Cause: Water droplets condensing on the instrument and evaporating very slowly. Usually traced to high mineral content in the water supply.
Solution:
Cause: Insufficiently rinsed linens or linens containing residue of caustic detergent chemicals.
Solution: Check with the laundry to be sure linens are rinsed thoroughly.
Cause: Baked-on blood in the box locks, serrations, and ratchets.
Solution: Open all box locks completely prior to cleaning.
Cause: Water softeners can cause rust-colored, dust-like film under certain conditions. High iron content in water can also cause mineral deposits on instruments.
Solution: Consult with hospital engineering staff for an evaluation of your water treatment program.
Cause: Exposure to saline solutions, blood, potassium chloride, and other compounds.
Solution: Rinse with distilled water as soon as possible after exposure.
Cause: Some detergents contain chloride or an acid base that, if not thoroughly rinsed from instruments, unites with steam in the autoclave to form hydrochloric acid.
Solution: Avoid detergents with chloride bases and select a detergent with a pH range no higher than 8.5.
Cause: Amine chemicals, which are used in steam lines to clean lime deposits, can be deposited on stainless steel by electrolytic action.
Solution: Use distilled or demineralized water instead of the local water source to cycle through the autoclave.
Microsurgical instruments are most vulnerable to damage through misuse, abuse, and rough handling. Their exacting performance is extremely crucial to microsurgery, so extra attention should be given to their care.
Use microsurgical instruments only for their intended purpose. Delicate construction can be easily damaged if used for other procedures.
All surgical instruments must be sterilized prior to surgery to prevent infection. However, sterilization can leave contaminants behind if instruments are not properly cleaned.
Tips:
Tip: Heated tanks do not significantly improve cleaning. Ultrasonic cleaning is 16 times more efficient than hand cleaning.
Procedure:
Tips:
Chamber Cleaning Steps:
Tip: Use a lubricant spray instead of a bath to prevent bacterial contamination. Lubricate all moving parts (joints, box locks, ratchets, screws) after every cleaning. Use only steam-penetrable surgical lubricants.
Troubleshooting Stain Guide:
| Stain Color | Cause |
|---|---|
| Brown / Orange | High-pH detergents, Chlorhexidine, improper soaking, or tap water |
| Dark Brown | Low-pH solutions, malfunctioning sterilizer, baked-on blood |
| Bluish Black | Reverse plating, exposure to saline, blood, potassium chloride |
| Multicolor | Excessive heat from localized hot spot in sterilizer |
| Light & Dark Colored Spots | Water droplets drying slowly, leaving minerals behind |
| Bluish Gray | Liquid sterilization solutions used beyond recommendations |
| Black Stains | Contact with ammonia or ammonia-containing solutions |
| Gray | Excessive use of liquid rust remover |
| Rust | Baked-on blood or soaking in tap water |
Proper care and maintenance of surgical instruments is essential to ensure long-term performance, prevent damage, and maintain patient safety. The following guide outlines common issues, preventive measures, and best practices for handling, cleaning, and sterilizing surgical instruments.
Cause: Slow evaporation of water droplets, often due to high mineral content in the water supply.
Solution: Follow autoclave manufacturer guidelines. Ensure steam is fully exhausted before opening the door. Check for leaking gaskets or valves that may cause excess condensation during the drying cycle.
Cause: Residual caustic detergents left on linens or inadequate rinsing.
Solution: Ensure linens are thoroughly rinsed.
Cause: Baked-on blood in box locks, serrations, and ratchets.
Solution: Always open box locks fully before cleaning.
Cause: Water softeners or high iron content in the water supply.
Solution: Request an evaluation of your water treatment system from facility engineering staff.
Cause: Exposure to saline, potassium chloride, blood, or corrosive chemicals.
Solution: Rinse instruments with distilled water immediately after exposure.
Cause: Chloride-based or acidic detergents not thoroughly rinsed, combined with autoclave steam forming hydrochloric acid.
Solution: Use detergents with a pH no higher than 8.5 and avoid chloride-based substances.
Cause: Amine chemicals from steam lines depositing onto stainless steel.
Solution: Use distilled or demineralized water in the autoclave.
Microsurgical instruments are extremely delicate and require careful handling. Their performance is crucial to precision surgeries, making proper maintenance essential.
Inspect instruments when purchased and after each use. Use a magnifying glass to check for nicks, burs, or misalignment.
During surgery, wipe instruments frequently using non-fibrous sponges to avoid damaging tips.
Clean microsurgical instruments by hand only. Avoid ultrasonic or washer-sterilizers. Ensure they are completely dry before storage.
Prevent metal-to-metal contact. Use protective racks, trays, or cases to separate delicate tips.
Schedule regular maintenance for sharpening, alignment, and adjustment.
Use microsurgical instruments only for their intended purpose.
All surgical instruments must be properly cleaned and sterilized to prevent infection.
When sterilizing in pouches, avoid stacking. Use a stand (e.g., spiral metal letter holder) to keep pouches upright for correct steam flow.
Ultrasonic cleaning is highly effective up to 16× more efficient than manual cleaning.
Proper lubrication prevents wear, dulling, and friction on moving parts.
If packs come out wet, place a towel inside the pack for moisture absorption.
If a pit mark appears: It is corrosion or rust.
Brown / Orange: High-pH detergents, chlorhexidine, soaking in tap water
Dark Brown: Low-pH solutions, malfunctioning sterilizer, baked-on blood
Bluish Black: Reverse plating, mixing metals in ultrasonic cleaner, exposure to salts
Multicolor: Excessive heat or hot spots in sterilizer
Light / Dark Spots: Minerals left after water droplets dry
Bluish Gray: Over-used cold sterilization solution
Black: Contact with ammonia
Gray: Overused rust remover
Rust: Baked-on blood or soaking in tap water
To ensure scissors are properly sharpened, use Theraband testing material:
Make several complete cuts through the material, especially at the distal tips.
BAC can loosen tungsten carbide inserts.