The importance of reliable equipment in surgery cannot be overemphasized. There is a lot of reliance on surgical equipment between the precision required to perform these operations and the accuracy that surgeons need to perform these operations successfully. Surgeons can only be as sharp as their equipment, and proper maintenance is crucial to the equation.

To keep surgical equipment in optimal working condition, you need to know how to maintain it. Cleaning, disinfection and proper storage are essential to keep surgical instruments in optimum condition for continued use. By following this guide, you can extend the life of your surgical equipment and make the most of your surgical tools for years to come.

Basic knowledge of surgical equipment nursing

There are many options to keep your instrument in top condition. If you know how to maintain your surgical instruments, you can extend their useful life while ensuring that they provide the best service over time. Most surgical instruments can last for years if you give them proper care regularly. Equipment maintenance consists of three different steps – cleaning, disinfection and sterilization.

Cleaning of surgical equipment

Cleaning removes dirt and any biological material from the surgical instruments prior to sterilization and disinfection. If dirt, body fluids, or tissues get into your surgical instruments, in addition to making the tools more difficult to clean, they can damage the surface. Equipment should be rinsed with cold water rather than hot water, as heat can cause the substance to coagulate if it contains enough protein.

Sterilizing surgical equipment

Surgical instruments require high level disinfection (HLD). You can use both thermal and chemical methods, but boiling is the preferred method because surgical instruments are usually unaffected by heat. It is important to note that boiling is not a method of sterilizing equipment.

If your instruments are fragile and could be damaged by heat, you need to chemically sterilize them. Three chemical disinfectants are recommended for surgical equipment:

Chlorine: Chlorine dioxide kills plant life within three minutes of exposure. It is a corrosive chemical that must take less than 14 days to function properly. If any organic matter is present, it will block the activity of chlorine.

Hydrogen peroxide: Hydrogen peroxide is effective, but will corrode the surface of the instrument. Extra care must be taken when rinsing.

Chlorhexidine: Chlorhexidine is effective against many viruses, but only kills a small percentage of bacteria. But it kills bacteria in its range very quickly.

Dry heat sterilization autoclave

This form of disinfection greatly reduces time. There are two types of dry heat to consider — static air and forced air. Using a static air sterilizer, it takes one to two hours to disinfect the device at 160°C. With forced air, you can disinfect the device in 6 to 12 minutes at 190°C.

Autoclave

Vertical Autoclave is a device that uses pressurized steam to sterilize equipment. Before starting the autoclave, you can place the instruments in a sterilization tray or wrap them in a paper or muslin bag. The use of trays or packaging helps to prevent contamination of the device after completion of disinfection. Do not stack instruments. Arrange them carefully so that steam can circulate efficiently through the machine and reach all surfaces of each instrument.

To be effective, one of the following thresholds must be met:

20 minutes at 121°C at 15 PSI above atmospheric pressure (unpackaged instrument)

For three to four minutes at 134°C at 30 PSI above atmospheric pressure (unpackaged instrument)

At 121°C for 30 minutes at 15 PSI above atmospheric pressure (packaged instrument)

Maintain a temperature of 134°C at 30 PSI above atmospheric pressure for 15 minutes

Care should be taken when opening autoclaves, considering that steam heat may cause burns. After the cycle is complete and the machine is decompressed, open the door a few centimetres and release the steam. Follow manufacturer’s recommendations for drying cycles. Most autoclaves will complete their drying cycle in about half an hour.

Use sterile pliers to remove trays and packages from autoclave and allow them to cool to room temperature before storage. If the item has been disinfected in its unpackaged state, it should be used immediately. Alternatively, you can store them in a covered sterile tray for a week or less. The wrapped equipment should be stored in a cabinet in a warm and dry environment. As long as the package remains dry, the wrapped sterile instrument has no expiration date.

Identification of improper use

When surgical instruments are poorly handled, they often show up visually. If your instrument changes color, you can visually identify several culprits:

Brown or orange stains indicate contact with high pH materials.

Dark brown stains indicate instrument exposure to low pH.

Blue or black stains indicate counterplating caused by mixing metals during ultrasonic cleaning.

Multi-coloured stains are the result of heat stress.

Bright and dark spots appear on the surface of the instrument where the water is dry.

Black stains indicate contact with ammonia.

Grey stains are the result of using too much rust remover.

Rust is the result of drying biological material or blood on the instrument.

With proper and diligent care, you can greatly extend the life of your surgical instruments. To treat your equipment properly, be sure to follow the manufacturer’s specifications for any machinery you use. For example, setting the wrong Settings for ultrasonic cleaning may mean that your instrument cannot be completely cleaned. Leaving surgical instruments in autoclave instruments for too long and exposing them to overheating can also shorten the service life of the device.An important factor in the service life of surgical equipment is the overall quality of the instrument. Start with higher quality instruments to ensure your cleaning and maintenance pays off in the long run.