in designated receptacles with covers where appropriate.
Cleaning Layer
Thorough cleaning is required prior to disinfection and sterilization to remove visible foreign matter from objects and surfaces. Inorganic and organic materials that remain on the surface interfere with the effectiveness of these processes.

Choose a cleaner with surfactants (soap or detergents) that has good cleansing properties when in dilute solutions to remove dirt, dust, stains, soils and associated odors from surfaces. Don't overlook that water is considered the universal solvent and is essential to most cleaning processes. Presoaking instruments, laundry, or surfaces with dried fecal material or blood dramatically improves results.

Friction is also extremely important. Scrubbing helps break down grime and assists with the removal of debris, allowing it to be more readily removed by ultrasonic cleaning, rinsing &/or wiping and better prepares the object for sanitizing, disinfection or sterilization. For instruments with channels too small for the bristles to reach pressurized fluids are used to dislodge soil and debris.
Sanitizing Layer
Sanitizing reduces or eliminates the number of pathogenic agents (such as bacteria) on surfaces to a safe level. This is often preferred for low-risk areas such as daily routine cleaning of a pet boarding kennel where the same occupant resides during its stay. This lessens the potential exposure to strong chemical agents, fumes and residues.
Disinfecting Layer
Disinfection eliminates harmful viruses and bacteria, except for bacterial spores, that remain on surfaces after cleaning. This should be used in all circumstances that are considered high or unknown risks and for deep cleaning of low-risk areas such as preparation for a new patient or high contact surfaces.
Sterilizing Layer
Sterilization kills all microorganisms from surfaces. Physical or chemicals methods such as pressurized steam, dry heat, ETO gas or liquid chemicals are used for surgical applications such as instruments, equipment and surgical packs.
Protection Layer
Unfortunately, as soon as the disinfection process is complete any exposed surfaces are immediately at risk for recontamination from potential pathogens in the air. Air Purification provides protection against airborne pathogens, however, not all air purifiers are the same. When choosing an air purifier look for an active system such as Photocatalytic Oxidation technology that releases ions into the environment to inactivate pathogens midair and on exposed surfaces. This will augment your sanitizing and disinfecting processes.
Other Considerations
Always check the Safety Data Sheet for every chemical to ensure it is safe and what, if any, hazards are associated with potential exposure or chemical interactions. To minimize risks, use complimentary chemistry's, always use per label directions and wear Personal Protective Equipment (PPE) as needed.

Prioritize frequent cleaning, disinfection and protection of rooms, high contact surfaces and frequently used equipment. Limit exposure by using disposable patient care equipment and supplies when possible.

Encourage frequent hand washing, use of hand sanitizers and changing of gloves.

Take advantage of resources provided by biosecurity experts in animal health.
Finally Set Expectations
Emphasizing the importance of good biosecurity practices is imperative to a successful business, especially those in the medical field. Collaborate with staff members to optimize current protocols and processes and help them become vested in their successful execution.

Not only will this lessen the potential of disease transmission but will improve employee morale, decrease costs associated with outbreaks, elevate standing in the community and optimize patient care.

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Effective Biosecurity Requires a Layered Approach - Ogena Solutions

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Biosecurity encompasses everything that is done to mitigate pathogens and protect against the spread of infectious diseases. Cleaning, sanitizing, disinfecting and sterilization each play a vital role in the overall protection of animal, human and environmental health. To address the unique needs in veterinary practices multiple strategies and processes are required to be effective but [...]

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Washing should remove all the dirt and biological debris from the surface of the materials and should be performed within 30 minutes of the end of the surgical procedures

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Disinfection can be effectively achieved by immersing the instruments in enzymatic detergent, at neutral pH, for 90 minutes at 25°C.

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Cleaning: physical removal of contaminants and the organic matter that protects them Disinfection: a process which reduces the number of micro organisms to a level which is not a threat to health Sterilisation: a process which physically removes contaminants including spores Quality Improvement Campa

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Disinfection can be effectively achieved by immersing the instruments in enzymatic detergent, at neutral pH, for 90 minutes at 25°C. At the end the instruments should be rinsed with demineralised or distilled water and dried with paper towels. Do not use alcohol when cleaning materials.

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Washing should remove all the dirt and biological debris from the surface of the materials and should be performed within 30 minutes of the end of the surgical procedures. To prevent blood from drying on the materials we suggest covering them with a damp towel.

The instruments shouldn't be overexposed to physiological saline solutions, since prolonged contact promotes oxidation.

At the beginning of the washing process the material should be rinsed under running water, while opening and closing the instruments. Manual washing should be done with hard plastic brushes, with the instruments immersed in demineralised or distilled water with enzymatic detergent at a neutral pH, under 45ºC, in order to avoid the coagulation of protein substances. We recommend always using new detergents and washing solutions since the overuse increases chemical concentration due to evaporation, favouring the corrosion of the materials and reducing the effectiveness of the disinfection.

Ultrasonic cleaning by cavitation is the most effective cleaning method.

Disinfection can be effectively achieved by immersing the instruments in enzymatic detergent, at neutral pH, for 90 minutes at 25°C. At the end the instruments should be rinsed with demineralised or distilled water and dried with paper towels. Do not use alcohol when cleaning materials.
2. Lubrication
Cleaning may render instrument's joints stiff due to mineral deposits and other impurities in the water system and regular metal to metal friction causes corrosion. Blue recommends applying a spray lubricant to all surfaces and instrument joints after each cleaning cycle.
3. Inspection
Before carrying out the sterilisation inspect each instrument and confirm the correct function of the joints, cleanness and general condition of the material.
4. Sterilisation
Sterilisation is essential to ensure that surgical instruments do not act as pathogen vectors. The most common method is autoclaving.

In the autoclave the instruments must always be in the open position to allow the steam to reach all surfaces. Do not overload the autoclave trays, which would block the steam penetration. The temperature, cycle duration and pressure should be those recommended by the manufacturer.

Regardless of the steriliser class, complete drying of all instruments and implants should be assured to prevent their degradation. The use of dry heat is not recommended for the sterilisation process.

Unpackaged instruments should be used immediately. Packaged instruments should be stored in a dry, closed and warm place.

Cold sterilisation, with prolonged immersion in enzymatic detergents, can impair delicate instruments. Avoid using solutions with benzium ammonium chloride on instruments with tungsten.

Most problems with the instruments can be attributed to one or more of the following causes:

Improper cleaning and drying immediately after use;

Prolonged exposure to sterilisation solution or use of corrosive solution;

Using normal running water instead of demineralised or distilled water in the cleaning and sterilisation processes;

Using non-recommended detergents or lubricants;

Some sort autoclave failure.

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1. Cleaning and Disinfection Washing should remove all the dirt and biological debris from the surface of the materials and should be performed within 30 minutes of the end of the surgical procedures. To prevent blood from drying on the materials we suggest covering them with a damp towel.

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Cold sterilisation, with prolonged immersion in enzymatic detergents, can impair delicate instruments.

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https://www.vetsurgeryonline.com/sterilization-techniques/

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Sterilization:
Surgical instruments should be free of gross contamination prior to any form of sterilization. Microorganisms can be concealed by the blood and debris, preventing effective sterilization and contaminating the surgery. Ultrasonic cleaning is useful for removing blood and debris lodged within the box locks and gripping surfaces of instruments.

Steam Sterilization:

Autoclave with pack ready for sterilization (open door)

Steam sterilization is by far the most common method used in veterinary medicine. Common chemical sterilization techniques include gas sterilization using ethylene oxide or hydrogen peroxide and cold liquid sterilization using aldehydes. Steam sterilization is extremely popular for disinfecting instruments and other surgical items such as gown packs. Steam sterilization kills microorganisms by using moisture and extreme heat to cause coagulation of cellular proteins required for survival. Pressure is used to increase the temperature of the steam and allow more efficient sterilization. Items such as oils and greases cannot be sterilized using steam sterilization. Three types of steam sterilizers exist including gravity displacement, prevacuum and steam pulsing autoclaves.

Gravity displacement autoclaves are the most common in private practice and operate by entering steam into the top of the autoclave chamber and displacing air towards the bottom for eventual removal. Once all of the air in the chamber has been replaced by steam, a specific temperature is reached in the chamber which is maintained for a period of time to kill the microorganisms.

Prevacuum autoclaves operate by removing all air from the chamber using a vacuum pump and then pumping in steam. This allows for a more rapid sterilization process and also allows for the steam to penetrate instrument packs much faster. As a result, 'flash' sterilization can be done to instruments when they are needed quickly (emergency or dropped instrument) - this cycle is done on a non-wrapped instrument and using a fenestrated tray.

Steam pulsing autoclaves operate by pulsing steam into the chamber to a set pressure and removing air. These autoclaves are cheaper but not as fast as prevacuum autoclaves. However, they are faster than gravity displacement autoclaves.
Standard vs. Flash Sterilization:

Single instrument ready for flash sterilization with chemical sterility indicator

In general, all instruments must be thoroughly cleaned of any organic debris before placement in an autoclave. Instruments must be dried, box locks opened and all surfaces exposed for proper sterilization. In the autoclave, containers are placed right side up and instrument packs are loaded vertically and longitudinally with space between them to allow steam to travel all around. The autoclave is set for a temperature of 121°C (250°F). Sterilization time of 13-15 minutes (at 15 psi) is the standard minimum exposure time, an additional 2 to 5 minutes is often added for safety. Typical references will quote a sterilization time of 30 minutes at 121°C for gravity displacement sterilizers.

Flash sterilization of single instruments can be done at 132°C (270°F) for 3-4 minutes (at 30 psi) in a fenestrated metal tray if a prevacuum autoclave is used.
Cold Sterilization:

Cold sterilization method

Cold sterilization is often used for material and instruments that cannot be steam sterilized, such as instruments with lenses (endoscopes and arthroscopes) and anesthetic equipment. Gluteraldehyde is a non-corrosive cold sterilant that utilizes alkylation to kill bacteria, viruses and spores. Gluteraldehyde and other aldehydes (such as formalin) can be irritating to skin and mucous membranes and can cause hypersensitivity reactions. Instruments soaked in an aldehyde cold sterilant should be rinsed thoroughly with sterile saline prior to use.
Ethylene Oxide:

Ethylene Oxide

Ethylene oxide is a gas when at temperatures above 10.9°C. This sterilization method can kill microorganisms such as all bacteria, spores, fungi and mainly large virus particles. Killing occurs by alkylation; impairing metabolic functions of the organisms. Effectiveness of sterilization using this compound varies with the gas concentration, temperature, exposure time and humidity of the environment used. Exposure time can vary from as little as 48 minutes upwards to several hours. The gas diffuses through instrument packs and packages killing organisms it contacts. Before the sterilization is complete, an aeration period must occur to allow the ethylene oxide to diffuse out of the packs. Certain objects such as plastics and rubbers require 168 hours or more before handling and use can occur, whereas stainless steel tools require little time to aerate. Surgical implants can require as much as 14 days aeration before handling and implantation is safe. Contact with ethylene oxide impregnated objects may cause severe burns to patients and handlers. Ethylene oxide is flammable and explosive in air mixtures and very irritating when inhaled. Storage of sterilized packs can range from 15 days up to 1 year in duration. Sterilization using ethylene oxide has been banned in several countries (including Canada) due to release of CFC12 during the sterilization process which damages the ozone layer. Items that have previously undergone radiation sterilization should not be exposed to ethylene oxide sterilization because of the formation of toxic ethylene chlorohydrine. Newer generations of ethylene oxide sterilizers that do not produce CFCs are however permitted in Canada. Items that have previously undergone radiation sterilization should not be exposed to ethylene oxide sterilization because of the formation of toxic ethylene chlorohydrine.
Plasma Sterilization:
Hydrogen peroxide gas is used to produce free radicals which kill microorganisms in a closed chamber. A radio frequency is turned on to activate the process and then turned off to revert the chemicals to unharmful oxygen, water and other byproducts. Sterilization takes approximately 1 hour and no aeration period is necessary after the sterilization cycle is completed. This method of sterilization is rapidly replacing ethylene oxide sterilization in some countries. It has the ability to kill a broad spectrum of microorganisms including mycobacteria, resistant bacterial spores, fungi and viruses. A significant disadvantage is that materials such as linens, gauze sponges, wood, some plastics, and liquids cannot be sterilized using this method.
Radiation:

Manufacturers of prepackaged material for sterile veterinary use often use ionizing radiation. It is an expensive method of sterilization and typically is reserved to manufacturing facilities and large hospitals. Commonly used sterile surgical supplies, such as syringes and catheters, are often sterilized by this method. In veterinary medicine, radiation sterilization is also sometimes used to re-sterilize objects that are meant for single use only and that cannot be easily sterilized using other methods. Items that have previously undergone radiation sterilization should not be exposed to ethylene oxide sterilization because of the formation of toxic ethylene chlorohydrin.

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Sterilization: Surgical instruments should be free of gross contamination prior to any form of sterilization. Microorganisms can be concealed by the blood and debris, preventing effective sterilization and contaminating the surgery. Ultrasonic cleaning is useful for removing blood and debris lodged within the box locks and gripping surfaces of instruments.

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Handling and Care of Instruments

Modern surgical instruments are made of stainless steel, an alloy of iron, chromium and carbon. The inclusion of chromium increases the resistance to corrosion. With proper care and attention, surgical instruments will last for years.

In larger veterinary hospitals it may be necessary to have a number of general surgical packs, with additional specialized instruments packed separately. A card index system, outlining the equipment needed for each procedure, facilitates efficient preparation prior to surgery. Coloured tape may be used for identification of instruments from within the same set to allow for easy repackaging; however, this must be used with caution as it provides a useful "hiding place"for bacteria.

Care

Instruments should only be used for the purpose for which they were designed. Allis tissue forceps should not be used as bone holders and Metzenbaum scissors should not be used for cutting sutures!

Instruments should always be placed on surfaces, not dropped or thrown.

Heavy items should not be placed on top of, or adjacent to delicate equipment.

Instruments with cutting blades should be protected to avoid dulling of the edges.

Protective sheaths should be left in place until the instrument is ready for use.

During surgery, the scrubbed nurse (if utilising this role) should ensure that the instruments are kept free of blood and debris by wiping with a sterile moistened swab after each use.

Checks

Instruments should be checked after each procedure.

Check tungsten carbide inlays for burrs
Check both sides for cracks
Check correct fit of the screw link
Perform cutting test

Forceps/clamps

Check the jaws for damages, scratches and deformation
Check the jaws teeth, serration and tines
Cracks in the link
Check the teeth lock fully engage
Teeth have same measurement and fit nicely
Check the clamp cannot be opened

Needle holders

Check and test the lock
Check serration for damages
Check the rounding of inner jaw tips visually and physically with finger tips

Dissecting forceps

Check jaws for damages, deep scratches and deformation
Check spring for cracks
Check spring for tension
Spring must not be bent

Other recommended checks:

Ratchets should close easily and hold firmly.

Box locks that are too loose will cause misalignment and will not hold tissue securely. When not in use, the box locks should be left secured on the first ratchet.

The shaft of instruments, in most cases, should be straight to ensure correct alignment.

Cutting instruments (scissors, osteotomes, chisels, periosteal elevators and rongeurs) should be checked for sharpness and chips in the metal.

Protective sheaths should be applied for storage.

Needle holders become damaged when too large a needle has been used for the given size and type of needle holders. An appropriately sized needle will be gripped firmly with the jaws locked on the second ratchet. Some needle holders have tungsten carbide inserts, which increase strength and reduce wear on the gripping surface. These instruments are usually more expensive but they will last longer as the inserts can be replaced, therefore prolonging the life of the whole instrument. Instruments with tungsten carbide inserts are identified by their gold-coloured handles.

Titanium alloy is used for microsurgical and ophthalmological instruments. This alloy has a bluish colour that reduces glare under the operating lights. Such instruments are lighter and stronger than surgical steel instruments. Because of the design and physical properties of the instruments, the surgeon is able to control their movements much more easily. Extra care should be taken when handling these instruments because they are not only delicate, but are also expensive to replace. They can be placed in special trays for cleaning and storage.

Manual Cleaning

Before cleaning the surgical pack, the priority is the safe removal and disposal of all sharps! This is important to avoid sharp and needle stick injuries to the theatre nurse when cleaning and handling the instruments. Common sharps to look out for in surgical kits include scalpel blades (there could be more than one used) and various needles (especially swaged onto lengths of suture material).

Always clean instruments straight after use. If thorough cleaning is not possible, then at least rinse the instruments in cold water to remove gross dirt and blood. Hot water should not be used as it causes coagulation of proteins (e.g., blood). Instruments should not be soaked for prolonged periods as this is detrimental to the chromium oxide layer on the instrument surface, which may lead to staining and corrosion. If soaking is necessary, a chemical cleaning solution specifically designed for instruments may be used. Instruments should be cleaned using a detergent specifically designed for instrument cleaning as ordinary soaps and detergents can damage the surface of the instrument. Enzymatic cleaners are available which break down the dirt and grease. Instruments that have movable parts should be disassembled prior to cleaning (e.g., depth gauges and drill guides, etc.) All box locks and ratchets should be opened to ensure thorough cleaning.

Serrations and box locks should be cleaned with a soft bristle brush. Abrasive materials should never be used as they scratch the surface of the instrument, which may collect organic debris in later use and cause corrosion. A final water rinse will remove any traces of detergent prior to autoclaving.

Ultrasonic Cleaning

Ultrasonic cleaners are effective at removing debris from inaccessible areas such as box locks, serrations and deep grooves. These cleaners act by a process of cavitation. Ultrasonic energy produces high-frequency sound waves that generate tiny bubbles in the solution in the cleaner. The bubbles expand until they become unstable and collapse. This collapse generates minute vacuum areas that dislodge and dissolve debris.

The bath is filled to a level one inch above the tray. Only instrument cleaner recommended by the manufacturers should be used. The instruments are placed into a wire mesh tray (heavier, bulkier instruments at the bottom) and lowered into the bath. The tray should only be half full to avoid overloading and damage to the instruments. Instruments are thoroughly rinsed after ultrasonic cleaning to remove any surface debris and detergent residue.

Instrument Lubrication

Following cleaning and rinsing, all instruments with moving parts should be lubricated. Instrument manufacturers recommend the use of water-soluble lubricants such as instrument milk, an oil-in-water emulsion that has antimicrobial properties.

As a general rule, the instruments should be submerged in the lubricant bath for thirty seconds and then left to drain without rinsing or drying. However, if the instruments are to be sterilised in a hot air oven, then all traces of the lubricant should be removed as the intense heat causes the milk to form a "gum," which is difficult to remove.

Machine or mineral oils are not suitable as lubricants as they leave a sheen on the instrument surface and will inhibit steam penetration during the sterilisation process. Some instruments, such as orthopaedic drills, have their own silicone gel. This should always be used in accordance with manufacturer instructions.

Once the cleaning process has taken place, surgical instruments must be left to dry. Instruments must be laid out flat with any ratchets and hinges open to ensure adequate drying and reduce the risk of rust damage. Instruments are always air dried in a clean, low-traffic area to avoid contamination. Alternatively, a drying cabinet may be used. Use of a cloth or towel to dry surgical instruments will lead to accumulation of debris, which could harbour bacteria.

Sterilisation

Surgical instruments and equipment are sterilised before each and every subsequent use. The sterilisation process takes place after the instruments have been cleaned and are dry.

Heat Sterilisation

Autoclaves

This is the most widely used and efficient method of sterilisation and is also the most economical. Most items used within the veterinary practice can be autoclaved and include:

Instruments

Cloth drapes and gowns

Swabs

Most rubber articles - need to check with manufacturer/instructions

Some plastic goods - need to check with manufacturer/instructions

References

1. The Animal Industries Resource Centre Course materials - Certificate IV in Veterinary Nursing.

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Instrument Care Tips and Techniques - WSAVA 2018 Congress - VIN

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Handling and Care of Instruments Modern surgical instruments are made of stainless steel, an alloy of iron, chromium and carbon. The inclusion of chromium increases the resistance to corrosion. With proper care and attention, surgical instruments will last for years.