Page 520 - WSAVA2018
P. 520

 25-28 September, 2018 | Singapore
Instruments should be checked after each procedure.
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.
  Check tungsten carbide inlays for burrs
Check both side for cracks
Check correct fit of the screw linkPerform 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 nicelyCheck the clamp cannot be opened
   Needle holders
   Check and test the lock
Check serration for damagesCheck 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 recommend 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

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