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Podiatry Instrument Sterilization

Bailey Instrument Ltd give this advice for re-processing reusable devices:

New instruments should be cleaned and sterilized prior to use. Contaminated instruments should be cleaned immediately after use. An ultra sonic cleaner is the recommended form of cleaning.
Autoclaving is the RECOMMENDED form of sterilizing. 134°C at 2 bar for 3 minutes.
Ensure distilled water is used in your sterilizer at all times. Do not use paper pouches in a non-vacuum autoclave. Cold liquid sterilization may cause staining on the instruments. If this is unavoidable use only a Medical Devices approved solution and adhere to the specified time. To avoid water spotting, do not allow instruments to lie wet or remain immersed in liquid for excessive periods. After decontamination check that your instrument is fit for purpose.
Preventative maintenance, i.e. Lubrication, will ensure your instruments last longer.

Taking Care of Your Instruments

When surgical instruments are used to treat a patient, there should not be any infecting microorganisms on them that can cause an infection and harm to the patient.
Prior to autoclaving, instruments should be placed in an ultrasonic instrument cleaner to clean debris from the instruments. They can then be placed into a sterilizer bag and then into the autoclave. All instruments should be autoclaved before using them to perform any surgical procedure including the debridement of nails. The sterilization process takes an hour, therefore a practitioner will usually have multiple sets of instruments on hand that can be used.
Do not allow your instruments to come into contact with aggressive substances such as acids and detergents. After drying instruments completely place them in a clean dry place. Do not store them in areas of high humidity or where they are subject to corrosive fumes. Protect tips with a special tube or gauze.
Only use instruments for the purpose for which they were designed. Any incorrect use of an instrument invalidates the warranty.
Distilled water is recommended for cleaning disinfecting sterilizing and rinsing instruments. Use a cleaning solution with a near neutral pH (7)

Ultrasound cleaning

This is the most effective method to clean instruments. First remove any residue before placing them in the ultrasound cleaner. The following is recommended:

• Do not mix instruments made of different metals in the same cleaning cycle.
• Open all instruments so that locks and latches are accessible.
• Avoid stacking instruments on top of each other during loading.
• Remove and rinse instruments immediately after the cycle has finished.
• Dry instruments thoroughly immediately after rinsing. Leave in open air to complete drying.
• Lubricate all movable parts
• After ultrasound cleaning inspect instruments for loosening of instrument parts e.g. screws.

Manual Cleaning

When cleaning instruments manually, carefully follow the instructions of the cleaning solution manufacturer while preparing the solution. Special attention should be paid to cleaning the locks, teeth, hinges and other parts that are difficult to access. DO NOT USE STEEL BRUSHES to clean instruments. Rather use nylon brushes. Rinse instruments thoroughly in warm water that have been in contact with blood, tissue saline or other matter before the substance dries. After rinsing dip the instruments in a cleaning and disinfecting solution. When foreign particles are allowed time to dry on the instrument they may become resistant to cleaning and even impossible to sterilize.

Inspection

Before each use check and test the instruments. Look for visible defects, cracks blunted blades etc.

Disinfectants and Cleaners

According to the Center for Disease Control hydrogen peroxide (H2O2) is not a high-level disinfectant and will not kill endospores and is therefore unsuitable for cold sterilisation of instruments. The CDC uses the guidelines (1996 ) set by APIC (The Association for Professionals in Infection Control and Epidemiology) and AJIC (The American Journal of Infection Controlrecent 1996 guidelines. OSHA will provide MSDS material data safety sheets on what safety level sterilization agents should be used and proper disposal. Gluteraldehyde is the only complete cold sterilization liquid agent capable of killing bacterial endospores. Immersion for 30 minutes if the instrument has been cleaned with wire brush is usually sufficient. Otherwise, 12 hours immersion is required and it has a killing cycle of 28 days without changing, unlike alcohol and H2O2. Gluteraldehyde should be changed once a month. Using H2O2 as a holding bath for later autoclaving, is not as important, but it should not be the primary cold sterilization agent. Peroxides are strong oxidizing agents, they work by chemical decomposition and release of oxygen, which are activated in animal tissues by peroxidase enzymes. Sterilizing instruments with peroxide could potentially cause etching or rust formation, especially in areas that may be nicked or scratched. This would probably void any manufacturers' warranties on these items. Although an autoclave is time consuming and will require that you stock up on many sets of nail nippers, curettes and scalpel handles and any other instruments you use on a regular basis, it is the only safe way to sterilize instruments.

Avoiding Spotting and Staining of Instruments

Spotting and Staining are serious problems in any healthcare facility. A hemostat may not open because of corrosion in the box joint area, scissors could become dull and instruments break during surgery as a result of corrosion. Spotting and staining interfere with sterilization and corrosion will result in a shortened instrument life.

Causes of Spotting

Water mineral deposits can be avoided by using de-ionized or softened water in the final rinse.
Chemical residues can be avoided by only using high quality cleaning chemicals that are hard water tolerant.
Steam residue is one of the major causes of spotting and can be avoided by making sure the steam and boiler water are monitored on a regular basis. Boiler chemicals can cross over into the steam system. Therefore make sure the boiler is maintained regularly and any filters are cleaned.
Poor soil removal after use can be avoided by using high quality chemical cleaners.

Causes of Staining

Stains are deposits on the surface of the instrument that have become so tightly attached that they have become a part of the surface itself. There are many causes for stains, but one of the most common causes is impure steam. This can be seen by the presence of a bluish appearance on the instrument. Keep the steam quality high and make sure there is not an excessive amount of neutralizing amines present in the steam.
Another cause is galvanic corrosion and occurs where metals that are not the same are simultaneously exposed to the same solution. Electrolysis from dissimilar metals touching in a solution (the steam in the autoclave acts as a conductive solution that allows electrolysis) transfers metal molucules from one instrument to the other, leaving pits and staining in one instrument. A sympton of this action is a gold colored tint on the instrument surface. This can be avoided by keeping instruments of different metals apart or use neutral pH cleaners.
For further information see: "Sterilization, disinfection and cleaning of medical equipment guidance on decontamination" ISBN 858391199 . Health Circular $-15C. 1999/1 79 Controls assurance in Infection Control

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