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Stained Surgical Instruments

Stains on surgical instruments present a challenge to individuals who manage these precision instruments. Prices of individual surgical instruments can cost several hundred dollars each, so proper care and cleaning procedures can protect patients as well as be cost efficient. Although these instruments are made of stainless steel, surgical instruments can rust, stain and develop pits that render them unusable. The problem can originate in the decontamination and sterilization process, the assembly of the instrument or with its use in the operating room. Brown stains are usually caused by deposits of chromium oxide. Detergents containing polyphosphates can cause a reaction with the copper components of the sterilizer that leads to deposits on the instruments. Blue-gray stains can some from cold sterilization solutions. Light and dark spots are caused by evaporated water droplets with a high mineral content.

  1. Instrument Storage

    • New instruments can be stained by condensation buildup inside the plastic packaging they are shipped in. Remove surgical instruments from the plastic as soon as you receive them and send them through the sterilization process before using. Surgical instruments should be stored at a recommended 30 to 40 percent humidity in an area protected from dust and away from caustic chemicals.

    Care During Use

    • Bodily fluids, blood, tissue, salts and caustic chemicals cause staining and corrosion. This can be reduced by continuously cleaning them during use. Do not soak them in alcohol, betadine, saline solutions, medications or other chemicals that may cause corrosion and staining. Design a system to promptly process surgical instruments as soon as possible after use.

    Instrument Disassembly

    • Surgical instruments should be disassembled prior to cleaning. Bodily fluids, tissue, blood and chemicals caught in hinged areas create stains. When sterilization is complete, reassemble them and lubricate the hinges.

    Water

    • Water impurities, mineral content ("soft" or "hard") and pH can affect the staining of surgical instruments. Manufacturers of surgical instruments recommend de-ionized water with a neutral pH. Regular testing of the water will help prevent stains. Do not wash instruments in an operating room scrub sink with tap water and hand soap.

    Detergents and Enzymatics

    • Detergents and enzymatics that have not been mixed accurately (according to product directions) are another source of stains. Do not put instruments into the sink and then add the cleaning chemicals and water. The chemicals are concentrated, not a neutral pH of 6.8 to 7.2, and can stain or damage the instruments.

    Hand Cleaning

    • Surgical instruments can be hand-cleaned. Using the appropriate soft brushes to clean the instruments, check joints carefully for debris. Rinsing with de-ionized water ensures all detergent is removed.

    Ultrasonic Cleaners

    • Ultrasonic cleaning chemicals can stain surgical instrumetns if they are not mixed according to the ultrasonic cleaner manufacturer's directions. Change the water according to manufacturer's directionswill also prevent stains. Water left too long in the cleaner begins to evaporate and changes the concentration of chemicals and pH. Complete rinsing will also reduce stains.

    Washer-Decontaminator

    • Low-foaming, pH neutral detergents and a neutralizing rinse help prevent stains during the washer-decontaminator process. All instruments placed in the washer-decontaminator should be in the open position and arranged so all areas can be cleaned. The pumps, water and chemical lines should be regularly checked. Ensure the detergent and lubricants are correctly metered. The surgical instruments should be dry after removal from the washer-decontaminator to prevent water spots from causing stains or pitting.

    Sterilizers

    • The inner walls and drain of the sterilizer can transfer stains to surgical instruments if they are not regularly maintained. Check the quality of the steam, and ensure the filters between the autoclave and boilers are clean and in place. Find out if any chemicals have been added to the water in the boiler that may condense on the instruments and cause stains.

    Linens

    • Detergents and chemicals used to launder linens can transfer to surgical instruments if laundered linens are used to wrap instrument sets or placed in the sterilizer. The detergents and chemicals can vaporize in the sterilizer and damage the surface of instruments.

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