Pawn Move instructions decontamination instructions are in accordance with Health Technical Memorandum and decontamination of surgical instruments (medical devices) (HTM) 01-01 used in acute care. Link

Cleaning should precede all disinfection and sterilization processes. Cleaning involves the removal of debris (organic or inorganic) from an instrument or device. If visible debris is not removed, it will interfere with microbial inactivation and can compromise the disinfection or sterilization process.

Care for your new instruments should begin from the moment you receive them to give them the best start in life.

1. Initially remove all transportation packaging before placing in storage or instruments usage processing cycle. Any protective caps or foils must also be removed.
2. New instruments should be put through the whole re-processing cycle separately so that they do not come into contact with other older instruments or instruments that may have corrosion present already. Our advice is to put them through the process at least twice but we appreciate that this is not always possible.
3. New instruments incorporated into sets that have corroded instruments present are more likely to corrode themselves relatively quickly until this passive layer has been established.
4. New instruments are vulnerable to poor water quality, used in both the cleaning process and final rinse, inadequate drying, poor maintenance, and the steam quality of the sterilization units, and will rust if not looked after correctly.

Please note before using new instruments they must be subjected to the same processing cycle of cleaning and sterilization as used instruments. The cleaning step is highly critical because residues from packing material could lead to the formation of stains/deposits during sterilization. Following the cleaning step make sure instruments appear to be visibly clean. New instruments tend to be more sensitive than used to critical treatment conditions, as the passive layer on the instrument is comparatively thinner.

Storage of New Instruments

1. Store at room temperature in a dry room/cabinet otherwise condensation may build up inside the plastic package due to temperature fluctuation causing subsequent corrosion damage
2. Do not store near chemicals such as active chlorine, which emits corrosive vapors.
3. Allow special care.

Tungsten Carbide (TC) inserts are much “harder” than regular stainless steel and therefore retain their sharpened edges longer than stainless steel. However, TC inserts require special care and handling during reprocessing.

Ultra-Sonic Cleaner

If an ultrasonic cleaner is utilized, please follow the manufacturer’s instructions regarding solution dilution and the length of time the instruments are left in the solution. Please use only solutions that contain a corrosion inhibitor.

Steam Autoclave

If a steam autoclave is utilized, please be sure to use a corrosion inhibitor – surgical milk “Clean act” and many products exist in the marketplace for this purpose. Please be sure that tungsten carbide instruments dry quickly during the “dry” or “vent” cycle of the autoclave – if the instruments are not drying or are removed wet, corrosion is still possible.

Sterilization can be achieved only if the sterilizing agent (e.g., steam) contacts all instrument surfaces. Therefore, hinged instruments, such as hemostats, scissors, and extraction forceps, should be sterilized in the open position to ensure that the sterilizing agent adequately contacts all surfaces.

Never remove the final polishing film by rubbing or sanding. Never leave it in tap water for any length of time. Acidic or alkaline pH will remove chromium oxide and chlorite ions will cause pitting. Copper, iron and manganese will cause brown and blue rainbow effects. Distilled water with a neutral ph. can be used sparingly.

To minimize staining, it is important that the autoclave runs perfectly, and that it has a well-functioning drying cycle. The instruments should come out completely dry, whether in wrappers or loose on a tray. If any moisture is left in the pack, or on the instruments, it will result in tiny water droplets on the instrument surface, which will leave a circular stain after drying. The color of this stain will depend on the pH, as well as the mineral or metal contents of the water. If the drying cycle works perfectly, however, there is a much less chance for deposits to form on the surface of the instrument.

Stains due to metal deposits or plating stains are always near the most magnetic parts of the instrument. New instruments are often highly magnetic in the locks, the serrations and ratchets. This happens because the carbon steel tools used to work on the instruments during production are very magnetic themselves. This magnetism wears off gradually during handling and sterilization. This is the reason why newer instruments tend to stain more visibly. Rubbing the instrument with Surgical Instrument Oil, (also called Instrument Milk) and putting a drop of it between overlapping surfaces, will aid in keeping your surgical instrument for years to come.

Corrosion

The presence of blood and soil in box locks, ratchets, serrations, hinges, etc. can cause corrosion. More care should be taken in cleaning. Excessive moisture left on the surface of the instrument can lead to corrosion.

Preheat the autoclave, do not rush the drying time. Foreign matters deposited in the autoclave can result in spotting and corrosion of instruments.

Inner surfaces of the autoclave should be given routine maintenance. Wipe down with acetic acid (equal parts of vinegar and distilled water) to remove any impurities.

Stress corrosion can be caused by not opening box locks during the sterilization procedure. The heating-up and cooling-down process during sterilization can cause tension in the material.

 Pitting

 When instruments are exposed to saline solutions, blood, iodine, potassium chloride and other compounds pitting will occur. Instruments should be rinsed thoroughly immediately after exposure.

 Pitting can also be traced to detergents with a high pH level (B-9) used for instrument cleaning. Instruments should be thoroughly rinsed after cleaning.

 It is impossible to completely restore an instrument after pitting or rust has eroded the hard surface. The instrument should be replaced immediately as a pitted instrument is far more susceptible to further corrosion.

The quality of water used during reprocessing is critical for the proper care and handling of instruments.

Water fulfils a number of functions during the reprocessing cycle.

1. Dissolves cleaners and other treatment agents
2. Transmission of mechanical forces and transfer of heat to the surface of the items to be washed
3. Dissolves soluble dirt and impurities
4. Flushes away cleaning and treatment solutions

Unfavorable water composition can have an adverse effect both on the treatment process and the appearance of instruments and materials. This is why water quality is critical during reprocessing cycles.

All-natural water contains dissolved salts, concentrations vary depending on the source of the water and purification processes used.

Depending on water hardness and temperature, freshwater used can lead to the formation of a hard layer (lime deposits, scale) that is difficult to dissolve. It is even possible for corrosion to occur underneath such deposits.

In softened water, alkalinity can greatly increase as a function of temperature and exposure. Especially when thermal disinfection is used in the final rinse, aluminum surfaces might be subject to attack.

When water evaporates, some substances contained in it remain as visible mineral residues. Chlorides dissolved in water are particularly critical substances because they tend to cause pitting even on stain-less steel instruments if present in higher concentrations.

To prevent excessive chloride concentrations and subsequent pitting we recommend using only fully demineralized water for the final rinse.

Other substances may cause brownish, bluish, grey-black or iridescent discolorations even when present in small quantities. Such discolorations may be caused silicates/silicic acids contained in the water, or by compounds containing iron, copper or manganese. As a rule, however, such discolorations are harmless, constituting very thin residual layers that do not cause or facilitate corrosion.

Apart from its natural constituents, drinking water sometimes contains rust, generally flushed from corroded pipework. During the processing cycle, this rust tends to adhere to instruments, causing rust spots (extraneous rust) and subsequent corrosion.

The use of fully demineralized water in the final rinse is not only recommended for the reasons described above (i.e. preventing chloride de-induced corrosion) but also because it helps keep the surfaces of the instruments free from stains and discolorations, and stabilizes anodized aluminum surfaces.

Debris can be removed from an instrument either by scrubbing the instrument manually with a surfactant or detergent and water or by using automated equipment (e.g., ultrasonic cleaner, washer-disinfector) and chemical agents. After cleaning, instruments should be rinsed with water to remove chemical or detergent residue. Splashing should be minimized during rinsing and cleaning.

Considerations in selecting cleaning methods and equipment include their effectiveness, their compatibility with the items to be cleaned, and the occupational health and exposure risks they pose. Because instruments cleaned with automated cleaning equipment do not need to be presoaked or scrubbed, the use of automated equipment can increase productivity, improve cleaning effectiveness, and decrease worker exposure to blood and body fluids. Thus, using automated equipment can be more efficient and safer than manually cleaning contaminated instruments.

If manual cleaning is not performed immediately, instruments should be placed into a container and soaked with a detergent, a disinfectant/detergent, or an enzymatic cleaner to prevent drying of patient material and make manual cleaning easier and less time-consuming. Naveed Intl also recommends using long-handled brushes to keep the hand as far away as possible from sharp instruments.

Instruments should be handled as though contaminated until processed through the sterilization cycle (unless the instrument has been processed with a thermal washer/disinfector that has a high-level disinfection cycle). To avoid injury from sharp instruments, personnel should wear puncture-resistant, heavy-duty utility gloves when handling or manually cleaning contaminated instruments and devices. Because splashing is likely to occur, they should also wear a facemask, eye protection or face shield, and gown or jacket. Employees should not reach into trays or containers holding sharp instruments that cannot be seen. To reduce their risk of injury, they should instead remove instruments using forceps or empty them onto a towel.