Dennis Wambua

 DEPARTMENT: PERIOPERATIVE THEATRE TECHNOLOGY NAME: LUISA NDANU ADMISSION: DPOTT/M-00086/THI/24 UNIT NAME: MAINTENANCE OF OPERATION THEATRE INSTRUMENTS TRAINER: MR. JUMA TASK: ASSIGNMENT DATE 12TH FEBRUARY 2025 INTRODUCTION. The preparation of instruments and apparatus for a surgical procedure is a critical step in ensuring patient safety and achieving intended outcomes. Proper sterilization and organization of surgical tools are essential to prevention of infections, minimizing delays and maintaining a smooth, efficient procedure. Inadequate preparation can lead to complications, prolonged procedures and increased rate of post-operative infections which adversely affect patient’s recovery. This report entails the whole process I used in preparation of operation theatre instruments and apparatus, focusing on the necessary steps to achieve a sterile and functional environment. It also defines the scope of preparation which includes sterilization, inspection and organization of surgical instruments and also the setup of essential apparatus and equipment. OBJECTIVES Major objectives. •To ensure that all surgical instruments are free from contaminates including biological and chemical residues. •To maintain a sterile environment in the operating room. •To reduce the risk of healthcare-associated infections(HAIs) and surgical site infections. •To comply with sterilization standards and guidelines established by health authorities. Specific objectives. •To categorize and clean instruments according to their function and material. •To inspect instruments for damage and proper functionality. •To package and sterilize instruments using appropriate methods. •To store instruments in a manner that preserves their sterility. The report covers the following aspects of preparation for surgical procedures: Sterilization procedure- steps for sterilizing surgical instruments and apparatus for elimination of microbial contamination. Inspection and Functionality check- Ensuring that each instrument is intact, functional and free from defects. Assembly- proper organizational of instruments and apparatus for ease of use during procedure. Cleaning-cleaning process of instruments before sterilization. Storage-Proper storage technique used for sterilized instruments to maintain sterility until use. The main instruments used in the operation include: Cutting and Dissecting instruments- Scalpels of various sizes and blade types, scissors (mayo, dissecting and suture scissors). Grasping and Holding instruments- Adson tissue forceps and tissue forceps (both atraumatic and traumatic). Retracting and Exposing instruments-Both manual and self-retraining retractors. Clamping and Occluding instruments- Hemostatic clamps, Bowel and Vascular clamps. Suturing and Stapling instruments- Both absorbable and non-absorbable sutures and skin staplers. Main surgical apparatus include: Anesthesia machine (with oxygen and nitrous oxide supply, vaporizers). Electrosurgical unit (with probes and cautery). Surgical lights (with adjustable lighting system). Surgical table (with adjustable settings for patient positioning). Suction Machine Sterilization equipment(Autoclave for instruments resistant to high temperatures and pressure and Sterilizing solutions for heat sensitive instruments, also chemical and biological indicators). Other necessary materials include: Sterile drapes and gowns, PPEs, Fluids and medication and patient monitoring equipments. PROCEDURE FOR PREPARATION. The procedure started by wearing protective gears for preparing instruments and the following steps followed: i. Cleaning- This is done to remove contaminants, biological materials and debris from surgical instruments. I used cold water to rinse and remove blood and tissue, scrubbing the instruments with a soft brush on the joints, hinges and crevices where debris was lodge. After, I soaked the instruments in a detergent solution and warm water for ten minutes and rinsed the instruments thoroughly with clean, running water to remove remains of the detergent solution, after the instruments were dried using a clean, lint-free cloth and air drier. ii. Inspection- This is done to identify any functional or structural issues in the instruments before sterilization. I used visual inspection to check for signs of wear, cracks, rust, or corrosion, also checked the sharpness of cutting edges, including scissors and scalpels, I also inspected the handles, hinges and joints for smooth movement, proper alignment and function. For functional testing, I tested mechanical instruments such as clamps or forceps, to ensure they open and close smoothly and securely lock. Any instruments that showed signs of wear or damaged beyond repair was removed and disposed according to hospital policy. iii. Assembly of instruments-Done to ensure proper assembly of instruments according to surgical procedure example: general surgery, orthopedics or neurosurgery. They should be placed in their correct positions on a clean, sterile tray or cassette to avoid contamination. For sterilization ,items like scissors or needle holders were positioned in an open position for thorough sterilization, delicate instruments such as forceps were placed in separate within tray to prevent damage. Instruments with hinges were placed open facing upwards to allow steam to reach all areas. Placing instruments on sterile field-When arranging instruments on the sterile field, the large commonly used instruments like drapes and retractors were placed at the back and more delicate and small instruments like scissors and needles toward the front. Over crowding was avoided on the sterile field for easy visibility and access. iv. Sterilization of instruments- Done to ensure complete elimination of all microbial life from instruments before use. Auto claving method was used for heat-resistant, metal-based instruments such as scissors, clamps, forceps under settings of 121℃ for 20 mins at a pressure of 19 psi. Gas sterilization was used for heat sensitive instruments such as plastic and rubber-based devices under cycle of 60℃ for 6 hours at low humidity. Dry heat sterilization was used for instruments that cannot withstand moisture but requires a longer cycle, was set for 170℃ for 2 hours. After sterilization, instruments were allowed to cool before removing them which prevents introduction of contaminants. Biological indicator was used to verify effectiveness of the sterilization process. v. Storage- Done to maintain sterility of instruments until they are needed for surgery. Sterilized instruments were stored in clean, dry environment with controlled temperature and humidity. Sterilized storage containers were used to keep instruments sealed and protected in sterile closed cabinets with proper labeling for easy identification. vi. Quality control- Done to ensure the integrity of the entire process of instrument cleaning, inspection, sterilization and storage. Documentation was done after the procedure to maintain a log of sterilization cycles and any equipment malfunction. Regular audits of the process were done to ensure adherence to protocols. Random checks will be performed to confirm that they remain sterile and intact. COMMON ISSUES AND SOLUTIONS. a) Corrosion- Harsh scrubbing using a metal brush causing corrosion of some instruments. Solution: Avoid scrubbing instruments harshly when using the metal brush. b) Incorrect assembly- Noticed missing instruments after assembling. Solution: Develop standardized lists and visual guides for assembling procedure-specific trays. c) Incomplete sterilization-Improper cycle time leading to ineffective sterilization. Solution: Regularly calibrate sterilization equipment and monitor cycle parameters. d) Residual moisture- some instruments harbor moisture, leading to microbial growth. Solution: Ensure proper drying times to prevent moisture accumulation. e) Sterile breach-Instruments become contaminated if stored improperly. Solution: Regularly inspect storage areas for cleanliness and proper conditions. CONCLUSION By adhering to this comprehensive procedure, the preparation of surgical instruments can be done efficiently and safely, ensuring patient safety during surgery. Key areas like cleaning, inspection, proper assembly, correct sterilization and meticulous storage are crucial. Regular quality control checks and preventive measures will help address potential issues before they arise, maintaining the highest standards of surgical instrument preparation. Reference https//researchgate.net.com (Preparation of Operation Theatre Instruments and Apparatus. https://apps.who.int (WHO Guidelines for Safe Surgery)