Naveed Intl’s instrument decontamination guidelines follow the standards outlined in the Health Technical Memorandum (HTM 01-01) for the decontamination of surgical instruments (medical devices) in acute care settings.[Link]

Cleaning must always take place before any disinfection or sterilization process. It involves removing organic and inorganic debris from instruments. If visible debris is not properly eliminated, it can hinder microbial inactivation and compromise the effectiveness of disinfection or sterilization.

Proper care of your instruments begins the moment they are received, ensuring the best start and extending their service life.

• Unpack Immediately: Remove all transportation packaging, protective caps, and foils before storage or processing.
• Initial Processing: New instruments must go through the full reprocessing cycle separately from older instruments to avoid contamination from corrosion. Ideally, they should be processed twice, although once is acceptable if necessary.
• Avoid Cross-Contamination: Incorporating new instruments into sets containing corroded instruments can increase the risk of corrosion until the passive layer is fully established.
• Vulnerability Factors: New instruments are more sensitive to poor water quality, inadequate drying, improper maintenance, or poor steam quality during sterilization, which may cause rust if not managed correctly.
• Before First Use: All new instruments must undergo the same cleaning and sterilization process as used instruments. Cleaning is critical, as packing material residues can cause stains or deposits during sterilization. Ensure instruments are visibly clean before use.

Storage Guidelines for New Instruments

• Store at room temperature in a dry, well-ventilated space or cabinet.
• Avoid storing near chemicals, especially chlorine-based products, as vapors can cause corrosion.
• Prevent condensation inside packaging by keeping instruments away from fluctuating temperatures.
• Handle with special care to protect the thinner passive layer on new instruments.

Tungsten Carbide (TC) inserts are significantly harder than standard stainless steel, allowing them to retain sharp edges much longer. However, due to their unique properties, TC instruments require special care during cleaning and sterilization to maintain performance and longevity.

Ultrasonic Cleaning

• Always follow the manufacturer’s instructions regarding solution dilution and immersion time.
• Use only cleaning solutions that contain a corrosion inhibitor to protect the inserts and instrument surface.

Steam Autoclaving

• When sterilizing in a steam autoclave, always include a corrosion inhibitor (e.g., surgical milk such as “Clean Act” or equivalent).
• Ensure that TC instruments dry thoroughly during the “dry” or “vent” cycle.
• Never remove instruments while wet, as residual moisture can still lead to corrosion.

Sterilization is only effective when the sterilizing agent (e.g., steam) reachesall instrument surfaces. To ensure full exposure, hinged instruments such as hemostats, scissors, and extraction forceps must be sterilized in thefully open position. This practice guarantees proper contact of the sterilizing agent with all internal and external surfaces, thereby ensuring patient safety and compliance with sterilization standards.

Final Polish Protection: Do not attempt to remove the final polishing film by rubbing or sanding. This protective layer is essential for maintaining the integrity of the instrument surface.

Water Exposure: Instruments should never be left in tap water, as acidic or alkaline pH levels can strip away the protective chromium oxide layer, while chlorite ions may cause pitting. Additionally, contact with copper, iron, or manganese can result in brown or rainbow-like discoloration. If required, distilled water with a neutral pH may be used sparingly.

Autoclave Performance: Proper sterilization requires that the autoclave be fully functional, particularly the drying cycle. Instruments should always exit the autoclave completely dry, whether wrapped or placed loosely on trays. Any residual moisture can leave water spots or circular stains, with their appearance influenced by pH levels and mineral or metal content in the water. A flawless drying cycle significantly reduces the risk of surface deposits.

Staining from Magnetism: Stains from metal deposits or plating are most often observed on highly magnetic areas, such as locks, serrations, and ratchets. New instruments may exhibit this more prominently due to residual magnetism from carbon steel production tools. Over time, this effect diminishes with use and repeated sterilization.

Maintenance Tip: Regular application of surgical instrument oil (Instrument Milk)—especially between overlapping or hinged surfaces—helps reduce staining, enhances lubrication, and prolongs the service life of instruments.

Corrosion

Corrosion commonly develops when blood, organic matter, or debris accumulate in areas such as box locks, ratchets, serrations, and hinges. To prevent this, instruments must be meticulously cleaned, ensuring all residues are removed.

• Moisture Control: Excessive moisture on the instrument surface significantly increases the risk of corrosion. Proper drying after cleaning and sterilization is essential.
• Autoclave Practices: Always preheat the autoclave and allow the drying cycle to complete fully—rushing this step can lead to spotting and corrosion. Foreign deposits within the autoclave chamber may also transfer onto instruments, so routine cleaning and maintenance of the autoclave interior are critical. Wiping the chamber with a solution of acetic acid (equal parts vinegar and distilled water) helps remove impurities and prevent buildup.
• Stress Corrosion: Instruments with closed box locks during sterilization are at risk of stress corrosion due to expansion and contraction during heating and cooling. Always sterilize hinged instruments in the open position.

Pitting

Pitting is one of the most destructive forms of corrosion, permanently compromising instrument integrity.

• Causes: Direct exposure to saline solutions, blood, iodine, potassium chloride, and similar compounds will trigger pitting if instruments are not rinsed promptly. High-pH detergents used in cleaning (such as B-9) may also contribute.
• Prevention: Thorough and immediate rinsing after exposure to corrosive substances or cleaning agents is essential.
• Irreversibility: Once pitting occurs, the smooth surface of the instrument is permanently eroded. Pitted instruments cannot be fully restored and should be replaced immediately, as they are far more susceptible to further corrosion and pose a greater risk during use.

Water Quality in Instrument Reprocessing

The quality of water used during reprocessing plays a vital role in ensuring the longevity, functionality, and safety of surgical instruments. Water is not just a medium but an active component of the cleaning and sterilization process, and its composition directly impacts outcomes.

Functions of Water in Reprocessing

Water serves multiple purposes throughout the reprocessing cycle:

• Dissolves cleaning agents and treatment solutions.
• Transfers heat and mechanical forces to instrument surfaces.
• Removes soluble contaminants, dirt, and residues.
• Flushes away detergents, disinfectants, and debris.

If water quality is poor, both the effectiveness of the treatment process and the appearance of instruments may be compromised.

Impact of Water Composition

All natural water contains dissolved salts and minerals, with concentrations varying by source and purification method.

• Hard Water: Can form lime deposits and scale on instruments, which are difficult to remove and may trap corrosion beneath.
• Softened Water: When exposed to high temperatures, alkalinity may rise, leading to damage—particularly on aluminum surfaces during thermal disinfection cycles.
• Evaporation Residues: As water evaporates, minerals remain as deposits. Chlorides are particularly harmful, as they can cause pitting in stainless steel instruments when present in high concentrations.
• Discoloration: Small amounts of silicates, iron, copper, or manganese in water can lead to brown, blue, black, or iridescent stains. Although generally harmless, these discolorations are undesirable and indicate residual deposits.
• Extraneous Rust: Drinking water from corroded piping may introduce rust particles, which adhere to instruments and promote corrosion.

Best Practices for Water Use

• Always use fully demineralized water for the final rinse to minimize chloride-induced pitting, staining, and discoloration.
• Demineralized water also stabilizes anodized aluminum surfaces, ensuring long-term protection.
• Maintain water systems and monitor water composition regularly to reduce the risk of deposits and corrosion.

By prioritizing water quality, facilities can significantly extend the service life of surgical instruments, minimize corrosion risks, and maintain compliance with infection control standards.

Debris can be removed from instruments either through manual cleaning—using a surfactant or detergent with water—or through automated processes such as ultrasonic cleaners or washer-disinfectors combined with appropriate chemical agents.

Following cleaning, instruments must be thoroughly rinsed with water to eliminate any residual detergents or chemicals. Care should be taken to minimize splashing during both cleaning and rinsing to reduce contamination risks.

When selecting cleaning methods and equipment, several factors must be considered:

• Effectiveness in removing organic and inorganic matter.
• Compatibility with the materials and design of the instruments.
• Occupational health and safety risks, including staff exposure to blood, body fluids, and chemicals.

Automated cleaning systems are often preferred because they:

• Eliminate the need for presoaking or manual scrubbing.
• Improve cleaning consistency and effectiveness.
• Enhance worker safety by reducing direct exposure to contaminants.
• Increase productivity in high-volume settings.

In summary, while both manual and automated cleaning are acceptable, automated methods provide a safer, more efficient, and more effective approach for processing contaminated surgical instruments.

If immediate manual cleaning is not possible, instruments should be placed in a suitable container and soaked with a detergent, disinfectant-detergent, or enzymatic cleaner. This prevents patient material from drying on the instrument surfaces, making subsequent manual cleaning easier, more effective, and less time-consuming.

For enhanced safety, long-handled brushes are recommended to maintain distance between the hands and sharp instrument surfaces, thereby minimizing the risk of accidental injury.

All instruments should be considered contaminated until they have been fully processed through the sterilization cycle (unless processed using a thermal washer/disinfector with a validated high-level disinfection cycle).

To minimize the risk of injury from sharp instruments, personnel must:

• Wear puncture-resistant, heavy-duty utility gloves when handling or manually cleaning contaminated instruments.
• Use appropriate personal protective equipment (PPE), including a facemask, protective eyewear or face shield, and a gown or jacket, since splashing is common during cleaning.
• Avoid reaching directly into trays or containers where sharp instruments are not clearly visible. Instead, use forcepsor carefully empty instruments onto a towel for safer handling.