Washing of instruments by the nurse after a case

shodobe · Feb 15, 2004

I'm a nurse in the OR and i want to know if in your hospital that nurses wash any of the instruments at all. This is a controvesy in our OR the nurses are told they must wash particular instruments.

There are only a few things we have to wash in the OR and one is some specialty vascular instruments we use on AV fistulas. I just don't want them going over to the CS to be taken of, too delicate. We also take care of cysto instruments in the department since we keep them here. Everything else goes to CS for processing. Mike

Daqueengene · Apr 29, 2004

I'm a nurse in the OR and i want to know if in your hospital that nurses wash any of the instruments at all. This is a controvesy in our OR the nurses are told they must wash particular instruments.

The cleaning of surgical insturments should be done in the central processing area and all instruments should go through similar processes to ensure uniformity of care and uniform levels of practice. All patients should be treated with the same level of care, processing some instruments in central processing then others in the sink in the OR represents two different levels of care and can come back to haunt you during inspections and surveys. Surgical instruments have many small moveing parts, rough and grooved surfaces, hinges and cannulas. These instruments are very difficult if not impossible to clean adaquately by hand even with brushes. Just eyeballing it you cannot ensure that all biological material is removed. ultrasonic cleaners utilize enzymatic solutions that penetrate protien molecules and break them apart, they use agitation and heat to continue the clean and remove particles from even hinged and cannulated surfaces. If istruments are being cleaned in the OR they must be cleaned in an area that is considered dirty they cannot be cleaned in scrub sinks, substeril rooms ect.. dirty instruments must go to a dirty area for decontamination then move on to the sterilizing area then on to the steril storage and or the operative field. Occasionally instruments must be flashed for another case but they should be properly decontamed and cleaned then sent back for flashing in the OR. It is always best to use instruments that are processed in CS but if you have to flash instrument sets they must be cooked on a 10 min cycle for trays of instruments and any with cannulas must be done on a 10 min cycle. Single instruments can be flashed on a three minute cycle as long as metal is not touching metal and all clamps are open wide. Standards of care are well deliniated in AORN standards and in the standards set out by the steril processing professional organizations. Cs can be taught how to handle special instruments safely and with out causeing damage to them. We aren't the only people who can clean delicate things we must be involved in the training of the people who will be cleaning then. I have seen many OR RNs and ORTs break and or tear up many different instruments and equipment themselves so it can happen to the best of us and we need to learn to let others take the role they have been given and rise to the higest level of preformance and know we all are human and can make mistakes.