I would like to know what everyone's thoughts are on having your Surgical Instruments closed to the first ratchet or left open on a pin when set on tray's for sterilisation.

Look forward to your thoughts

Regards
Judy Hatton
Team Leader
Sterile Production Centre
Wellington Hospital
New Zealand

Hi Judy,

I believe that surgical instruments must never be closed to any ratchet during sterilization.

As the temperature of the metal changes during the sterilization, the change in temperature is uneven due to the varying thickness's / mass in different parts of the instrument. This causes great stress to build up at the hinge point of the instrument. Over time, these stresses lead to the formation of stress fractures (cracks) in the box lock / pin region of the instrument. Any instrument with a crack in the box lock is damaged beyond the possibility of repair and the instrument may fail catastrophically when a surgeon uses it.

A second consideration comes into effect if the sterilization technique used is Steam or EtO sterilization. The sterilant must come in contact with all surfaces to be sterilized. Without contact between the sterilant and the item to be sterilized, the item is not sterilized. When an instrument is closed with the ratchet, the sterilant can not enter the places where the metal touches metal under tension. This means in the ratchet itself, and on the working tip of the instrument, one may find spots that are not sterilized.

Regards, Pete Bobb