One purpose of Sterile Processing is to provide instruments to the surgical field that function as they are intended. Repeated use or use for purposes an instrument was not intended to be used for can cause instruments to not function correctly. Two categories of instruments with a high need for routine function testing are cutting instruments and needle holders.
Surgeons depend on using scissors that when used, produce a clean, smooth, cut of the tissue. When a scissor is not sharp a chewing action can result leaving jagged tissue edges. A dull scissor can also result in surgeon hand fatigue when the cutting action requires more force. Proper selection of the scissor should be based on the type of tissue to be dissected. Using a scissor that is too small or delicate for the tissue to be dissected can cause damage such as a stress fracture. Needle holders are also subject to the same damage when the needle used is too large for the needle holder tip or the tissue is too thick for the needle to easily pass through it.
Inspection is the first step in assuring an instrument is functioning correctly. This step can reveal a stress fracture in the joint area of the scissor or needle holder and any visible damage to the scissor cutting edges or needle holder jaws. Physical damage is an indication the instrument should be removed from service and repaired or replaced. Physical damage is likely to require replacement.
Scissor function testing is easily accomplished by using a testing material intended as scissor testing material, scissor manufacturer recommendation, or a surgical instrument repair company. Open the scissor to allow exposure of scissor cutting edges, place outer two-thirds portion of the cutting edges over the testing material and firmly close the scissor holding the scissor by finger holes. The scissor should cut easily and cleanly from the back to the end of the tips. When the scissor does not perform in this manner, remove from service and repair or replace.
Needle holder function testing is easily accomplished by closing on the first ratchet and holding the instrument jaws in front of light to determine the jaws meet evenly. Aluminum foil may also be used to determine that the needle holder jaws have even serrations to the tips, or the smooth jaws are even surfaces over the entire jaw. The needle holder jaws are placed on either side of the aluminum foil and closed on the first ratchet, then opened and removed. The pattern on the aluminum foil will show the even serrations or smooth jaws. When the serrations are worn at the tip, this is an indication the needle holder will not properly hold a needle which results in the needle turning when being pushed through tissue.
Scissors that do not cut easily and cleanly or needle holders that do not hold needles securely, can result in a delay of a procedure while a properly functioning scissor or needle holder is provided, tissue being resected to a greater extent than planned due to a jagged edge resulting from using a damaged scissor, and an erosion of trust in having properly functioning instruments for every procedure.
Quality is a properly functioning instrument every time.
About the author
Joan M Spear is AKI Ambassador for the U.S. and Canadia. She is an Independent Consultant. Her passion for instrument issues led to authoring patient safety columns, “Instrument count sheets and set reviews as patient safety tools” and “Dirty Instruments Present Patient Safety Issues; the Role of the Perioperative Team” in the AORN Journal.