Methods of Decontamination and Sterilisation of Surgical Instruments
The reuse of surgical instruments helps keep costs down and protect the planet from creating even more medical waste. But surgical instruments, by their very nature, get exposed to biohazards with virtually every use. Given the optimal environment and enough time, bacteria can multiply on surgical instruments and put the next patient at risk.
The WHO requires in its 2009 Guidelines for Safe Surgery that all surgical instruments be confirmed to be sterile before surgery. What are the methods for decontamination and sterilisation of surgical instruments to maintain best practices and keep a sterile field in theatre? Find out in this article.
The Spaulding Classification for Medical Devices and Levels of Disinfection
Decontamination procedures for surgical instruments should follow the Spaulding Classification system, an internationally-recognised framework for cleaning, disinfecting, and sterilising reusable medical equipment.
| Level of Distinction | Definition | Minimum Procedure |
|---|---|---|
| Non-Critical | The device does not touch the patient or only touches intact skin. | Sterilisation to destroy 100% microbial life. |
| Semi-Critical | The device touches mucous membranes but does not penetrate through the skin barrier. | Cleaning by two-level disinfection: cleaning to remove dirt and debris and disinfection to reduce the microbial load to a safe level. |
| Critical | The device touches sterile tissue or the bloodstream. | High-level disinfection/sterilisation to destroy vegetative microorganisms, small or non-lipid viruses, mycobacterium, medium or lipid viruses, bacterial spores and fungal spores. |
Surgical instruments are generally in the critical category as they are used to penetrate the skin barrier, enter sterile tissues and enter the bloodstream. There are three main stages to the decontamination of surgical instruments: cleaning, disinfection, and sterilisation. The cycle below shows the journey surgical instruments take in hospital settings.
1. How are surgical instruments cleaned?
Surgical instruments must be kept in good condition. Any signs of rust, damage, or other degradation mean they will need to be disposed of. Care of surgical instruments starts with cleaning. The surgical instrument cleaning protocol is to remove any ‘visible soil’ to prepare the instruments for disinfection.
Visible soil is the tangible matter you can see on the device. This could be bone, tissue, blood, dirt, dust, debris, or any other matter. Disinfection can only be effective when the entire surface of the instrument makes contact with the disinfectant solution, so this dirt needs to be removed completely.
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Want to know more about different types of surgical instruments and their uses? Find out in our knowledge base.
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2. Disinfection of Surgical Instruments
Disinfection is a process that reduces the number of potentially infectious agents to a safe and defined level in a given area. Methods for how to disinfect surgical instruments usually either employ a disinfectant solution or a heat process. If you use a washer/disinfector machine, this step is automatically carried out after the cleaning procedure.
Disinfectant active ingredients include:
- Alcohol
- Formaldehyde
- Glutaraldehyde
- Chlorine and chlorine compounds
- Iodophors
- Ortho-phthalaldehyde (OPA)
- Hydrogen peroxide
- Peracetic acid and hydrogen peroxide
- Phenolics
- Peracetic acid
- Quaternary ammonium compounds
3. Sterilisation Methods of Surgical Instruments
Once surgical instruments are completely clean and disinfected, they can be immediately taken to the sterilisation step, which will remove the bacterial load to zero. Instruments must first be dried and checked to ensure they are completely clean and in good condition. Then they must be packaged, ready to be sterilised.
Packaging for surgical instruments can vary from peel-open, disposable pouches to rigid containers and even reusable woven wraps for organisations that want to reduce their plastic waste. Choosing a type of packaging for sterilisation and storage of surgical instruments, look for these ideal qualities:
- Penetrability to allow the sterilant to be effective.
- Sufficient barrier effectiveness to prevent bacteria from entering and contaminating the instrument after sterilisation.
- Aeration to allow the sterilant to dissipate after the process.
- Puncture and tear resistance.
- Transparency for easy identification of the instrument.
- Easy opening to access the instrument using an aseptic non-touch technique (the instrument should be easily extractable).
Sterilisation of surgical instruments is most commonly done via heat, but some instruments cannot withstand the extremely high temperatures needed to thoroughly irradicate all bacteria on surfaces. Below, see common methods for how to sterilise surgical instruments.
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The reuse of surgical instruments helps keep costs down and protect the planet from creating even more medical waste. But surgical instruments, by their very nature, get exposed to biohazards with virtually every use. Given the optimal environment and enough time, bacteria can multiply on surgical instruments and put the next patient at risk.
The WHO requires in its 2009 Guidelines for Safe Surgery that all surgical instruments be confirmed to be sterile before surgery. What are the methods for decontamination and sterilisation of surgical instruments to maintain best practices and keep a sterile field in theatre? Find out in this article.
The Spaulding Classification for Medical Devices and Levels of Disinfection
Decontamination procedures for surgical instruments should follow the Spaulding Classification system, an internationally-recognised framework for cleaning, disinfecting, and sterilising reusable medical equipment.
| Level of Distinction | Non-Critical |
|---|---|
| Definition | The device does not touch the patient or only touches intact skin. |
| Minimum Procedure | Sterilisation to destroy 100% microbial life. |
| Level of Distinction | Semi-Critical |
| Definition | The device touches mucous membranes but does not penetrate through the skin barrier. |
| Minimum Procedure | Cleaning by two-level disinfection: cleaning to remove dirt and debris and disinfection to reduce the microbial load to a safe level. |
| Level of Distinction | Critical |
| Definition | The device touches sterile tissue or the bloodstream. |
| Minimum Procedure | High-level disinfection/sterilisation to destroy vegetative microorganisms, small or non-lipid viruses, mycobacterium, medium or lipid viruses, bacterial spores and fungal spores. |
Surgical instruments are generally in the critical category as they are used to penetrate the skin barrier, enter sterile tissues and enter the bloodstream. There are three main stages to the decontamination of surgical instruments: cleaning, disinfection, and sterilisation. The cycle below shows the journey surgical instruments take in hospital settings.
1. How are surgical instruments cleaned?
Surgical instruments must be kept in good condition. Any signs of rust, damage, or other degradation mean they will need to be disposed of. Care of surgical instruments starts with cleaning. The surgical instrument cleaning protocol is to remove any ‘visible soil’ to prepare the instruments for disinfection.
Visible soil is the tangible matter you can see on the device. This could be bone, tissue, blood, dirt, dust, debris, or any other matter. Disinfection can only be effective when the entire surface of the instrument makes contact with the disinfectant solution, so this dirt needs to be removed completely.
Click to expand:
Want to know more about different types of surgical instruments and their uses? Find out in our knowledge base.
2. Disinfection of Surgical Instruments
Disinfection is a process that reduces the number of potentially infectious agents to a safe and defined level in a given area. Methods for how to disinfect surgical instruments usually either employ a disinfectant solution or a heat process. If you use a washer/disinfector machine, this step is automatically carried out after the cleaning procedure.
Disinfectant active ingredients include:
- Alcohol
- Formaldehyde
- Glutaraldehyde
- Chlorine and chlorine compounds
- Iodophors
- Ortho-phthalaldehyde (OPA)
- Hydrogen peroxide
- Peracetic acid and hydrogen peroxide
- Phenolics
- Peracetic acid
- Quaternary ammonium compounds
3. Sterilisation Methods of Surgical Instruments
Once surgical instruments are completely clean and disinfected, they can be immediately taken to the sterilisation step, which will remove the bacterial load to zero. Instruments must first be dried and checked to ensure they are completely clean and in good condition. Then they must be packaged, ready to be sterilised.
Packaging for surgical instruments can vary from peel-open, disposable pouches to rigid containers and even reusable woven wraps for organisations that want to reduce their plastic waste. Choosing a type of packaging for sterilisation and storage of surgical instruments, look for these ideal qualities:
- Penetrability to allow the sterilant to be effective.
- Sufficient barrier effectiveness to prevent bacteria from entering and contaminating the instrument after sterilisation.
- Aeration to allow the sterilant to dissipate after the process.
- Puncture and tear resistance.
- Transparency for easy identification of the instrument.
- Easy opening to access the instrument using an aseptic non-touch technique (the instrument should be easily extractable).
Sterilisation of surgical instruments is most commonly done via heat, but some instruments cannot withstand the extremely high temperatures needed to thoroughly irradicate all bacteria on surfaces. Below, see common methods for how to sterilise surgical instruments.
Click to expand:
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