Effective Management of Surgical Instruments Instructions for Use In-Service

Effective Management of Surgical Instruments Linda Timmons, RN, BA, CNOR

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Developed with an unrestricted educational grant from:

Required Disclosures Provided To Activity Participants 1. Requirements for Successful Completion a. View the activity in its entirety b. Achieve at least the minimum score on the Post-Test c. Complete the Evaluation Form

2. This presentation was developed with an unrestricted educational grant from Bausch + Lomb Storz® Ophthalmics 3. The content was developed by Linda Timmons, BA, RN, CNOR with documentation on file that she had no conflict of interest 4. The activity contains no statement of endorsement of any specific product 5. The activity contains no off-label use of any product

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Effective Management of Surgical Instruments

Required Disclosures Provided To Activity Participants • This activity was approved by AORN for 1.0 contact hour with a minimum score of 80 on the post test The Association of periOperative Registered Nurses, Inc. is accredited as an approver of continuing nursing education by the American Nurses Credentialing Center’s Commission on Accreditation. • This Continuing Education program has been granted Continuing Education credits from the Certification Board for Sterile Processing & Distribution, Inc. (CBSPD) for 2.0 contact hours with a minimum score of 70 on the Post-Test • This Continuing Education program has been granted Continuing Education credits from the International Association for Healthcare Central Service Materiel Management (IAHCSMM) for 2.0 contact hours with a minimum score of 70 on the Post-Test Full Screen

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Effective Management of Surgical Instruments

Objectives 1. Discuss goals of effective management of surgical instrumentation 2. Describe the process of managing surgical instrumentation effectively 3. Explore problems related to managing surgical instruments

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Effective Management of Surgical Instruments

Outcomes Patient Safety –– Promote optimal surgical outcome –– Reduce recuperation time –– Reduce incidence of infection –– Reduce complications related to tissue damage

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Effective Management of Surgical Instruments

Outcomes Reduce Expenses –– Extend instrument life; reduce replacement costs

• A major cause of instrument damage is misuse and abuse

–– Reduce patient length of stay

• Reduce expenses related to hospital-associated infection • Reduce expenses related to complications

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Effective Management of Surgical Instruments

Managing Instruments Do. . . –– Handle instruments carefully –– Hand instruments one at a time or in small numbers –– Protect the tips of instruments, especially from other instruments –– Wipe blood off instrument immediately after use - Allowed to dry, blood causes deterioration, corrosion and pitting –– Leave instruments in solutions if necessary, for as brief a time as possible; rinsing them thoroughly with demineralized, distilled water

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Effective Management of Surgical Instruments

Managing Instruments Don’t. . . –– Toss or drop instruments onto one another or weigh them down by stacking them on top of one another –– Throw sharp and delicate instruments in basins –– Rinse or soak instruments in saline or bleach; prolonged exposure can lead to pitting and corrosion. –– Permit stainless steel to come in contact with strong solutions such as any chloride, any acid, Disinfectants, Salts of any kind, Phenol, Potassium, Mercury, Iodine, Bleach

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Effective Management of Surgical Instruments

Management of Specific Instruments Scissors –– Should be used to cut only the material for which it was designed –– Cutting other materials will cause misalignment, loss of sharpness and blade damage –– Abuse will immediately impair functionality

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Effective Management of Surgical Instruments

Management of Specific Instruments Sharp Instruments –– Rongeurs, osteotomes, knives and curettes should only be used for their intended purpose –– Misuse can cause blades and edges to dull and affect surgical performance

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Effective Management of Surgical Instruments

Management of Specific Instruments Forceps –– Mishandling can significantly impair the performance of these delicate instruments, creating improper alignment of tips –– Improper alignment creates serious problems in function –– Each forceps should be used for the purpose of its design

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Effective Management of Surgical Instruments

Management of Specific Instruments Needle Holders –– Must be matched to the needle size for which it is intended –– Large closure needles will spring the jaws of a delicate needle holder intended for plastic or ophthalmic surgery –– Misuse can throw jaws out of alignment and reduce holding power

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Effective Management of Surgical Instruments

Preperation of Instruments for Surgical Procedures • Clean –– Rinse –– Wash

• Lubricate • Prepare for sterilization • Sterilize • Store

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Effective Management of Surgical Instruments

Instrument Cleaning • Rinse all instruments immediately • Clean instruments as soon as possible after use • Avoid allowing blood and debris to dry on instruments • If cleaning cannot be done immediately, place instrument sets in a basin of sterile water • Include all instruments in tray whether used or not –– Blood or saline may have splashed on them during surgery Full Screen

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Effective Management of Surgical Instruments

Instrument Cleaning • Do not soak instruments in saline or chlorinated solutions during or after surgery • Use demineralized, distilled water to rinse and remove blood and debris • All cannulated equipment and handpieces should be flushed as specified by manufacturer’s Video - Flushing a cannula after a surgical procedure recommendations

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Effective Management of Surgical Instruments

Instrument Cleaning • Separate delicate and sharp instruments of dissimilar metals from other instruments • Move instruments to the decontamination area in mesh trays or baskets – instrument trays should be covered and contained when transported • All instruments opened for a procedure should be cleaned, whether or not they are used Full Screen

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Effective Management of Surgical Instruments

Instrument Cleaning Hand wash microsurgical instruments –– Do not put delicate microsurgical instruments in mechanical washer unless it has a delicate cycle –– Open all hinged microsurgical instruments –– Disassemble microsurgical instruments with removable parts

• Debris left in box locks or crevices can be baked on in sterilization, causing future breakage under stress

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Effective Management of Surgical Instruments

Instrument Cleaning • Give special attention to suction tube and cannula instruments to prevent caking and obstruction –– Flush thoroughly with distilled water

• Do not use abrasive cleaners when cleaning microsurgical instruments which can damage or scar finishes

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Effective Management of Surgical Instruments

Instrument Cleaning Mechanically wash other hand-held instruments –– A washer-decontaminators can be used to mechanically wash instruments in an agitated detergent bath –– Place heavy instruments in the bottom of the tray or basket –– Load delicate, smaller instruments in separate trays, scissors and lighterweight instruments on top

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Effective Management of Surgical Instruments