Maximizing the Lifespan of Surgical Instruments

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, providing it is cared for properly. However, there are several factors that can contribute to damage and may shorten the lifespan of instruments. There is an astonishing range in the number of surgical instruments utilized in just one procedure for one patient. Anywhere from 25 up to about 1,000 single instruments or items may be unpacked in an operating theater for just one surgical procedure.

The Importance of Care and Handling

Whatever is unpacked from its sterile packaging or sterile barrier system (SBS) is considered ‘contaminated’ and therefore needs to go through a full reprocessing procedure comprising of cleaning, disinfection, maintenance, function control, packaging and sterilization. Without sterile processing, clean and sterile items would not be available for patients’ procedures and hospitals would not be able to properly reuse these complex, intricate and often highly expensive tools.  

Surgical volumes are increasing and procedures are becoming gradually more advanced. If you stop to think about how many times one pair of scissors or a scalpel handle is used on different patients, it’s remarkable. During this lifespan, it is important for all healthcare providers within a 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 shared responsibility of everyone handling or using these sophisticated tools – the quality status of which can quite literally be a matter of life or death. 

Factors that Contribute to Damage 

From transportation to sterilization, surgical instruments travel on a dangerous expedition of exposure to blood and other bodily fluids, highly corrosive substances such as chlorines from saline solutions, various aggressive cleaning and disinfection chemicals and harsh sterilization conditions of typically 134°C in saturated steam or alternatively strong oxidizing chemicals such as hydrogen peroxide. 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 an expensive inventory. Most causes of damage can be grouped into the following categories: 

1. Misuse – when an instrument is not used as intended by its manufacturer. Examples of this could include the following:

• A surgeon or surgical technician using a needle holder to change the burr on a drill
• A nurse or doctor using mayo scissors to cut paperwork in the office
• A CSSD (Central Sterile Services Department) technician using a bone osteotome as a screwdriver to loosen a screw in their desk

2. Abuse – which means any rough or careless ‘mistreatment’ of instrumentation that may cause damage to the respective instruments, such as:

• Stacking
• Dropping
• Throwing
• Slamming
• Improper sharpening or maintenance
• Tangling (e.g. of cables or wires)
• Scratching or scraping

3. Reprocessing induced damages (including surface changes and corrosion) – improper transporting, cleaning, disinfecting or sterilization practices that cause damage to medical devices:

• Leaving blood or other corrosive contaminations on the surface of instruments for too long before removing them
• Soaking of instruments in corrosive solutions (saline solutions, inappropriate cleaning or disinfection chemicals) 
• Improper dosing (generally too high) of process chemicals or use of detergents during cleaning
• Choice of process chemicals that are not compatible with the treated materials (e.g. alkaline detergent for anodized aluminum)
• Insufficient cleaning may lead to contamination deposits and the formation of biofilm
• Poor water quality may lead to corrosion or surface deposits
• Improper temperatures and pH levels during reprocessing steps
• Inadequate rinsing of process chemicals may lead to deposits or make plastic surfaces brittle

Improve Practices to Avoid Damage to Instruments 

The best way to maintain quality during instrument handling is to establish a quality system that defines a standard procedure for each instrument to be processed, while at the same time ensuring full compliance of that particular standard procedure. While this task can be challenging, it is necessary to consistently provide patients with quality instruments, as well as consistent and safe outcomes. Another important ingredient is a ‘quality mindset’ throughout the instrument cycle – from surgeons to CSSD techs. Every single CSSD employee needs to consider the instruments for which they are responsible as a ‘vital part of patient care’ instead of ‘just another tray to process’. Taking this approach will have a significant, positive impact on the personal attention required at each handling point. Here are a few general suggestions based on global best practices: 

• 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 appear 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 and functioning of instruments. This ensures that both the OR staff and surgeons are provided with the correct instrument and will increase the understanding of the critical role that reprocessing staff has in the patient supporting team.
• 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.
• Use state-of-the-art washer disinfector racks to make sure canulated instruments are connected so that lumens and inner surfaces are cleaned as well as outside surfaces.
• Use adequate silicon mats and holders for delicate instruments in the washer disinfector so instruments are protected from moving within the tray  
• Place small, easy-to-lose parts into approved containment devices that allow for proper cleaning and sterilization.
• Do not use other instruments to pry, force or manipulate multipart 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 the items are safe and effective for use on patients.

And most importantly… be a role model for a ‘quality mindset’ and dedication to patient protection for everyone you encounter.

References and Resources:

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. 

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