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CHAPTER 17
Care of Surgical Instruments
Introduction
Since the very early days of surgery it has been recognised that a surgeon’s ability is not only reliant on a good technique but also on the fine manipulation of the tools required in order to elicit the desired outcome for the patient. Hippocrates alluded to this, asserting that ‘What concerns surgery are the patient, operator, assistants and instruments; the light’ (Debakey 1991, Zimmerman and Veith 1993). This insight from ‘the father of western medicine’ supports the notion that the art of surgery is a partnership, and thorough consideration must be dedicated to each aspect of it; this will incorporate the acquisition and care of the surgical instrument.
The term ‘surgical instrument’ includes everything on a spectrum from simple scalpel to highly specialised technologically advanced medical equipment; these are often referred to as medical devices.
Several different international classification systems for medical devices continue to exist however, the World Health Organization, with its partners, is working towards achieving harmonisation in medical device nomenclature, which will have a significant impact on patient safety. (World Health Organization 2003)
Surgical Instrument Procurement
Patient safety and outcome is paramount and therefore the integrity of the instruments and their procurement must be subject to a rigorous process. Before an instrument or set of instruments is chosen, careful consideration has to be given to its quality to prevent inadvertent harm to the patient, which could be attributed to the instrument. This will include deciding whether the instrument could become scratched or dented, and whether it is manufactured from a durable substance that will withstand numerous decontamination cycles or is assembled from several parts that could become detached in a patient cavity or misplaced.
Each organisation will have its own procurement process and this will determine how instruments are purchased and managed effectively. All organisations, however, should use a prepurchase research procedure which has contribution and input from the infection prevention and control team, sterile services and other specialisms that govern aspects of patient safety, to ensure that any instruments or equipment under consideration for purchase can be accommodated within existing cleaning and sterilisation standards and controls.
Information should also be sought, as part of this procedure, from the instrument manufacturers as they should provide the required reprocessing information in accordance with the requirements of the Institute of Decontamination Sciences (Beesley and Pirie 2005, Institute of Decontamination Sciences 2011). Regardless of which process is in operation, it is important that prior to purchasing any new instrumentation, dialogue has occurred between the manufacturers, sterile services, infection control and the theatre personnel. The Institute also stipulate that it is up to the purchaser to ensure that the recommended reprocessing guidelines such as the sterilisation method and cycle (including temperature and recommended exposure time) can be followed on site and that these comply with current decontamination guidelines. If they do not, the product should not be purchased as failure to have these conversations could prove costly (Medicines and Healthcare products Regulatory Agency 2006).
The Health and Social Act 2008, updated 31st December 2010, has determined through its Code of Practice, overall requirements for healthcare providers in relation to infection prevention and control practices; it also details the overall requirements for decontamination of medical devices. (Institute of Decontamination Sciences 2011)
Regardless of whether single components or sets of instruments are being purchased, training for both the sterile services staff and theatre personnel should be an integral part of the agreement package from the manufacturer supplying the instrumentation (Medicine and Healthcare products Regulatory Agency 2006).
Prior to the purchase and introduction of any new instrumentation, research into responsibilities and procedure for maintenance and repair needs to be undertaken. If it is possible for repairs to be carried out in-house, authorisation must be obtained from the manufacturers to do this, especially within any agreed warranty period.
Training
The training delivered by the manufacturer to the sterile services personnel should incorporate the correct methods of decontamination and sterilisation in accordance with the Institute of Decontamination Sciences guidelines. It is recommended that this will include the number of components that make up each instrument by disassembling and rebuilding each one.
The training provided by the manufacturer for the theatre staff should include the names of the instruments and their specific use. In addition, the training should cover the surgical technique. This could be delivered to the theatre team, including the specific surgeons, who are likely to be using the instruments. For new theatre personnel it is recommended that individual personal competencies are in place to cover the use and function of the instruments (Beesley and Pirie 2005).
The process for learning surgical procedures will vary depending on the organisational structure within the theatre team. Consideration should be given to the different individuals’ learning styles within the team and the teaching of instruments and surgical techniques adapted accordingly (e.g. the use of acronyms or photographs). It is at this point in the practitioner’s development that emphasis is given to ensure that instruments are only used for the purpose for which they were surgically intended. There will no doubt be a time when a scrub practitioner will be asked for a certain instrument to be used for a different function and this should be prohibited. Instruments such as artery forceps should not be used to secure drapes as this could strain the mechanism and render them useless. Within the training package, reference should be made to the correct way in which instruments are handed to the surgeon as there is a right and wrong way of doing this (Beesley and Pirie 2005). Empowering a new trainee is key to ensuring safe systems of work are adopted and maintained.
Inclusion in Surgical Counts
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