IAHCSMM CRCST Lesson Plans

This series of self-study lessons on Central Service topics was developed by the International Association of Healthcare Central Service Materiel Management (IAHCSMM). The lessons are administered by Purdue University’s Continuing Education Division.

EARN CONTACT HOURS:
You can use these lessons as an in-service with your staff, or visit www.iahcsmm.org for online grading at a nominal fee ($5 per single lesson plan, or bundled packages are available for quantities of 6 lessons for $25 (save $5) or 12 lessons for $50 (save $10) for greater savings).

Each lesson plan graded online with a passing score of 70% or higher is worth one point (contact hour). You can use these points toward your re-certification of CRCST (12 points).

Mailed submissions to IAHCSMM will not be graded and will not be granted a point value.

To order a paper/pencil subscription for the CRCST Lesson Plans, please call Purdue University at 877-537-7732. IAHCSMM does not provide written grading service for any of the Lesson Plan varieties, and Purdue University ONLY provides written grading services for the CRCST Lesson Plans (not the ICE or SCE Lesson Plans).

IMPORTANT! Click here for brief tutorial (click to collapse)

IAHCSMM now has the ability to grade any of our lesson plans online for a nominal fee. And not only will grading be instantaneous, but your passing score will be immediately sent to IAHCSMM headquarters and applied toward your account.

The more lesson plans you complete online, the less paperwork you’ll have to submit with your annual dues. So whether you want to tackle all of your points at once or you want to take your time throughout the coming months, you now have an easy, convenient and FAST option to re-certify.

Lesson Plans can be graded online with an activation code given by IAHCSMM
To receive an activation code, please visit our store at www.iahcsmm.org/ecommerce/store.php
Lesson Plans are worth 1 (one) point each and cost $5 per grading attempt or
- Bundled packages:
  - Purchase 6 plans worth 6 points for $25 (save $5)
  - Purchase 12 plans worth 12 points for $50 (save $10)
Only IAHCSMM (www.iahcsmm.org), offers online grading for all 3 of the lesson plans offered through Communiqué:
- 3M sponsored CRCST - Technical Continuing Education (TCE) Lesson Plans
- Aesculap sponsored CIS - Instrument Continuing Education (ICE) Lesson Plans
- IAHCSMM sponsored CHL - Supervision Continuing Education (SCE) Lesson Plans

Make your choice below, picking the appropriate Lesson Plan for your certification. Lesson Plans are shown with most recent first. Have your copy of Communique open to the article or click on the link next to the Lesson Plan to open the article in a separate browser window.

After activating the quiz, you will be be asked to fill in your first and last name (mandatory) in addition to your IAHCSMM Membership Number and your choice of billing cycle to apply your grade.

If you fail the quiz (minimum of 70% to receive credit as a passing grade), you will need to attempt another exam grading to receive credit — please purchase either a new activation number or use one of the remaining numbers you may have purchased in a bundle package.

If you pass, you are encouraged to print the confirmation page out as your proof of a passing grade. Upon receipt of your annual dues/re-certification invoice, a listing of passed lesson plans will be deducted from the points due on the statement, and you should compare your printed confirmations to this list.

ADVISORY COMMITTEE Click here for info (click to collapse)

Anne Cofiell, CRCST, FCS
Consultant
Cofiell Consulting Services
Mt. Laurel, NJ

Scott Davis, CMRP, CRCST, CHMMC
Director, Technical Operations
Integrated Medical Systems International
Birmingham, AL

Susan Klacik, CRCST, ACE, FCS
Corporate Director
Forum Health
Youngstown, OH

David Narance, RN, BSN, CRCST
MedCentral Health System
Nurse Manager
Specialty Clinician Sterile Reprocessing
Materials Management
Mansfield, OH

Patti Koncur, CRCST, CHMMC, ACE
Director, Clinical Operations
Integrated Medical Systems International
Birmingham, AL

Natalie Lind, CRCST, CHL
IAHCSMM Education Director
Ada, MN

Technical Editor:
Carla McDermott, RN, ACE
Education Specialist
Morton Plant Mease Healthcare
Dunedin, FL

Series Writer/ Editor:
Jack D. Ninemeier, Ph.D.
Michigan State University
East Lansing, MI

Lesson Plan CRCST 87
Care and Maintenance of Surgical Instrumentation
[Reprinted from Communiqué: March/April 2006]

Surgical instruments must be maintained in perfect condition to help preserve the safety and well-being of patients. In addition, the cost of purchasing, maintaining, and processing surgical instruments represents a significant portion of every healthcare facility's budget. With proper care, many surgical instruments have a useful life of twenty years or more. Each step in the processing of these instruments affects how well they perform in the operating room and how long they can remain in the facility's inventory. Consequently, Central Service technicians must know and consistently use proper methods of maintaining these instruments. This Self-Study Lesson provides basic knowledge about the care and maintenance of surgical instruments commonly used in today's healthcare operations.

Objective 1: Review proper procedures for handling instruments at their point of use and during transport to Central Service processing areas.

If Central Service departments do not control point of use procedures, operating room personnel should be properly educated in the following procedures. Always bear in mind that surgical instrumentation is designed for a specific purpose; devices should be used only for their intended purpose, and the proper instruments must be requested for the procedure being performed. Some examples:

Careful handling during use is extremely important to prolonging the life of surgical instruments. Users must not drop or toss instruments during procedures or while
returning instruments to their trays at the end of a procedure. The tips of delicate and sharp medical devices should be protected at all times to avoid unnecessary damage.

Gross contaminants should be removed from instruments immediately after use to help prevent corrosion. Human blood naturally contains sodium that can corrode instruments if not promptly removed. Therefore, instruments soiled with blood should be kept moist (but not wet). During a procedure, sterile water should be used to wipe blood off of medical devices. When the procedure is completed, an
enzymatic solution or spray should be used to help prevent the remaining blood from drying on the instruments. Do not use saline, Betadine, hand soaps, or surgical hand scrubs to clean or moisten instruments because these chemicals will degrade the instruments.

All devices should be separated from soiled linen and disposable items at point of use. Instruments should never be washed with laundry items, because the chemicals used in laundry cleaning can damage the instruments' passivation layer (the outer layer of a surgical instrument). The passivation layer is specially treated with chemicals to help make the instrument more resistant to corrosion, including rusting and staining. Instruments "hidden" in soiled linen can also injure
unsuspecting laundry workers, and those left in disposable packaging material may be inadvertently discarded as waste.

Instruments should be transported to the decontamination area for complete processing as soon as possible after gross contaminants have been removed. This helps to minimize the potential for corrosion and eases cleaning and decontamination. During transport, take care to place lighter instruments on top of heavier instruments and to always protect sharps and delicate devices from damage.

Objective 2: Describe the basic techniques that should be used to decontaminate and clean surgical instruments.

Instruments should be inspected and cleaned as soon as possible after transport to the decontamination area. Do not drop or dump instruments onto work surfaces. Instruments that are obviously damaged should be removed, tagged for repair, and processed separately from the remaining instruments in a set. Always follow the instrument manufacturer's cleaning recommendations, including the use of
appropriate cleaning solutions. Cleaning tools should include soft, lint-free cleaning cloths and soft-bristled brushes of the correct size for each lumen to be cleaned.

Cleaning solutions should be approved for use by the federal Environmental Protection Agency (EPA) and by the hospital. Also check state regulations regarding the amounts and types of chemicals that can be discharged through drains while selecting cleaning solutions. Chemicals should always be measured and mixed following manufacturers' recommendations to avoid unnecessarily high concentrations, which can damage the instruments' passivation layer, or lower
concentrations, which can hinder cleaning effectiveness. In addition to the chemicals noted above, never use peroxide, bleach, or abrasives such as steel wool, cleansers, or metal brushes to clean surgical instruments. Hot water should not be used to pre-clean instruments because it may harden existing soils, and additional
cleaning will then be difficult. The use of acid base cleaners or rust and stain removers is discouraged, unless absolutely necessary, because they can also damage instruments' outer passivation surfaces. If these harsh
chemicals must be used, they should remain in contact with the instruments no longer than necessary, and the instruments should then be thoroughly rinsed to remove all traces of the chemicals.

If possible, disassemble instruments for cleaning. Components should be kept
together—but not reassembled—after cleaning. Pay careful attention to the removal of bone, tissue, chemicals, and blood. Lumens, crevices, and box locks should be carefully cleaned and inspected prior to mechanical cleaning. Mixing devices made of different metals—such as chrome and stainless steel or aluminum— during the cleaning process will cause oxidation (rusting), and should be avoided.

Power equipment should be cleaned by carefully following the manufacturers'
recommendations. Power cords, hoses, and batteries should remain in place on the
equipment during cleaning to avoid water damage to power connection areas. After the instruments are cleaned, hoses, cords, and battery connection devices should be removed for cleaning. Power equipment should be properly lubricated, if recommended by the manufacturer.

Endoscopic instruments are delicate and should be cleaned by carefully following the manufacturers' recommendations. Scopes should never be placed in a washer-decontaminator or ultrasonic cleaner. When cleaning flexible scopes, do not coil the insertion tube or light source cable. To do so could damage the fiber optic bundles in the instrument and permanently reduce, or eliminate, light transmission. Without adequate lighting and visibility, the instrument is useless.

Only chemicals recommended by device manufacturers should be used for mechanical cleaning. Instruments should be placed in mesh pans before putting them in a washer-decontaminator or ultrasonic cleaner. All instrumentation that can be, should be opened as wide as possible. Delicate instruments or devices should be placed on top of the other instruments in the tray. They should be in plain view and in a position that will prevent movement. Delicate items should not be processed in a washer-decontaminator's normal instrument cycle. Instead, use either an ultrasonic cleaner or the washer-decontaminator's gentle cycle. Chrome-plated instruments should never be processed in an ultrasonic cleaner because to do so may cause the plating to flake off. Once this occurs, the instrument must be removed from service and repaired, or replaced.

If the facility has hard water (which contains dissolved minerals), be sure that a water softener is used. Hard water can cause mineral deposits on the instrumentation, which can impede their function and cause staining and spotting. Also be sure that the injectors of mechanical equipment are not clogged with foreign matter, which will cause corrosion. Also, correctly dilute any cleaning chemicals to assure that they will properly clean instruments without leaving damaging mineral deposits on the devices.

After each cleaning process, metal instruments should be mechanically or manually lubricated using only water-soluble, anti- microbial lubricants. These products often
contain rust inhibitors that help protect instruments.

Objective 3: Explain important protocols to follow when inspecting and assembling surgical devices.

Significant patient harm and instrument damage can occur if devices are not carefully and correctly inspected as part of the processing procedures. Do not drop or toss instruments onto work surfaces. Instead, carefully handle all instrumentation to avoid damage. Instruments should be inspected carefully when they are assembled into sets to ensure that they are in proper working order and without pitting, rusting, or staining. Proper alignment should also be verified by carefully closing the instrument and ensuring that the tips and teeth of the device meet as they should. When devices are disassembled, it is important to ensure that all components are available for reassembly, and that they will fit together without force, to avoid damage. If an instrument is damaged, the sooner it is repaired, the longer it will last. These instruments should be assembled to ensure they are working properly, and they should then be disassembled for sterilization.

Hand-held forceps should be inspected to ensure proper alignment by carefully closing the instrument and ensuring that its tips and teeth meet as they should. If forceps are even slightly out of alignment, they should be repaired as soon as possible, to avoid further damage. All sharp instruments should be inspected carefully to ensure that their cutting surfaces are smooth and sharp. Instruments such as scissors, osteotomes, curettes, rongeurs, and bone cutters should be tested for sharpness by cutting material that is recommended by the manufacturer. The sooner a dull instrument is discovered, the fewer repairs will be needed, and the longer will be its useful life. Instruments such as gelpis, weitlanders, and Volkmann's should be checked to ensure that their tips are sharp and straight. Bent tips should be repaired before they break off and ruin the instrument. All sharps should be placed carefully in their trays, or approved tip protectors should be used to avoid damage during the sterilization and transportation cycles.

Numerous other protocols are important when instruments are inspected and prepared for processing. For example, ratchets should be checked to ensure that they hold and are not loose. Cords, hoses, and flexible scopes should be placed to avoid kinking and damage of internal components. They should never be tightly wrapped but, instead, should be packaged as loosely as possible. Instruments with screws and pins should always be checked to ensure that they hold device components securely.

Objective 4: Note important considerations for sterilizing and storing surgical devices and for implementing a preventive maintenance program.

Careful handling is at the heart of preventing instrument damage. Instruments must be placed carefully on sterilizer carts. Whenever possible, trays to be sterilized should be placed flat on the sterilizer cart, or within the sterilizer's chamber, to keep instruments from contact with each other. After sterilizing instrument trays should be placed carefully onto storage shelves. Trays should be kept flat and should not be tipped on end, to keep instruments from coming in contact with each other and possibly being damaged.

A preventive maintenance program is essential to maintaining the life of medical devices. Instruments should be regularly checked by qualified instrument repair
technicians to ensure that they are in good working order and that repairs are done before the instrument is badly damaged. The frequency with which instrument trays are used should determine how often the trays are checked. For example, some sets may need to be checked once a month or quarterly; others will need an annual maintenance check.

Effective policies and procedures are necessary to guide the handling of all surgical
instruments, to best assure patient safety, and to protect the facility's financial investment. Never use shortcuts when processing instruments because the corrosion, spotting, staining, rusting, and physical damage that may result can make the devices unsafe and unusable. Taking the time to properly process, handle, inspect, and care for instruments will ensure patient safety and minimize the expense of instrument purchase, processing, maintenance, and repair.