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Surgical Instrument Cleanliness and Sterility: How are you fighting dirty?

Kerrison rongeur with gross bioburden

Happy New Year from ORx Solutions!

From a sterile processing and surgery perspective, the end goal is to provide the patient with completely clean, safe, functioning, and sterile surgical instrumentation. In an ideal situation, one would be able to disassemble surgical instrumentation and thoroughly clean every nook and cranny of each respective part. Often times, however, surgical instruments are not modular by design, or not meant to be easily taken apart in the field. Many of these types of instrumentation require advanced training and/or tooling to properly disassemble.

From the instrument servicing and repair perspective, we all too often see what would be considered heart-stopping nightmares for those on the sterile processing and surgery front-lines. When we disassemble these "non-take-apart" instruments for repairs, we routinely find what lies beneath - and it isn't pretty!

Kerrison - peened screw

Attached is a picture of a kerrison rongeur that has peened screws. To disassemble the instrument, we often have to drill out both the handle and slide screws. Screws have to be replaced on re-assembly. See the picture for reference regarding peened screws. Note, we used kerrisons as an example, but the idea applies to any surgical instrument.

So what can you do to address these instrument types? There are different solutions to these issues. While not insurmountable, there are varying financial and operational ramifications associated with approaches. The following are some options:

  1. Have professional instrument servicing providers like ORx Solutions perform disassembly and thorough cleaning. As stated before, many times this requires advanced technique, tooling, and time.

  2. Move your inventory to modular instrument designs: take-apart or push-button, detachable style instrumentation. It goes without saying that this overhaul would be capital intensive.

With that said, there may be other options. The intent of this post is to have a discussion for those in and around surgery:

What are you seeing, and more importantly, what steps are you taking to fight dirty?

As a side note, we have to give credit where credit is due on part of the #WeFightDirty movement. We aren't sure where it started, but we have seen the SPD gurus Hank Balch and his team at Beyond Clean, as well as Shawn Flynn use the catchy but relevant phrase. Hopefully we credited appropriately. Please reach out if we need/should add others.

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