Author: Nili Walp
Marketing Manager, Vision Engineering Inc

APPLICATION NOTESURGICAL INSTRUMENT INSPECTION:MISSION FOR ZERO PATIENT HARM
Surgical instruments are a costly investment to any hospital. Thecare and maintenance of these instruments, is critical to theirperformance during surgery as well as patient care.
The Sterile Processing Department (Central Supply, or Sterile Processing Service as it isalso known), is the service within the hospital in which medical/surgical supplies andequipment, both sterile and non-sterile, are cleaned, prepared, processed, stored, andissued for patient care.
Sterile Processing Departments are typically divided into four major areas to accomplish
the functions of decontamination; assembly and sterile processing; sterile storage; anddistribution.

Surgical instruments
are a costly investment
to any hospital. The
care and maintenanceof these instruments,
is critical to theirperformance during
surgery as well as
patient care.

In the decontamination area, reusable equipment, instruments, and supplies arecleaned and decontaminated by means of manual or mechanical cleaning processes andchemical disinfection. Following the cleaning process the microscopic inspection of theinstruments takes place.

Inspection
After cleaning, all instruments should undergo inspection before being packaged
for reuse or storage. The importance of inspecting each instrument cannot be overemphasized. A visual check for cleanliness and dryness should be made for all items
washed, as part of the decontamination process, before being packaged for reuse orstorage.
The condition of the instrument has a significant effect on how adequately it can becleaned. Instruments subjected to rough handling will develop scratches and roughened
surfaces over time, which will trap and hold dirt. Damaged surfaces not only allow dirt
and bacteria to collect, but can also be potentially dangerous for both medical staff andpatients.
Box locks, serrations, and crevices should be critically inspected for cleanliness.
Instruments with cutting edges such as scissors, rongeurs, chisels, curettes, etc., should
be checked for sharpness. There should be no dull spots, chips, or dents.
Hinged instruments such as clamps and forceps should be checked for stiffness andalignment of jaws and teeth. Tips should be properly aligned, jaws should meet
perfectly, and joints should move easily.

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Vision Engineering Ltd.

SURGICAL INSTRUMENT INSPECTION: MISSION FOR ZEROPATIENT HARM

Ratchets should close easily and hold firmly. Any instruments with pins or screws should
be inspected to make sure they are intact. Plated instruments should be checked tomake sure there are no chips, worn spots, or sharp edges. Worn spots can rust during
autoclaving. Chipped plating can trap dirt and can also damage tissue and rubber gloves
when used, if not cleaned properly.
If any problems are noticed during the inspection process, these instruments should beeither cleaned again, or sent for repair depending on the problem observed.
“There are a number of visualization tools on the market for visual inspection ofinstrumentation. However, stereo inspection microscopes provide technicians with a 3Dview of instruments and the ability to view all sides of the instrument at once, clearly andeffectively. Ideal for visualizing troubled areas like box locks and jaws, which often harbor
residual bioburden.“Assistant SPS Chief at Northeast Ohio VA Health Care System.

A general guide on how the instruments are inspected
Forceps and Hemostats: A visual test would be to close the jaws lightly. If they overlap
they are out of alignment and need re-aligning. If the forceps have serrated jaws theyshould be checked to see that they mesh fully. There should be no play in the box jointof the instrument.
“There are a numberof visualization toolson the market forvisual inspection ofinstrumentation.
However, stereo
inspection microscopes
provide technicianswith a 3D view of
instruments and theability to view all sidesof the instrument
at once, clearly andeffectively.”

Scissors: Blades should be checked for burrs and they should be in good approximation
all the way down the length. There should not be excessive fretting around the pivot pin
which would lead to possible corrosion and breakage.
Needle Holders: A needle should be clamped in the jaw and the instrument closed toensure that the needle can not be moved or turned easily.

Suggested stereo inspection system configuration
Lynx EVO: Multi-Axis or Ergo stand, LED ring-light and magnification ranging
from 6x - 90x.

Tracking and traceability of surgical instruments
It is important to be able to trace surgical instruments through the decontamination
processes to which they have been subjected and also to the patient on whom they
have been used, thus tracking systems, such as bar codes or RFIDs, are steadily
becoming more common. The ability to track and trace surgical instruments andequipment through the decontamination life-cycle enables corrective action to be taken
when necessary.

Suggested inspection system configurations
EVO Cam ll: Multi-axis or Ergo stand; LED ring-light and USB for image capturing ofdefects or failures.
Lynx EVO: for the inspection of the bar codes used to track and trace the instruments.
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Vision Engineering Ltd.