Archive September 2018 XIX, No. 9

Infection Prevention: The Instrument Whisperer Has Spoken

Tips on dealing with instrument repair and maintenance.

Weston "Hank" Balch

Weston "Hank" Balch, CRCST, CIS, CHL


INSTRUMENT ATLAS Rick Schultz's illustrated guide to conquering the world of surgical instrument inspection.

The Instrument Whisperer. That's what they call Rick Schultz, the author of The World of Surgical Instruments: The Definitive Inspection Textbook, a 500-plus-page illustrated guide to inspecting and identifying surgical instruments. From tungsten carbide needle holders to stainless steel forceps, the book features more than 1,100 high-resolution images that demonstrate everything from how to inspect the gaskets and latches on sterilization containers, to how to identify inspection points and damaged instruments. It should be required reading for you and your reprocessors. Here are a few of the many pearls you'll find.

1Know your instrument repair costs. Few know their instrument repair costs, and that's a problem. Do you have an hourly rate model or an annual capitation agreement with your repair vendor? Yes, repair pricing can be confusing. Here are a few of the critical questions Mr. Schultz suggests you ask your potential repair vendors. "Does the repair rate include complete refurbishing?" "How do you price instrument repairs that are not on the price list?" "What is the vendor's availability for repairs?"

2Stop engraving your instruments. One of the potential root causes of instrument damage might surprise you: instrument engraving, which could lead to the formation of biofilm in the resulting troughs. With high-resolution close-ups and prevention highlights, the book also brings you face-to-face with damaged pin cutters, flaking orthopedic mallets and bent insufflation needles.

3Inspect instruments with a sharp eye. A key to improving patient safety as well as physician satisfaction? Identify issues with instruments at the point of inspection, rather than at the point of use. Better for a reprocessing tech to identify a dull scalpel blade than a surgeon. Make this happen, says Mr. Schultz, by building a proactive instrument quality management program.

4Size matters (down to the millimeter). What is the difference in the bite size of a Kerrison rongeur and its bite opening? Your reprocessors had better know instrument measurement specifications, not only for identification purpose but for patient safety as well. Clinical outcomes can come down to mere millimeters. It was incredibly useful to read Mr. Schultz's explanation of the various tools available for validating instrument length, degrees of angle and the important differences in these measurements across instrument specialties.

5What's staining my instruments? We all know that poor steam or water quality cause most instrument stains, but there are 6 other common staining categories and potential causes. Whether it's the dark brown staining of low pH caused by improper detergents or the multicolored stains of localized "hot spots" that occur during processing, the book helps you identify and react to these enemies of surgical instruments.

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