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Sontec Instruments
A guide to ensure you, that every time you need an instrument to work properly, it Does.

Everything you ever wanted to

know about surgical instruments
AND A LITTLE BIT MORE...

7248 South Tucson WayEnglewood, CO 80112(303)790-9411(800)821-7496Fax(303)792-2606

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In 1937 the author first realized the importance
of checking surgical instruments in the operating room. In
those days most of the surgeons owned their own instru-
ments. Problems were many for the Operating Room
supervisors because the number of surgical instruments
surgeons had was limited. Surgeons were forced to bor-
row from each other to complete their sets, especially
when some of their instruments were set aside for repair.
In an average hospital it was not uncommon to
have 20 to 25 surgeons each owning his personal instru-
ments. It was necessary for Operating Room supervisors
to receive the surgeons permission prior to having his
instrument repaired. If a surgeon worked in several hos-
pitals in a city, his instruments had to be transported from
one hospital to another. In emergencies, the OR supervi-
sor had to improvise to make up sets, and much dissension
occurred among doctors as to who had borrowed their
instruments.
George Pencer taught many nurses the technique
of checking instruments, and in hospitals of 200 beds or
more , he would actually set up portable repair equipment
allowing the repair and sharpening of instruments without
removing them from the hospitals.
Since 1937 many advance in the quality, repair,
and ownership of surgical instruments have taken place.
But we feel this handy check list, reviewing the care and
maintenance of surgical instruments, should still prove
helpful for all members of the surgical team.
Forceps and Hemostats
A surgeon faces a most irritating and frequently
frustrating problem when a forcep or hemostat does not
function properly. In most cases, this can be avoided if a
surgical nurse knows how to check and test these instru-
ments correctly before including them in the surgical sets.
Forceps are probably abused more than any other
instrument. Experience indicates that breakdown of high
quality forceps is often the direct result of their misuse.
They are most frequently misused in orthopedic surgery.
Here they are often applied to steinman pins, bone plates,
screws, and nails-usually when pliers are not avail-
able. They also are used to clamp large sponges, tubing,
needles, etc. The smaller the misused forcep, for example
a Mosquito or Kelly, the greater the damage. As the jaws
of a forcep are overloaded, inevitably misalignment of the
jaws occurs and reduction of tension in the shanks. Thus,
the instruments effectiveness is greatly impaired. When
this situation occurs in a Kelly or similar type instrument,
the forcep will not hold tissue securely: therefore, fail-
ing to accomplish the job for which it was intended. If a
surgeon continues to use the instrument, further damage
at an accelerated rate will result. For example: when the
jaws of a Allis clamp do not align, the teeth will not mesh
properly, and they will break or wear very rapidly. When
the jaws of an Ochsner forcep do not align and a surgeon
continues to use it, the tooth on the male jaw usually
breaks off. Thus, not only is the instrument destroyed, but
pieces of the tooth may be lost in surgery.
How to test a forcep for jaw alignment
Start with a visual test. Close the jaws of the for-
cep lightly. If the jaws overlap, they are out of alignment
. On forceps with serrated jaws, observe to see if the teeth
are meshing properly. Holding the shanks of the forcep in
each hand , with the forcep open, try to wiggle the instru-
ment. If the box lock has considerable play, and if it very
loose, this will cause jaw misalignment. If this occurs, the
instrument is faulty and should be repaired.
Forceps and Hemostats which spring open
It is extremely annoying to a surgeon, and hazardous to the
patient, when a forcep or hemostat springs open; especially
when clamped on a duct or a large vessel, such as a kidney
pedicle. Operating room nurses have surely seen this hap-
pen.
The above problem is usually caused by forcep
misalignment, worn ratchet teeth, or by lack of tension at
the shanks. As ratchet teeth are subject to constant metal
to metal wear, they are the fastest wearing parts of a for-
cep. By constant strain of closing and opening the instru-
ments, there is continues friction and wear; in particular
on the first ratchet tooth. Therefore, when a surgeon takes
a large bite with the forcep and locks it on the first ratchet
tooth, a small jar of any kind may cause it to spring open.
How to check the ratchet teeth on instruments
Clamp the forcep on the first tooth only. When
clamped, the instrument should produce a sounding snap.
After the instrument is locked on the first ratchet tooth,
take and hold the instrument at the box lock; then tap the
ratchet teeth portions of the instrument lightly against a
solid object (a weighted vaginal retractor is ideal). If the
instrument springs open, it is faulty and should be re-
paired.
How to check the tension between the shanks
Close the forceps lightly. When the jaws touch,
there should be a clearance of 1/16" or 1/8" between the
ratchet teeth of each shank. Such clearance provides ad-
equate tension at the jaws when closed.
For a forcep to work effectively and efficiently,
the jaws must align and meet exactly; the serrations should
mesh correctly; the shanks should be flexible and resilient
to compensate for a larger bite. The ratchets must hold.
The forceps, when closed, must not spring open. The
ratchet teeth should slide over each other smoothly when
opening and closing. In short, the forceps should open and

close easily, permitting the surgeons to work rapidly and
efficiently.
Orthopedic Instruments
Chisels, osteotomes, and gouges in constant use
need sharpening and honing at frequent intervals. If they
are accidentally misused, such as on a steinman pin, bone
plate, or screw, the edges become dull and nicked. In these
cases, the instrument should be sharpened immediately.
Your author has been told that it is difficult for a surgeon
not to occasionally encounter a pin, a bone plate, or a
screw with an osteotome; particularly when it is neces-
sary to remove an old plate which has some bone growth
around it. In such a situation , it is prudent to have an older
or special osteotome or chisel available for the surgeon. In
the regular course of cleaning and sterilization, care must
be exercised not to hit the edges of the chisels, gouges, and
osteotomes against each other or other instruments. Such
jostling not only dulls the edges of the instruments, but it
can also chip or dent the sharp edges.
Visual test for checking orthopedic instruments
Check for nicks and burrs on edges on chisels
and osteotomes. On bone cutting forceps and double
action ronguers, one should again check to see whether
the jaws align. If the screws at the fulcrum are slightly
loose, the jaws inevitably become misaligned; conse-
quently damage occurs to the jaws when the instruments
are used. Frequently, a bone cutting forcep or ronguer is
used to cut wire or a pin. To preclude this practice, it is
very important to have wire cutter or pin cutter available
to the surgeon. Orthopedic instruments are very expensive;
therefore, they merit exceptional care.
Tonsil Instruments
Adenotomes
The proper fitting of the adenotome blades is a
problem. An adenotome blade should slide smoothly in the
channels of an adenotome. When closed the blades should
not overlap the adenotome. If overlapping does occur,
the blade is too long and could be hazardous in use. If the
blade is to short , it will not close completely, causing tear-
ing of tissue rather than a clean cut.
Check the blades. Be sure they slide smoothly
and close so that no visible light can be seen between the
tip of the blade and the adenotome. When ordering new
blades, send your adenotomes to your surgical instrument
repair company and have the blades fitted to each adeno-
tome. This is very important because no two adenotomes
are alike, even though they may be the same size. Also,
be sure to have each blade stamped or lettered with the
same code number as the adenotome. For instance, if the
adenotome is coded 1-A, the blade should be coded 1-A.
This identification procedure insures a proper fitting blade
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for each adenotome.
Tonsiltomes
If blades do not close properly, the sluder presents
the same problem as ill-fitted adenotomes. In checking,
be sure the blade slides close, so that no light is visible be-
tween blade and tip of tonsiltome. Also, the blade should
not extend beyond the tip of the tonsiltome.
Tonsil Snares
On tonsil snares, Tydings and Eves type, one
should inspect the tip of the cannulas. Tonsil snare wires
have a tendency to wear grooves into the tips of the can-
nulas, thus causing the wire to stick or catch and not pull
through the cannula completely. If the wire sticks, it will
have a pulling and tearing effect on the tissue instead of
a clipping effect. If grooves are visible in the tips of the
cannulas, the instrument should be repaired.
Eye Instruments
Cataract Knives, Keratomes
It is very important to know how to test a cataract
knife correctly. Once the eye surgeon penetrates the con-
junctiva of the eye with a cataract knife only to discover it
will not cut, he is in trouble.
A small buckskin is the proper device for de-
tecting a faulty knife. This item is a must for testing eye
knives. To make the test, lay the handle portion of the eye
knife across the palm of your hand. Do not touch it with
your fingers. Hold the buckskin drum in your other hand.
Then, push or slide the knife blade through the buckskin
drum while it still rests in you palm. The blade should
penetrate the drum as though it were passing through
butter. If it sticks or has a tearing effect, then the knife is
in need of repair. The same procedure is used for testing
Keratomes.
Extreme care should be taken in handling all eye
instruments. Too much emphasis cannot be given to this
matter. During cleaning and sterilization, caution must be
taken to prevent the instruments from touching each other.
Metal to metal contact should never be permitted. Eye
instruments, even at best, can stand improvement.
There are a number of other fine eye cutting
instruments which are too numerous to mention in this
article; however, the same procedure of care should be
followed on them as on the cataract knives previously
discussed.
Scissors
Scissors, especially Mayo operating and Metzen-
baum dissecting, which do not cut on the tip of the blades
can cause surgical havoc. Not only should a dissecting,
or an operating scissor, cut tissue on the tips, but it is also
4 needle holder. It is the only instrument involving constant
important that the scissor blades glide over each other
smoothly. Only a correctly ground scissor with properly
set blades can provide this action. The precise setting of
the blades is very important. To achieve this state involves
a highly skilled procedure. And it takes an exceptionally
skilled craftsman with years of experience to grind and set
blades correctly.
Various types of scissors are made for different
types of use. It is important, therefore, that the surgeon
has the proper scissors available to him. Light, fragile
scissors, such as eye scissors with fine blades, should be
meticulously guarded against misuse. For the surgeon to
work quickly and methodically, an eye scissor must have
a particularly smooth and delicate action and cut on the
tips of the blades. Dissecting scissors are made for the ac-
curate cutting and dissection of tissue. The tips and edges
of the blades of these scissors should not be used for any
other purpose. If a dissecting scissor, especially a Metzen-
baum, is used for cutting heavy sutures or catgut, not only
will the edge be dulled, but there will be a tendency for the
blades to separate thus causing the scissors to loosen and
lose their effectiveness.
Suture scissors should be available to the surgeon
for cutting sutures. Wire of any kind should never be cut
with scissors. A wire cutter should be available for this
purpose. A scissors should be used only for its intended
purpose.
Sharpening surgical scissors is a highly skilled
procedure. Very often when scissors are incorrectly
ground by a incompetent repairman, the blades become
overheated. Consequently, they loose their temper, and
the edge of the scissors is caused to soften. This situation
practically ruins a scissor because the blades will not hold
their edges and must be repeatedly sharpened. Constant
sharpening, in turn, causes the tips to eventually become
pointed and sharp . In addition , the fact that they do not
close properly makes the instrument useless for dissecting.
How to test a scissor for maximum efficiency
All operating Mayo and Metzenbaum scissors
should cut four layers of gauze at the tips of the blades.
Smaller scissors less than 4" in length should cut at least
two layers of gauze at the tips. Additionally, eye scissors
should have a delicate touch when cutting. The Mayo
and Metzenbaum scissors should cut with a fine, smooth
feel and a minimum amount of pressure by the blades.
Check the action the scissors; it should not be too tight or
too loose. Check the tips (points) of the scissors. Are
they too sharp? Are there burrs on the tips of the blades,
especially on the Mayo and Metzenbaum scissors? When
the scissors are closed, are the tips of the blades open? A
scissor should both cut on the tips and feel very smooth
when cutting.
Needle Holders
No instrument receives greater abuse than a
metal to metal contact. Many times when pliers are not
available, especially to orthopedic surgeons, needle hold-
ers are used on screws, pins, bone plates, etc.
How to test a Needle Holder
The test is very simple. First, clamp the needle
in the jaws of the needle holder. Then, lock the instrument
on the second ratchet tooth. If the needle can be turned
easily by hand, the instrument should be set aside for re-
pair. When the instrument is new, it will hold securely on
the first ratchet tooth for a considerable time.
Needle Holders, such as a Crile Wood, Derf, or
Halsey used in plastic surgery, should hold at least 6-0
suture. Eye needle holders, such as a Castroviejo or Kalt,
should hold 7-0 suture.
Lubricating surgical Instruments
Ordinary oil or mineral oil is not permeable by
steam and should never be used on surgical instruments.
Neither should it be used for oiling the screw lock on scis-
sors or the box-lock on forceps.
Extensive test have shown that oil will harbor
bacterial spores in box-locks even though the instruments
are autoclaved. Common lubricating oil acts continuously
as a collector of dust and dirt. The problems caused by
indiscriminate oiling if instruments are matters of grave
concern.
The development of a lubricant called Instru-
ment- Milk resulted in a dramatic break through in the
science of instrument maintenance. After the Instrument-
Milk dip is applied, the instruments are autoclaved. The
lubricant's unique characteristics permit complete steril-
ization of both lubricant and instrument while lubricating
qualities are fully retained.
A knowledge of the operating and the testing
characteristics of surgical instruments can substantially
benefit many segments of the nursing profession. In-
struments which are kept in optimum conditions by
periodic testing, at least monthly, and which are repaired
as required, produce multiple profitable gains. Surgeons
save time and are able operate with unerring precision.
Operating Room supervisors abide in an atmosphere of
satisfaction which comes from doing an important as-
signment exceptionally well. Subsequently they develop
and enjoy increased rapport with surgeons and gain their
respect. Hospitals save money be keeping their surgical
instruments in optimum condition. As with the mainte-
nance of most technical equipment, the best maintenance
is the cheapest. In consequence, the patient gains the most
from the increased potential for a completely successful
operation.
 CORROSION OF STAINLESS STEEL SURGICAL
INSTRUMENTS
Corrosion of stainless steel surgical instruments
is a constantly recurring problem to both the surgeons and
the instrument maker. The surgeon is justly chagrined
when he finds rust on his delicate hand made instruments.
The blame is likely to fall on the instrument maker when
no other cause is apparent. However, corrosion is not
uniformly observed. In some hospital corrosion of stain-
less steel instruments is rarely seen, while in others, each
sterilization produces a coating of corrosion. The purpose
of this paper is to explore some of the causes of corrosion
and to indicate what is being done by the user to minimize
corrosion.
There is a need for some explanation as to the
choice of stainless steels used for fabricating surgical
instruments. Also a question may arise as to why stainless
steel should rust under any circumstances. In the usual in-
dustrial situation a manufacturer's choice of raw materials
is guided by economics. He must balance desired physi-
cal properties against costs. This is not the case in the
manufacture of hand made surgical instruments. Here, raw
material costs are insignificant compared to labor costs so
that only metallurgical properties are considered.
A wide range of metallurgical properties are of-
fered by the class of metals called stainless steel. These
metals have iron and chromium in common, but contain
carbon, nickel, sulfur, tungsten, manganese, molybdenum
and many other elements. It is chromium which imparts
the stainless quality; and in general, the more chromium
present in the alloy, the more resistant it is to the cor-
rosion. Carbon reduces the corrosion resistant effect of
chromium, but it is necessary to produce hardness. Hard-
ness is a prime consideration in instruments that require
extremely sharp edges or accurate jaw approximation. It is
a unhappy circumstance that there are only a few stainless
steel alloys which may be hardened sufficiently to be used
in the manufacturer of delicate surgical instruments. These
alloys are low in chromium content and high in carbon
content. They belong to the broad class known as stainless
steel, but are the least corrosion resistant of the group.
In order to minimize corrosion of these harden-
able stainless steel alloys, special handling is required
by the processor. A properly made instrument will have
passed through two processing steps which increase its re-
sistance to corrosion. In one of these steps, called passiv-
ation, the instrument is treated with nitric acid. This dis-
solves away any particles of carbon steel which may have
been ground in during processing. All tools necessary for
fabricating are of necessity made of carbon steel (regular
steel). The nitric acid bath also promotes the formation
of a surface coating of chromium oxide. The formation
of the chromium oxide coating is usually considered the
mechanism by which chromium produces resistance to
corrosion in stainless steel.
Polishing is the second processing step which
reduces corrosion. Polishing removes sites of possible
corrosion attack by producing an extremely smooth sur-
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face upon which a continuous layer of chromium oxide
may form. Surfaces which may not be effectively polished
are usually the first to show corrosion. Thus, knurled
handles or handles with milled grooves may rust , while
the remainder if the instrument is unaffected. Even the
satin-like, dull finish used to reduce glare is somewhat
more prone to surface corrosion than highly polished sur-
faces. This surface corrosion will not penetrate deeply and
usually may be removed by scrubbing with a brush and an
abrasive soap. Instruments with surface corrosion can be
repolished and passivated by the manufacturer to new con-
dition. Usually, the surface corrosion does not reappear
under proper maintenance thereafter.
A more distressing type of corrosion is that which
takes place on blades of knives, in box-locks or between
the blades of scissors. In these cases the function of the
instrument may be impaired. The most common causes of
this type of corrosion are as follows:
•Inadequate cleaning and drying immediately
after use.
•The use of corrosive sterilizing solution or too
long exposure to sterilizing solution.
•The use of faulty autoclave.
Probably the single most important consideration
in the care of surgical instruments is cleanliness. Any
foreign material either organic or inorganic on the surface
of hardenable stainless steel is likely to promote corrosion.
Thorough cleaning is more difficult than is realized by
some surgical nurses. This was shown by investigation
of Allegheny Ludlum Steel Corporation to determine the
specific cause of corrosion on certain surgical instruments.
A microscopic examination revealed foreign material scat-
tered over the surface of these instruments. Also chlorides
were found in the corrosion products. These findings
indicate that the instruments had not been thoroughly
cleaned or rinsed. A good soap and rubbing is required.
Often a soft brush is needed. Such as the Whisk'R Brush
available from Sontec Instruments. Finally the instrument
should be disassembled after use, thoroughly cleaned, and
thoroughly dried before they are reassembled. Instruments
of this type will corrode if they are stored with trapped
moisture.
A convenient method of removing corrosion
products from inaccessible places is to soak the instrument
in a mixture of equal parts ethyl alcohol and aqueous am-
monia. After contact with this solution for about twelve
hours, the corrosion products may be rinsed or lightly
brushed away. This procedure is particularly useful in
freeing box-locks which have frozen because of corro-
sion. Box-locks present a problem due to a tendency to
retain sterilizing solutions and moisture; furthermore, the
intersurfaces are not polished.
Sterilizing solutions are a likely source of the
chloride found in the corrosion products. Certain qua-
6 utilizes proper technique during the use, care, and handling
ternary ammonium chlorides make good cold sterilizing
agents as they have very strong germicidal properties as
well as being detergents.
The detergent property results from the molecular
structure which contains a large organic group and an ionic
portion. Such compounds are inherently corrosive due
to the presence of the chloride ion. These materials are
usually compounded with rust inhibitor which is effective
for only a limited time. When cold sterilizing solutions
are used, they must be replaced frequently. If corrosion
still persists, the solutions should be prepared with distilled
water.
Corrosion during autoclaving will take place
if (1) the autoclave is not operating properly, (2) cor-
rosive materials are in contact with instruments or (3)
tap water instead of distilled water is used to generate
steam. Autoclaves in which a large amount of corrosion
takes place should be inspected for leaking valves. Such
autoclaves may not be drying the instruments adequately
or may even be drawing corrosive matter back from the
drain. The source of the trouble may be as remote as the
laundry. Cloth used to wrap instruments to be autoclaved
may contain residual detergents, bleaches or starch. These
compounds can promote corrosion at the operating tem-
peratures of the autoclave.
The best material now available for the manu-
facturer of surgical instruments is a hardenable stainless
steel. With this material, extremely fine points, sharp
edges and durable sets may be fashioned into instruments.
However, in obtaining hardness, some resistance to corro-
sion is sacrificed. Special handling by the manufacturer
as well as the user indicated. In order to reduce corrosion
, instruments must be thoroughly cleaned and dried, and
they must not be given prolonged exposure to sterilizing
solutions. Care should be taken that no corrosive materials
are introduced into the autoclave and that the autoclave in
functioning properly. Whenever the autoclave is suspect,
distilled water should be used. When corrosion does occur
in stainless steel instruments, it is usually of superficial
nature. This surface corrosion may be removed by soaking
in a solution of alcohol and ammonia or by repolishing by
the manufacturer.
Instruments used in speciality surgery are the
products of a few highly skilled craftsmen. At their finest,
these instruments reflect not only craftsmanship but a high
degree of artistic ability in design and styling. When such
instruments are give the very special care which they de-
serve, they will retain their beauty and function for many
years.
Every hospital owns many thousands of dollars
worth of surgical instruments. The care and maintenance
these instruments receive is critical to their performance
during surgery and to the cost containment effort of each
hospital. Having made the investment in a quality product,
the hospital can expect several years of use if the staff
of its surgical instruments.
Manufacture
Metallurgical research has enabled instrument
makers to produce accurate, long lasting surgical instru-
ments. The steel used in most O.R. instruments is a 400
series alloy which has several useful properties. It can
be brought to very sharp cutting edge and will hold this
edge through continuous use. In addition, it has a high
tensile strength enabling it to maintain precisely set jaw
approximations. The metal is often referred to as stainless
because of its corrosion resistant qualities. A chromium
content of 11.5-18% gives the steel some of its stainless
characteristics. However, a manufacturing step known as
passivation actually provides the instrument with its corro-
sion resistance properties. Passivation, which follows the
final polishing steps, is a chemical bath which creates an
oxidized layer on the surface on the instrument. Through
routine hospital use and exposure to the air this oxidation
process continues, effectively maintaining and even build-
ing up a barrier to most stains and corrosive elements.
Maintenance Procedures
Designed and crafted to exacting specifications,
instruments will perform for a reasonable number of years
when the following steps are observed:
Instruments should be used during surgery for
their intended purpose exclusively. Misusing instruments
will lead to damage that is usually not repairable. A he-
mostat, for example, that is used to clamp tubing can come
out of alignment and quickly break.
Certain compounds are highly corrosive to
stainless steel and will cause serious damage despite the
passivated protective surface. Instruments should never be
exposed to Hydrochloric acid, Aqua regia, dilute Sulfuric
acid, Iodine, or Ferric chloride. In addition the following
substances should be kept away from instruments when-
ever possible:
•Aluminum chloride
•Ferrous chloride
•Barium chloride
•Mercury chloride
•Bichloride of Mercury
•Potassium Thiocyanate
•Carbolic acid
•Potassium permanganate
•Calcium chloride
•Sodium Hypochlorites
•Dakin's solution
•Stannous chloride
•Chlorinated lime
Instruments should be rinsed immediately follow-

ing contact with any of these substances.
It is important to rinse instruments that have
been exposed to blood and saline solutions before these
substances dry. Blood will cause a stain that is difficult to
remove, and saline solutions are highly corrosive. Instru-
ments should be placed in a basin of sterile distilled water
immediately following use.
The box-lock portion of instruments must be kept
clean and free of debris. A buildup of substance in this
area will cause instruments to become stiff and eventually
break. Manual cleaning should remove all visible residue,
and it is essential to keep the box-locks open during any
automated cleaning procedure.
When cleaning, sterilizing and rinsing instru-
ments, it is important to use solutions with a pH as near
7.0 (neutral) as possible. Distilled water is recommended
rather than tap water because it is free of many compounds
which exist in ordinary water. These substances alone
cause stains and when tap water is combined with some
detergents it will form insoluble deposits on the instru-
ments.
During Manual cleaning, avoid the use of steel
wool, wire brushes and highly abrasive detergent cleaners.
These will damage the instrument's protective surface and
lead to corrosion. Manual cleaning will be most effective
with a solution of distilled lukewarm water and a neutral
pH detergent. This should be followed by a two stage
rinse of distilled water, first warm then cool.
The use of an ultrasonic cleaner is highly rec-
ommended. Avoid overloading the tank and always use
a detergent created for the use with these machines in the
suggested proportions. Thorough rinsing must follow
ultrasonic cleaning in order to remove suspended particles.
Never autoclave dissimilar metals together, i.e.., titanium,
silver etc.
Follow manufacturers specifications when using
automatic washer-sterilizers. Use a freerinsing , low-
sudsing detergent with a neutral pH (7.0), and do not alter
prescribed cycle times. A high-sudsing detergent may
clean effectively but often leave residual deposits on the
instruments. Again, do not autoclave dissimilar metals
together.
Before instruments are wrapped for storage they
must be thoroughly dry. Remaining moisture, particularly
in box-locks may result in corrosion that will weaken the
instrument and lead to breakage during use. The most
effective method of drying instruments are in a dry heat
oven, a sonic energy oven, or a hot plate.
The use of water-soluble instrument lubricant is
recommended. This will help keep a clean box lock mov-
ing freely and will aid in protecting the entire surface from
mineral deposits. Note that ultrasonic cleaners remove
all lubricants which will result in stiff box locks; hence
this maintenance procedure should routinely be done after
ultrasonic cleaning and before autoclaving.
An effort should be made to protect sharp cutting
edges and fine working tips during all maintenance pro-
7
cedures. Such as tip covers by Medi Spec. Avoid loading
retractors and other heavy items on top of delicate and
hollow instruments.
Inspection is a vital part of proper care and main-
tenance. Instruments in need of repair will not perform
accurately in surgery and breakage is likely to occur.
Worn ratchets, loose box locks and misaligned tips can
be repaired at a fraction of the cost of new instruments.
Contact Sontec Instruments for information regarding a
cost effective instrument repair program.
Spots and Stains
It is common for instruments to become stained
or spotted despite the best effort of the manufacturers and
the hospital staff. In nearly all cases these problems are the
result of minerals being deposited upon the surface of the
instruments. Adhering to proper technique during cleaning
and sterilizing procedures will prevent most staining oc-
currences. However, they will not disappear on their own.
The following section identifies the various instrument
related problems hospitals may encounter.
Brown Stains
Detergents containing polyphosphates may dis-
solve copper elements in the sterilizer. This results in
copper being deposited on the instruments by an electro-
lytic reaction. The hospital may try a different detergent
or check the quantities used. Usually a dull blue or brown
stain is simply a buildup of oxidation on the surface. This
film is harmless and will actually protect the instrument
from serious corrosion.
Blue Stains
Are usually the result of cold sterilization tech-
niques. It is important to prepare the solution according
to exact proportions and to change the solution when
recommended. Serious corrosion may occur if the solu-
tion is used past the manufacturer's time limit. The use of
distilled water and rust inhibitor in the solution will help
retard discoloration.
Black Stains
May be the result of contact with ammonia.
Many cleaning compounds contain ammonia and it will
remain on the instruments unless they are well rinsed.
A black stain may also be the result of amine deposits
traced to the steam in the autoclaves. Solutions contain-
ing amines are often used to clean the steam lines. It is
necessary to follow steam line cleaning procedures with a
cycle of distilled water to remove all traces of amines from
the autoclave system.
Light or Dark Spots
8 Are the results of slow evaporation of water
condensed on the instruments. What often remains is a
mineral deposit which is related to the mineral content of
the water. Using distilled water for sterilizing procedures
will help to eliminate the formation of these residual
spots. It is also important to follow manufacturer's specific
autoclave operating instructions. Spots may result, for ex-
ample if the autoclave doors are opened before the steam
is completely vented. An additional cause of spotting can
be traced to the instrument wraps. During laundering pro-
cedures it is vital that detergents are thoroughly rinsed out
and that the final rinse is prepared so that the wraps are left
with a pH between 6.8 and 7.0 This will inhibit spotting
during steam sterilization.
Rust Deposits
It is very unlikely for surgical grade steel to rust.
What appears to be rust is usually residual organic matter
in box locks or mineral deposits which have been baked
onto the surface of the instrument. Localities where the
water has a high iron content, for example, an iron deposit
will result in a metallic film on the instrument. This is not
the fault of the instrument and can be prevented with the
use of distilled or demineralized water during cleaning
procedures.
Important Information
The use of neutral pH detergents is vital to the
maintenance of surgical instruments. Contact with acidic
or alkaline solutions will remove the instruments protec-
tive barrier of chromium oxide, often leading to corrosion,
pitting or breakage. There is no guarantee if the instru-
ments are continually exposed to acidic solutions pH4 and
lower or alkaline solutions pH10 and higher.
Conclusion
The most effective method of dealing with
instrument problems is to prevent them from occurring.
The use of distilled water, careful preliminary cleaning,
using neutralized pH solutions, following manufactur-
ers instructions, visual inspection, will all help to keep
instruments performing accurately and cosmetically free
of troublesome stains. It is important to act quickly should
a problem arise. Delay will compound the problem and
irreparable harm may result.
PREPARATION FOR DISINFECTION
AND CLEANING
Disinfection of soiled instruments not only helps
to preserve the instruments themselves, but also serves
to protect those persons responsible for their transporta-
tion and cleaning. Wherever possible, instruments should
be disinfected and cleaned immediately after use. Any
soiling left to dry will make eventual cleaning much more
difficult and could result in damage to the instruments. If
necessary, instruments should be taken apart, allowing the
disinfectant to cover all surfaces.
For disinfection of the instruments either humid
heat or chemical disinfection can be used. Humid heat is
preferable providing the instruments are suitable for treat-
ment in this manner.
Occasionally, corrosive caustic agents and
medicines (e.g. silver nitrate, iodine preparations, albotyl
and mercury components) are used in operations and for
medical treatment. Remnants of these substances have to
be removed immediately.
Under no circumstances must instruments be
stored in physiological saline solutions as prolonged con-
tact causes pitting and rust.
Undue "dropping" can cause damage to the
instrument, hard metal tips on scissors may be chipped or
small, delicate clamps can be deformed. In order to avoid
this, carefully handle and deposit instruments after use.
To avoid encrustation and corrosion, in case of
removal in dry conditions and return to CSSD, the instru-
ments must immediately be subject to machine treatment.
For this treatment, deposit the instruments on suitable
trays, e.g. perforated sterilizing trays. For effective clean-
ing, hinged instruments have to be opened (such as scis-
sors, clamps, gouge forceps).
Instruments which are subject to machine treat-
ment have to be immersed into a combined disaffecting
and cleaning agent.
For removal in wet conditions and return to
CSSD use only noncorrosive agents in prescribed concen-
trations. Water alone is not sufficient. The instruments
have to be fully covered by the solutions.
Instruments should never be left overnight
before cleaning as the risk of causing permanent damage
increases with the length of time between use and prepa-
ration.
Handles and cables for HF-surgery have to be
prepared like surgical instruments.
Microsurgical instruments require special prepa-
ration and for this reason have to be deposited on racks
or suitable holding devises. Dental materials, such as
filling materials, adhering to dental instrument have to be
removed directly after use. Otherwise there is the risk of
hardening and/or corrosion.
Rotating dental instruments such as burrs, drills,
and grinding tools, have to be separated and stored in spe-

cial containers or holding devices; such instruments have
to be prepared separately.
If possible, surgical motors have to be dismantled
in to their components immediately after use; follow the
instructions of the manufacturer. Surfaces of the various
parts have to be wiped with a lint free cloth, impregnated
with a disinfecting and cleaning agent, or sprayed with a
disinfection spray in order to avoid blockage and encrus-
tation.
Simple tools can be prepared like surgical instru-
ments.
Tubing sets for cooling liquid and spray nozzles
have to be rinsed immediately with water from the rinsing
bottle and checked for leakage (visual control, see chapter
"inspection").
Prior to preparation, rigid endoscopes have to be
dismantled according to the manufacturer's instructions.
Optical equipment has to be placed in special containers.
In case of flexible endoscopes , the insertion part
has to be wiped with a lint free cloth immediately after
use. The cloth should be soaked in instrument disinfectant
which should contain either a suitable detergent compo-
nent or a cleaning intensifier suitable for disinfectants.
In order to avoid encrustations and blockage, the
extraction channel and any other additional channels have
to be rinsed with the same solution, The air/water channel
has to be rinsed with water from the rinsing bottle.
Prior to further processing, the leak test has to
be carried out according to the instructions of the man-
ufacturer. This allows for the detection of leaks and
perforations in good time and avoids expensive subsequent
damage caused by the penetration of fluids.
A damaged endoscope together with a fault
description has to be returned immediately to the manu-
facturer.
Cleaning and disinfecting of endoscopes should
preferably be done in automatic machines.
Dismantle elastic instruments and breathing sys-
tems according to the manufacturers instructions. Cones,
sealing surfaces, thread connections and valve plates have
to be carefully handled and protected against mechanical
damage.
Prior to preparations, completely remove breath-
ing line from the absorbers. Data readers have to be
prepared only according to the manufacturer's instructions.
Manual disinfecting and cleaning
For manual preparations, instruments have to be
immersed into a combined disinfecting and cleaning solu-
tion with proven disinfecting effect.
The instructions of the manufacturer have to be
strictly followed regarding concentration, temperature
and induction time. Special attention has to be paid to the
manufacturer's instructions with regard to material com-
patibility of instruments not made of high-grade steel.
Use fresh disinfecting and cleaning solutions ev-
9
ery day. The following problems may occur due to using
the same solutions for too long:
•Risk of corrosion due to soiling
•Risk of corrosion due to increasing
concentration caused by evaporation.
•Decrease if disinfecting effect due to
excessive dirt concentration.
Instruments with a narrow lumen (tubings, cannu-
lae) or with cavities are generally difficult to prepare. One
must, therefore, take care that the passages are free and
that the inside is completely in contact with the solutions.
If powdered products are used, completely dis-
solve the powder first. Only then should one immerse the
instruments since undissolved particles may lead to clog-
ging of the narrow lumen and discoloration of the instru-
ments.
After chemical disinfection and cleaning, the
instruments must always be rinsed well under running
water. Any residue has to be removed manually (no metal
brushes, no scouring agents). In order to avoid water
spots, a final rinsing with demineralized water is recom-
mended. Finally, the instruments have to be dried immedi-
ately.
Water on the surfaces of elastic instruments made
of rubber or plastic may cause white spots to appear which
can only be removed by drying.
If after manual cleaning , instruments are chemi-
cally disinfected instead of being sterilized, a separate
disinfectant has to be used.
The instruments then must be rinsed thoroughly
with sterile demineralized water.
If pneumatic air used for drying, make sure that
the air flows through a sterile filter.
Preference should be given to manual preparation
of microsurgical instruments as they are very sensitive to
mechanical damage. Even then, damage is possible, e.g.
when removing blood encrustations, the main causes for
damage are:
•Metal brushes
•Scouring agents
•Too much exertion
•Dropping or knocking
For cleaning, it is recommended to use either
lintfree soft cloths, plastic brushes or cleaning pistols.
Drying with a pneumatic-air pistol is particularly safe and
effective and should therefore be given preference over
any other drying method.
In general, dental instruments can be prepared
like surgical instruments. Instructions for preparation of
10
dental instruments, recommended for separate treatment,
are given as follows.
Hand pieces and angled hand pieces as well as
turbines must not be immersed. The outside is either
cleaned with a cloth or sprayed with disinfectant. Only the
methods specified by the manufacturers have to be applied
for internal cleaning and care.
As a result of the material used, rotating dental
instruments have to be placed in special disinfecting and
cleaning solutions. In order to avoid corrosion, the instru-
ments, after quick rinsing, have to be dried at once and
treated with corrosion protecting agent suitable for steril-
ization. In the case of ceramic-bonded or plastic-bonded
grinding tools, one must first check whether the disin-
fecting and cleaning agents are suitable agents for these
instruments. Unsuitable agents may destroy the bonding
materials.
Root canal instruments are sensitive to me-
chanical damage and, therefore , have to be prepared
separately. Root canal instruments with color-anodized
handles will loose their color codes when attacked by
alkaline solutions.
The various components of the surgical mo-
tor line have to be externally cleaned with lint-free cloth
impregnated with disinfecting and cleaning agents. Soft
brushes can also be used. When spraying the surfaces with
disinfection spray, wipe the parts afterward with a cloth.
Under no circumstances should these components be im-
mersed. Any penetrated liquid has to be removed immedi-
ately by turning the aperture upside down.
Simple tools can be prepared like surgical instru-
ments. Rigid endoscopes have cavities and channels which
are difficult to clean. Careful preparation of these instru-
ments requires:
•Removing the seals/washers
•Opening the stop cocks
•Dismantling according to the manufacturer's
instructions.
When immersing the endoscope into the cleaning
and disinfection solutions, make sure that all air bubbles
escape from the cavities by moving the instrument to and
fro or by holding it in a sloped position thus guaranteeing
complete wetting of the surface.
Do not use metal brushes or scouring agents, but
only swabs, cleaning guns and brushes with natural or
plastic bristles.
Use a wooden applicator with cotton wool soaked
in alcohol to gently rub off any dirt on windows or glass
surfaces, otherwise use a neutral detergent (hand washing
liquid).
Prior to preparation take off valve and caps from
flexible endoscopes, thus guaranteeing thorough clean-
ing and flushing of the channels. For cleaning, put the
endoscope in the container filled with instrument disin-
fecting and cleaning agent and make sure that the surface
is thoroughly wet.
Clean the channels with the brush belonging to
the system followed by flushing with the cleaning solution.
For this purpose some manufacturers offer a hand pump.
Take particular care when cleaning the distal end (optical
system, Albarran lever etc.).
Immediately after this pretreatment abundantly
rinse the instrument inside and outside with water. Then
place the flexible endoscope into the container with
instrument disinfecting solution so that all channels are
filled. The hand, 1.c. pump can now be used. Take care to
disinfect the extraction nozzle. Soaking time and solution
concentration have to be strictly observed according to the
instructions of the manufacturer.
After chemical disinfection, thoroughly rinse all
surfaces and channels leaving no residues. To avoid water
spots use demineralized water. Additional sterile filtration
of the water prevents undesired recontamination.
Dry the outside of the flexible endoscope with
a lint-free cloth. Drying the channels should be done ac-
cording to the manufacturer's instructions by using a hand
pump, light source and suction pump or by means of com-
pressed-air of max. 0.5 bar. Undesired recontamination is
prevented when sterile and filtrated compressed-air is used.
Elastic instruments with lockable cavities, such as
bellows and breathing masks, have to be cleaned and dis-
infected in closed conditions thus avoiding the penetration
of liquid into the cavities.
To avoid damage on diaphragms and functional
parts of the breathing system, no compressed air should be
used for cleaning. Machine preparation allows disinfec-
tion, cleaning, after rinsing and drying without having the
instrument handled.
Machine disinfection and cleaning
Machine preparation is usually done in the case of
a dry return to CSSD. When wet removal to CSSD is the
case, then either a low-foam producing disinfectant has to
be used or else the instruments have to be thoroughly pre-
washed as foam development in the machine can consid-
erably influence the cleaning results. This also applies for
instruments having to be pretreated either in a splashing
or by ultrasonic treatment because they are soiled. (e.g.
owing to dried-on blood and secreta or remnants of filling
material).
The temperature of the inflowing water should
o
not exceed 45 C as higher temperatures lead to protein
coagulation and cause cleaning problems.
Disinfection can either be performed chemother-
mally or thermally.
When using cleaning agents combined disin-
fecting and cleaning agents on it is recommended to
strictly follow the instructions of the manufacturer regard-

ing induction time, concentration and temperature.
Using the correct dosage rate does not only
guarantee a perfect disinfection and cleaning result but
also the most careful treatment of the material. If alkaline
detergents are underdosed (false economy) there is a risk
of pitting, which can be avoided at pH-values over 10.5.
When acid detergents are used, corrosion may occur due to
the chlorides in the water. This can be prevented by using
demineralized water. With machine cleaning, special at-
tention has to be paid to the following:
•Hinged instruments have to be opened, thus
guaranteeing thorough cleaning in the joint.
•Do not overload the perforated trays so that all
instruments can be well rinsed.
•A thorough internal flow has to be guaranteed
with instruments having long, narrow cavities
(tubing, cannula, breathing systems). Use
special inserts.
•Place instruments in such a way that they
cannot damage each other.
•Place large and bulky instruments properly on
the ray thus avoiding "shadows" on other
instruments
•Color-anodized aluminium instruments may
lose their color and thus their coding function if
normal machine preparation methods are used.
Remnants from the cleaning phase have to be
totally removed in the subsequent rinsing procedures as
otherwise spotting and/or discoloration may occur. Ad-
ditional use of suitable neutralizing agent improves the
rinsing results.
o
For final rinsing a temperature of 70-90 C has
proved to be best.
Should corrosion occur on surgical instruments
due to bad water quality, then the rinsing temperature
o
should be limited to 70-75 C. Corrosion, water spots and
discoloration will be avoided when using demineralized
water for final rinsing . No temperature limit must then be
observed.
When the machine operation is done without dry-
ing, then the goods have to be removed from the machine
immediately after the program has finished. If drying is
not sufficient, repeat it.
Machine preparation for microsurgical instru-
ments is possible if the instruments are held in place in
reliable and safe manner, e.g. racks.
Dental instruments can be treated like surgical
instruments for machine preparation. Pay special attention
to the following:
•Probes and other delicate instruments have to
placed in racks or holding devices to be pro-
tected against damage.
•Rotating instruments like burrs, drills, milling
11
cutters and grinding tools are suitable for
machine preparation only to a limited extent.
Preference should be given to an ultrasonic bath.
•Root canal instruments should also be cleaned
in an ultrasonic bath.
•Hand pieces can be prepared in a machine only
if recommended by the manufacturer; special
holding devices are, however, necessary.
Immediately after the end of the machine
program remove any moisture using a mainte-
nance spray recommended by the manufacturer.
•Mouth mirrors may be dull due to machine
treatment which will shorten their life
span.
With the exception of simple tools and acces-
sories, machine preparation for disinfecting and cleaning
is not possible for the components of the surgical motor
line.
Rigid endoscopes have to be dismantled for ma-
chine preparation according to the manufacturer's instruc-
tions. Seals/washers have to be removed and stop cocks
opened.
Machine preparation should only be done if
recommended by the manufacturer for this procedure (e.g.
optical equipment). In order to avoid damage, secure the
parts safely and make sure that the insides of all cavities
are thoroughly flushed.
Flexible endoscopes can only be processed in
special automatic machines. Standard disinfecting and
cleaning machines are not suitable. If endoscopes are
disinfected prior to machine preparation, only use a low-
foam product as foam which develops in the machine will
deteriorate the cleaning and disinfecting results.
Prior to further processing, the leak test has to be
carried out according to the manufacturer's instructions.
This allows for the detection of leaks and perforations in
good time and avoids expensive damage caused by the
penetration of fluids.
There are machines in which a leak test is incor-
porated either before or while the program is activated. A
leaking endoscope has to be returned to the manufacturer
together with a fault description.
Standard alkaline cleaning agents may cause
damage to the endoscopes, therefore, use only those
products recommended as suitable by the manufacturer.
Chemo-thermical processing should not exceed a tempera-
o
ture of 60 C.
During machine preparation, make sure the
endoscope is secured and that all external surfaces and the
inside of all channels are thoroughly and reliably flushed.
Final rinsing should be performed with sterile
demineralized water. If, for technical reasons, this is not
possible, at least water of drinking quality must be used.
Subsequent to final rinsing, machine drying should be pos-
sible. Prior to storage, thoroughly dry the endoscopes.
12
Elastic instruments with lockable cavities, such as
bellows, breathing masks etc. have to be cleaned and dis-
infected in closed conditions thus avoiding the penetration
of liquid into the cavities. To avoid overstretching of the
edge of the mask, remove the nipple prior to preparation,
press out some air and replace the nipple.
Elastic instruments, made of PVC for example,
with low temperature resistance have to be disinfected,
o
cleaned and dried at max. 65 C.
Care has to be taken with rubber instruments
because imperfectly removed residues of cleaning agents
lead to irreversible damage by subsequent drying and ster-
ilization. The surface of the material depolymerizes and
gets sticky. Latex-coating dissolves under blistering.
Especially serious are residue not completely
flushed out of functional parts of the breathing system.
Furthermore, all parts have to be completely dry as rem-
nants of moisture may lead to functional troubles.
Elastic instruments may not be dried above 95 C;
o After ultrasonic treatment, the instruments have
higher temperatures considerably shorten their life span.
Functional parts of breathing systems are
specially designed by the manufacturers of either units.
Preparation can, therefore, only be performed according to
the manufacturer's instructions.
Ultrasonic treatment
Ultrasonic treatment is particularly suitable for
cleaning instruments of high-grade steel. Delicate instru-
ments (microsurgical instruments, dental instruments) can
be carefully and thoroughly cleaned by ultrasonic treat-
ment.
Furthermore, ultrasonic treatment is a suitable
method to effectively remove encrustations.
In order to achieve optimum efficiency of the
ultrasonic treatment, please observe the following when
preparing a bath:
•Fill the bath to the markings.
•Add a suitable cleaning and/or disinfecting
agent to the water
•Temperature above 40oC promotes degassing
and cleaning.
•No protein coagulation occurs at higher
temperatures if suitable cleaning agent is used.
•When using disinfecting and cleaning agents
make sure that the concentration and tempera-
tures are correctly maintained.
Even with a properly prepared bath, faults can
arise. These can be avoided by observing some principle
rules:
•Instruments have to be completely covered by
the cleaning solution. Non-immersed instru-
ments will not be cleaned.
•Hinged instruments, e.g. scissors, have to be
opened
•Only trays which do not affect the ultrasonic
treatments should be used.
•Large and bulky instruments such as lead hands
or kidney trays must be placed in such a way
that there are no wave shadows or inactive
zones. Place such items either vertically or put
them on top of the other instruments.
•An excessively dirty solution in the ultrasonic
bath decreases the cleaning effect and increases
the risk of corrosion. Depending on the frequent
cies of use, the solution has to be renewed at
regular intervals.
•Ultrasonic treatment times of approx. 3 minutes
have proved to be efficient for cleaning at
frequencies of at least 35 KHz.
to be thoroughly rinsed either manually or by machine.
Rinsing has to be performed with clear water of at least
drinking quality or, better still, with demineralized water in
order to avoid water spots.
The instruments should then be thoroughly dried.
To avoid damage, microsurgical instruments have
to be deposited on special racks.
In order to avoid destruction of surfaces and
soldering seams on dental instruments, no acid cement
remover should be added to the ultrasonic bath.
Hand pieces and turbines are not suitable for
ultrasonic cleaning.
As a result of the material used, rotating dental
instruments have to be treated with special disinfecting
and cleaning agents. Prior to ultrasonic treatments place
them on special holding devices to avoid contact damage
between the instruments (e.g. by sharp cutting edges, dia-
mond grain). After a quick rinsing under running water
followed by immediate drying, rotating dental instruments
have to be treated with a corrosion protecting agent suit-
able for sterilization.
Mouth mirrors can be damaged by ultrasonic
treatment.
Under no circumstances use ultrasonic treatments
for components of the surgical motor line, with the excep-
tion of simple tools and accessories.
Ultrasonic treatment is only allowed for those
parts of rigid endoscopes which are suitable for this proce-
dure according to the manufacturers's instructions (e.g. no
optical systems).
Flexible endoscopes are not to be treated in an ul-
trasonic bath. Accessories, such as valves, caps, bite rings,
and forceps are suitable for ultrasonic treatment.
Elastic instruments are not suitable for ultrasonic
treatment as ultrasonic waves have no effect on elastic
surfaces.
Functional parts of the breathing system can also
not be prepared in an ultrasonic bath.

Care and maintenance
Instruments with joints or ratchets have to be
treated with suitable lubricating agents during the clean-
ing process.
These lubricating agents prevent the friction of
metal on metal and preserve smooth function of the instru-
ments, thus avoiding corrosion by friction. Furthermore,
constant use of such agents prevents "sticking" of the
hinged parts.
The care agents can either be applied manually or
during the final rinsing in the machine.
In any case it is indispensable that threads, joints
etc. difficult to access are directly treated with each prepa-
ration.
Dental instruments have to be cared for like
surgical instruments with the exception of the following:
•Hand pieces, angular hand pieces as well as
turbines have a very complex internal design.
Therefore, they have to be treated with special
agents in accordance with the instructions of the
manufacturer.
•Immediately after drying, treat all rotating
dental instruments (drills, burrs) with a
corrosion protection agent, suitable for steriliza-
tion in hot air or steam.
Motor lines have to be lubricated and maintained
with agents recommended by the manufacturer. Hand
pieces which are not watertight have to be sprayed with
special care agents for inside cleaning and lubrication.
Apply a few drops of special oil into the supply
channel of pneumatic surgical motor. To distribute the oil
inside , run the motor for a few seconds with compressed-
air. Proper lubrication and maintenance of the motor
line is of great importance, therefore, the manufacturers
instructions must be followed.
Rigid endoscopes must be lubricated.
However, joints and non maintenance-free stop-
cocks may have to be treated with special oil or special
grease according to the manufacturer's instructions.
The only necessary maintenance on flexible endo-
scopes is to treat the valves with silicon oil before inserting
them into the valve housing. Do not spray them with car
agents as the propellent gases will damage the instruments.
Only silicon oils and grease-free gels should be
used as lubricants. Agents containing vaseline or paraffin
cause swelling or softening of rubber parts.
Refrain from treating elastic instruments and
breathing systems with lubricants prior to sterilization.
Special care and maintenance measures are prescribed by
the manufacturer, should the need arise.
Elastic instruments of silicon rubber may not be
13
treated with silicon because of swelling which makes them
inoperable. Under no circumstances use paraffin agents
for rubber and latex instruments; this prevents them from
swelling up.
Inspection
After each cleaning, the instruments have to be
macroscopically clean, ie. free of visible protein remnants
and other contamination.
Prior to functional inspection, surgical instru-
ments with movable parts should be cooled down, thus
avoiding metal friction leading to corrosion. Before car-
rying out functional inspection, oil any instrument with
joints, ratchets or threads.
Instruments with non-traumatic toothing have to
be specially inspected, and, if necessary, manually reclean
the non-traumatic toothing.
Worn out or damaged instruments should be
removed for repair or replacement. Corroded instruments
should be discarded immediately as these can cause con-
tact corrosion even on a perfect surgical instrument.
Stains on surgical instruments are due to improper
preparations. Cause of such stains or spots can be:
•Insufficient mechanical or manual cleaning.
•Unsuitable cleaning, disinfecting and care
agents.
•Failure to observe the dosage instructions for
cleaning, disinfecting or care agents.
•Remnants of cleaning and disinfecting agents-
insufficient rinsing.
•Poor water quality.
•Residue in the sterilizing steam, when steam
quality is not accordance with recommenda-
tions.
•Remnants of medications, marking pens or
chemo-indicators.
•Procedural faults e.g. not cleaning brand-new
surgical instruments prior to sterilization.
These and other causes for spots on surgical
instruments show the complexity and difficulty of the
problems dealt with here. To facilitate tracing and finding
the cause for such stains, it is recommended to cooper-
ate with competent manufacturers. By making use of the
company's service, you will not only take advantage of
their practical experience but their well-equipped laborato-
ries as well.
To avoid permanent damage, instruments with
remnants on the surface have to undergo a special treat-
ment. The method of treatment is adapted to the cause of
the stain. In order to avoid damage and subsequent corro-
sion due to metal friction, under no circumstance use metal
brushes or metal sponges to remove stains. More details
about causes of stains and corrosion are given in chapter
14
12.
Each surgical instrument is designed for a specific
purpose. Inspection has to be carried out to ensure that
they function as they should. If any doubt, a reliable man-
ufacturer can advise you on suitable inspection methods.
Especially fine and delicate instruments are
inspected under the magnifying glass. In order to avoid
damage during transportation, place the instruments in
specially designed racks or use special holding devices to
prevent them from slipping.
Faultless surgical instruments should not be
packed together with instruments having damaged sur-
faces. Older instruments with chipped chromium and/or
nickel coating may cause discoloration or corrosion on
high-grade surgical instruments. It is, therefore, recom-
mended to discard such instruments or pack them sepa-
rately.
Handles, cables and cables for neutral electrodes
for HF-surgery have to be checked for faultless function.
(Caution: defective contact). It is compulsory to
sort out defective parts.
Prior to sterilization the surgical motor line with
accessories should undergo a functional inspection accord-
ing to the manufacturer's instructions.
Units operating with compressed air should be
checked for leaks and be given a functional inspection.
Any leakage will be audible or can be found by immersing
the hose into water.
For checking the exhaust channel additionally
connect the pneumatic surgical motor to the compressed-
air hose. With the motor running, leaks can be best
detected in the water.
Simple tools are inspected as general surgical in-
struments. In order to avoid damage during transportation,
store the tools in special racks or place them in suitable
holding devices to prevent them from slipping.
The leak test for tubing sets for cooling liquid
can be carried out by means of a clamp and a large syringe
filled with water. Fill the tubing with water; close one end
with the clamp, and insert and empty the filled syringe in
to the other end.
In case rigid endoscopes are used, check the ad-
ditional instruments for HF-surgery for absolutely perfect
installation. Exchange damaged parts.
Surfaces of electrodes/loops must be free from
encrustations which can be removed with fine abrasive
powder. Take care that neither insulation nor clips get
damaged or deformed.
To avoid damage to optical systems, clean them
carefully with a swab, moistened with alcohol. If this does
not remove the clouding return the part to the manu-
facturer for inspection. Damage can be avoided by using
wooden or plastic applicators, metal is not suitable.
Optical wave guides and fibre-optic cables have to be
checked for optical fibre breaks. To find this out, take one
end of the fibre optic cable, hold it against the light and
then look into the other end. Little black spots indicate
breaks in the fibres. A large number of breaks reduces the
light output. Such fibre optics as well as endoscopes with
surface damage and surface deformation should be sent for
repair.
Normally, clouding of the optical system on flex-
ible endoscopes can be removed by using a wooden appli-
cator (not metal) soaked in alcohol. If this does not help,
return this instrument to the manufacturer for inspection.
Optical fibre breaks in the optical wave guide can
be seen by holding the proximal end against the light and
looking into the distal end. Quite a number of breaks con-
siderably reduce the light output. Such damaged instru-
ments have to be returned to the manufacturer.
Endoscopes with visible external damage (e.g.
deformation in the insertion part or on the supply tube,
overstretched angled rubber) have to be returned to the
manufacturer.
Flexible endoscopes are best dried while sus-
pended and should be stored unfolded. Locks and feed-
reels should be loosened. The transportation case should
be used for storage.
Prior to every use, check all functions of the
endoscope. Use only silicon oils or greaseless gels as
lubricants. Under no circumstances should vaseline or
lubricants containing paraffin be used as these cause soft-
ening or swelling.
Breathing systems have to be inspected according
to the manufacturer's instructions.
Elastic instruments have to be inspected ac-
cording to their function and range of use. The most
important inspections are:
•Bellows have to be undamaged and airtight
•Filling system of the bellows must not show any
leakage.
•Lumina of catheters and probes have to be free.
•Connections have to meet functional safety.
•There should be no changes of design, e.g.
radius of curvature of tracheal tubes.
Elastic instruments with faults or damage have to
be replaced. Frequent problems are
•Dissolvation (blister forming)
•Cracked surface
•Sticky surface
•Hardenings
•Porous surface
•Discoloration

To prevent premature failure, take care that elastic
instruments are stored in a dry place without being kinked
or overstretched.
Sterilization
General
Sterilization conditions as well as units have to be
in conformity with valid quality standards.
Follow the sterilization instructions of the
manufacturer. Sterilizing accessories as well as sterilizing
packings have to meet the requirements of the both the
instruments as well as the sterilizing method used.
Autoclaving
Normally, autoclaving is performed with satu-
o
rated water steam at 134 C. In special cases a temperature
o
of 121 C can be used for a longer time.
Sterilization procedure has to be standard suitably
for the goods to be sterilized. Sterilizing packings have
to meet the valid standards with regard to quality and ap-
plicable to the procedures selected.
Steam used for sterilization has to be free from
any contamination and should neither impede the process
nor do damage to the sterilizer of the goods to be ster-
ilized. In order to guarantee this, meet the recommend-
ations of pr EN 285 regarding the quality of the water in
the tanks as well as the condensate, otherwise rust particles
from the conducting system may cause corrosion or a
high content of silicic acid may lead to discoloration of the
instruments.
Due to heating and cooling down during the
sterilization process, a surgical instrument with a closed
ratchet may suffer from tension stress which causes stress
cracking in joints or deterioration of the clamping force.
Therefore, such instruments have to be sterilized either in
open condition or closed on the first ratchet only.
The loading weight of perforated trays filled with
instruments should not exceed 10kg.
After sterilization, instruments have to be stored
dry until used again. Instruments as well as the inner
covering of sterilized goods have to be absolutely dry after
having cooled down to room temperature.
Excessive condensate production during ster-
ilization is avoided by observation of the recommended
maximum weight for loaded perforated trays. Drying is
facilitated by wrapping the perforated trays into a cloth
within the container or external paper packing.
If heavy sets are unavoidable, the instruments
should be distributed among several perforated trays. In
addition, special measures may be necessary for drying.
In general, dental instruments can be autoclaved
like surgical instruments. When separate treatment for
dental instruments is necessary, obey to the following
instructions.
15
•Rotating dental instruments (e.g. burrs or
milling cutters) can be autoclaved.
•Hand pieces should, wherever possible, be
o
autoclaved at 134 C, due to the shorter
induction time.
•Check whether turbines are suitable for auto
claving with the manufacturer.
•For mouth mirrors, refer to manufacturer's
instructions.
All components of the surgical motor line, meant
o
for sterile application, can be autoclaved at 134 C. Refer
to the manufacturer's instructions. Special instructions of
the manufacturer have to be observed for storage during
sterilization.
Hoses for compressed-air have to be protected
against pressing during sterilization.
Apart from the optical system with rigid endo-
scopes, all endoscope parts (insert, trocar, trocar sheath,
shaft, mandrel) have to be separated from each other and
can then be sterilized like other surgical instruments.
Sterilizing instructions from the manufacturer have to be
observed for optical systems. Optical systems suitable
o
for autoclaving should be processed at 134 C instead of at
o
121 C due to the shorter thermal stressing.
Flexible endoscopes are not autoclavable due
to restricted temperature compatibility. If necessary, use
gas sterilization. Instruments used for endoscopy, such as
clamps, catheters etc. may be autoclaved.
Elastic instruments with and without bellows
made of silicon and natural latex are suitable for auto-
claving. Due to the shorter thermal stress, preference is
o
given to a processing at 134 C. Items of thermo-materials
(plastic) may only be autoclaved if recommended by the
manufacturer.
When elastic instruments are autoclaved, take
care that the cavities, e.g. edge of mask, bellows are open
in order to avoid damage due to changes in pressure.
Prior to sterilization, cavities closed with valve
(e.g. bellow catheters) have to be sucked free of air and
water by means of a syringe.
Functional parts of breathing systems can be
o
autoclaved at max. 134 C. Cavities must not be closed in
order to avoid damage to the valves.
Hot-Air Sterilization
When surgical instruments are hot-air steril-
ized, please take care to load and operate the sterilizers
properly. To ensure safe sterilization, the temperature
o o
should not be below 180 C but should not exceed 200 C as
this may cause structural changes leading to irreversable
damage, especially as far as microsurgical instrument are
concerned. Instruments with parts of rubber, plastic, or
textile as well as plastic-coated instruments and handles
16
for electrodes are not suitable for hot-air sterilization.
The general use of lubricating agents should be
omitted prior to hot air sterilization. Only oil the joints and
ratchets of surgical instruments.
Dental instruments can generally be sterilized like
surgical instruments. When separate treatments for dental
instruments is necessary, obey to the following instructions:
•Temperature should not exceed 180oC when
sterilizing hand pieces.
•Turbines are not suitable for hot-air sterilization.
•Burrs and milling cutters must not be sterilized
o open to air. Temperature fluctuations may otherwise lead
at a temperature exceeding 180 C in order to
avoid softening.
•The sterilizing of mouth mirrors has to be
carried out in accordance with the manufacturers
instructions.
Components of the motor line are only partly suit-
able for hot-air sterilization, due to the various materials
used.
Rigid endoscopes are not suitable for hot-air ster-
ilization.
Flexible endoscopes are not suitable for hot-air
sterilization.
Elastic instruments are not suitable for hot-air
sterilization. Breathing systems are not suitable for hot-air
sterilization.
Gas Sterilization
Gas sterilization should only be used when no
other method is suitable.
Components of motor line should only be gas ster-
ilized when explicitly recommended by the manufacturer.
Optical systems of rigid endoscopes may be gas
sterilized, however, follow the instructions of the manu-
facturer.
Flexible endoscopes can be gas sterilized at a tem-
o
perature limit of 60 C. Use higher temperatures only when
indicated by the manufacturer.
For gas sterilization, the flexible endoscope is
packed in a transparent sterilizing hose allowing a curva-
ture diameter of at least 30cm. It is very important to make
sure that the venting cap is adapted to the supply connector
as otherwise irreversible damage will occur.
To ensure protection against mechanical dam-
age, the sealed flexible endoscope is put into a wire basket
belonging to the gas sterilizer. Again, pay attention that the
curvature diameter is not less than 30cm.
Goods sterilized with ethylene oxide require suf-
ficient airing times before being used again. Depending on
the goods sterilized and on available airing conditions, such
airing times can differ considerably. Reliable airing times
can be given only by the manufacturer of endoscopes.
After airing, flexible endoscopes should be stored in an
extended position.
Elastic instruments of thermolabile plastic are not
autoclavable but can be gas sterilized if the manufacturer
gives instructions about a suitable procedure.
Elastic instruments of rubber and functional parts
of breathing systems do not have to be gas sterilized; use
autoclaving.
Treatment of brand new instruments
Packings of brand-new instruments have to be
removed and instruments have to be stored in dry rooms,
to condensation within the plastic packing and thus cor-
rosion.
Under no circumstances store instruments in
cupboards or rooms where chemicals are kept which can
produce corrosion vapors.
Prior to first use, brand-new instruments have to
be prepared. First remove any protective caps or foils.
Cleaning, rinsing, lubrication, inspection and sterilization
have to be carried out according to the procedures previ-
ously described.
Prior to the first preparation, microsurgical instru-
ments have to be placed in racks or holding devices to
avoid damage.
Elastic instruments have to be kept in their
original packing and stored in a dry, cool and dark place.
When ordering supply, please keep in mind that in addition
to wear through use, elastic instruments are prone to aging
even when in storage.
Functional parts of the breathing system fre-
quently contains valves or membranes which can get
sticky when stored for a longer period. Such valves or
membranes have to be tested and operated before being
put to use.
Special information
•By following these instructions properly, there
is no difference in the preparation of instru-
ments with a mirror finish or matte surface.
•These instructions do not refer to disposable
items
•Instruments and cables with optical waveguides
can generally be prepared like surgical
instruments, if the manufacturers have not given
other instructions. Only hot-air sterilization and
ultrasonic baths cannot be used.
•Fibre-optic cables should not be bent, nor coiled
too tightly.
•Cables and handles for HF-surgery can be

machine prepared and are autoclavable.
For all other preparation processes, refer to the
instructions of the manufacturer.
Water for preparation
Instruments must have certain characteristics
in order to fulfill their function (e.g. cutting ability of
scissors, clamping force of clamps and forceps). Only a
very limited number of steels meet these requirements.
Unfavorable water composition can, therefore, have a
detrimental effect on such steels. Consequently, the qual-
ity of water must be taken into account when planning the
sanitary installations.
Ordinary water contains dissolved salts. The
amount of salts contained varies depending on the water
purification process. Evaporation of water leaves remnants
of salty encrustations (lime). Of all water components,
chlorides have to be regarded as the most potentially dam-
aging because in higher concentrations they cause pitting
on instruments.
The relationship between chloride content in the
water and pitting are not predictable in some cases.
In general, the danger of chloride induced pitting
rises with:
•Increasing chloride content
•Increasing temperature
•Decreasing pH-value
•Longer induction time
•Rougher instrument surface
•Insufficient drying
Experience shows that with a chloride content up
to approx. 129mg/1 (corresponding to 200mg/1 NaC1=
sodium chloride) the possibility of pitting is low but rises
rapidly with increasing chloride content.
Low concentration of other components can cause
brown, blue, grey-black, or rainbow colored discoloration.
Such discoloration can be caused by contact with the ele-
ments iron, copper, manganese, magnesium and silicon in
the water. Generally, there is no corrosion. By immersing
or rubbing the instruments with suitable products contain-
ing acid (follow the instructions of the manufacturer) such
decolorization can be removed to a great extent. In addi-
tion to the natural water components, sometimes there are
rust particles in the water. Almost always, such rust comes
from corroded piping systems. When preparing the instru-
ments, such rust particles deposit on the goods and cause
rust spots (extraneous rust) followed by corrosion.
Make it a basic rule to use demineralized water
for final rinsing.
Even when using an ion exchange for demin-
eralization, tarnishing can occur due to penetration of
17
silicic acid. The remedy is in-time regeneration of the
exchanger-consult an expert.
Materials
When producing surgical, microsurgical, and
dental instruments, the manufacturer will use the materials
most suitable for the purpose for which the instrument is
intended.
In most cases, the demands for high elastic and
toughness, good cutting ability and high wear resistance,
together with best possible corrosion resistance can only
be answered by using metal materials for surgical instru-
ments. Therefore, stainless and hardenable chromium
steels with a chromium content of approx. 13% are used.
Instrument characteristics, such as smooth and homo-
geneous surface, a matte or mirror finish, and a hardened
condition can be achieved with steels. The user has to
observe, however, that these instrument steels, listed in na-
tional (DIN) and international (ISO) standards, are gener-
ally resistant to chemical and thermal stress as occurring in
doctor's practices and hospitals, but are, on the other hand,
very sensitive to stress corrosion and chloride induced pit-
ting.
Apart from the hardenable stainless chromium
steels, non-hardenable chromium steels with modified
chromium content and rust and acid resistant chromium-
nickel steels are used. The use of the latter steels is limited
to certain instrument types due to restricted mechanical
properties.
For the manufacturer of rigid and flexible endo-
scopes of all kinds, chromium steels are hardly taken into
consideration. Due to the application technique and design
of the endoscopes, the greatest variety of materials is used.
Here are some of the most important ones:
•Rust and acid resistant chromium-nickel steels.
•Surface treated non-ferrous heavy metal alloy
e.g. brass, chromium-nickel plated.
•Light metals (e,g, anodized aluminium).
•Non-corrosion resistant steels, e.g. for lac-
quered modules and single parts.
•Glass for optical systems.
•Ceramic
•Cement and adhesives.
•Plastic and rubber.
The combination of these heterogenous materials
is, with regard to the preparation of the units, a weakness
in the chain of materials. It may, therefore, be possible
that the special processing, deviating from the ordinary
preparation processes, may become necessary. When in
doubt, ask the manufacturer should he not have given
already recommendations for use.
Elastic instruments and breathing systems also
18
demand a wide variety of materials, similar to those used
for endoscope, i.e. rubber, latex, and silicon.
The full scale of materiels dealt with in this bro-
chure is used for the motor line as far as design, structure
and manufacturing is concerned. Stainless, hardenable
chromium steels are used for burrs, drills, milling cutters,
saw blades and gearing parts as well as sterilizable plastic
materials for handles, switches, gearing parts or cable and
hoses.
Special preparation methods may be necessary for
enamelled housing of the unalloyed steel sheet, lacquered
color codes for identification of the gearing on hand pieces
or anodized housing of aluminium for hand pieces and an-
gular hand pieces. Heavily used flexible cables, bearings
and gearing parts of stainless, but also of non-stainless
heat-treatable steels as well as bronze materials require
special preparation and lubrication methods.
Should any questions or doubt arise, it is strongly
recommended to ask the advise of the manufacturers.
Due to chemical or thermical influences dur-
ing use, preparation or sterilization, all instruments and
units, dealt with in this brochure, can experience surface
changes, corrosion or aging.
Surface changes, corrosion and aging
Surface changes are visible appearances. Nor-
mally, this refers to all kinds of instruments and units,
independent of the material. In particular this refers to
removable residues such as adhering or already encrusted
remnants from operations or other soilings. Through
cleaning using special basic cleaning agents, such as sur-
face changes, can be completely removed without doing
any harm to the instruments.
Quite often, yellow-brown, to dark-brown blister-
like spots show on sterilized instruments and units made of
metal and are mistaken as rust. In most cases, such residue
can contain high degrees on chlorides which then lead to
chloride induced pitting on parts made of stainless steel
if the spots are not removed immediately. Such residues
are usually found on those places with difficult access for
cleaning.
Annealing colors, black tints or water spots ap-
pear mostly on metallic instruments and units and hardly
ever on rubber or plastic products.
In general, discolorations do not show clearly de-
fined edges. Flowing color shadings or deep and uniform
staining (black colorings) can appear. Discoloration does
not permanently damage or destroy the instrument or units.
Causes can either be the be the bad quality of water used
for cleaning or autoclaving as well as inadequate machine
cleaning and installations for steam supply. The only
remedy is to check the technical equipment in the house
installation, in cooperation with the manufacturer of clean-
ing, sterilization and steam supply plants and also together
with the manufacturer disinfectants or cleaning agents.
Water Spots are similar in appearance. However
normally they show sharply defined edges and are caused
by too high a concentration of minerals e.g. lime or or-
ganic substance in rinsing water or sterilization steam.
The remedy is to use demineralized water for
final rinsing and pure steam.
Overloaded sterilizing plants may cause increased
condensation and consequently increase stains during
sterilization, therefore, avoid overloading.
The term corrosion refers to metallic material
only. Corrosion is specific to materials and occurs on vari-
ous metals in different appearances. Almost always the
corrosion leads to permanent damage or even destruction
of instruments and units.
Any kind of corrosion on surgical instruments
and units can only occur due to inductions of water, aque-
ous solutions or steam. Following is a description of the
most important kinds of corrosion and their effects, in the
sequence of their frequency of appearance.
Pitting corrosion refers only to metallic materials.
Unfortunately, pitting can also appear on stainless steels
of which not only most surgical instruments are made, but
also endoscopes, (although fewer in number), surgical mo-
tor line and parts of breathing systems. With all types of
steel, pitting is mainly caused by active chlorides (chloride
induced pitting). Other halide ions (iodides, bromides)
have the same effect. Nonferrous metals such as copper
and aluminium alloys can also be damaged by pitting,
however, other electrochemical causes may also be the rea-
son.
Pitting means that holes developed on the surface
of the instruments. These holes indicate rust and, with
continuous corrosion, get rapidly bigger and destroy the
instruments within a short time.
Pitting can only be avoided in instruments hav-
ing been in contact with chlorides or other halide ions are
cleaned immediately after use. Please note that operation
debris also contains chlorides which leads to pitting should
these remnants stay long enough on the instruments.
Attention also has to be paid to the quality of
water used for cleaning and disinfection, especially with
regard to its chloride content.
Stress Corrosion cracking normally occurs only
in steels used for surgical instruments; it can have consid-
erable effects on the life span of the instruments.
The cause of this type of corrosion can lie either
in the manufacturing process or in incorrect handling.
In order to avoid damage, it is absolutely neces-
sary that during the complete cleaning phase, all instru-
ments are kept in open condition.
In order to avoid damage in such as stress cracks
in the joints and a reduction of clamping force, when ster-
ilizing such instruments, only close the first ratchet. This
prevents stress forces from occurring while heating and
cooling during the sterilizing process.
Even tiny quantities of chloride in the water may
favor the forming of stress corrosion cracking.
Fretting and crevice corrosion have almost simi-

lar causes. Both types of corrosion occur in narrow joints
due to chemical or mechanical destruction of the natural
passive coating of the high quality steel. In addition,
due to the lack of sufficient lubrication, metallic abrasion
occurs in joint crevices and hinders smooth action of the
instrument. In both cases, and together with humidity, rust
blisters occur in the crevices.
Contact corrosion can occasionally be observed
when surgical instruments are machine cleaned. Metal-
lic contact of instruments and unfavorable cleaning and
rinsing conditions, e.g. tap water containing chlorides, can
cause rust.
Particularly severe contact corrosion occurs if
stainless steel instruments get in contact with non-stain-
less goods, such as needles, cutters, etc. Chromium-plated
instruments with chipped surfaces also cause contact cor-
rosion.
With Surface corrosion the total surface of a
metal part is relatively uniformly attacked by chemical or
other electrochemical influences. The surface can show
parts which differ in color to undamaged surfaces. This
corrosion takes the form of rust where steels are con-
cerned.
Surface corrosion hardly ever occurs with instru-
ment made of stainless steel.
Instruments, trays and containers of anodized
aluminium ask for a preparation method suitable for the
material. Acid or alkaline solutions may cause laminar
corrosion which, especially on colored parts, causes,
"bleaching"
Instruments and units of stainless steel or non-
ferrous metal, protected by galvanically applied coatings,
show surface corrosion only with damaged protective coat-
ings.
Any kind of corrosion leads to rust on steels.
Rust particles are transferred from one instrument to
another during disinfection, cleaning or sterilizing, so this
transferred rust causes resultant corrosion on the second
instrument. If corroding instruments are not separated,
further preparation processes promote rust formation on
other instruments.
Sterilizing steam from rusty steam supply pipes
may transport rust particles into the sterilizer. This extra-
neous rust deposits itself on the inside of the sterilizing
chamber, on the packings, on instrument surfaces. This
extraneous rust also leads to resultant corrosion on instru-
ments.
Aging mainly refers to rubber and latex materials
used for flexible instruments, such as parts of endoscopes
and breathing systems. Aging is a slow going antral pro-
cess occurring also during storing. The aging process is
accelerated by the induction of dry heat with temperatures
above 80oC, by stretching and overstretching when storing
as well as by the action of light (e.g. sunlight, UV beams).
Aging is visible on rubber by decolorization (brownish) or
brittleness (cracks on the surface). Plastic also ages: it gets
hard and becomes yellow. However, silicon cautchouc,
19
also called silicon elastomer, does not age.
Another result of aging on rubber, latex and
plastic is the so-called swelling which is caused by the
penetration of liquid or gases to the surfaces.
Swelling can be reversible and occurs only tem-
porarily by the induction of volatile solutions or propellent
gases of sprays. This also applies if rubber and certain
plastic get into contact with either gases such as halothane.
Irreversible swelling, however, occurs by contact with
nonvolatile oils (paraffin), vaseline and unsuitable disin-
fectants (e.g. phenol derivates). Silicon cautchouc reacts
reversibly on propellent gases of sprays and either gases;
irreversibly on silicon oils and solvents.
Typical signs of swelling are soft sticky surfaces
as well as damage to thin-walled instrument parts.
Brief Information
•Brand-new instruments have to be cleaned prior
to the first sterilization
•Instructions for use have to be strictly observed.
•Strictly adhere to dosage, induction, time and
temperature for disinfecting and cleaning.
•Used instruments have to be treated as soon as
possible.
•Use proper accessories for cleaning
•Do not overload washing machines and ultra
sound devises. Avoid rinsing shadows as well as
wave shadows.
•Never use metal brushes or metal sponges for
manual cleaning.
•Rinse thoroughly and carefully after cleaning.
If possible, use demineralized water.
•Dry sufficiently after rinsing.
•Worn corroded, deformed, porous or otherwise
damaged instruments have to be sorted out.
•Each preparation of instruments with joints
needs a treatment with a care agent based on
paraffin oil (this does not apply to flexible
endoscopes and accessories).
•Prior to sterilization, only close the first ratchet
on the instruments.
•Sterilization is no substitute for cleanliness.
20
CLEANING, STERILIZATION & MAINTENANCE
Rinsing
Immediately after surgery, rinse instruments un-
der warm (hot water. Rinse should remove all blood, body
fluids and tissue.
Cleaning
If not done immediately after rinsing, instruments
should be submerged in a solution of water and neutral PH
(7) detergent.
Ultrasonic cleaning
For micro and eye instruments, use manual clean-
ing (step C).
Instruments should be processed in the cleaner for the full
recommended cycle time (usually 5 to 10 min.).
Place instruments in a open position into the ul-
trasonic cleaner. Make sure that "sharps" (scissors, knives,
osteotomes, etc.) blades do not touch other instruments.
All instruments have to be fully submerged.
Do not place dissimilar metals (stainless, copper,
chrome plated, etc.) in the same cleaning cycle.
Change solutions frequently at least as often as
manufactures recommends.
Rinse instrument after ultrasonic cleaning with
water to remove ultrasonic cleaning solution.
Automatic Washer Sterilizers
Follow manufactures recommendations but make
sure instruments are lubricated after last rinse cycle and
before sterilization cycle.
Manual Cleaning
Most instrument manufacturers recommend
ultrasonic cleaning as the best and most effective way to
clean surgical instruments, particulary those with hinges,
locks and other moving parts. If ultrasonic cleaning is not
available, observe the following steps:
I. Use stiff plastic brushes (nylon, etc.).
Do not use steel wool or wire brushes except
specially recommended stainless steel wire brushes for in-
struments such as bone files, or on stained areas in knurled
handles.
II. Use only neutral PH (7) detergents because, if not
rinsed off properly , low PH detergents will cause break-
down of stainless protective surface and black staining.
High PH detergents will cause surface deposit
of brown stain, which will also interfere with smooth op-
eration of the instrument.
III. Brush delicate instruments carefully and, if pos-
sible, handle them totally separate from general instru-
ments.
IV. Make sure all instrument surfaces are visibly
clean and free from stains and tissue.
This is a good time to inspect each instrument for
proper function and condition.
Check and make sure that:
Scissors blades glide smoothly all the way
(they must not be loose in the closed position). Test scis-
sors by cutting into thin gauze. Three quarter of length of
blade should cut all the way to the scissors tip, and not
hang up.
Forceps (pickups) have properly aligned tips.
Hemostats and Needleholders do not show light
between the jaws, lock and unlock easily, joints are not to
loose. Check Needleholders for wear on jaw surfaces.
Suction tubes are cleaned inside.
Retractors function properly.
Osteotomes and knives have sharp undamaged
blades.
Test Biopsy Punches by cutting tissue paper.
Punches should produce a clean cutout, without hanging or
tearing.
V. After scrubbing, rinse instrument thoroughly un-
der running water. While rinsing open and close scissors,
hemostats, needleholders and other hinged instruments to
make sure that the hinge areas are rinsed out, as well as the
outside of the instruments.
After Cleaning
If instruments are to be stored, let them air dry
and store in a clean and dry environment.
Autoclaving
If instruments are to be reused or autoclaved:
A. Lubricate all instruments which have any "metal to
metal" action such as scissors, hemostats, needleholders,
self retaining retractors, etc.
Recommended surgical lubricants such as
instrument milk are best. Do not use WD-40 oil or other
industrial lubricants.
B. Put instruments up for autoclaving either individually 21
or in sets.

Individual instruments

Disposable paper or plastic pouches are ideal.

Make sure you use a wide enough pouch (4" or wider) for
instruments with ratchet lock such as needleholders and
hemostats so the instrument can be sterilized in an open
(unlocked) position.
Instrument Sets

Unlock all instruments and sterilize them, in an

open position. Place heavy instruments on bottom of set
(when two layers are required).
Never lock an instrument during autoclaving. It
will not be sterile as steam cannot reach the metal to metal
surfaces. The Instrument will develop cracks in hinge
areas because of heat expansion during autoclave cycle.

Do not overload autoclave chamber, as pockets

may form that do not permit steam penetration. Place
towel on bottom of pan to absorb excess moisture during
autoclaving. This will reduce the chances of getting "Wet
Paks". Make sure the towels used in sterilization of instru-
ments have no detergent residue and are neutral PH (7) if
immersed in water. This can be real problem as laundries
frequently use inexpensive but high PH (9-13) detergents
and do not properly rinse out or neutralize those detergents
in the final wash/rinse cycle. Also, sometimes bleaches
such as Clorox are added and are not neutralized.
CAUTION-At the end of the autoclave cycle-
before the drying cycle-unlock autoclave door and open it
3
no more than a crack (about /4"). Then run dry cycle for
the period recommended by the autoclave manufacturer.
If the autoclave door is open fully before the drying cycle,
cold room air will rush into the chamber, causing conden-
sation on the instruments. This will result in water stains
on instruments and also cause wet packs.
If you have any unusual staining on your instru-
ments during sterilization, contact your local instrument
representative.

Cold Sterilization

Most cold sterilization solutions render in-

struments sterile only after a 10 hour immersion. This
prolonged chemical action can be more detrimental to
surgical instruments then the usual 20 minute autoclave
cycle. if the instruments need to be "disinfected" only,
cold sterilization is okay as disinfection will take place in
only 10 minutes. But keep in mind the difference between:
STERILE -an absolute term (no living organism survives).
And DISINFECTED- basically clean.
Always use the proper sterilization/cleaning tech-
nique to render the instruments in the required condition
for use.
22
COMPREHENSIVE SURGICAL
INSTRUMENT CARE
Cleanliness, lubrication, correct handling and storage
procedures will insure an instrument's proper perfor-
mance. Additionally, inspection, troubleshooting, and a
professional instrument maintenance program can actually
lengthen the serviceable life of your surgical instrument.
To that end, the following instrument care habits are rec-
ommended.
Use of short cuts in instrument care can lead to
rust, corrosion, stains and spotting. Corrosion, the gradual
wearing away of material, will eventually impair the func-
tion of an instrument. The most common causes are linked
to:
•Inadequate cleaning and drying after use
•Corrosive chemicals or sterilizing solutions
•Use of ordinary tap water rather than distilled
or softened water in cleaning process
•Laundry detergent residue remaining in
operating room linens
•Harsh detergents
•Malfunctioning autoclave
Corrosion also will appear on knurled or grooved
surfaces. Glare-reducing satin finishes are more prone
to corrosion than mirror finishes. This type of corrosion
does not penetrate deeply and can easily be removed with
simple brush and detergent scrub. Should this procedure
fail, an instrument can be repolished.
Autoclaving causes oxidation of surgical instru-
ments while they are exposed to air, moisture and heat.
Water left in the box locks is another offender. Never auto-
clave dissimilar metals together, i.e., titanium, silver etc.
Light and dark-colored spots are caused by the
slow evaporation of condensation on instruments. Traced
to mineral
residue, such spots can be prevented by fol-
lowing the autoclave manufacturer's directions carefully
and using distilled or demineralized water for all cleaning
procedures and solution preparation.
Rust-colored film is particularly prevalent in new
hospitals due to foreign matter inside steam pipes during
installation. Unfortunately, nothing can be done, but the
situation is temporary.
Bluish-grey stains are indicative of cold steril-
izing solutions. Following manufacturer's directions
explicitly will remedy the situation. A brownish stain is a
chromic oxide film which forms on stainless steel when
dishwashing compounds are used by hospitals. Frequently
experimentation with another compound used successfully
within the community will minimize discoloration, Ad-
ditionally, such compounds should be measured accurately
and sterilizers filled with cold water. Purplish-black stains
indicate exposure to ammonia; thorough rinsing after use
and cleaning in the usual manner should eliminate this
stain.
Rust deposits present a unique problem that they
can not be rinsed off. Once an instrument surface has been
rusted or pitted, it is far more susceptible to further corro-
sion. Fortunately, passivation and repolishing can return
the instrument to a like-new condition. Prevention of such
rust deposits and pitting can be aided by not sterilizing
together metals of dissimilar composition. For example,
the sterilizer's electrolytic action can carry carbon particles
from imperfectly chrome-plated instruments and deposit
them on a stainless steel instruments causing a rusty ap-
pearance. Sterilize different metals separately, replace
chrome-plated instruments with stainless steel counter-
parts.
•Cleanliness:
All instruments should be thoroughly cleaned
immediately after use. Never allow blood in a box-lock
or debris to dry on the instruments. Baked on blood in
a box lock or crevice can result in corrosion and subse-
quent cracking under stress. Therefore, box locks should
be opened and instruments with removable parts should be
disassembled.
Cleaning solutions with a natural pH level (7.0
to 8.5) are recommended. An extremely alkaline detergent
(higher than 9.0) may stain and might cause breaks; an
extremely acid detergent (lower than 6.0) may cause an
instrument to pit.
Washing-sterilizer's are ideally suited for washing
and terminally sterilizing soiled instruments. However, it is
imperative that the sterilizer itself be cleaned and func-
tioning properly. Hospitals in the hardwater areas should
implement a water softening or demineralizing system.
Surgical wrappings must be free of any laundry detergent
residue.
Ultrasound provides a speedy and complete meth-
od for instrument cleaning. Although an ultrasonic cleaner
removes up to 90% of the soil, it does not preempt the
need for sterilization. Caution: Microsurgical instruments
must not come in contact with one another during ultra-
sonic cleaning. The units vibration may cause premature
wear of their precision tips. Never clean dissimilar metals
together i.e., titanium, silver etc.
•Lubrication:
It is recommended that instruments are lubricated
after every cleaning process to guard against mineral
deposits and other water system impurities which may lead
to stains, rust and corrosion. Also prior vigorous cleaning
removes all lubrication which may result in "frozen" box

locks. To impede the growth of bacteria in the lubricant
wash, only antimicrobial, water-soluble lubricants
recommended. Instrument milk baths produce
excellent results.
•Correct Handling:
Proper usage helps insure instruments will func-
tion well when they are needed. To avoid unnecessary
instrument abuse, we strongly urge that instruments be
used only for specifically designed purpose.
Needle Holders
Should never be used as pliers. This will lead to
improper alignment of the jaws. Always match the needle
holder to the size needle being used.
Scissors
Are particularly subject to abuse. Misuse can eas-
ily dull or chip the cutting edge and misalign the blades.
Eye scissors are extremely delicate and must be treated
accordingly.
Rinse & Sterilization
During rinse and sterilization, never allow delicate
instruments to be laid in a steel pan or on a tray or to be
bumped against one another. Always lay instruments on a
towel or specially designed rubber or foam tray.
After Use
Put protective tips over the ends of delicate instru-
ments. Available from Sontec.
Meticulous care during surgery will also prolong
the life of the surgical instruments. Although blood and
saline are the most common causes of corrosion and pitting,
instrument contact with the following solutions should be
avoided if possible:
•Aluminum chloride
•Mercury salts
•Barium chloride
•Phenol
•Carbolic acid
•Potassium Permanganate
23
•Chlorinated lime
•Dakin's solution
•Sodium hypochlorite
•Ferrous chloride
•Stannus chloride
•LYSOL
•Tartaric acid
•Mercury bichloride
Exposure to the following solutions is extremely detri-
mental:
•Aqua regia (a mix of nitric and
hydrochloric acids)
•Ferric chloride
•Diluted sulfuric acid
•Hydrochloric acid
•Iodine (not to exceed 1 hour)
Instrument counts guard both patients and instru-
ments and reduce the instruments` chance of an unneces-
sary trip to the laundry.
•Storage:
Well defined storage procedures reduce the
chance of bent, broken and dulled instruments.
Do not bounce, drop or weigh down instruments.
Treat them gently; handle them individually or in small
quantities. Masses of entangled instruments cause damage.
Do not force a large instrument into a small tray.
Place heavier instruments in the tray bottom with the
lighter instruments on the top.
Instruments should be arranged accordingly:
A. Place ring-handled instruments on a holder
to keep them in an open position.
B. Instruments with curved jaws should all point
in the same direction.
C. In order that the edges do not come in contact
with another instrument, scissors should be
kept separate on the rack.
D. Cupped instruments should be arranged so
that water does not collect in them.
E. Use specially designed racks for microsurgical
instruments.
•Inspection:
In addition to being completely clean and free-
moving to insure proper function and sterilization, instru-
ments must be inspected prior to packaging for reuse.
Hinged instruments should be inspected for align-
ment of jaws, meshing of teeth and stiff or cracked joints.
Rachets should close easily and firmly. To test rachets
clamp the instrument on the first tooth. Holding the instru-
24
ment at the box, tap the rachet end against a solid object.
Repair is required if the instrument springs open. Close
instrument to test its tension, when jaws touch, a space of
1 1
/16" to /8" should exist between rachet teeth of each shank.
Ring-handled instruments can be tested by hold-
ing one handle in each hand. Open instrument and try to
wiggle it. If the box lock is very loose, jaw misalignment
will occur.
Scissor blades should be inspected for burrs.
If a needle which is clamped in the jaws of a
needle holder locked on the second ratchet tooth can eas-
ily be turned by hand, the jaws need replacement and/or
aligning and should be sent for repair.
Elevated heat temperatures weaken stress points
and can actually change molecular structures of the metal.
This change weakens and dulls instruments resulting in
their continual diminished performance. Be on the lookout
for weakened stress points.
•Maintenance Program
After repeated use and sterilization, instruments
will show signs of wear. They will become misaligned,
stiff from metal fatigue, dulled and chipped. When they
will no longer function properly, they will either need
professional repair or replacement.
Because repairs can be costly, a specifically
scheduled preventive maintenance program based on usage
turn is the best alternative. Particular steps include:
•Inspection and evaluation
•Re-passivation
•Clean and lubricate
•Replacement of worn and
missing parts ( tungsten carbide inserts,
lost screws, cracked springs.)
•Restoration of finish ( grind out scratches and
gouges and repolish.)
•Sharpening
•Final adjustment to insure an instrument works
easily and is properly aligned.
Implementing the above program restores your instru-
ments to surgical grade quality before major repairs and/or
possible replacement becomes necessary. Although your
instrument repair cost may rise, your new instrument cost
will decline over the long run, an important factor to con-
sider in the present economy.
A preventive maintenance program not only is an
investment in lengthening the life of your surgical instru-
ments but also precludes unnecessary repairs and unwar-
ranted replacements.
MICRO-INSTRUMENT CLEANING
AND CARE GUIDE
Protect your investment. Microsurgical instru-
ments are fine, delicate and precise. They require correct
care in cleaning, drying, lubrication and storage. Even the
finest stainless steel really is highly corrosion-resistant,
and is still subject to water spotting, staining and eventual
rust. Take care of your micro and regular instruments and
devices with these facts in mind.
During and after Surgery
Deposit used instruments only on a cloth or, bet-
ter yet on a surface covered with gauze or disposable wrap
free of soap, detergent and hard mineral deposits. Do not
put "micros" together with heavier instruments.
•Neutral Disinfecting Solution Immersion: Such
temporary immersion should be done after use only if im-
mediate cleaning is not possible. Do not soak instruments
overnight, that is the worst thing you can do especially
with microsurgical instruments. Do not mix "micros" and
bigger instruments. When preparing cleaning or disinfect-
ing solutions strictly observe the manufacturer's instruc-
tions.
Cleaning
Micro-instruments should be cleaned gently and
absolutely thoroughly one at a time immediately after use,
preferably by hand with a soft cloth or a very soft brush, to
remove all blood, debris and most especially saline
solution. Do not use metal brushes or steel wool. Avoid
excessive pressure and instrument-to-instrument contact.
Never allow blood or debris to dry on instruments. Caked-
on or baked-on blood in a box lock or crevice can result
in corrosion and subsequent cracking under stress. When
cleaning, box locks, joints and catches should be opened
and removable parts disassembled.
Cleaning solutions with neutral pH level (7.0 to
8.5) are recommended. An extremely alkaline detergent
(9.0 or more) may cause staining. A very acid solution
(6.0 or lower) may result in pitting and stress corrosion.
Do not use scouring agents or abrasives. Calgon has two
popular products: "Manu-Klenz" for washing by hand and
"Instru-Klenz" for machines, as ultrasonic cleaners. There
are other good cleaners. Change cleaning solutions often to
keep suspended soil at a minimum.
Ultra sonic cleaners provide a speedy yet gentle
almost complete system for cleaning micro-instruments. A
small office unit may be appropriate for your needs. The
ultrasonic cleaner must be clean and functioning properly.

Hard water should be avoided by prior softening or demin-
eralizing. Side by side placement of the instrument is best,
not on top of one another. Treatment with ultrasonic waves
must be as short as possible. An ultrasonic cleaner removes
up to 90% of the soil, but further washing and sterilizing
is still required. Follow manufacturer's instructions as to
cleaning solution and procedure.
Washer-Sterilizers are not recommended for
micro-instruments. The agitation may damage delicate
instruments. Standard instruments can survive the turbu-
lence. Non-micro instruments can be cleaned well and be
semi or terminally sterilized in these units. The units must
be clean and functioning properly. Make sure the ejector is
not fouled, which may lead to the formation of detergent
scale. Hard water should be avoided by prior softening or
demineralizing. Autoclaves are better for terminal steril-
ization.
Rinsing
After cleaning of type, rinse the instruments thor-
oughly in distilled water to remove any residue. If distilled
water is not available, then rinse in cold or warm running
water.
Drying
Use a soft, absorbent non-fibrous cloth. Hot air is
acceptable. Many doctors use hair dryers in their offices.
Knurled or grooved surfaces and glare-reducing satin fin-
ishes (which are intentionally micro-pitted) are more prone
to corrosion then mirror finishes. However,
satin
finishes are a virtual necessity when operating in a highly-
lighted field under a microscope. Exercise especial care
that box locks, crevices, blades and knurled, grooved and
satin-finished instruments are dried thoroughly.
Lubrication
This step is most important after cleaning, rinsing
and thorough drying to avoid "frozen" box locks, stain-
ing and corrosion caused by mineral deposits and other
water system impurities. Remember that vigorous cleaning
removes prior lubrication, so it must be replaced. Only an-
timicrobial, water-soluble lubricants should be used. "In-
strument Milk" is widely used. Follow the manufacturer's
instructions carefully. Machine and mineral oils as well as
silicones become gum-like with age and therefore are to
be avoided. The gum formation may trap germ spores and
inhibit complete sterilization.
Assembly
After lubrication the instruments should be reas-
sembled and placed in their respective storage trays. Use
specially-designed microsurgical racks for you micro-in-
struments. Treat your instruments sensibly and with gentle
tender loving care. Handle them individually. Masses of
25
entangled instruments cause damage. Do not cram them
in to undersized tray compartments. Place heavier instru-
ments in the tray bottom with lighter ones on top. Ring-
handled instruments should be placed on a holder to keep
them in a open position. Curved jaws should all point in
the same direction, so they do not touch. Especially avoid
that scissor tips and edges come in contact with anything.
Keep scissors in a separate rack. Water should not be al-
lowed to collect in cupped instruments.
Sterilization
You can either sterilize terminally or semi-terminally,
sterilizing again just prior to the next surgical use of the
instrument and devices. Autoclaves, steam or gas, are used
for terminal
sterilization. Before placing your instru-
ment in the autoclave make absolutely certain that they are
clean of soil, blood, debris, soap, detergent, bleach, starch,
all of which can leave harmful deposits. It is most impor-
tant to follow the manufacturer's instructions for cleaning,
care and maintenance of all equipment. A dirty malfunc-
tioning autoclave can be the source of many problems. Do
not exceed recommended temperature, as this may cause
rapid deterioration of the instrument. Never autoclave dis-
similar metals together, i.e., titanium, silver etc.
Preheat instrument in the sterilizer chamber
before sterilization to avoid the problem of residue-laden
condensation forming on the cold instruments, which can
lead to subsequent staining. Also after sterilization, do not
open the autoclave too quickly so a blast of cold air causes
steam condensation and residue deposit on the instruments.
Wrapping can be done with either cloth or
disposal wraps. Cloth wraps must be free of any laundry
detergents, soap or hard water residue. Disposable wraps
are free of contaminants, and therefore may be preferable.
Unless thoroughly vacuum dried, wraps could retain mois-
ture which leads to stainless and rust. Therefore, it may be
best not use wraps.
Sealing
This can be done with either cloth or paper dust
covers. Cloth covers may provide protection up to 30 days.
Paper dust covers may protect up to six months. Rester-
ilization before surgical use is indicated for respective
longer storage.
Clogged Cannula
Use Enzyme tablets of the type used for contact
lenses to unclog deposit proteins and other impurities.
Cold Sterilization Solutions
26 Such as "Cydex" and "Zephrine" when fresh are
slightly corrosive. These solutions are not recommended
mainly because most professional offices do not use them
properly: First, instruments are left immersed far longer
than recommended by manufacturers, excessive hours
and even days, resulting in corrosion and dulling of sharp
edges on knives, scissors, hooks, etc. (a 20 to 30 min-
ute steam sterilization is much less corrosive.) Second,
the solutions are not changed as recommended, causing
undesirable suspensions, as blood, saline, proteins, medi-
cations, detergents, soap, debris, to circulate forward to
new instruments. Third, the instruments generally are not
rinsed with deionized (softened) distilled water after being
removed from these somewhat corrosive solutions. With
time and use these solutions become ever more corrosive.

Sontec Instruments
7248 South Tucson WayEnglewood, CO 80112
(303)790-9411(800)821-7496Fax(303)792-2606
A TRADITION OF FINE SURGICAL INSTRUMENTS