In the bustle of a veterinary surgical ward, proper care of surgical instruments can easily be overlooked. But clinics that neglect proper cleaning and maintenance of equipment pay for such neglect in the long run in costly repairs and replacements. If properly cared for, surgical instruments can last the life of a practice, says Derek Lashua, director of marketing for Spectrum Surgical Instruments/STERIS Specialty Services in Stow, Ohio. The first step in proper care is to begin the cleaning process as soon as possible after surgery—within 20 minutes, he says. "Even if your instruments are not going to be sterilized until later, washing instruments shortly after surgery prevents blood from drying on them and is your best defense against staining, pitting and corrosion,” Lashua says. Cleaning, Sterilization Dried blood is the biggest enemy of surgical instruments, Lashua says. In fact, one of the most common problems his company sees is damage caused by dried-on blood and the use of improper cleaning solutions. If instruments can’t be washed immediately after surgery, clinic staff can use a pre-cleaning spray to prevent blood from drying on them, Lashua says, making cleaning faster and more efficient. "Also, use only solutions designed specifically for use on surgical instruments,” Lashua says. Household cleansers, dish soap, chlorhexidine-based solutions, laundry soap or surgeons’ hand scrub will cause spotting and corrosion on instruments. Cleaners used to wash instruments should have a neutral pH, Lashua says. Instrument cleaning brushes are useful for hard-to-clean areas such as jaw serrations, teeth and hinges, Lashua says. "Additionally, the use of an ultrasonic cleaner is a highly effective method of cleaning that is 16 times more efficient than manual cleaning alone,” he adds. After instruments are cleaned and dried, Lashua recommends, use a spray-on water-based instrument lubricant that includes a rust inhibitor. Such solutions are designed to keep hinges, ratchets and other moving parts in good working order. "Avoid sterilizing the instruments with the ratchets in the closed or locked position,” Lashua says. "Autoclaving instruments in the open position will allow for improved steam penetration and help relieve stress and potential cracks caused by rapid expansion under high heat.” Hans Jorgensen, DVM, president of Jorgensen Laboratories in Loveland, Colo., agrees. He also notes that staff must ensure that autoclaves are clean and operating at the correct temperature. Instrument Handling In addition to proper cleaning and sterilization, veterinarians and staff must ensure they are using and handling their instruments correctly in order to avoid damage. Lashua says pin cutters are one of the most commonly misused instruments. "Always remember when using any type of pin cutter that the weakest part of the jaw is the distal tip,” he says. "Do not use the tips of the jaws for cutting, as this may damage the pin cutter, rendering the instrument non-repairable and in need of replacement.” Staff should be properly trained to handle surgical instruments, says Stefan Scanlan, operations manager at Sontec Instruments in Centennial, Colo. This training could vary according to a clinic’s surgical specialty, as the size of surgical instruments varies greatly, he adds. "For example, ophthalmology instruments are made using a microscope to create teeth on forceps as small as .12 mm (approximately a tenth of a millimeter),” Scanlan says. "Staff that has been trained to clean and handle such micro instruments will then understand the importance of a gentle yet thorough cleaning of this type of instrument. "All instruments, micro and macro, are designed with a precision working end/tip,” he adds. "These ends are where most of the care has to be concentrated and the integrity monitored.” Selecting Instruments New veterinary clinics and those looking to replace or upgrade their surgical instruments have a variety of options. Often, manufacturers offer two to three levels of quality. Scanlan says veterinarians should have hands-on help in selecting which quality level fits both their budget and environment. If a veterinarian is considering starting a new practice and looking to purchase new instruments, Lashua recommends contacting vendors to find out what they offer in the way of new practice start-up programs. "This should include volume discounts, help with instrument selection, creation of a ‘wish list,’ financing assistance and other value-added services such as free instrument identification labeling (etching of initials),” Lashua says. Jorgensen notes that the majority of veterinary hand instruments are of either German or Pakistani manufacture, with German steel fetching a higher price. "One of the keys is where the stainless steel being used originates and the quality that is being used,” Jorgensen says. "True German-manufactured instruments are made from German stainless steel.” Because of the large price differential between German and Pakistani instruments, veterinarians must decide where to "put their money,” Jorgensen says. "To me, the needle holder is the one instrument that should always be German made with tungsten carbide inserts,” he says. "Towel clamps are one item that you can save on, as both qualities perform well.” Lashua says veterinarians should ensure that their instruments are backed by a lifetime guarantee that includes replacement or repair if problems arise. He also notes that veterinarians should look for instrument vendors that service the products they sell. <HOME>
