NUEVA ECIJA UNIVERSITY OF SCIENCE AND TECHNOLOGY

Cabanatuan City, Nueva Ecija, Philippines

INSTRUMENT PREPARATION

(DELIVERY SET)

ACTIVITY

1. Identify the following instruments.

1.

2.

3.

4.

5.

6.

7.

8.

9.

10.

11.

12.

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 NUEVA ECIJA UNIVERSITY OF SCIENCE AND TECHNOLOGY
Cabanatuan City, Nueva Ecija, Philippines

ABSTRACTION-
LECTURE

Instrument Selection and Use

Instruments used for delivery of the newborn are delicate and typically designed
for a specific function. Incorrect use of these instruments will damage them and
make it difficult, if not impossible, to use them correctly. For example,
hemostatic forceps are designed to grasp and hold tissue such as blood vessels
or skin. While they can be used to hold a needle for suturing in an emergency,
routine use of hemostatic forceps instead of a surgical needleholder is not
recommended. These forceps are not designed to securely grasp the needle and
using them for suturing will damage the tips making them useless for their
intended purpose. Instruments should also be of the appropriate size for
delivery of the newborn. Using instruments that are too large will exaggerate
hand motions and decrease surgical precision resulting in poor technique and
increased tissue trauma.

It has been reported that repeated use of glass bead sterilizers will make
instruments brittle and dull over time. Any instrument that is used frequently,
handled roughly or cleaned with abrasive materials can be damaged or dulled.
Instruments should be assessed on a regular basis and replaced when
necessary. Scissors and other sharp instruments can sometimes be re-
sharpened to prolong life. Instruments must be gently cleaned after each use to
ensure that all blood and tissue is removed. Proper care will extend the life of
the instruments and help preserve them.

Instrument Sterilization

Prior to surgery, instruments and other supplies are placed in a ‘surgical pack’.
The surgical pack must not only hold the instruments and supplies during the
sterilization process, but also maintain the sterility of the contents until used in
surgery. A variety of packing methods exists, including:

▪ Instruments, with or without an instrument tray, are packed inside a folded

cloth or paper wrap and sealed with tape designed to indicate when
sterilization has been achieved. Other types of sterilization indicators may be
placed inside the pack.

▪ Peel packs –self-sealing ‘envelopes’ used for steam or gas sterilization. A

sterilization indicator is included on the envelope.

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 NUEVA ECIJA UNIVERSITY OF SCIENCE AND TECHNOLOGY
Cabanatuan City, Nueva Ecija, Philippines

Keeping Instruments Sterile During Surgery

Use an extra piece of sterile drape material or the inside of the surgical wrap or
envelope as a sterile space to place instruments during surgery. One of the
most common errors for an inexperienced surgeon is setting instruments down
on an unsterile surface

Sterilization Procedures
Surgical instruments and other material or equipment that will contact the
surgical site must be sterile prior to use. The process of sterilization kills all
forms of life, including bacterial spores and viruses. Chemical disinfection is
not the same as sterilization and is not acceptable as the primary
method of instrument preparation for surgery. Methods of instrument
sterilization include steam (autoclave) and gas (ethylene oxide) sterilization. Dry
heat sterilization using a glass bead sterilizer is not acceptable for initial
sterilization of instruments prior to surgery.

Steam Sterilization

▪ Steam or autoclave sterilization is the most common method of instrument

sterilization.

▪ Instruments are placed in a surgical pack and exposed to steam under

pressure.

▪ A sterilization indicator (required) such as autoclave tape or an indicator

strip is used to identify instruments that have been sterilized.

Ethylene Oxide

▪ Ethylene oxide gas is used to sterilize items that cannot withstand the high
temperature and steam of an autoclave.

▪ Ethylene oxide is highly toxic. Items sterilized with ethylene oxide must be
aerated before use to allow the gas to dissipate.

Reusing Instruments

▪ The instruments must be initially sterilized by autoclaving or gas

sterilization.

▪ Blood and tissue particles on instrument tips must be removed

using alcohol before placement in the glass bead sterilizer.

▪ The tips of instruments must be placed in a hot bead sterilizer

▪ A new set of sterile instruments must be used after every patients.
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 NUEVA ECIJA UNIVERSITY OF SCIENCE AND TECHNOLOGY
Cabanatuan City, Nueva Ecija, Philippines

▪ If the instrument tips have become contaminated by contact with a non-

sterile surface or non-sterile portions of the body (such as contents of
the gastrointestinal tract) a new sterile set of instruments must be used.

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 NUEVA ECIJA UNIVERSITY OF SCIENCE AND TECHNOLOGY
Cabanatuan City, Nueva Ecija, Philippines

ANALYSIS

Case Scenario:

Preparation of Medical Equipment and Supplies: Over the last

month, the delivery room has received rigid containers without filters,
assembled instruments in sterilized sets, and closed versus open
packaged and processed instruments. Why are all three of these
occurrences an issue? Discuss the instrument preparation process. What
can the sterile processing technician do to ensure that all items are
prepared and packaged correctly? What might the operating room staff
have to do if items are received closed, assembled, or without the
appropriate filters, chemical indicators, etc.? How can it affect the patient
if those items are used?

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 NUEVA ECIJA UNIVERSITY OF SCIENCE AND TECHNOLOGY
Cabanatuan City, Nueva Ecija, Philippines

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 NUEVA ECIJA UNIVERSITY OF SCIENCE AND TECHNOLOGY
Cabanatuan City, Nueva Ecija, Philippines

APPLICATION

Equipment Needed:

• Delivery Set (per Affiliated Hospital)

• Chlorine solution
• Gloves
• Detergent and cold water
• Soft brush
• Autoclave Machine
• Glutaraldehyde solution (chemical sterilization)
• Sterile Water

Implementation :

ASSESSMENT
1 Check the used items/instruments
PLANNING
2 • Prepares materials and equipment:
• Delivery Set (per Affiliated Hospital)
• Chlorine solution
• Gloves
• Detergent and cold water
• Soft brush
• Autoclave Machine
• Glutaraldehyde solution (chemical sterilization)
• Sterile Water
IMPLEMENTATION
3 Wash Hand and Don Gloves
4 Decontamination
▪ Place the used items/instruments unlocked and in an open position in a
0.5% chlorine solution. Let them soak for 10 mins
▪ Wear utility gloves, remove instruments from chlorine solution and
rinse them in water

5 Cleaning
▪ Clean the instrument with detergent and cold water using a soft brush.
Scrub the instruments, with special attention to toothed areas and locks,
in a container filled with water to avoid splashing
▪ Rinse them thoroughly to remove all detergent and air-dry them
6 Sterilization
▪ Fill the bottom of the autoclave with water up to the ridge
▪ Place the autoclave drum items loosely, close the lid, and adjust the
temperature and pressure and put on the stove or into an electrically
connected system
▪ Note the time when steam emits from the pressure valve. Keep the
items wrapped for 30 mins and unwrapped for 20 mins at 15 lbs/sq.
inch(106 kPa)at121°C
▪ Open the pressure valve to release the steam and allow the autoclave
to cool for 15-30 mins before opening

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▪ For chemical sterilization –completely immerse instruments like bag

and mask, etc. in Glutaraldehyde solution for at least 10 hours. Prepare
the 2% Glutaraldehyde solution as per the manufacturer's instruction on
the bottle and label the date of reconstitution on the container for
reference. The solution has to be changed after 15 days or as per the
instructions on the bottle
▪ Rinse the items with sterile water to remove the Glutaraldehyde
solution.
Place the items loosely in the autoclave to allow steam to circulate
NOTE: The sterilization method is preferred over HLD (High-level
disinfection)
For chemical sterilization, immerse instruments in 2% glutaraldehyde
for 10 hours
While autoclaving, use a steam indicator to ensure the items are
sterilized
Periodically take samples from the autoclave and send them for lab
investigation to rule out bacterial/viral/fungal presence
For the HLD by boiling method, allow 20 mins after the water starts
boiling
While boiling the instruments, ensure that the lid is closed and the
instruments are well covered in water and that there is no adding or
taking out of the water and instruments during the process
7 Storage Store the instruments in a clean, dry, sterile container
EVALUATION
8 If the container is not opened, the instruments can be used within seven
days. If the lid is opened, resterilize the remaining instruments within
24 hours
DOCUMENTATION
9 Label the package (date, time and signature)

Nursing Tips:

Sterile surgical gloves do not have to be worn if the following criteria are strictly
adhered to:

▪ Gloves are changed after completing the procedure such that new clean
gloves are donned at the beginning of the procedure.

▪ The gloved hands never touch the working (tip) end of the instruments, the
suture, suture needle or any part of the prepped surgical field.

▪ Only the sterile tips of the instruments are used to handle the human’s
tissues.

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