The purchase of Accu-Sur instruments represents a considerable investment for our customers. By following these guidelines our customers can protect their investment and ensure many years of productive and satisfactory performance.
Newly purchased instruments must be cleaned, lubricated and autoclaved immediately before use.
Obvious as it sounds, it bears repeating: instruments are designed for a particular purpose and should be used only for that purpose. Even the strongest instrument can be damaged when used inappropriately, i.e., when a nail splitter is used to cut wire.
Ordinary tap water contains minerals that can cause discoloration and staining. Therefore, we recommend the use of distilled water for cleaning, disinfecting, sterilizing and rinsing instruments. To avoid staining, use a cleaning solution with a pH near neutral (7). Instruments should be placed in distilled water immediately after use. They should never be placed in saline solution, as it may cause corrosion and eventually irreversible pitting.
When handling instruments, be very careful not to damage their fine tips and mechanisms. If instruments have been exposed to blood, tissue, saline or other foreign matter, they must be rinsed in warm (not hot) water before these substances are allowed to dry. Failure to do so may result in rust. After rinsing, immerse them in a cleaning and disinfecting solution. Because many compounds, including certain chemicals, are highly corrosive to stainless steel, rinse and dry instruments immediately, in case they have come in contact with any potentially harmful substances.
If no ultrasonic cleaner is available, clean the instrument very carefully. Pay particular attention when cleaning box locks, serrations, hinges and other hard to reach areas. What's more, use nylon (not steel) brushes, and warm (not hot) cleaning solutions. Follow the manufacturer's instructions for the preparation of the cleaning solutions. Remember to change these solutions daily.
Ultrasonic cleaning is the most effective and efficient way to clean instruments. To maximize its effectiveness, instruments should be cleaned of all visible debris before they are put into an ultrasonic cleaner. Please note that chrome-plated instruments may rust if they are not dried and lubricated immediately after sterilization. In addition, we recommend the following:
The best time to review the condition of instruments is after they have been cleaned and lubricated and have cooled off. Consider the following:
“Sharps” must cut cleanly (resharpen if needed) and close properly. Check for burrs along the cutting edges. Needle holders and clamps must engage properly and meet correctly at the tips.
Carefully inspect surfaces for any sign of staining, cracking or other irregularities. Common sources of staining are:
All instruments must be properly cleaned before autoclaving. Then their moving parts, such as box locks and hinges, should be well lubricated. Be careful to use surgical lubricants and not industrial oils. Always sterilize instruments in the open, unlocked position. We recommend that instruments be wrapped in cloth
and then placed in the container, or that a cloth be put on the bottom of the pan to absorb moisture. The cloth should be pH(7) neutral and have no residue of detergents. Finally, avoid sudden cooling. Instruments should be allowed to air dry, not rinsed or dried off.
Prolonged immersion in disinfecting or sterilizing solution can damage surgical instruments. Do not soak instruments for longer than 20 minutes. To render the instruments sterile and ready for use, use an autoclave cycle.
Instruments with tungsten carbide inserts, such as wire cutters, needle holders and TC scissors, should never be immersed in sterilizing solutions containing benzyl ammonium chloride (BAC). BAC will soften and dissolve the tungsten carbide. Never use bleach as it will cause severe pitting.
Once instruments are thoroughly dry, store them in a clean, dry environment. Never put them in areas where chemicals may emit corrosive vapors or where temperature and moisture variations could cause condensation on the instruments.
This guide is intended as a quick reference to handle many of the most basic questions and problems regarding surgical instruments.
Staining is most frequently the result of improper or inadequate cleaning. Stains can be caused by mineral deposits in the water or electrolysis. Instruments should be cleaned in distilled water to avoid this. Staining should not be confused with rusting.
This discoloration is usually caused by cold disinfecting or sterilizing solutions. Solutions should be changed frequently, as corrosion may otherwise occur. Distilled water will also inhibit discoloration.
This discoloration can occur when instruments are exposed to ammonia, which is present in many hospital cleaners, and are not then adequately rinsed. When possible, avoid using cleaning agents with ammonia, and always rinse instruments thoroughly. Black stains can sometimes be caused by residues of chemicals used to clean the steam pipes.
Brown stains are probably the result of oxidation and should not be confused with rust. It forms naturally on stainless steel and helps prevent atmospheric corrosion. It should not be a cause of concern.
Spotting is usually the result of improper cleaning. It may be caused by the water in which instruments are washed or by detergent residues in the wrapping material.
Mineral-rich tap water or detergent residues may leave deposits. Rinsing the instrument in distilled water will generally remove these deposits; if this fails, they can usually be cleaned off using a special, nonabrasive stainless steel cleaner or stain remover. To avoid this problem, thoroughly dry instruments in the autoclave and avoid using cloths with detergent residues.
Like light spots, these are usually caused by mineral deposits in the water used to clean, rinse and sterilize instruments. To avoid this problem, always use distilled water.
This film may be caused by residue in steam pipes. Unfortunately, little can be done in this situation. The film may also be caused by chemical compounds used to treat water. As a result, iron may be deposited on instruments. Take this up with hospital engineering staff. Use distilled water to clean instruments.
Spots and stains may also be caused if too much or the wrong kind of detergent is used to wash the instruments. Use a cleaner formulated specifically for surgical instruments.
If treated properly, stainless steel does not usually rust. Brown discoloration, which looks like rust to the ordinary eye, is often mistaken for rust.
A quick test to check whether you are dealing with rust or discoloration is to take an ordinary rubber eraser and try to rub away the imperfection—if you are able to do so, the problem is not with the instrument, and you should look into possible causes in the care and handling of the instrument. If the instrument is corroding, it can be seen with a magnifying glass, because small pits begin to form in the steel. Such instruments should be removed from circulation and no longer used.
Rusting may be the result of exposure to salts, saline, blood, iodine, chloride, bleach or other aggressive substances or due to the use of abrasives in the cleaning process, which can wear away the passive layers. Surgical instruments should only be cleaned with solutions which the manufacturer has specifically stated are safe for such use.
Corrosion can also be the result of inadequate cleaning. If blood or other bodily secretions are allowed to remain on the instruments, corrosion may occur. This is particularly a problem in hard-to-clean areas such as jaw serrations, box locks and ratchets. Instruments should be cleaned in the open position, and whenever possible should be disassembled. Instruments should also be cleaned in distilled water. Deposits may form on instruments if they are washed in tap water, which may cause spotting and eventually corrosion.
Incomplete drying may also end in corrosion—instruments should not be removed from the autoclave until they have been thoroughly dried.
Instruments should always be carefully lubricated. Failure to do so may result in wear, which could lead to corrosion.
Improper usage is another common cause of corrosion. When corrosion appears at stress points in an instrument, e.g., at the jaws or box lock, this may be a sign of improper usage.
Rust can also be caused by improper marking of the instrument with an engraver. Never mark anything on a box lock since it may weaken it.
Rust transfer can occur when instruments made of dissimilar metals come into contact for an extended period of time—to avoid this, wash and sterilize instruments of different metals separately. Transfer rust can usually be removed with a rubber eraser. If neglected, however, rust may begin to mar the surface.
Pitting may be caused by the use of improper cleaning agents, such as saline or bleach. Use only cleaners formulated for use with surgical instruments. It may also be the result of the use of improper concentrations of cleaning agents, or cleaning agents which have a pH level which is too acidic or alkaline. Avoid using these kinds of detergents. The optimal pH for a cleaning fluid is close to neutral, pH (7). Pitting may also occur in the ultrasonic cleaner if instruments of different metals are cleaned in the same cycle. This can also occur in the autoclaving process.
An instrument should not normally break if it is being used for its intended purpose. Breakage is likely the result of either an instrument being used for something other than what it was designed for, or being used to perform a task beyond its capacity, e.g., a wire cutter with a maximum cutting capacity of .045” is used to cut a wire of a larger size. Another cause of breakage comes during the ultrasonic or autoclaving process. Instruments should be cleaned and autoclaved in the open, not locked, position. In the locked position, the heat may make the instrument expand and crack the box lock. Instruments may also break as the result of careless handling. Some simple guidelines:
In the rare case that a flaw in the material or workmanship caused the breakage, Accu-Sur will replace the item free of charge.
Tungsten carbide inserts, while more durable than steel, are not designed to last forever. It is possible that damaged or worn inserts may simply need replacement. Premature wearing can be avoided by always using the instruments for their intended purpose. Damage may also result from improper cleaning. Instruments with TC inserts should never be cleaned in sterilizing solutions containing benzyl ammonium chloride (BAC). BAC will soften and dissolve the tungsten carbide.