STERILE PROCESSING INSIGHTS
Cleaning hinged instruments effectively, anticipating ANSI/AAMI ST 79 updates
by Stephen Kovach
Q A
We are having a hard time cleaning our double-action bone rongeur. What advice do you have for us?
That is an excellent question. The double-action type bone rongeur does
offer a signifi cant challenge for cleaning. Stille first developed the double-action bone rongeur around 1872; the “double- action” provides a second hinge point. (See Figure 1) This increases the pressure and force applied to the cutting edges of the rongeur through the lever-action provided by the second pivot point and results in better cutting for the surgeon. The double- action bone rongeur can be found in orthopedic, neurosurgery and plas- tic surgery instrument trays. While this is an excellent feature for the surgeon, the “dou- ble-action” creates a cleaning concern for the medical device repro- cessing staff because it can harbor tissue or bone from the surgery,
Figure 1: Ronguer not open
Figure2: Dirty ronguer, not open
as seen in the picture. (See Figure 2) Our mantra in Sterile Processing is to refer to the original equipment manufac- turer’s (OEM’s) instructions for use (IFU). However, in reviewing many IFUs for this type of surgical instrument, I cannot fi nd specifi c details on how to eep the rongeur open during the cleaning process or how to inspect at the shans specifi cally for lodged tissue or bone during the assembly process. The IFU usually gives us general directions. Here is direction from just one example of an IFU for these types of surgi- cal instruments:
“The cavitation action of ultrasonic clean-
ers can remove particles of debris from areas of the instrument inaccessible to a brush and is recommended as part of the reprocessing procedure. With the jaws in
the open position, place the instrument in a mesh bottom instrument baset. isually inspect the instrument for cleanliness and clean off any remaining debris. isually inspect the instrument for damage. Open and close the jaws to ensure proper opera- tion of the instrument.” The uestion is how to eep the jaws open during the cleaning process. It is dif- fi cult. nd we now that if not given the proper tools for our job, the CPD (creative people downstairs) staff, as they are sometimes referred to, will come up with solutions to help solve concerns. (See Figure 3) I have seen inventive measures such as using tongue blades, pics, or anything else to eep the jaws open to allow for the cleaning action to wor properly. The cleaning action wors to get into the hard-to-reach spots that must stay open during this critical step. One must not forget that pre-cleaning is important, and this area is sometimes overlooed when it comes to proper brushing tech- nique or is never brushed,
and this sets up failure. Many companies provide solutions to
eep all types of instruments open dur- ing the cleaning process (i.e., adjustable stringer). Exposure to the cleaning process is vital to having clean and functional instruments. You need the proper brushes; that is a given. My other suggestion is to
Reference
(Rongeurs – Recommended Cleaning, Sterilization, and Instruc- tions for Use)
https://www.medline.com/media/mkt/pdf/ Rongeurs-IFU.pdf
Stephen M. Kovach, BS, CFER, started in the medical fi eld in 1975 as a sterilization orderly and has worked in many positions within the healthcare industry. He presently is Clinical Educator Emeritus at Healthmark Industries.
find companies that sell these types of products and provide solutions to help resolve your quest for cleaner double- action bone rongeurs or any other type of hinged instrument that must be ept open during the cleaning process . (See Figure 4)
Q A
I have heard that ANSI/AAMI ST 79 has been updated. Is that true?
NSII ST was last approved in 20. Offi cially, it is on a fi ve-year review process, so it will be around until 2022 when there is another complete docu- ment review. Yet, the committee felt there were four signifi cant concerns that needed to be addressed before 2022. (See list below) To my understanding, the results of the changes are to be shared and updated in early 2021, which had not happened yet at press time in early January.
A.1: Amendment for Environmental Services/Fans/ Food and Drink.
A.2: Amendment for Inspection of Insulated Instruments.
A.3: Amendment for Modification of Content Pertaining to Frequency of Cleaning for Routine Care of Sterilizers for Sterile Processing Areas in Health Care Facilities.
A.4: Amendment for Content Addressing Record- ing BI Lot Numbers in Sterilizer Records for Sterile Processing in Health Care Facilities. HPN
Figure 3: Open ronguer tactics 52 February 2021 • HEALTHCARE PURCHASING NEWS •
hpnonline.com
Figure 4: Better open ronguer solutions
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