I. RINSING
Immediately after surgery, rinse instruments under luke warm, not hot, running water. Rinsing should remove most blood, body fluids and tissue.

II. DISINFECTING
(to protect personnel from accidental contamination during cleaning)

A. To avoid blood and other proteins from sticking to instrument surfaces, an enzymatic cleaner bath or soak should be used on all instruments. After soaking for a minimum of 10 minutes, rinse instruments under running tap water.

B. Immerse instruments completely in an EPA approved disinfectant for another 10 minutes to 15 minutes. Then rinse again.

C. Never expose stainless steel or any other type of instruments to bleach or other corrosive chemicals for the purposes of disinfection. Exposure to bleach will result in severe pitting of your instruments and will Void all manufactures' warranties.

III. CLEANING
Instruments should be submerged in a solution of water and neutral pH (7) detergent.

A. Ultrasonic Cleaning

Place instruments in their open position into the ultrasonic cleaner (please make sure you expose the joints completely or as best as you can). Make sure that "Sharps" (i.e. Scissors, osteotomes, knives) blades do not touch other instruments.

All instruments need to be fully submerged in ultrasonic solution.

Instruments should be processed in the ultrasonic cleaner for the full recommended cycle time (please refer to manufacturers recommended cycle time) - usually 5 to 10 minutes. A lid should cover the ultrasonic unit during operation to avoid splashing.

Change solution weekly - or as often as ultrasonic solution manufacturer recommends.

Check manufacturers' recommendations for rinsing after ultrasonic cycle.

H & H Company recommends HealthSonic non-ionic multi-purpose ultrasonic solution (part# 10-8041). Rinsing is not necessary with HealthSonic's ultrasonic cleaner and or used with all ultrasonic units.

B. Automatic Washers
Please follow manufacturers' recommendations.

C. Manual Cleaning

Most instrument manufacturers recommend ultrasonic Cleaning as the best and most effective way to clean surgical instruments. Ultrasonic cleaning works best for instruments with hinges, locks, joints and other moving parts. If ultrasonic cleaning is not available, please observe the following steps:

1. Use a durable cleaning brush (part# 10-7065).

Do not use steel wool or wire brushes. Stainless steel wire brushes may be used for instruments with serrated areas or on bone files, burs or on stained areas in knurled handles.

2. Use only neutral pH (7) detergents because if instruments are not rinsed off properly, low pH detergents, acidic - 6 pH or less, will cause breakdown of stainless protective surface (pitting) and black staining High pH detergents, alkaline - 8 pH or more, will cause surface deposit of brown stain (phosphates) which will also interfere with smooth operation of the instruments, Most brown stains are not rust - but merely a high pH surface (phosphate) deposit and can be easily removed with any good instrument stain remover.

3. Brush delicate instruments carefully and handle separately from general instruments.

4. Make sure all instrument surfaces are clean and free from stains, tissue and other deposits.

5. After scrubbing, rinse instruments thoroughly under running water- During rinsing, open and close jointed instruments such as forceps, hemostats, needleholders, scissors, and all other jointed instruments. Make sure the jointed areas are rinsed clean.

IV. AFTER CLEANING

A. Inspect each instrument for proper working condition and that all are visibly free from stains or deposits.

B. Check all instruments to make sure that: Scissors glide smoothly and that they are not loose when in the closed position. Test scissors to be sure they do not hang up.

Tissue forceps are properly aligned and that the teeth line up. Needleholders closed in the first ratchet position should not show light between beaks when held up to the light. Make sure hemostats and needleholders lock and unlock easily, and that joints are not too loose. Check for wear on jaw surfaces.

Suction tips are clean inside. Cleaning vAm or brushes should be used to clean out inside (part #10-6170 thru 10-6177). Water should be clear when run through the suction tip.

Cutting instruments and knives have undamaged blades and are sharp.

V. AUTOCLAVING

A. Lubricate all instruments which have metal to metal joints such as forceps, mngeurs, scissors, hemostats and needlehowers. Any good surgical lubricant can be used.

B. Individual instruments

Disposable paper or plastic pouches are Ideal. Make sure you use a big enough pouch for instruments with joints (heniostats, forceps, needleholders, scissors) to be sterilized in the completely open position (not just unlocked - but open as far as the instrument can open).

Closed or locked instruments will cause cracked hinges and other defects during autoclaving because of heat expansion and voids mantftcturer's warranty.

If you use towels to wrap instruments, make sure the towels are free from detergents or detergent residue as this can stain instruments.

C. Instrument sets

Sterilize all instruments in their completely open position. Place heavy instruments on bottom. Instruments that are looked during autoclaving will not be sterile. Steam cannot reach into the metal to metal surfaces. Do not overload autoclave chamber as steam will not be able to penetrate properly.

Place towel on bottom of pan to absorb excess moisture. This will help prevent the chances of getting wet packs.

CAUTION

For most portable or tabletop autoclaves, at the end of the autoclave cycle, but before the drying cycle, unlock and just crack the door open a 1/4". Then run the dry cycle according to manufactures' recommendations. Do not open the door completely, as this will cause the cool room air to enter the chamber and cause condensation. This will cause wet packs and water stains on instruments.

Make sure autoclave filters and chambers are cleaned consistently. Check daily for residue in the t>ottom of the chamber. Clean the chamber immediately 9 residue is found as the residue will just deposit on instruments during autocliaving.

VI. COLD STERILIZATION

Most cold sterilization solutions take a minimum of 10 hours to render instruments sterile. This prolonged exposure to chemical action can be mom harmful to instruments than the usual 20 minute autoclave cycle.

Check manufacturers' specs to determine if the instruments need to be disinfected or sterile. Disinfection can be achieved within 10 minutes or more of soaking.

CAUTION

Instruments with Tungsten Carbide inserts (these instruments are identified with gold handles), we do not recommend the use of cold sterilization solutions containing Benzyl Amonium Chloride as this will deteriorate the Tungsten Carbide inserts.