Cleaning Instructions for Surgical Instruments After Surgery

Proper cleaning of surgical instruments post-surgery is essential to maintain their sterility and
ensure they are ready for future use. Below are the steps to clean stainless steel surgical instruments
effectively:

Pre-Cleaning
Immediate Rinse:

• Immediately after use, rinse instruments under lukewarm running water to remove blood,
  tissue, and other debris. Avoid using hot water as it can cause protein coagulation, making
  cleaning more difficult.
  Disassembly:
• Disassemble instruments with movable parts, such as scissors and forceps, to ensure all
  surfaces are accessible for cleaning.

Cleaning
Manual Cleaning:

• Soaking: Place instruments in a basin with an enzymatic cleaner or mild detergent
  specifically designed for surgical instruments. Follow the manufacturer’s instructions for the
  correct dilution and soaking time.
• Brushing: Use a soft-bristled brush to scrub each instrument thoroughly, paying particular
  attention to hinges, joints, and other hard-to-reach areas. Avoid using metal brushes or
  abrasive materials that can scratch and damage the instruments.
• Rinsing: Rinse instruments thoroughly with deionized or distilled water to remove all
  detergent residues.
  Ultrasonic Cleaning:
• Preparation: Arrange instruments in a wire basket or rack, ensuring they do not touch each
  other to allow effective cleaning.
• Cleaning Solution: Fill the ultrasonic cleaner with an appropriate cleaning solution as per
  the manufacturer’s recommendations.
• Cleaning Cycle: Run the ultrasonic cleaner according to the manufacturer’s instructions,
  typically for 5-10 minutes. Ensure all parts of the instruments are submerged and exposed to
  ultrasonic waves.
• Rinsing: After the ultrasonic cycle, rinse instruments with deionized or distilled water to
  remove any remaining cleaning solution.

Inspection
Visual Inspection:

• Inspect each instrument for cleanliness under good lighting, ensuring there is no visible
  debris, stains, or residues. Use magnification if necessary to examine intricate areas.
  Function Check
• Test the functionality of each instrument (e.g., opening and closing of forceps, smooth
  movement of scissors) to ensure they operate correctly and have not been damaged during
  cleaning.

Drying
Manual Drying:

• Use a clean, lint-free cloth or sterile compressed air to thoroughly dry each instrument. Pay
  special attention to joints and hinges to prevent rust formation.
  Automated Drying:
• If available, use an automated drying cabinet designed for surgical instruments to ensure
  thorough and consistent drying.

Lubrication
Instrument Milk:

• Apply a water-soluble, instrument-approved lubricant (commonly referred to as “instrument
  milk”) to hinges, joints, and moving parts of instruments. This helps maintain smooth
  operation and provides a protective barrier against moisture and rust.

Storage
Packaging:

• Once dry and lubricated, package instruments in autoclave pouches, wraps, or trays
  designed for sterilization. Ensure that instruments are properly arranged to prevent damage
  during storage and sterilization.

Sterilization Instructions

Steam Sterilization (Autoclaving)
Preparation:

• Clean and decontaminate instruments to remove any organic matter or debris.
• Disassemble instruments with movable parts.
• Inspect instruments for any signs of damage or corrosion prior to sterilization.
• Ensure instruments are thoroughly dried before sterilization to prevent rust formation.
• Use distilled or deionized water for cleaning and autoclave operations to avoid mineral
  deposits that can contribute to corrosion.
• Apply a water-soluble, instrument-approved lubricant (commonly referred to as “instrument
  milk”) to hinges and joints of instruments to create a protective barrier against moisture and
  rust.
  Procedure:
• Preheat the autoclave to the required temperature.
• Arrange instruments in the autoclave tray, ensuring they are not touching each other to allow
  steam penetration and even drying.
• Standard parameters for steam sterilization:
  o Temperature: 121°C (250°F) for 30 minutes or 134°C (273°F) for 4-5 minutes.
  o Pressure: 15-30 psi.
• Use autoclave pouches or wraps that are specifically designed to allow steam penetration
  while protecting the instruments from excessive moisture.
• Ensure proper drying time to prevent moisture retention inside the autoclave.
  Post-Sterilization:
• Allow instruments to cool inside the autoclave before handling to prevent condensation and
  moisture buildup.
• Open the autoclave door slightly after the cycle is complete to allow steam to escape
  gradually and avoid rapid cooling, which can cause condensation.
• Remove instruments promptly and place them on a clean, dry surface.
• Inspect instruments for any remaining moisture and thoroughly dry them if necessary.
• Store instruments in a sterile, dry environment to prevent exposure to moisture.
  Additional Tips:
• Regularly check and maintain the autoclave, including the water reservoir, to ensure it is
  free from impurities and mineral buildup.
• Use instrument trays made of non-corrosive materials, such as stainless steel or medical-
  grade plastic, to minimize the risk of rust.
• Avoid prolonged exposure to saline, blood, or other corrosive substances that can contribute
  to rust formation.

Ethylene Oxide (ETO) Sterilization
Preparation:

• Clean and dry instruments thoroughly to remove any organic matter or debris.
• Place instruments in gas-permeable packaging (e.g., Tyvek or paper-plastic pouches).
• Ensure instruments are dry before packaging to prevent rust.
  Procedure:
• Precondition the sterilizer with proper temperature and humidity settings.
• Standard parameters for ETO sterilization:
  o Temperature: 37-63°C (98.6-145.4°F).
  o Humidity: 40-80%.
  o Gas concentration: 450-1200 mg/L.
  o Exposure time: 2-6 hours.
• Ensure proper aeration time post-sterilization to remove residual ETO (8-12 hours at
  50-60°C or up to 7 days at room temperature).
  Post-Sterilization:
• Ensure instruments are fully aerated to remove ETO residues.
• Inspect instruments for any signs of rust or residue.
• Store in a sterile, sealed environment to prevent exposure to moisture.
  Additional Tips:
• Regularly inspect and maintain the ETO sterilizer to ensure it is functioning properly.
• Avoid using ETO sterilization for instruments with complex, hard-to-dry internal structures
  unless they can be thoroughly dried before sterilization.

Hydrogen Peroxide Plasma Sterilization
Preparation:

• Clean and dry instruments thoroughly to remove any organic matter or debris.
• Place instruments in non-cellulose packaging (e.g., Tyvek pouches) that allows hydrogen
  peroxide vapor penetration.
  Procedure:
• Standard parameters for hydrogen peroxide plasma sterilization:
  o Temperature: 37-44°C (98.6-111.2°F).
  o Hydrogen peroxide concentration: 59-95% solution.
  o Cycle time: 28-75 minutes, depending on the sterilizer model and load.
• Ensure proper loading of the sterilizer to allow even distribution of the hydrogen peroxide
  plasma.
  Post-Sterilization:
• Instruments can be used immediately after the cycle, as there is no toxic residue.
• Inspect instruments for any signs of rust or residue.
• Store in a sterile, dry environment to prevent exposure to moisture.
  Additional Tips:
• Regularly check and maintain the hydrogen peroxide plasma sterilizer.
• Use this method for heat-sensitive instruments that cannot withstand autoclaving.

Dry Heat Sterilization
Preparation:

• Clean and dry instruments thoroughly to remove any organic matter or debris.
• Place instruments in metal trays or foil wrapping (avoid plastic packaging).
  Procedure:
• Standard parameters for dry heat sterilization:
  o Temperature: 160°C (320°F) for 2 hours or 170°C (340°F) for 1 hour.
• Ensure proper air circulation within the dry heat sterilizer.
  Post-Sterilization:
• Allow instruments to cool before handling to prevent condensation and moisture buildup.
• Inspect instruments for any signs of rust or residue.
• Store in a sterile, dry environment to prevent exposure to moisture.
  Additional Tips:
• Regularly check and maintain the dry heat sterilizer.
• Use dry heat sterilization for instruments that may be damaged by moisture, such as certain
  cutting instruments.

Chemical Sterilization (Cold Sterilization)
Preparation:

• Clean and dry instruments thoroughly to remove any organic matter or debris.
• Inspect instruments for any signs of damage or corrosion prior to sterilization.
  Procedure:
• Immerse instruments in a high-level disinfectant solution (e.g., glutaraldehyde, ortho-
  phthalaldehyde).
• Follow manufacturer’s instructions for concentration and immersion time (typically 10-12
  hours for sterilization).
• Ensure complete immersion of instruments in the solution to avoid air pockets.
  Post-Sterilization:
• Rinse instruments with sterile water to remove chemical residues.
• Dry instruments thoroughly to prevent rust formation.
• Inspect instruments for any signs of rust or residue.
• Store in a sterile, sealed environment to prevent exposure to moisture.
  Additional Tips:
• Use chemical sterilization for heat-sensitive instruments.
• Regularly replace the disinfectant solution as per the manufacturer’s guidelines to maintain
  efficacy.
• Ensure proper ventilation in the area where chemical sterilization is performed to avoid
  inhaling fumes.

General Steps to Ensure Sterility

Visual Inspection:

• Before and after sterilization, inspect instruments for cleanliness, integrity, and absence of
  rust or damage.
• Ensure instruments are dry and free from any organic or inorganic residues.
  Packaging Inspection:
• Ensure that sterilization packaging (e.g., autoclave pouches, wraps) is intact, without any
  tears, punctures, or signs of moisture.
• Check the integrity of seals on packaging to confirm they are secure and unopened.
  Sterilization Indicators:
• Use appropriate sterilization indicators (chemical, biological, and mechanical) to validate
  the sterilization process.

Steam Sterilization (Autoclaving)
Chemical Indicators:

• Place chemical indicator strips or tapes inside and outside of each package.
• Confirm that indicators have changed colour according to the manufacturer’s guidelines,
  indicating that the package has been exposed to the proper temperature and steam.
  Biological Indicators:
• Use biological indicator vials or strips containing heat-resistant spores (e.g., Geobacillus
  stearothermophilus).
• Place the biological indicator in the most challenging location within the autoclave load.
• After the sterilization cycle, incubate the indicator according to the manufacturer’s
  instructions.
• A negative result (no microbial growth) confirms effective sterilization.
  Mechanical Indicators:
• Monitor and record autoclave parameters (temperature, pressure, and time) for each cycle.
• Use the autoclave’s printout or digital record to verify that the cycle met the required
  conditions.

Ethylene Oxide (ETO) Sterilization
Chemical Indicators:

• Use chemical indicator strips inside each package to verify exposure to ETO gas.
• Confirm the colour change as per the manufacturer’s guidelines.
  Biological Indicators:
• Place biological indicator vials or strips containing Bacillus atrophaeus spores in the
  sterilization load.
• After the cycle, incubate the indicator and check for microbial growth.
• A negative result indicates successful sterilization.
  Mechanical Indicators:
• Monitor and record ETO sterilizer parameters (temperature, humidity, gas concentration,
  and exposure time).
• Verify that the cycle met the specified conditions.

Hydrogen Peroxide Plasma Sterilization
Chemical Indicators:

• Use chemical indicator strips that change colour when exposed to hydrogen peroxide
  plasma.
• Place indicators both inside and outside the sterilization packaging.
  Biological Indicators:
• Use biological indicators containing Geobacillus stearothermophilus spores.
• Place indicators in the load and incubate post-sterilization to check for microbial growth.
• A negative result confirms sterility.
  Mechanical Indicators:
• Record and review sterilizer cycle parameters (temperature, pressure, and exposure time) to
  ensure compliance with specifications.

Dry Heat Sterilization
Chemical Indicators:

• Use chemical indicators that change colour when exposed to the correct temperature for the
  required time.
• Place indicators inside and outside each package.
  Biological Indicators:
• Use biological indicators containing Bacillus atrophaeus spores.
• Place indicators in the load and incubate them post-sterilization.
• A negative result indicates effective sterilization.
  Mechanical Indicators:
• Monitor and record sterilizer parameters (temperature and time).
• Ensure the cycle met the required conditions.

Chemical Sterilization (Cold Sterilization)
Chemical Indicators:

• Use chemical indicator strips or tests specific to the high-level disinfectant used.
• Ensure indicators change colour according to the manufacturer’s guidelines.
  Biological Indicators:
• Although not always used with chemical sterilization, biological indicators can be used if
  validated for the specific chemical sterilant.
• Follow the manufacturer’s instructions for placement, exposure, and incubation.
• A negative result confirms sterility.
  Mechanical Indicators:
• Ensure the disinfectant concentration is appropriate by using test strips.
• Record the immersion time to confirm it meets the required duration for sterilization.
  General Post-Sterilization Checks
  Sterility Assurance Level (SAL):
• Aim for a Sterility Assurance Level (SAL) of 10^-6, meaning there is less than a one in a
  million chance that a viable microorganism is present on the instrument.

Documentation:

• Maintain thorough records of sterilization cycles, including the type of sterilizer used, cycle
  parameters, indicator results, and the operator’s initials.
• Regularly review sterilization logs to ensure consistency and compliance.
  Training and Quality Control:
• Ensure staff involved in sterilization processes are adequately trained.
• Conduct regular quality control checks and audits to validate the effectiveness of
  sterilization procedures.

Note: Kindly note that despite following sterilisation instructions as mentioned above, there will

always be chance of contamination. Therefore, it crucial to ensure sterility using any above-
mentioned methods or any other known standard method.