10 Tips for Managing Instruments when the Pressure is on

By Hassan BilalMedical DevicesLeave a Comment


Surgical technologists have an incredible amount of responsibility during a procedure, including the management of instruments, supplies and equipment. In such a fluid environment, it is critical that they exercise extreme care and precaution. But as with so many important jobs, there are a lot of details to remember when the pressure is on.

To explore chaos prevention best practices that can help prevent bad results, Margie Summerfield, CST, CBSPD, and I are sharing our favorite tips for ensuring instruments are prepared and organized when your OR team is under the hot lights of the surgical suite

One: Be sure you have a complete set of instruments
Make sure nothing is missing from the instrument set at the start of the procedure. You don’t want to have an empty hand when the surgeon asks for a specific instrument.

Two: Check the grade level of the instruments
As you’re laying out the case, check the instruments to ensure they are surgical-grade stainless steel and not one-time use, floor-grade instruments. Because they look similar, sometimes floor-grade can get mixed in with the surgical instrument set. To tell the difference, surgical-grade instruments are usually marked with company name, item number, and perhaps even the country or origin. Also, you can often tell by comparing the weight and feel of these instruments. If you think you’ve found a floor-grade instrument, set it aside.

Three: Check instruments for functionality
When setting up the procedure, inspect all the instruments and be sure they are clean, sterile and working properly. There is nothing worse than handing a surgeon a clamp or forceps that is not working correctly.

Four: Keep instruments clean and properly working throughout the procedure
Keep a moist lap sponge (with sterile or distilled water) close by to wipe off any gross contamination on the used instruments. Dried blood can become sticky and difficult to remove, which can impact the handoff to the surgeon and the instrument’s’ functionality if used more than once during the procedure.

Five: Presoak instruments once the case is over
Place instruments in a basin and spray them down with a presoak such as Bio-Zolve. Doing so will break down the bioburden in the blood and other material to help make the decontamination process easier and more effective.

Six: Do not use sodium chloride (saline) to clean instruments prior to returning to the SPD
The salt will break down the stainless steel and damage the instrument. Instead, use a presoak liquid as cited above.

Seven: Organize unused instruments
Restring unused instruments and place them back in the tray. This way, they’ll be cleaned and sterilized more quickly and ready for the next case.

Eight: Check instruments for rust or staining
More than likely, it won’t be rust. Here’s a quick check method: Rub the instrument with a pencil eraser. If you can remove the stain, then it’s a problem with your water. It may have too much magnesium and calcium, or you have dirty steam lines in your autoclave process. The solution is to use a deionizing or a reverse osmosis system to purify or soften the water. If it is ruse, throw the instrument away. Rusting can create safe havens for bioburden and compromise the integrity of the instrument itself. Following standards of instrument care and maintenance should keep instruments from rusting.

Nine: Crosstrain on other procedures
In case of emergencies or scheduling conflicts, you’ll make yourself indispensable by learning procedures in other specialty areas. Additionally, as personnel resources become tighter, learning multiple procedures or skills may become the standard method of operation at most agencies. Flashcards can help teach you the different instruments, and observing different cases will ensure you are comfortable with them if you are ever called on to help.

Ten: Handle wrapped trays with care
The sterilization wrap can tear and compromise the sterile barrier. When handling trays, always place them on a solid, smooth surface. In addition, do not place them on a ring stand that can cut fabric, do not drag trays across shelving and, when moving the tray, place your hands underneath and lift. Each tray is limited to 25 pounds, per AAMI standards. If you stack wrapped trays, be sure to follow the manufacturer’s instructions for use.


This article originally appeared in Outpatient Outcomes magazine. Click here to subscribe.



About the Author
Hassan Bilal

Hassan Bilal

Hassan Bilal supports and advises a sales force of over 1,000 Medline sales representatives on central sterile products, standards and technology which cover the United States and Canada. He is a voting member on the ST79 Sterilization Standards Committee for the Association for the Advancement of Medical Instrumentation (AAMI).

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