When a nurse dropped a diamond knife on the floor at Brookside Surgery Center in Battle Creek, Mich., administrator Christy Therrien, RN, knew she'd be in for quite a repair bill. She was right: $600 to repair a chipped diamond blade - about half of what the knife cost in the first place.

"Diamond knives are extremely cost effective if you handle them properly," says Brian Chandler, the president of Malvern, Pa.-based Accutome, Inc. "The blade will literally last indefinitely."

The tricky part, he says, is taking care of them: "They're made of diamond, but they're so thin, they chip extremely easily."

Here's how to extend the life of your diamond knife, making it a cost-effective investment for your facility. (See "Figuring Out Your Savings" on page 42.)

Designate a handler
Assign someone the task of caring for your diamond knives, says Tom Mancuso, the chief operating officer of Diamatrix Ltd. in The Woodlands, Texas.

"Usually, the person would be a tech, but depending on the size of the facility and how it's staffed, it could be an RN," he says. "The important thing is to have one person. We find if a single person is devoted to the care and maintenance of diamond knives, the issues of their getting broken are much less."

It's also easier to train one person thoroughly than several staff members. But in a large facility, you may want to assign the duty to a handful of staffers so you can ensure all shifts are covered and that, if someone leaves, you will still have staff trained in caring for the knives.

Inspect the gadget
Inspecting your diamond knives is critical.

"You want to check that they are in good condition and that, if they're calibrated - set at a predetermined depth - they're within those settings," says Mr. Mancuso. "If it's chipped, it won't cut as well, and that will delay the procedure. If it's out of calibration, that could be dangerous - you could pierce the cornea."

Set rules of engagement
Unless the diamond knife is cutting eye tissue or is being cleaned, retract the blade.

"It should always be handed off closed," says Mr. Chandler. "The doctor and whoever is assisting should agree that it will be passed closed. Then it's used, closed and handed back."

And if a healthcare worker isn't following this protocol, the staffer in charge of caring for the knives must speak up.

"They have to make sure the doctors treat the diamond knives right," says Mr. Man-cuso. "It can be hard for a tech or a nurse to say to a doctor, 'Don't do that,' but the blade should always be retracted. Otherwise, the diamond knife can easily be set down on the tray or it can roll into another instrument and be damaged.

"It's good to get in the habit of passing it retracted so you can focus on the patient and not the knife. Passing the knife retracted also eliminates the potential for a sharps injury."

Figuring Out Your Savings Diamond knives are expensive; they start around $1,000 and only go up. But the large outlay can pay off in the long run - and the not-so-long run. "If you're doing enough procedures, you can see a payout in six months," says Tom Mancuso, the chief operating officer of Diamatrix Ltd. Usually only single-specialty eye centers will see returns this quickly, but large facilities fare well, too. "It's really not that long-term a prospect to recoup your costs, but the key is proper maintenance," he adds. Besides, buying metal blades at up to $20 each really adds up. In addition, says Brian Chandler, the president of Accutome, Inc., having one or two diamond blades saves on stocking, storage and sharps-disposal costs. "When you do a cost-benefit analysis, you have to factor in the ability of what you've bought to function as though it's brand new, so cleaning and maintaining it are critical," says Rhein Medical President John Bee. Sample 4-year Savings "One Diamond-Knife Set" shows your savings if you've bought one black diamond main-incision and one sideport knife for $1,420, with estimated annual repairs of $875. "Two Diamond-Knife Sets" shows savings if you've bought two of each ($2,840), with $1,750 in yearly repairs.

Clean with care
There are two big don'ts when it comes to cleaning your diamond knives, says Mr. Chandler: Don't scrub them, and don't stick them in a foam block to get the protein off.

Even using something soft, such as a sponge, is not recommended, says Mr. Mancuso.

"Physically touching the blade with something creates an incident that could damage the blade," he says. "The fewer situations you have, the better."

Mr. Chandler recommends these steps for cleaning:

• As soon as possible, rinse the blade, point down, under tepid water. "The quicker, the better," says Accutome Instrum-ent Repair and QA Manager Paul Kiss. "Don't give the protein a chance to dry."
• In the dirty room, flush the protein for about a minute with a steamer. "Hold the knife about 2 inches from the nozzle, with the blade pointing down," says Gilberto Martinez, Accu-tome's production manager.
• With the blade retracted position, submerge the end of the knife in an ultrasonic machine for two to three minutes, being careful not to bump the sides or bottom. You can buy enzymatic cleaner for the machine or simply use distilled water and enzyme tablets.
• Rinse with tepid water.
• Allow the blade to dry; an alcohol rinse is an acceptable way to speed this process.

Both Accutome and Dia-matrix offer steamers, the ultrasonic cleaners and accessories.

Another cleaning option is Rhein Medical's self-contained, three-step cleaning system, in which the user plunges the blade into hydrated cleaning foam, then rinses with two oth-er solutions from the company.

"The foam can get any kind of stubborn debris off," says John Bee, the president of Rhein, in Tampa, Fla. "You can go ahead and finish the case, close up and before you autoclave the instruments, go ahead and clean the blade. The cleaning system doesn't harm the blades, and takes about five seconds."

Sterilize alone
Before you sterilize, be sure the blade is dry and free of debris. "Other-wise, a piece of protein may get baked on," says Mr. Chandler.

And, of course, retract the blade before starting the sterilization cycle. If possible, segregate the diamond knife.

"Even if the blade is retracted in the housing of the handle, an instrument can get pushed forward into the diamond," says Mr. Bee. "If the diamond knife has its own sterilization tray, you can segregate it while autoclaving it in the same cycle with other instruments."

The knife is ready to store. Retract the blade, and store in a dry spot, advises Mr. Chandler.

Pack for shipment
If you do have to send your diamond knife off for repairs or cleaning, be sure to pack it as cautiously as you've been handling it.

"In some cases, surgery centers send us diamonds for cleaning that end up broken or damaged in shipping," says Mr. Martinez. "You can't just put a fragile sticker on the package."

Retract the blade, and pack the knife in foam or bubble paper so that it can't squeeze out or rattle around in its box.

"When the diamond hits something hard, it doesn't have any give, and it breaks," says Mr. Kiss. "We've had to replace blades [due to bad packaging]."

Make it policy
"If there's a chip, it seems like such a tiny thing," says Ms. Therrien. "But sometimes they can't fix them, or it's $600."

Including these steps in a protocol can protect your diamond knife - and repairs budget.

"Ultimately," says Mr. Kiss, "if you have doubts, check with your manufacturer for care."