orm_june-2024 - 24

Common inspection points for surgical instrumentation
QUALITY IMPROVEMENT
nspecting surgical devices is a timeconsuming
process. However, diligently
checking every instrument
prior to sterilization is essential to ensuring
safe, proper functioning.
As the last people to see devices
I
before they are used for patient care,
sterile processing technicians must be
thorough. Exterior surfaces should be
inspected for flaws such as nicks, rust,
and staining. Surgical instruments with
crevices, serrations, lumens, and other
areas that can be difficult to see and
clean may require enhanced inspection,
whether with a handheld magnifier, a
tabletop/swivel-arm tool, or even computer-supported
magnification.
phate (ATP), protein, and hemoglobin.
Cleaning verification tests are commercially
available and are rapid, easy to
use, repeatable and free of interfering
substances. To assure accurate results
are obtained cleaning verification
processes including borescopes should
only be used following the IFU and after
training.
Whatever the tools employed, certification
courses, textbooks, and other
resources can provide education on the
latest inspection techniques. With so
many types of devices, some with multiple
inspection points, consulting IFU
also is essential. The following provides
a general overview of essential testing
points for most traditional, handheld
Borescopes-small, flexible, fiberoptic
devices available in many lengths
and widths-are particularly useful
for identifying flaws such as debris,
scratches, and foreign objects during
inspections of internal channels and
ports. Although these tools are commonly
associated with inspecting flexible
endoscopes, they can also be effective
for the inner components of suction
devices and even some power equipment,
some of which have instructions
for use (IFU) calling specifically for borescope
inspection. Borescope inspection
occurs in both the decontamination process
in the decontamination room and
during the final preparation step in the
clean prep area.
Other cleaning verification processes
used for directly testing instruments for
residual soils include adenosine triphos24
OR
Manager | June 2024
surgical instruments:
* Tips and shanks can distort or bend.
Ensure shanks are straight and that
tips align and meet precisely.
* Box locks with visible scratches
could be misaligned due to wear.
Cracks could indicate a risk of the
instrument breaking under pressure.
BY SUSAN KLACIK
* Ratchets benefit from two checks.
The first is locking the instrument
in each position to ensure closure
throughout the full range of motion.
The second inspection checks the
locking function by locking the instrument
on the first rachet and gently
tapping the rings on the surface
of the table, on both sides. During
this test, the instrument should not
open.
* Serrations or teeth should be inspected
for excessive wear or breakage.
*
Screws should be tightened if loose
or replaced if missing.
* Instrument tape often degrades by
flaking or chipping, and may need to
be replaced if instruments are not
easy to identify
* Cutting edges with nicks, chips, and
scratches could compromise proper
functioning of single-piece sharp instruments
(such as osteotomes).
Check sharpness with a testing
dowel.
* Adjustment tools and interfaces
(sockets, wrenches, screwdriver
tips) could become stripped or otherwise
ineffective from excessive wear
or misuse.
* Moving parts should actuate
smoothly and easily. Stickiness or
resistance may indicate residual soil,
misalignment, or lack of lubrication.
* Scissors should be tested on maAs
witnessed with the introduction of
robotics, the complexity of devices
increases along with the complexity of
surgical procedures. Any review of a new
procedure using a new device should
account for more stringent processing
requirements, such as additional equipment
and increased inspection time.
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