We have a lot of problems cleaning the soil off of the Bi-polar and Mono-polar surgical instruments at our facility, do you have any suggestions?
The problem of cleaning eschar off of electrosurgical instruments has been an issue since these instruments first started being used. As you know these instruments are used to cauterize tissue to minimize the amount of bleeding at the surgical site. This is done by passing an electrical current through the instrument either through opposing tips with different electrical charges or through a mono-polar tip that passes the current through the patient to a grounding pad. In the case of mono-polar cauterization the tip of the instrument touching the tissue does the brunt of the work, while the weakened electrical charge passes through the patient to the grounding pad. (I hope that everyone is checking the insulation on their electrosurgical laparoscopic instruments after each use, since a break in the insulation can cause a “misfire” during a surgical procedure. Electrical current can pass through breaks in the insulation, and if this break is close to any other organ the current will take the closest route out of the instrument, damaging tissue that was not meant to be cauterized). When these tips cauterize, tissue, blood and body fluid are basically cooked onto the instrument. This burned on tissue or Eschar (your new $50.00 word) should be removed AT POINT OF USE. Many surgical “kits” come with a little scouring pad that the surgical tech should use to remove the eschar AT POINT OF USE. Each time the instrument is used the eschar should be removed, but we’ve all seen those bipolar forceps with layer upon layer of burned on blood and tissue come into decontamination. I have capitalized and underlined “at point of use” twice now for a reason, The Association of Surgical Technicians, AORN, and AAMI all state in their recommended best practices that “The cleaning of instruments should begin during the surgical procedure to prevent drying of blood, soil and debris on the surface and within lumens.”(AST RSOP for the Decontamination of Surgical Instruments, Standard of Practice I). If you are constantly receiving electrical surgical instruments with layers of eschar on them, then someone in the OR is not doing their job correctly. Here I would suggest you get together with your manager arm yourself with photographs of the instruments as evidence and written recommended best practices, the A.S.T. version is readily available on line and set up a meeting with the Director of the OR.
Now as far as the removal of eschar from electrosurgical instruments, my first recommendation would be the use of a stiff plastic brush, soak your instruments as recommended in their IFU preferably in a high quality multi-enzymatic detergent (see our deconex® Power Zyme http://www.potomaclabs.com/power-zyme.php). Brush them under the soak water surface to remove the eschar. If staining from the burned on tissue is still a problem, and the material you are cleaning is stainless steel, I would suggest you use a surgical stain remover (deconex® 34GR is great for the removal of both organic and inorganic stains on surgical instruments and Washer/Disinfectors http://www.potomaclabs.com/deconex-34gr.php) again refer to the IFU of the product you are using.
One more suggestion I would like to make is that if you are in a larger institution and have more than one washer, you dedicate one of your washers for instruments that are difficult to clean. Use a two component cleaning chemistry system in your washer (deconex® Twin pH10/Twin Zyme http://www.potomaclabs.com/deconex-twin.php) Two component cleaning chemistries like the “Twin system” employee both an enzymatic detergent and a mildly alkaline detergent that when combined in the washer/disinfector form an extremely effective cleaning system and have demonstrated efficacy in cleaning hard to clean instruments like the DaVinci Endowrist instruments.