- Mayo scissors
- Heavy surgical scissors with short, thick blades for cutting tough tissue, fascia, and suture.
- Metzenbaum scissors
- Surgical scissors with long, thin, delicate blades for fine dissection of soft tissue.
- Mayo vs Metzenbaum — the tell
- Blade shape: Mayo is short and thick (tough tissue/suture); Metzenbaum is long and thin (delicate tissue). Not length.
- Mosquito forceps
- Small, fine hemostatic forceps with serrations that run the full length of the jaw; for delicate vessels.
- Kelly forceps
- A hemostatic forceps whose serrations extend only partway (about halfway) down the jaw.
- Crile forceps
- A hemostat that looks like a Kelly but has serrations running the full length of the jaw.
- Kelly vs Mosquito — the tell
- Serration pattern: Kelly is serrated about halfway down the jaw; Mosquito is fully serrated and finer/smaller.
- DeBakey forceps
- Atraumatic tissue (thumb) forceps with fine rows of interlocking teeth that grasp vessels/tissue without crushing; used in vascular surgery.
- Adson forceps
- Tissue forceps with a single fine tooth (or fine serrations) at the tip, used for delicate grasping such as skin closure.
- Tissue (thumb) forceps
- Tweezer-style, spring-handled forceps with NO ratchet that grasp tissue — e.g., DeBakey and Adson.
- Hemostatic forceps (hemostats)
- Ringed, ratcheted clamps that occlude bleeding vessels (Mosquito, Kelly, Crile); identified by their serration pattern.
- Mayo-Hegar needle holder
- A needle holder with straight, plain cross-hatched jaws and straight ring handles.
- Heaney needle holder
- A needle holder with a grooved/serrated jaw and a curved (angled) handle, designed for deep OB/GYN work.
- Needle holder
- A ratcheted instrument with short, stout, cross-hatched jaws that holds the suture needle without it rotating.
- Richardson retractor
- A handheld retractor with a deep, curved blade used to retract large amounts of tissue.
- Army-Navy retractor
- A handheld, double-ended retractor with flat blades of two depths.
- Self-retaining retractor
- A retractor that holds itself open (e.g., Weitlaner, Balfour), freeing hands and exposing the surgical site.
- Kerrison rongeur
- A forward-cutting rongeur used to bite away bone in spinal surgery.
- Rongeur
- A heavy instrument with spring or box-lock jaws that bites away bone.
- Satinsky clamp
- A curved partial-occlusion vascular clamp used to occlude part of a large vessel.
- Allis clamp
- A grasping clamp with sharp, short toothed tips for holding tough tissue securely.
- Babcock clamp
- A grasping clamp with smooth, rounded, fenestrated tips that hold delicate tissue without crushing.
- Box lock
- The hinged pivot joint where the two halves of a ringed instrument meet; a frequent site of retained soil.
- Ratchet
- The locking mechanism on hemostat/needle-holder handles that holds the jaws closed at set positions.
- Gold ring handles
- An industry convention flagging a tungsten-carbide insert in the instrument's jaws or blades.
- Tungsten carbide
- A very hard material inserted into jaws/blades for longer-lasting grip or cut; flagged by gold handles; avoid chlorine products.
- Stainless steel
- The workhorse instrument metal; protected from corrosion by passivation (a chromium-oxide layer).
- Passivation
- A chemical process that builds a protective chromium-oxide layer on stainless steel so it resists corrosion.
- Titanium (instruments)
- A lightweight, strong, non-magnetic metal for microsurgery/ophthalmic instruments; often anodized (colored).
- Anodizing
- An electrochemical (often colored) protective finish applied to titanium and aluminum.
- Single-use device
- A device labeled for one patient and one procedure; must not be reprocessed unless legally remanufactured.
- Reposable device
- A hybrid combining a reusable component with limited-use or disposable parts; each tracked to its own use count (e.g., bipolar cords, breast sizers).
- Surgical-grade vs floor-grade
- Surgical-grade instruments use higher-quality steel and finish for repeated reprocessing; floor-grade are lower quality and not for the sterile field.
- Implantable device handling
- Track to the patient, use the correct washer cycle, document sterilization, and quarantine until the biological indicator is read.
- Osteotome
- A bone-cutting/chiseling instrument (orthopedic) tested for a sharp, undamaged edge.
- Instrument marking methods
- Laser etching, mechanical etching, color tape, or dipping — applied so they don't harbor soil or impair function.
- Ophthalmic instruments
- Tiny, delicate (often titanium) instruments; processed with meticulous cleaning and rinsing to prevent TASS.
- Robotic instruments
- Reposable/limited-use instruments with defined use counts; require specific disassembly and washer cycles per IFU.
- Visual inspection (instruments)
- Examination under good light and magnification for cleanliness AND function before assembly.
- Cleanliness inspection criterion
- Any visible soil, bioburden, adhesive, or staining fails the instrument — it returns to decontamination.
- Integrity/function checks
- Sharpness, jaw and tip alignment, working ratchets and box locks, and no cracks, pitting, corrosion, or chips.
- Borescope
- A thin optical/video probe used to inspect inside lumens and channels for retained soil, debris, scratches, or moisture.
- Insulation tester
- A device that checks the coating on electrosurgical instruments for breaks, cracks, or pinholes.
- Why insulation testing matters
- A coating defect lets current escape and burn tissue away from the surgical site — an injury the surgeon may not see.
- Sharpness test
- Cutting scissors/osteotomes through a size-appropriate material (gauze, index card, dowel rod, leather, rubber band) all the way to the tip.
- Sharpness test — pass criterion
- The blade cuts cleanly at several points along its length to the tip; snagging or failing to cut means reject/sharpen.
- Continuity tester
- A device that verifies powered and cabled instruments conduct electricity correctly.
- Preventative maintenance (PM)
- Scheduled inspection, testing, and servicing — including PM of the inspection/testing tools themselves (borescope, insulation tester).
- Repair routing
- A dull, damaged, or out-of-spec instrument is tagged and sent for PM/repair, NOT assembled into a set.
- Cleaning before and after PM/repair
- Instruments are cleaned and inspected both before AND after PM/repair so a vendor return is verified clean before reuse.
- Instrument lubrication
- Apply a water-soluble, steam-penetrable 'instrument milk' to hinges per IFU — never oil/petroleum, which blocks the sterilant.
- Set assembly to count sheet
- Build trays to the count sheet, even weight distribution, within weight limits, with delicate tips protected.
- Open/unlocked for sterilization
- Hinged instruments are assembled open and unlocked so the sterilant reaches every surface, including the box lock.
- Internal chemical indicator placement
- Placed in the hardest-to-reach spot of the set (often the center) where sterilant penetration is most challenged.
- External chemical indicator
- Placed on the outside of every package to distinguish processed from unprocessed packs.
- Microsurgical instrument inspection
- Tip alignment is the most critical check — even slight misalignment ruins precision.
- Ratchet test
- Check that the ratchet engages and releases smoothly and holds the jaws closed; a ratchet that won't hold is rejected.
- Endoscope/optical lens check
- Inspect for lens clarity and absence of fogging or scratches that degrade the image.
- Powered-tool inspection
- Verify battery charge/continuity and smooth operation before the set is released.
- Tray weight limit
- Sets are kept within weight limits with even distribution so the load sterilizes and dries properly (common benchmark ~25 lb).
- Unique Device Identifier (UDI)
- An FDA-required code that identifies a specific medical device through distribution and use; feeds instrument tracking.
- Instrument tracking system
- Manual or electronic system that records, locates, and traces every instrument/tray and stores repair histories.
- Lot control number
- A number letting staff trace a package to the sterilizer used, the cycle date, and the load (cycle) number — the basis of recall.
- Root Cause Analysis (RCA)
- A structured method that finds the underlying cause of an error so it can be permanently corrected, not just the symptom.
- Fishbone (cause-and-effect) diagram
- A visual tool that maps the possible causes of a problem into categories to support root cause analysis.
- FMEA
- Failure Mode and Effects Analysis — a proactive method that identifies how a process could fail and the impact of each failure.
- Lean / Six Sigma
- Process-improvement frameworks used in SPD to reduce waste, variation, and turnover; paired with KPIs and action plans.
- SWOT analysis
- A planning tool listing Strengths, Weaknesses, Opportunities, and Threats to guide process improvement.
- Key performance indicators (KPIs)
- Measured benchmarks (e.g., tray accuracy, turnaround, IUSS rate) used to monitor and improve quality.
- Quality audit methods
- Random sampling, rounding, customer surveys, and storage checks used to verify the process is performing.
- Loaned instrumentation
- Vendor-owned sets that must be cleaned, inspected, and sterilized on arrival per their IFUs — never assumed sterile or clean.
- Loaner — #1 rule
- Every loaner set is decontaminated on arrival; a vendor delivery is never accepted as already clean or sterile.
- Loaner timing
- Loaner sets should arrive well before the case (with count sheet + IFUs) so time pressure does not force IUSS.
- IUSS
- Immediate Use Steam Sterilization (formerly 'flash') — for items needed right away; minimized and tracked as a quality metric.
- SPD–OR communication
- Huddles and conflict resolution between Sterile Processing and the OR that prevent delays, errors, and IUSS.
- Competency and continuing education
- In-services, certification, and documented competencies kept current per facility requirements and renewal frequency.
- IFU (Instructions For Use)
- The manufacturer's validated, FDA-cleared method for reprocessing a specific device; legally binding and reviewed periodically.
- Human factors in reprocessing
- Training/competency variability, attention to detail, adaptability, and safety culture that drive consistency and error reduction.
- Redundancy of safety checks
- Multiple layers of checks so that if one step is missed, another catches it — building resilience to human error.
- Database management (tracking)
- Keeping count sheets, repair histories, and UDI data current through manual and electronic system updates.
- Cleaning precedes everything
- Cleaning must always precede disinfection and sterilization — soil shields microbes; 'if it is not clean, it cannot be sterilized.'
- Biofilm
- A protective layer of microbes and soil that forms when soil dries on an instrument; it resists cleaning and disinfection.
- Point-of-use treatment
- Keeping instruments moist right after use so soil does not dry into biofilm before reprocessing.
- Cavitation
- The imploding of microscopic bubbles in an ultrasonic cleaner that dislodges fine soil from hinges, box locks, and lumens.
- Ultrasonic cleaner
- Uses cavitation to remove fine soil AFTER gross soil is removed; instruments must be open and fully submerged.
- Dissimilar metals in ultrasonic
- Do not mix dissimilar metals (e.g., stainless and titanium/chrome-plated) in one ultrasonic load — galvanic/electrolytic damage.
- Enzyme cleaner
- A detergent containing enzymes that break down organic soil; activity is temperature-dependent and used per IFU.
- Detergent pH selection
- Choose a pH compatible with the instrument — too alkaline or too acidic damages the metal/finish.
- Utility water
- General tap water used for flushing and the early stages of cleaning.
- Critical water
- Treated, purified water (RO/DI) used for the final rinse to avoid mineral and contaminant deposits.
- AAMI ST108
- The standard defining water-quality categories and parameters (utility, critical, steam) for processing medical devices.
- Decontamination PPE
- Fluid-resistant gown, gloves, and face/eye protection — full standard precautions in the highest-risk zone.
- Washer-disinfector loading
- Proper rack placement so spray reaches all surfaces; hinged instruments open, lumens connected to irrigation ports.
- Cleaning verification testing
- QA tests (e.g., protein/ATP residual) on instruments and equipment that confirm cleaning actually removed soil.
- Prions (CJD) processing
- Prions resist normal sterilization; suspected contact requires enhanced processing (extended steam parameters ± chemical treatment); single-use preferred.
- TASS
- Toxic Anterior Segment Syndrome — sterile eye inflammation from residues on ophthalmic instruments; prevented by thorough cleaning and rinsing.
- Specialized cleaning processes
- Ophthalmic, robotic, powered, and flexible-endoscope instruments each follow specific disassembly and washer cycles per IFU.
- Borescope in decontamination
- Used to confirm internal channels/lumens are free of soil and debris — a channel that is not visibly clean is reprocessed.
- Adhesive remover
- A cleaning-toolbox chemistry used to remove tape adhesive/residue from instruments without damaging the finish.
- Cleaning QA planning
- Plan and prioritize the workload, run verification tests, and identify process gaps before they reach a patient.
- Sterile barrier (packaging purpose)
- The package must let the sterilant in during the cycle and keep microbes out afterward.
- Sterilization wrap
- Woven or non-woven wrap (square or envelope fold) for trays/sets; check for holes/tears and method compatibility.
- Peel pouch
- A paper-and-plastic package for small, light items; write only on the plastic side and seal fully.
- Rigid container
- A reusable sterilization container; inspect filters, gaskets, valves, and latches each use.
- Material–method compatibility
- Packaging must match the sterilization method — cellulose works for steam but is banned in hydrogen peroxide/gas-plasma cycles.
- Tyvek
- A flash-spun polyethylene (non-cellulose) material used to package items for low-temperature sterilization.
- Why instruments are dried
- Moisture dilutes sterilants, blocks penetration, causes wet packs, and can abort low-temperature cycles.
- Lumen drying
- Internal channels are dried (air-purge or drying cycle) because trapped water is hard to remove and aborts low-temp cycles.
- Double wrapping
- A second wrap placed perpendicular to the first gives complete, sequential coverage and aseptic opening.
- Peel-pouch writing rule
- Write only on the clear plastic side — ink on the porous paper can bleed through and the paper is the sterilant's entry point.
- Heat sealer quality testing
- Routine checks of seal integrity, temperature, and seal-strength/dye-penetration so pouches do not fail.
- Rigid-container maintenance
- Inspected each use and maintained per IFU; a missing filter or worn gasket is a sterile-barrier failure.
- Internal indicator placement (packaging)
- Position the internal chemical indicator where the sterilant is hardest to reach (often the center of the pack).
- Wrapping textiles and instruments
- Wrap instruments and textiles separately because they need different sterilization handling.
- Packaging weight/density
- Stay within weight and density limits so the sterilant penetrates and the load dries.
- Lumen penetration aid
- A sterilant-penetration aid inserted into a lumen helps the sterilant circulate inside the channel.
- Spaulding classification
- Ranks devices by infection risk: critical (sterilize), semicritical (high-level disinfect), noncritical (low-level disinfect).
- Critical item
- A device entering sterile tissue or the vascular system (most surgical instruments) — must be sterilized.
- High-level disinfection (HLD)
- Destroys all microorganisms except small numbers of resistant spores; the minimum for semicritical items.
- HLD critical parameters
- Minimum effective concentration (MEC), contact time, and temperature — all must be met and monitored.
- Minimum effective concentration (MEC)
- The lowest concentration at which a high-level disinfectant still works; verified with test strips before each use.
- Contact time
- The minimum time a surface must stay wet with the disinfectant for it to be effective.
- Biological indicator (BI)
- A vial/strip of resistant spores that, after incubation, proves a cycle actually killed microorganisms — the only direct proof.
- Chemical indicator vs BI
- A chemical indicator confirms the sterilant reached the item (a process check); only the BI proves the load was sterilized.
- Positive (failed) BI
- Means the load is NOT sterile: recall to the last negative BI, quarantine, remove the sterilizer, document, investigate, reprocess.
- Steam sterilization parameters
- The critical factors are time and temperature held for the cycle (e.g., gravity ~30 min @121°C; prevacuum ~4 min @132–135°C).
- Ethylene oxide (EO) aeration
- Aeration removes residual toxic EO gas from items after the cycle so they are safe to handle and use.
- Hydrogen peroxide gas plasma
- A low-temperature method (e.g., STERRAD) that needs no aeration; cellulose and moisture are not allowed.
- Cellulose in low-temp cycles
- Cellulose-based materials (paper, linen, cotton) are incompatible with hydrogen peroxide/gas-plasma sterilization.
- AORN / AAMI standards
- The professional standards (AORN guidelines, AAMI ST79) the specialist applies to disinfection and sterilization.
- Sterilization failure causes
- Packaging errors, sterilizer faults/failure codes, poor loading, wet packs, and failed biologicals.
- Load recall
- Pulling every load back to the last negative BI when a failure is found, located via lot control numbers.
- Intended use sets the process
- Whether an instrument is sterilized or high-level disinfected is decided by how it is used (Spaulding), not convenience.
