Chapter 17 Instrument Care

Chapter 17 Instrument Care
17
Chapter 17
INSTRUMENT CARE
Instrument Care
The majority of surgical instruments are made of Stainless Steel. There
are many different types of stainless steel alloys (60+), with varying
amounts of Nickel & Chromium to increase resistance to corrosion. All
types of stainless steel will corrode under certain conditions – ‘stainless’
is a little misleading. The proportions of the various constituents affect
the characteristics of the final steel, along with the degree of hardening
applied.
Surgical instruments must be hard enough to take and keep a cutting
edge (e.g. scissors) or have a certain spring (e.g. artery forceps). The
steel possessing these qualities contains less chromium and more
carbon than orthopaedic implants, which are made of steel with the
primary characteristic of resistance to corrosion, making it too soft for
instruments. The penalty is that this type of higher carbon stainless steel
(called Martensitic) is much more likely to corrode and stain.
Cleaned lubricated instruments are
ready for packaging. Always carry
out a visual check at this stage –
are the cutting edges of scissors
free of damage, do the jaws of
artery forceps & needle-holders
meet correctly with no signs of
twisting for example. Check that all
thumbscrews are tight, as in Gelpi &
Stifle Distractor joints
Also look for fine cracks in
instruments, for example across the
box joints in Artery Forceps.
The parts of the steel likely to rust are protected by a thin layer of
chromium oxide which is produced by the chromium part of the steel.
Actions which encourage the production of chromium oxide minimise
corrosion. Actions which either physically or chemically destroy this
layer of chromium oxide encourage rusting or staining. Maximising the
chromium oxide layer is the basis of sound instrument care. This layer
thickens with age and increases the resistance of your instruments to
corrosion – in new instruments it is relatively thin. This is why you may
have marking problems with new instruments but your old ones are fine
– new instruments will be more intolerant of inappropriate detergents,
inadequate lubrication and the corrosive environment of the autoclave
etc.
Manual Cleaning Protocol – Stainless Instruments
1. Open all joints and rinse gross loose debris from instruments in
warm water (NOT hot – this will coagulate proteins & make the
instruments much harder to clean) immediately after use. They
will be much harder to clean if left to dry!
2. Completely submerge instruments in an enzyme based neutral
pH detergent – soak for time specified in detergent instruction.
3. Gently scrub instruments with a soft bristled brush to remove all
remaining visible soil, keeping the instrument under the surface
of the detergent to reduce spray. Use a pipe-cleaner brush
on instruments with a lumen. Pay special attention to joints &
ratchets.
4. Remove from the enzyme solution and rinse thoroughly in tap
water for at least 3 minutes.
5. Ideally place the instruments in an ultrasonic cleaning bath for
10-15 minutes or as per cleaner instruction manual.
6. Remove from bath at completion of cycle, (or after step 4 if no
ultrasonic available) then rinse instruments thoroughly with
purified (distilled) water.
7. Dry with a clean non-shedding wipe – leaving them to air-dry will
result in water spotting.
8. Lubricate with either spray surgical instrument oil or place in
instrument milk bath – follow directions for product used.
To keep your instruments in peak condition, there are some basic rules
which should be followed.
1. Handle your instruments with care – dropping, scratching etc. will all
damage the surface of instruments and reduce their resistance to
corrosion.
2. Store with care. If instruments are stored damp they will corrode.
Delicate instruments should be packed with protective tips & silicone
storage box inserts to stop them rattling around. Always make sure
heavy instruments are not stored on top of lighter equipment.
Needleholder with damaged jaws
Joint showing wear due to
inadequate lubrication
Box joint showing cracking
& biological debris
Damaged items should be sent for repair or disposed of. It is good
practice to sterilize items being sent for repair. Many repairers require
a certificate of decontamination to be sent with instruments, and
instruments should never be sent out in a soiled condition.
There are many materials for packing instruments for autoclaving. Paper
peel-packs are commonly used, along with nylon autoclave film. We
do not recommend the use of laundered fabrics as instrument wraps,
as residual detergents and bleaches can cause pH & chlorine related
damage to your instruments. Disposable autoclavable instrument
wrapping fabrics similar to disposable drapes are available.
Sterilisation
The autoclave is a very hostile environment for your instruments.
The combination of heat & moisture promotes corrosion and staining,
particularly if there are residual detergents etc. in wrapping materials.
This is also true where tap water instead of distilled or demineralised
water is used in the autoclave. Mineral deposits on instruments are
unsightly as well as interfering with normal joint function etc. They are
difficult to remove, so prevention is better than cure.
Rust in the steam pipes of your autoclave will transfer to your
instruments, so autoclave maintenance is important. Regular servicing
ensures the autoclave is working correctly. Vacuum autoclaves help
remove residual steam from packs, and it is important that directions
are followed and cycles are completed. Regularly check the door seal
is undamaged, and replace if necessary. If applicable to your machine,
drain & refill the water tank regularly with distilled water. You may well be
surprised what comes out!
If your packs are coming out of the autoclave wet through then there
is a cycle problem & you need to speak to your autoclave engineer
for advice. Wet storage will result in corrosion and damage to your
instruments.
So – store your instruments clean, dry, lubricated & protected and they
will give you many years of service. A good, easy to follow instrument
care protocol will extend instrument life, save money and result in happy
surgeons!
3. Use them to do what they were designed for! Artery Forceps are
not Needleholders or Wire Twisters. Bone Cutters are not designed
to cut Wire, and Implant Cutters have a size rating for a reason!
Inappropriate use will damage instruments and invalidate warranties.
4. Avoid mixing different metals when processing instruments – keep
chrome plated, industrial finish & aluminium items separate from
stainless, particularly in ultrasonic cleaners.
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INSTRUMENT CARE
Instrument Cleaning
What is Ultrasonic Cleaning?
Henry Schein Sweep 2000 Ultrasonic Instrument
Cleaner
Ultrasonic cleaning is created by sound waves that are transmitted at
frequencies beyond the range of human hearing. A generator located
within your system develops the high frequency power which to causes
a transducer to radiate and produce the sound waves.
The solution in the tank and create a unique vibrational pattern causing
alternating high and low pressures in the liquid.
New version for 2015!
This updated Ultrasonic Instrument Cleaner features Sweep technology.
Which automatically switches frequencies creating a ‘grid’ effect,
sweeping the tank and eliminating the ‘hot spots’ and weak areas which
can occur in traditional ultrasonics. This results in a more thorough
cleaning outcome.
The unit has a hinged, locking lid and is designed to reduce noise levels
from the cleaner when in use – noise is a common issue with ultrasonics
in practice!
During the low pressure stage, millions of tiny bubbles form. This
process is called CAVITATION, meaning the formation of cavities.
Controls are sited on an easy clean front panel. Timer is in increments
- 6, 12, 20, 30 and 60 minute presets changed by a simple touch. Heat
is also available – on and off on a separate touch-button, with indicator
light.
Items to be cleaned should not be allowed to rest on the bottom of the
cleaner. A basket is included. The accessory pack (see below) includes
an extra basket and some very useful additional components.
Tank capacity is 4 litre.
External Dimensions: Width 266.7mm x Height 266.7mm x Length
374.65mm - weight 6.8kg.
Internal Dimensions: Width 139.7mm x Height 88.9mm x Length
285.75mm
During the high pressure stage, the bubbles collapse or implode,
releasing enormous amounts of energy. Working in all directions, the
bubbles attack every surface and invade all recesses and crevices,
pulling debris off the object being cleaned.
Warranty is 2.5 years against manufacturing defects. Please noterunning the unit dry with the heater on will result in failure – this is not a
warranty issue!
Accessory Kit
This consists of 1 x full basket, 1 x bur box, 1 x bur tray, 1 x full
positioning cover, 1 x half positioning cover and 2 x 600ml beakers.
The bur accessories are useful for small components including burs
& drill bits, avoiding ‘losing’ small items in the bottom of the tank. The
beakers are used with the positioning covers which support them in
the carrier solution, and are used when smaller quantities of specialist
cleaning solutions are needed which may damage the cleaner unit.
HENRY SCHEIN SWEEP 2000 ULTRASONIC INSTRUMENT CLEANER
HS9006376
HS Sweep 2000 Ultrasonic Cleaning Machine
with Basket
HS1113452
HS Sweep 2000 Spare Basket
HSSWEEPKIT
HS Sweep 2000 Accessory Kit
Maxisweep machines utilize Sweep technology that enhances the
ultrasonic activity by automatically changing frequencies, thus creating
a cleaning grid which literally sweeps through the tank. A more uniform
cleaning pattern and significantly shorter cleaning times result when ‘hot
spots’ present in traditional ultrasonics are eliminated.
375
£595.00
£79.50
£195.00
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INSTRUMENT CARE
Repair Service
Instrument Cleaning Agents
Veterinary
Instrumentation has a
network of specialists
who can repair any
surgical instrument.
Send the damaged item
to us and we will advise
if it is worth repairing.
For some power tools,
it may be necessary to
send them back to the
original manufacturer for
assessment, which may
be overseas. All carriage
fees will be charged at
cost.
Rapidex Cleaner - (Now supplied in bulk or water soluble
sachets)
Routine sharpening
and setting of scissors
is performed quickly
and professionally by
Len Richardson, an
instrument maker with
over 55 years of experience.
An effective degreaser and general instrument cleaner. Some users
dislike the loose powder format. The new soluble sachets are simply
dropped into the ultrasonic bath. No dry powder is released.
• Ideal for Ultrasonic Cleaners.
• Also effective as a pre-soak for long standing or difficult residues
• Tested by the Royal Institute of Public Health
RAPIDEX CLEANER
RAPIDEX
Rapidex Soluble Sachets (Box of 50)
RAPIDEXBULK Rapidex Bulk Powder 2.25kg
Instrument Cleaning Brushes and Pipecleaners
£39.50
£59.50
Rapizyme
Stainless Steel Instruments are protected from corrosion by a very
thin layer of chromium oxide. This should not be damaged by regular
wire brushes. Brushes available with Nylon and Stainless Bristles.
Orthopaedic Cleaning Brush is Double Ended with superfine soft
Stainless Steel Bristles. General instrumentation is the same with Nylon
Bristles. One end has 3 rows of Bristles, the other has a single row for
delicate work. Pipe Cleaners are 1/8” diameter and 12” long. Absorbant
for cleaning and drying. Supplied in packs of 100.
• Three new enzymes.
• Easy to use measured bottle.
• 2ml per litre dilution.
• Removes all organic material.
• Ideal for endoscopes.
INSTRUMENT CLEANING BRUSH
CB1
Cleaning Brush Nylon for Gross Contamination
CB2
Cleaning Brush Stainless for Large Burs & Reamers
CB3
Cleaning Brush Nylon for General Instrumentation
CB4
Cleaning Brush Stainless Steel for Orthopaedic
CBPIPE
Pipe cleaners 1/8” 12” Long (Pack of 100)
• Low foam for ultrasonics.
£13.50
£13.50
£16.50
£16.50
£49.50
• Completely rinsable.
• Biodegradeable.
• Tested by The Royal Institute of Public Health.
RAPIZYME
RAPIZYME
376
Rapizyme 1 Litre
£49.50
17
INSTRUMENT CARE
www.vetinst.com
Instrument Lubrication
Micro 90 Concentrate
Liquid general purpose Instrument Cleaner
(dilute 1:100) for Ultrasonics.
MICRO 90 CONCENTRATE
100300
Micro 90 1 Litre Dilute 1:100
BA Ultimate Oil Spray
£16.25
BA ULIMATE OIL SPRAY
BAOIL
BA Ultimate Oil Spray
Perasafe
Perasafe is a rapid, instrument
compatible, user and
environmentally friendly chemical
sterilant. Supplied as a safe,
space-saving powder Perasafe
is activated by simply dissolving
in luke-warm tap water.
Providing rapid sterilisation
and re-use of endoscopy
instruments, Perasafe gives
confidence to users and patients
alike. A unique aldehyde-free
formulation gives efficacy without
harm to instruments, health risks
to nursing staff and avoids the
need for special fume extraction
or waste disposal systems.
£22.00
Surgical Instrument Lubricant
After washing and drying, a regular spray
of Instrument Lubricant will prolong working
life and improve the function of your jointed
instruments.
Perasafe is a pale blue/ white powder which, when in solution, sterilises
within 10 minutes. Suitable for all surgical instruments and fibrescopes.
Formulated not to damage surgical instruments. Prepared solution lasts
24 hours. 81g pack makes 5 litres. May be subdivided to make less.
PERASAFE
100100
100101
Perasafe Cold Sterilant 24 x 81g (5 litre size)
Perasafe Cold Sterilant 6 x 81g (5 litre size)
SURGICAL INSTRUMENT LUBRICANT
100009
Instrument Lubricating Spray
£205.00
£72.50
£13.95
Instrument Lube
Instrument Oil - (Autoclavable)
Diluted with water Instrument
Lube becomes an oil emulsion.
Instruments are allowed to soak
to allow penetration of lube to
all working parts. The excess is
drained off prior to autoclaving.
The water evaporates during
autoclaving, leaving a film of oil in
the joints. Concentrated solution.
Regular lubrication will keep your instruments working longer. Failure to
lubricate will result in stiff joints and ultimately breakages. Low boiling
point oils are quickly lost during the autoclaving process.
Oils containing Teflon offer significant extra lubrication.
Can be autoclaved.
INSTRUMENT OIL – AUTOCLAVABLE
100003
Instrument Lubricating Oil
100006
Teflon Drops
Recommended dilution rate 1 part
EZEE-Lube to 50 parts water for
use with manual application or
static bath. When applied into a
disinfection cycle the recommended
dilution rate is 1 part EZEE-Lube to
100 parts water, as the dispersion
of the product in hot water is much more efficient.
Clear solution becomes white when diluted.
Remove excess EZEE-Lube with suitable cloth or towel before placing
instrument into autoclave.
INSTRUMENT LUBE
100008
EZEE Lube Instrument Lube 4 Litre (makes 200 litres)
£15.00
£18.95
377
£89.50
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INSTRUMENT CARE
Instrument Marking
Protective Autoclavable Tips
Colour Coded Identity Rings
For Steinman, ESF pins and delicate or sharp instruments. Protect both
tips and staff.
PROTECTIVE AUTOCLAVABLE TIPS
100011-W Protective Tip White
up to 1.6 - 2.0mm Diameter Pack 20
100011-BL Protective Tip Blue
2.5 - 3mm Diameter Pack 20
100011-G
Protective Tip Green
up to 3.2 - 4.0mm Diameter Pack 20
100011-R
Protective Tip Red
up to 4.8mm Diameter Pack 20
100011-Y
Protective Tip Yellow
up to 6.0 - 6.5mm Diameter Pack 20
100011-O
Protective Tip Flat Orange
up to 10mm Wide Pack 20
100011-BR Protective Tip Flat Brown
up to 16mm Diameter Pack 20
100011-BLK Protective Tip Flat Black
up to 25mm Diameter Pack 20
100020
Protective Tips Silicone Multi Pack
One pack of each colour 160 (8 x 20)
Strong tear-resistant Silicone Instrument Coding Rings.
COLOUR CODED IDENTITY RINGS
100012
Coloured Silicone Instrument I.D. Rings x 120
£15.95
Instrument Marking Tape
£9.95
£9.95
£9.95
£9.95
£9.95
£9.95
£9.95
£9.95
£69.50
Tube Brushes
Allows rogue instruments to be returned to their kits. Also useful when
going on practical courses. Available as a Kit or in individual rolls.
INSTRUMENT MARKING TAPE
100001
Instrument Marking Tape (Box 8 colours) (120cm)
100001Y
Instrument Marking Tape Single Yellow (300cm)
100001R
Instrument Marking Tape Single Red (300cm)
100001BR Instrument Marking Tape Single Brown (300cm)
100001OR Instrument Marking Tape Single Orange (300cm)
100001BLU Instrument Marking Tape Single Blue (300cm)
100001G
Instrument Marking Tape Single Green (300cm)
100001W
Instrument Marking Tape Single White (300cm)
100001BLK Instrument Marking Tape Single Black (300cm)
Fine brushes are very useful for cleaning the lumen of drill guides and
tissue protectors down to 2mm, particularly where ultrasonic cleaning is
not available. Use to remove gross contamination and ensure patency
before ultrasonic cleaning.
£22.00
£9.95
£9.95
£9.95
£9.95
£9.95
£9.95
£9.95
£9.95
TUBE BRUSHES
END02
Tube Brush 12 Inch Long 2mm
END03
Tube Brush 12 Inch Long 3mm
END04
Tube Brush 12 Inch Long 4mm
END05
Tube Brush 12 Inch Long 5mm
378
£14.95
£14.95
£14.95
£14.95
17
INSTRUMENT CARE
www.vetinst.com
Sharpening Accessories
Autoclaving
IM3 White Stone Slip
Instrument Box Padlock Security Tags - No Indicator
To work effectively both
scalers and elevators
need to be sharp. Regular
sharpening will keep
your instruments working
correctly.
The Slip Stone has both
flat and rounded surfaces
to sharpen elevators and
curettes. Use baby oil as
lubricant.
IM3 WHITE SLIP STONE
012150
IM3 White Slip Stone for Curettes and Elevators
012146
Luxator Cylindrical Sharpening Stone
Anti-tamper security padlock. Useful for marking instrument boxes.
Single use only. Padlock has to be broken to be removed. Good value
Supplied in packs of 100
INSTRUMENT BOX PADLOCK SECURITY TAGS - NO INDICATOR
PSS100
Disposable Security Padlocks No Indicator (x 100)
£29.95
£29.50
£17.95
Instrument Box Padlock Security Tags with Indicator
Diamond Card - Fine
This credit card sized, Diamond Covered Plate is ideal for sharpening
Dental Elevators and Luxators. To work efficiently these instruments
must be sharp. The diamond is virtually indestructable. An additional
advantage is that the lubricant used is water rather than the oil used with
sharpening stones.
DIAMOND CARD - FINE
012144
Flat Diamond Sharpening Card (Fine)
£24.95
Diamond Cone
Anti-tamper Security Padlock with steam sterilisation indicator spot. Spot
colour changes from pale blue to brown. Single use only. Padlock has to
be broken to be removed.
Supplied in packs of 20 and 100
INSTRUMENT BOX PADLOCK SECURITY TAGS WITH INDICATOR
PSL20
Instrument Box Padlock Security Tag with Indicator (20)
PSL100
Instrument Box Padlock Security Tag with Indicator (100)
£6.95
£25.00
Instrument Padlock Security Tags - Repair
Subgingival Curettes must be kept sharp to work efficiently. They should
be checked and sharpened at least weekly. The Diamond Cone is
indestructable compared with stones which break very easily and uses
water rather than oil as a lubricant.
DIAMOND CONE
012148
Diamond Cone 205mm
£44.50
Plastic Test Stick PTS
Used to check the sharpness of curettes. The sharp curette will bite
when used on the test stick at the angle used on the tooth. If it slips, it is
not sharp.
PLASTIC TEST STICKS
HUF-PTS
Plastic Test Sticks Pack of 6
Useful for marking instruments which should be sent for repair. Single
use only. Padlock has to be broken to be removed.
Supplied in packs of 10
INSTRUMENT PADLOCK SECURITY TAGS - REPAIR
PSTR10
Instrument Padlock Security Tag - Repair (10)
£17.95
379
£4.95
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INSTRUMENT CARE
Autoclaves
VetAssure Class B & Class S Autoclaves
The VetAssure Range of Autoclaves
The VetAssure Range of Autoclaves comply with all the relevant
European Directives and Standards, including BS EN13060.
Designed and manufactured in Italy, the VetAssure is built to the highest
standard delivering quality, efficiency, speed, simplicity and reliability.
Midmark are market leaders in the US for benchtop steam sterilisation
and have a major market presence in Germany, UK Dental and Italy,
proving to be the professional’s choice across Europe.
Above all else we realise that what the busy veterinary surgery requires
is reliability and peace of mind. The autoclave needs to perform day
in day out. This is exactly what VetAssure offers. Our uptime figures
are in excess of 99.5%, providing the exceptional reliability of Midmark
autoclaves.
One of the unique features of the VetAssure range is that all models
incorporate a steam generator, injecting steam directly into the chamber.
This enables the Autoclave to operate with some of the fastest cycle
times on the market whilst remaining highly energy efficient.
The VetAssure Series of autoclaves has all the features listed opposite
and meets all the regulations which cover vacuum veterinary autoclaves.
Both ‘Bowie and Dick’ and ‘Vacuum Test’ parameters as specified by the
NHS are met. The double-stage vacuum pump evacuates the chamber
both prior to the cycle and after the sterilisation process.
Both the VetAssure B and S class autoclaves meet the highest
standards required for vacuum sterilisation and are suitable for all
wrapped, non-wrapped, solid, hollow and porous loads, meeting the BS
EN13060 standard for steam penetration and resulting in dry packs and
instruments.
Both B and S class autoclaves have the following features:
•
Fast sterilisation times
•
Steam generator to reduce water and energy consumption by up to
50%
•
Internal thermal printer as standard with last 10 cycle reprint facility
•
Optional internal USB data-logger facility
•
Graphic display for easy operation and control
•
Practical water loading from self-priming pump
•
Direct connections for automatic water fill and drainage
•
Separate water loading and drainage tanks for improved hygiene
•
Motor operated door closure with triple safety protection
•
Suitable for all load and instrument types
•
Available in 18 or 23 Litre capacity
•
Up to 52cm chamber length (B&S 23L) – one of longest on market
- for those larger kits
•
Reversible tray holders and 5 trays as standard
•
Competitively priced
•
Superior build using quality materials ensure reliability and longevity
of machine.
The graphic display indicates
current temperature and
pressure plus details of cycle
phases.
Details of operator errors also
displayed.
Midmark Customer Service includes:
After-sales Service and Maintenance.
Free Delivery (UK Mainland), Installation, Commissioning and Staff
Training on purchase.
Service is recommended every 1500 cycles or at least once per year.
Manufacturer Trained Engineers.
BCAS Accredited.
Two Year Warranty (5 Year Warranty on Chamber).
Free Technical Support by phone.
Tray holders carry 5 trays as standard. 5 trays included.
Tray holder is reversible and removeable for larger packs.
Wrapped packs up to 4.5kg may be sterilised (B23 & S23).
Chamber length up to 530mm (23L).
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INSTRUMENT CARE
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Process Indicator Pen (PIP)
An on board printer is
standard to provide a
permanent record of the
complete cycle.
Reprint option on previous 10
cycles available.
A really handy Process Indicator Pen (PIP) - you will wonder how you
did without it.
Conforms to EN ISO 11140-1. Writes on all standard sterilization
wrapping materials. Changes colour from purple to green. Clear Stop/
Go colour change. Non toxic and lead free.
AUTOCLAVE PEN
AUTOPEN
Autoclave Pen
£34.50
Autoclave tape
Use to seal bags and boxes. Integral marking changes colour when
passed through a full cycle. Note that a change in colour of the tape does
not necessarily guarantee that the contents of the bag or pack are sterile.
Conforms to ISO 11140-1 Class 1
19mm x 50m roll
AUTOCLAVE TAPE
AUTOT12
Autoclave Tape 19mm x 50m roll (12 Pack)
AUTOT48
Autoclave Tape 19mm x 50m roll (48 Pack)
£27.95
£84.50
Steam Sterilization Indicators
VETASSURE MIDMARK AUTOCLAVES
VS1800000 VetAssure ‘S’ Autoclave 18 Litre
VS2300000 VetAssure ‘S’ Autoclave 23 Litre
VB1800000 VetAssure ‘B’ Autoclave 18 Litre
VB2300000 VetAssure ‘B’ Autoclave 23 Litre
KROTB
Thermal Printer Paper (Pack of 10 Rolls)
£2,900.00
£3,100.00
£3,400.00
£3,750.00
£24.00
The VetAssure Autoclave Range are also available with an Internal Data
Logger - optional extra. Please contact the Vet Tech Team on 0845 130
9596 or email [email protected] for further details.
Customer service includes:
After-sales Service and Maintenance.
Free Delivery (UK Mainland), Installation, Comissioning and Staff
Training on purchase.
Service is recommended every 1500 cycles or at least once per year.
Manufacturer Trained Engineers.
BCAS Accredited.
Two Year Warranty (5 Year Warranty on Chamber).
Free Technical Support by phone.
Available in Class 4 Dual Steam Multi Parameter and Class 6 Steam
Emulating indicators
Class 4 monitors all 121˚C to 134˚C steam sterilization cycles
Class 6 monitors critical parameters - Time, Temperature and Steam
5.3 min at 134˚C and 15 mins at 121˚C
Clear colour change.
STEAM STERILIZATION INDICATORS
AUTOINDMP Class 4 Dual Steam Multi Parameter Indicators (500 Pack)
AUTOINDE Class 6 Steam Emulating Indicators (250 Pack)
381
£49.50
£49.50
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