SURGICAL

INSTRUMENTS
 INTRODUCTION
 How to start
• Mention the complete name of the instrument
e.g. medium sized Spencer Well’s curved hemostatic forceps.

 Common Questions
• Explain the built and parts if asked
• How did u differentiate from other similar looking or functional instruments?
• Where do we use this instrument?
• Other uses
• Methods for sterilization
STERILISATION
• Sterilization - all microorganisms like bacteria, fungi, viruses and the bacterial
spores are killed.

• Disinfection - microorganisms are killed or removed except the bacterial spores.

Low level : Decreases the overall number of microorganisms. The tubercle bacilli and
bacterial spores are not killed.

Intermediate level : Kills tubercle bacilli and other microorganism, most viruses and fungi.

High level : Kills almost all microorganisms but does not kill the bacterial spores.
Techniques of disinfection
• Boiling: At 100°C for 5 minutes at normal pressure.

• Formaldehyde vapour: Kept in Formaldehyde vaporizer at 50°C.

• Glutaraldehyde solution (Cidex): Instruments kept dipped in 2% glutaraldehyde

solution for 15–20 minutes.

• Low temperature steam: Exposure to dry saturated steam at a temperature of

73°C for 20 minutes at subatmospheric pressure.
Sterilization of instruments
Autoclaving
• Steam under high pressure.

• Standard autoclaving
• Temperature of 121°C at 15lb/sq inch pressure for 30 minutes for
metallic instruments and 15 minutes for rubber goods (Catheters,
gloves, drains, etc.).

• High pressure autoclaving

• Suitable for bulk sterilization.
• Temperature of 134°C at a pressure of 30 lb/sq inch for 3 minutes
Boiling
• Boiling for half an hour kills all the bacteria and its spores.

• Boiling of the instruments should be continued for half an hour after

water achieves a temperature of 100°C.

• Not suitable for sharp instruments

• Loss of sharpness
• Formation of crust over the instruments
Chemical sterilization
• Sharp instruments are particularly sterilized by keeping them dipped in chemicals.

1) 2% Glutaraldehyde solution (Cidex):

• Immersed in for 4 hours.
• Fiberoptic instruments like laparoscope, laparoscopic hand instruments, Cystoscopes
• In between cases a period of 15–20 minutes of dipping is adequate for disinfection

2) Lysol:
• Sterilization of sharp instruments.
• Concentrated lysol for 1 hour.
• If dilute lysol for 24 hours.

3) 70% alcohol:
• Needles, unused sutures may be kept immersed in 70% alcohol for 12 hours for subsequent use.

4) Sterilization by peracetic acid (Steris):

• Immersion in the chemical peracetic acid at a temperature of 50–56°C for 12 minutes.
Gas sterilization

1) Ethylene oxide gas (ETO):

• A special ethylene oxide gas chamber
• Instruments are kept in the chamber exposed to ethylene oxide for 12 hours, i.e. overnight
• Also used for industrial sterilization.

2) Formaldehyde gas:
• Formalin tablets placed in a formalin vaporizer
• Optical instruments like cystoscope, laparoscope by keeping them in formalin vaporizer for
1 hour
Plasma sterilization
• Liquid hydrogen peroxide is inserted into the sterilizer.

• The liquid is heated up in a vaporizer in order to turn it into gas.

• The hydrogen peroxide gas is heated to an even higher temperature, at which point it turns
into plasma

• Plasma sterilizes by a process called oxidation (free radicals).

• USES:
• Non-hollow loads: eg electrocautery instruments, dopplers, laser probes, defibrilator
paddles, thermometers, Ophthalmic lenses, and harmonic cables
• Hollow loads: Laryngoscopes and their blades, shaver handpieces, fiber optic light cables,
and surgical power drills
• Endoscopes, such as rigid and flexible endoscopes
Others
Gamma irradiation:
• Useful for large scale industrial sterilization.

Direct flaming:
• In case of urgency when an instrument has fallen down from the operation
table
• The instrument is kept in a bowl and some amount of rectified spirit is poured
and flamed.
• Temperature as high as 1400°C.
• Damaging for sharp instruments.

 Hot air oven:

• Ward articles like glass syringes, test tubes may be sterilized in a hot air
• Temperature of 160°C for 2 hours is adequate
SUMMARY
• All the metal instruments are sterilized by autoclaving except sharps

• Sharp instruments – chemical sterilization

• All the rubber articles like gloves and catheters are sterilized by
autoclaving for 15 minutes instead of 30 minutes required for metal
instruments.

• Scopes – Gas/Chemical