Microsurgical Instruments Demand Maximum Attention

The attention to detail that’s required to properly care for the tools of surgery takes on even greater importance when microsurgical instrumentation is involved. Proper care and regular maintenance extend the longevity of these delicate tools and ensure they perform as intended for the duration of their lifespan. This demands a partnership between members of the surgical team and instrument reprocessing techs, according to Susan Klacik, BS, CRCST, CIS, ACE, CHL, FCS, a clinical educator at the Healthcare Sterile Processing Association (HSPA) in Chicago. “Surgical team members should place delicate instruments on the top of heavier items to limit the risk of damage during transport to the sterile processing department (SPD), and reprocessing techs should give the surgical team confidence that the instruments they use will be in prime condition,” she says.

• Proper cleaning. The team-based approach begins in the OR. Instruments don’t have to be thoroughly cleaned in the OR, but gross debris must be removed and lumens should be flushed. “Point-of-use treatment is one of the most important elements of instrument care because it prevents biofilm from forming on surfaces and soils that are moist are easier to remove,” says Ms. Klacik.

She recommends treating dirty instruments in the OR with sterile water, an enzymatic or detergent spray or keeping them moist with a damp towel over them. “Avoid soaking them in a basin of water, which could fill with contaminates and might splash and spill during transport to decontamination,” she says. 

Humidity packs are also available that seal delicate instruments and keep them moist and safe until they’re able to be cleaned in sterile processing. The packs also help to prevent rusting and corrosion caused by blood and organic materials drying on instrument surfaces.

Meticulous manual cleaning occurs when the instruments reach the SPD. “If instruments aren’t clean, they can’t be sterilized,” says Ms. Klacik. It’s an often-repeated mantra, to the point of seeming obvious. “There are a lot of good cleaning verification tools available, including ATP testing and protein tests, and we encourage facilities to use them,” she adds.

• Safe handling. The key to caring for delicate microsurgical instruments is keeping them separate from trays of general instrumentation, according to Gretchen Steelman, MBA, BSN, RN, CNOR, supply chain category manager at the University of North Carolina Health System in Durham. “Microsurgical tools are expensive to purchase and there are high costs associated with them breaking or getting damaged,” she says.

Microsurgical instruments should be segregated in small baskets, an inner layer tray or a nipple pad and have protectors placed on the tips when staged in larger trays for shipment to the ORs, suggests Ms. Steelman. She says the manufacturers of rigid sterilization containers offer smaller instrument baskets as available accessories. She also points out that individual instruments should be seated properly in trays with the handles and tips situated carefully in the proper slots.

“I’ve seen several instances of very expensive instrumentation that was newly purchased slip between holes in basket inserts because they weren’t placed properly,” says Ms. Steelman. “They ended up getting crushed under the weight of the heavier tools in the tray.”

Segregating microsurgical tools from general instrumentation also alerts reprocessing techs to take extra time and pay extra attention while cleaning and preparing them for sterilization. “I’ve witnessed techs simply dump these instruments out of a tray in decontamination,” says Ms. Steelman. “The tools should be removed from trays one at a time and handwashed in the sink.”

• Regular upkeep. Instruments are given a cursory check in decontamination for minor damage, but reprocessing techs who are preparing sterilized trays for shipment back to the ORs should give the tools a close inspection with light magnifiers to make sure each item is in perfect working condition. Microsurgical instruments that are in need of repair should be removed from the rotation and placed in a dedicated bin, according to Ms. Steelman.

“Techs must make sure instruments are sharp, aligned properly and free of pitting. They must also examine the tips to confirm they aren’t damaged and check that hinged tools work properly,” says Ms. Steelman. “That ensures instruments are sent to ORs in pristine shape and won’t cause patient harm.”

• Constant focus. Proper care of microsurgical instruments is all about awareness, says Ms. Steelman. “Staff in the ORs and the SPD need to know they’re dealing with delicate tools,” she adds.

Ms. Steelman created dedicated trays for minimally invasive cardiac tools and has her team fast-track trays of microsurgical instruments so they don’t get mixed in with case carts full of general instrumentation. She points out that most instrument tracking systems include a field where staff can enter notes about the specialized care specific tools require, and says use of this feature keeps staff who handle the instruments in the OR and SPD informed about the extra attention they need to give the sets. She also says automated reminders can be programmed into tracking software that alert staff whenever microsurgical instruments are scanned in the OR or SPD.

Ms. Steelman has asked microsurgical instrument vendors for an estimate of how long she can expect their tools to last and is often told a decade of useful life is typical. “However, they also tell me that with good care and handling the tools can last 30 to 40 years,” she says.

That seems hard to believe, but Ms. Steelman has proof that it’s possible. “Some of our hospital’s microsurgical instruments were etched with their date of purchase, and I recently found some from the 1980s that are still in the regular rotation,” she says. “If they’re properly cared for, they can last a long time.” OSM

This three-part article series is supported by Synovis.