Recommended practices for cleaning and caring for surgical instruments and powered equipment

AORN Journal,  March, 2002  

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The following recommended practices were developed by the AORN Recommended Practices Committee and have been approved by the AORN Board of Directors. They were presented as proposed recommended practices for comment by members and others. These recommended practices are effective Jan 1, 2002.

These recommended practices are intended as achievable recommendations representing what is believed to be an optimal level of practice. Policies and procedures will reflect variations in practice settings and/or clinical situations that determine the degree to which the recommended practices can be implemented.

AORN recognizes the numerous types of settings in which perioperative nurses practice. These recommended practices are intended as guidelines adaptable to various practice settings. These practice settings include traditional ORs, ambulatory surgery units, physicians' offices, cardiac catheterization suites, endoscopy suites, radiology departments, and all other areas where operative and other invasive procedures may be performed.

Purpose: These recommended practices provide guidelines to assist perioperative nurses in decontaminating, cleaning, maintaining, handling, storing, and/or sterilizing surgical instruments and powered equipment. These recommended practices are general recommendations as it is impossible to make a recommendation for each instrument. These recommended practices complement AORN's "Recommended practices for sterilization in perioperative practice settings." (1) Perioperative nurses should consult this document to assist in providing a safe environment for the patient. The appropriate committees in the practice setting should review all practices related to care and handling of surgical instruments and powered equipment.

RECOMMENDED PRACTICE I

Surgical instruments and powered equipment should be cleaned, handled, and used according to manufacturers' instructions.

1. Manufacturers' instructions provide direction for care, cleaning, handling, and correctly using surgical instruments and powered equipment. Proper care, cleaning, and handling helps safeguard instruments' function and effectiveness. Using instruments according to their intended use reduces the likelihood of procedure delay, patient/personnel injury, infections caused by instrument damage or malfunction, and/or costly repairs. (2)

RECOMMENDED PRACTICE II

Instruments should be kept free of gross soil during surgical procedures.

1. Instruments should be wiped with sponges moistened with sterile water. Corrosion, rusting, and pitting occur when blood and debris are allowed to dry in or on surgical instruments. (3)

2. Lumened instruments should be irrigated with sterile water. Cannulated or lumened instruments may become obstructed with organic material. Irrigating instruments with sterile water helps remove residue. Saline causes deterioration of instrument surfaces and should not be used. (4)

RECOMMENDED PRACTICE III

Effective and timely decontamination of instruments should be performed in a manner that minimizes risk to those performing the task.

1. All instruments opened on the sterile field require decontamination.

2. Personal protective attire should be worn by personnel when decontaminating instruments. Personal protective equipment can prevent contaminated blood and body fluids from coming in contact with personnel involved in decontamination. Protective attire is designed to protect the skin, mucous membranes, and eyes from exposure to blood, body fluids, and other infectious materials. (5)

3. Instruments should be prepared for decontamination after use. Instruments should be taken apart and arranged in an orderly fashion in mesh-bottom trays so that all surfaces are exposed to the action of an automated cleaner, if used. The following activities should be completed:

* open instrument box locks;

* place heavy retractors and/or other heavy instruments on the bottom or in a separate tray;

* place scissors, lighter-weight instruments, and microsurgical instruments on top;

* separate all reusable sharp instruments from general instruments; and

* cover instruments with a damp towel, at a minimum, to prevent drying during transportation to the decontamination area. (6)

An enzymatic soak solution, spray, gel, or foam may be used for these and other hard-to-clean instruments during transport. (7) Corrosion, rusting, and pitting occur when blood and debris are allowed to dry in or on surgical instruments. (8) Cannulated or lumened instruments may become obstructed with organic material. (9)

4. In the decontamination area, automated and/or manual cleaning methods of equal effectiveness should be used for decontaminating instruments. (10) The following methods may be used for decontamination.

* Washer/sterilizer. The washer/sterilizer processes instruments through several cycles, including cold water prerinse, high-temperature wash with alkaline detergent, neutralizing cycle, final rinse, sterilization, and drying.