Post-Operative Cleaning and Sterilization

Post-Operative Cleaning and Sterilization

• After general surgery, clean the surgical suite to prepare for the next day’s procedure.
• Surgical instruments and gowns require thorough cleaning and sterilization before reuse.

Surgical Suite Cleaning Room

• Designate a specific room near the surgical suite for cleaning and sterilizing surgical instruments.
• The main goal of sterilization is to eliminate all organisms from the instruments.

Handling Laundry from Surgery

• Separated from regular hospital laundry, surgical laundry must be processed in a specialized machine.
• Includes:
  • Gowns
  • Drapes
  • Towels
• Cloths affected by blood should first be rinsed in cold water before laundering.

Cleaning Surgical Instruments

• Gather all dirty instruments within the surgical pack; even unused instruments in an opened pack are considered dirty.
• Ensure all scalpel blades or needles are removed carefully from the pack before proceeding.

Cleaning Procedure

• Clean instruments in cold water with a neutral pH cleaner.
• Instruments should be brushed clean by hand, ensuring thorough inspection for damage.
• Perform a final rinse with water before proceeding to disinfection.

Ultrasonic Cleaner Use

• Place cleaned instruments in an ultrasonic cleaner filled with:
  • Distilled water
  • Enzymatic cleaner
• Ensure instruments are positioned open to allow effective cleaning.
• Run the cleaner for 10-15 minutes to ensure that any residual particles are loosened and removed.

Drying Instruments

• After removing instruments from the ultrasonic cleaner, rinse them with distilled water.
• Dry the instruments on a towel, and apply instrument lubricant (often called "instrument milk") either via spray or submersion before air drying.
• Ensure complete air drying prior to wrapping.

Wrapping Instruments

• Instruments must be wrapped for sterilization, commonly with:
  • Cloth
  • Paper
• Some instruments may be placed in trays prior to wrapping.
• Packs should include an indicator strip to verify that sterilization has reached the center.
• Close packs with special indicator tape.

Instrument Pack Example

• Typical contents of a surgical pack include:
  • 23 instruments total, examples include:
  • Straight Kelly Forceps (1 pr, yellow)
  • Curved Kelly Forceps (1-2 pr, green)
  • Curved Mosquitos (4 pairs, yellow & black)
  • Allis Tissue Forceps (1 pr, orange)
  • Carmalts (1-2 pr, white)
  • Crile forceps (1 pr, black)
  • Various others including scalpel handles, spay hooks, scissors, and towel clamps.

Packing Arrangement

• Each veterinary practice has specific arrangements for instruments in the pack.
• The “diamond” wrapping technique for the contents is universally applied.

Individual Wrapping

• Instruments wrapped individually should be placed within sterilization pouches for added safety.

Labeling Packs

• Each pack and instrument must be labeled with:
  • Contents
  • Sterilization date
  • Expiration date for re-sterilization if not utilized prior.

Sterilization Methods

Autoclave

• The autoclave employs distilled water to generate steam under high pressure to sterilize instruments.
• Instrument arrangement is crucial for allowing adequate steam circulation.

Ethylene Oxide Gas Sterilization

• Used for sterilizing plastic surgical supplies sensitive to heat or moisture.
• This process takes longer (approximately 12 hours) and requires airing contents for an additional 24 hours post-sterilization due to toxic gas concerns.

Endotracheal Tubes

• Some practices utilize disposable endotracheal tubes; others clean and sterilize them.
• To clean:
  • Remove saliva residue, utilizing tools like pipe cleaners.
  • Soak for cold sterilization and hang to dry.

Surgical Drapes

Cloth Drapes

• Used to maintain a sterile surgical area, cloth drapes should be washed, folded (fan-folded preferred), and sterilized for reuse.
• Can be fenestrated or presented in a 4-pack.

Paper Drapes

• Single-use, made from rolls, cut to size, and sterilized before application in surgery.

Surgical Gowns

• After washing, cloth surgical gowns can be folded and sterilized.
• Ensure proper folding technique keeps the gown’s front sterile when donned.

Cleaning the Surgical Suite

• Spot cleaning can be conducted in-between surgeries; however, deep cleaning is reserved for end of day.
• Avoid sweeping or mopping during surgeries to prevent dust aerosolization, which can contaminate sterile fields.
• Post-surgery cleaning should include:
  • Removal of dirty materials.
  • Cleaning monitors and equipment with disinfectant.
  • Disinfection of anesthesia equipment.
  • Proper cleaning and organization of all surgical surfaces, including tables and floors.
  • Use dedicated mops and disinfectants exclusive to the surgical suite.

References

• Sirois, M. (2021). Elsevier's Veterinary Assisting Textbook. 3rd Edition.