The Life of an Instrument
The Importance of Care and Handling
The health and longevity of a surgical device or stainless-steel instrument is dependent on many factors. The expected useful life of an instrument can be well over 20 years if cared for properly. However, there are a number of factors that will contribute to its damage, and shorten its lifespan. If you consider the number of surgical instruments utilized in just one procedure, for one patient, it’s astonishing. Anywhere from 1,000 to 10,000 single items may be used for one surgical procedure, and that procedure varies from patient to patient. Without sterile processing patients wouldn’t have clean and sterile items for their procedure, and hospitals would not be able to properly reprocess these complex and intricate tools. Surgical volumes are increasing, and procedures are becoming more and more advanced. If you stop to think about how many times one scissor or knife handle reaches different patients, it’s remarkable. During this lifespan, it's important for all healthcare providers within the hospital to be aware of their role in the care and handling of the devices they utilize to care for each patient. The journey of an instrument is extensive, repetitive, and is the responsibility of everyone handling or using these complex tools.
Factors that Contribute to Damage
From transportation to sterilization, each surgical instruments travels on a long expedition of exposure to water, blood, chemicals and sterilant. Some instruments may be handled hundreds, sometimes thousands, of times during their life. Attention to care and handling is a key factor in maximizing the life of your expensive inventory. Most causes of damage can be categorized into the following categories.
1. Misuse- when an instrument is not used as design was intended. Examples of this could include the following:
- An SPD tech using a bone osteotome as a screwdriver loosening a screw in their desk.
- A surgeon using a needle holder to change the burr on a drill.
- A nurse using mayo scissors to cut paperwork in the office.
2. Abuse – any mistreatment of instrumentation that causes potential for damage to occur during normal use and handling:
- Improper sharpening or maintenance
- Scratching or scraping
3. Break Down or Corrosion- improper cleaning, disinfecting or sterilization practices during reprocessing that causes irreparable damage to the surface or material:
- Soaking instruments in chemicals for long periods of time
- Improper dosing or use of detergents during cleaning
- Using corrosive products not intended for that purpose such as iodine, alcohol, saline.
- Allowing biofilm formation and improper cleaning of devices
- Poor water quality used during processing.
- Improper temperatures and pH levels during reprocessing steps
Factors that Contribute to Damage
The best way to maintain quality during instrument handling is to establish a facility standard for each instrument processed. While this task can be challenging, it is necessary to provide quality instruments to each patient, every time, with consistent and safe outcomes. Everyone needs to consider instruments a vital part of patient care, instead of just another tray to process. Taking this approach will have as significant, positive, impact on the personal attention needed at each handling point. Here are few recommendations.
- Always adhere to the manufacturer's instruction for use for each device, instrument, and piece of equipment.
- Handle ALL items with care. Most devices are complex and fragile, even if they look to be sturdy.
- Never dump devices out of a container onto a surface, always lift them out carefully and place them on or into the working surface.
- Educate the sterile processing team and OR staff on the proper naming of instruments. This ensures that both the OR staff and surgeons are provided with the correct instrument and will eliminate inappropriate use.
- Pass and place delicate and sharp tipped items carefully, making sure not to drag them across any surface such as a mesh basket or countertop.
- Place instruments in the containment device (mesh basket, rigid container, plastic holder, silicone mat) in a manner that helps protect them.
- Place small, easy-to-lose parts into approved containment devices, that allow for proper sterilization and cleaning.
- Do not pry, force, or manipulate multipart instruments, by using other instruments, to keep them in the “open” position.
- Protect coated, insulated, ceramic, dipped, and laser marked instruments from wear and tear or nicking or scratching of the surfaces.
- Use tray inserts, silicone mats and corner protectors whenever possible to help create a secure sterilization tray that, when moved, protects the items inside.
- Test all instruments for functionality and sharpness during inspection to ensure items are safe and effective for use on patients.
Author: Randalyn Walters
References for this blog post include:
International Association of Healthcare Central Service Materiel Management, Central Service Leadership Manual, Third Edition, 2020.
ANSI/AAMI ST79:2017 & 2020 Amendments A1, A2, A3, A4 Comprehensive guide to steam sterilization and sterility assurance in health care facilities, 2017, Association for the Advancement of Medical Instrumentation.