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Instrument Damage Often Begins in the Operating Room

By Julie E. Williamson

Consistent, on-time availability of clean, sterile, well-functioning instrumentation is essential for safe, high-quality surgical outcomes. Although sterile processing (SP) professionals bear much of that responsibility, it’s essential that surgical services professionals recognize how improper care and handling of instrumentation in the surgical suite can lead to costly device damage and, sometimes, the need for premature instrument replacement.

What follows are some of the most common instrument care and handling mistakes that take place during and after surgical procedures, along with recommendations for preventing them.

Using instruments for the wrong purpose

Instruments used for purposes other than which they were designed can lead to costly damage and dangerous malfunction. Hemostats, scissors and needle holders are several commonly misused devices. Hemostats are designed to clamp blood vessels, grasp and secure tissue during surgery, or more deeply explore areas of a surgical site to improve the surgeon’s visualization; however, they are sometimes improperly used to clamp tubes. Only a tube occluding clamp should be used for this function. Hemostats have finer jaws than a tube clamp and hemostats’ box lock is also not as strong as tube clamps; therefore, using hemostats for this purpose can lead to cracks in the box lock. Also, serrations on hemostats can damage tubing.[1]

A pair of fine scissors, which are designed to cut fine human tissue, should never be used to cut bandages, suture, gauze or other materials; doing so can dull the tip and place unnecessary stress on the hinge area. A dull blade can tear tissue.

Needle holders are designed to hold the needle to close an incision, but surgeons may incorrectly use them to pull and twist wire (this underscores the importance of ensuring needle-nosed pliers, which are designed for such a purpose, are included in the set). Needle holders should never be used in place of pliers because irreparable cracks can occur.[2]

Not performing appropriate point-of-use instrument care

Post-procedure instrument care begins at the point of use, not in the sterile processing’s decontamination area. Dried blood and bioburden make cleaning far more challenging and can contribute to biofilm formation, which requires more aggressive cleaning processes to remove. Scratches and other damage can occur when aggressive cleaning is required, which makes future cleaning and sterilization processes more difficult as well.[3] Blood and bioburden that’s allowed to dry and harden onto instrument surfaces can also lead to staining, rusting and pitting.

During and following the procedure, gross blood and bioburden should be gently wiped from each device with a sponge moistened with sterile water and kept moist with a dedicated moisturizing spray or enzymatic cleaner (in the absence of such products, instruments can be covered with a lint-free, water-moistened towel). Note: Before applying any point-of-use treatment product, be sure to check the instrument manufacturers’ instructions for use to ensure compatibility. Saline should never be used because it can lead to corrosion.

Instruments should be transported to the decontamination area for proper cleaning and high-level disinfection or sterilization as soon as possible following the conclusion of the procedure.

Failing to transport delicate devices in the proper container

It’s not uncommon for SP professionals to receive instruments from the OR in a state that can cause damage, such as heavier instruments being piled on top of delicate instruments. Devices with fine tips should be separated from regular instruments to prevent those tips from becoming bent, broken or otherwise damaged during transport. Basins or trays containing instruments should never be stacked on top of unprotected instruments (doing so can not only damage the unprotected devices, it can also create an unlevel surface that makes it more likely for instruments to shift or fall during transport. This increases the odds for instrument damage and can jeopardize employee safety).

Endoscopes are sophisticated, expensive pieces of equipment and require special care and handling. Endoscopes should be transported in their own protective containers, away from sharps and other instruments that can damage the delicate lens and other components of the endoscope. The endoscope’s distal end is highly prone to damage, which often occurs during impact with another surface (such as when the device is dropped or banged against other instruments, equipment, etc.). The endoscope’s cord must also not be too tightly coiled during transport, and the device should be placed in its container with knobs facing upright and in the unlocked position.

References
1. Schultz R. Hemostats 101: Understanding One of the Most Common Surgical Instruments. PROCESS. Nov/Dec 2019. International Association of Healthcare Central Service Material Management. Chicago, IL.
2. Schultz R. Needle Holders: Proper Care and Inspection Crucial to Their Performance. PROCESS. Sept/Oct 2019. International Association of Healthcare Central Service Material Management. Chicago, IL.
3. International Association of Healthcare Central Service Materiel Management. Instrument Resource Manual, First Ed. 2018, pp. 28-29. Chicago, IL.

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