Introduction

During orthopaedic surgery instruments become contaminated with blood, tissue and bone chips. Saline and irrigation fluids are corrosive to instruments and these are often used for preventing heat necrosis of bones during orthopaedic procedures. These must all be removed during the cleaning process prior to sterilisation.

Basic and more specialised orthopaedic instruments that are made from stainless steel can be cleaned and sterilised as discussed in the Care and sterilisation of instruments notes. Often orthopaedic instruments have some very heavy large components as well as small delicate ones. It is important not to stack heavy instruments on top of others as this can cause damage, especially if they are placed in an ultrasonic bath or washer/disinfector.

Instruments with Lumen

Instruments such as drill sleeves should be cleaned internally with a small circular brush (pipe cleaners can be useful) to ensure all blood debris is removed. A water jet can also be used to flush it through and as a final check a drill bit or Steinmann pin can be passed through the lumen.

Items That Can Be Disassembled

Depth gauges and drill guides with removable ends must be taken apart for cleaning. It is important for the nurse to be able to reassemble the instruments correctly ready for use in the next surgery.

Implants

Often more than one size of implant is opened on to an operating trolley when the surgeon is deciding on the repair. If the implant is not used it can be cleaned and resterilised. However, it is important to remember that implants that have been used must be disposed of. If a plate is repeatedly contoured (bent) or a screw is placed into a bone it can be stressed and be weakened and so should obviously not be used in another patient. Some implants are purchased sterile but most are unsterile. New implants do not need cleaning prior to sterilisation.

General Guidelines

Below are some general guidelines in the care and maintenance of orthopaedic equipment. However, it is important to remember all powered instruments, air or battery driven, should be operated, cleaned and sterilised according to the manufacturer's recommendations.

Cleaning of Air-Driven Equipment

After each use the equipment should be disassembled, saw blades, nuts, drill bits etc., and then cleaned externally without immersing them in water. Disinfectant wipes are useful for this as they can be disposed of afterwards preventing any recontamination. Quick coupling chucks are cleaned with a small brush, ensuring the collars are moved to check for contamination. Ideally an air jet should be used to dry the equipment before oiling.

Air-driven equipment should not be left wet; if they are not to be resterilised immediately they must be dried.

Air Hoses

The outside of the air hoses should be cleaned with a mild detergent and soft brush or cloth. Water should not be allowed to enter the hose, so the ends should remain out of the sink or bowl or alternatively the ends can be connected together. Specially produced ends are available to seal the hose to allow them to be washed in a washer/disinfector. The distributor of the air hose will be able to advise whether this is possible. Moving parts are oiled as discussed later.

Oiling

After cleaning, all equipment with moving parts should be oiled to prevent any parts sticking or failing. Specialised ASIF or AO oil should be used and this is available from veterinary orthopaedic stockists. AO oil can withstand sterilisation temperatures without hardening; other non-medical oils or lubricants do not do this and will only cause damage to the instrument. Once the oil has been applied to the moving parts, the equipment should be attached to an air supply and run for 20 seconds in both forward and reverse to distribute the oil throughout the piece of equipment.

Lubrication/Greasing

This is usually carried out in the yearly service by a recommended manufacturer, so it is not generally part of the veterinary nurse's role.

Sterilisation

For most items air-powered equipment can be steam autoclave-sterilised up to a maximum temperature of 140°C, but it is important to confirm this with the manufacturer's guidelines. It is important that items are not placed on top of air hoses during the sterilising cycle and their ends should not be connected to allow steam to enter cavities. Batteries must never be steam sterilised and are usually kept unsterile and placed into the hand piece with a sterile transfer collar that is then classed as unsterile and removed by the circulating nurse.

New Instruments

New instruments should also be cleaned, rinsed, dried and oiled before their first use.