STERILE PROCESSING INSIGHTS Erasing instrument errors


by Stephen M. Kovach


From the Author: s this is y fi rst coln,  wol lie to than y rien an entor, ay arasi, an  or allowin e to carry the torch o answerin yor estions ay wrote this coln or  years, an  will o y est to ollow in his ootsteps to rin yo eiencease answers that are clinically releant e now that any o the processes we peror are sacre cows that hae een passe own to s an thereore, we ay not hae ata or


inoration to ac p the practice  will o y est to answer yor estions, neertheless


I saw an employee use an eraser on an instrument. Why would they have one at their workstation?


Q A


Your question has taken me back to the start of my career in healthcare in 1975 as a sterilization orderly. When I was inspecting and assembling  oor trays between sterilization cycles, if I saw a cer- tain color, spot, or stain on the instrument, I would use an eraser to check it out. But why was I allowed to use an eraser? My manager shared that staff think surgi- cal instruments do not “stain” because the instruments are made from stainless steel, but stainless steel is only corrosion resistant. It can still rust or stain if handled improperly.


We were taught that if we saw a brown- orange discoloration, we could check to see if it was rust by using a standard pencil eraser. We would rub the eraser on the stain/spot and take note of what we saw1 (see Fig. 1 & 2). If the discoloration was removed and the metal underneath shined with a smooth, clean look, the mark was not corrosion/rust. If a pit mark appeared under the discoloration, the spot/stain was corrosion/rust and needed to be pulled from usage and sent out for repair. Using an eraser is a time-proven test. In the American V. Mueller Care and Han- dling of Surgical Instruments, it is stated that a simple and easy way to test for corro- sion on an instrument is to take an ordinary rubber eraser and try to erase the spot or stain.2


In the book “The Basics of Sterile


Processing,” they remind staff when using a pencil eraser, it is important to wash the instrument afterwards to remove eraser marks and residues.3


The practice of using an eraser on stain-


less steel is not a new idea. Wm. H. Kellogg noted (1907) that a very convenient way of removing rust and brightening surfaces of tools, such as steel, brass, or silver, is to rub the surface with a common ink eraser. It does not scratch the surface as emery cloth does, and it is always available. ut is using an eraser a verifi able process in your workplace today? My answer is yes, based on the information I have just


shared. You need to work with your man- agement team to put in place a practice guideline to check instruments, including stains/spots, addressing the various ways you check instruments when these stains are present. One way may be using an eraser. Other ways might be using products that detect protein, or hemoglobin, or using enhanced visual inspection.


data to explore potential causes, starting with the list of issues that can cause cor- rosion/rusting of your instruments. The list of causes below will get you started in solving this concern. • Sterilizing instruments of different met- als in the same cycle will cause rusting. An electrolytic action carries the carbon particles from the exposed metal and deposits them on the stainless-steel instruments.5


• Exposure of instruments for a prolonged time to saline solution or blood can result in pitting and rusting.6


• If any moisture remains on instruments, they may rust in storage.7


Figure 1


 Insuffi cient rinsing of operating room linens after the laundry service has used caustic chemicals. When instruments are wrapped or placed on towels, the chemi- cals may be absorbed by the instruments.8


• Reduction of the passivation layer on instruments by etching of instruments, poor water quality, poor steam quality, or improper cleaning chemistries.9


• Excess amounts of iron or other minerals from the local water supply may cause the rust deposits.10


 The rust fi lm on the surface of stainless- steel instruments can be caused by chemicals in the detergent.11


Figure 2


I cannot complete this response without addressing some basic facts about cor- rosion/rust on instruments. According to I ed ook, rust is defi ned as the product of corrosion on iron, steel, and steel alloys as a result of oxidation, a reaction with oxygen in an atmosphere contain- ing water.4


• Ensuring instruments are dry is impor- tant – if water is left on the instruments it can form water spots.12 In closing, if you are using an eraser and


fi nd rust, you need to start a process to fi nd out why and “erase this concern” before it spreads out of control. HPN


Finding the source of rust on your instruments is paramount for every medical device reprocessing department. Surgical instruments are a major asset for every facility, and it is, therefore, important to ensure they last a long time. My general suggestions are to work with your instrument manufacturer and repair company to review data on how many instruments could not be repaired because of rust/corrosion concerns. Then, use that


40 January 2021 • HEALTHCARE PURCHASING NEWS • hpnonline.com


tephen  oach, , , starte in the eical fi el in  as a steriliation orerly an has wore in any positions within the ealthcare nstry e presently is linical cator erits at ealthar nstries


oe say nowlee is power, t  eliee real power coes when we share or nowlee with each other his coln is how we will share or nowlee with each other


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