Reprocessing electrosurgical instruments: cleaning, insulation checks and sterilisation

Start with the manufacturer's instructions

Every reusable instrument must come with validated reprocessing instructions, and these override any general advice, including this article. They state the permitted cleaning agents, whether the instrument can go in a washer-disinfector, whether it must be disassembled, and the sterilisation parameters. Information supplied by the manufacturer for reprocessing is covered by ISO 17664, and steam sterilisation processes are covered by ISO 17665.

Also record the maximum number of uses. For example, BOWA states that its ERGOact laparoscopic bipolar instrument is reusable up to 50 times and simple to reprocess. A tracking method for use counts, whether manual or electronic, is therefore part of your process. COMFORT instruments carry an RFID chip that lets compatible ARC generators count uses.

Point of use and cleaning bipolar forceps

Remove gross soil immediately after use with a damp lint-free cloth and keep the tips moist until transport, since dried tissue and blood are the main reason for failed cleaning. Never use metal brushes or abrasive pads on the tips, which damage coatings and insulation. Inspect the working surfaces for carbonised tissue.

When cleaning bipolar forceps, handle the tips gently because they are fine and easily bent. Use soft brushes and the detergent permitted in the instructions, and avoid solutions that corrode or discolour the metal. NON STICK versions, such as those in the REDA general surgery range, include bipolar forceps in straight, 45 degree angled and bayonet shapes with NON STICK options, and a coated tip should never be scraped. For non-stick coated scissors such as the BiZZER, follow the same principle: no abrasives, and no hard tools to remove tissue.

Insulation testing of laparoscopic instruments

Damaged insulation on a laparoscopic instrument can allow stray current to reach tissue outside the surgeon's view, which is why insulation testing of laparoscopic instruments matters. Begin with careful visual inspection of the whole shaft under good light, looking for cracks, bubbles, scratches, peeled areas and discolouration, especially near the tip and the connector.

Many hospitals add an electronic insulation tester that applies a test voltage and alarms on a breach. Use the type, voltage and procedure specified by the manufacturer of the instrument and the tester, and record each result. Remove any failed instrument from circulation until it has been assessed. Our article on electrosurgery in laparoscopy explains the risks behind this check.

Reprocessing electrosurgical instruments: sterilisation

For sterilisation of electrosurgical instruments, follow the validated method in the instructions. Steam is the most common method for heat-stable reusable instruments, but cables, coated parts and RFID-equipped connectors may have temperature or cycle restrictions. Do not assume that a pack can be mixed: place delicate tips so they are not under the weight of other instruments, and use trays or holders designed to protect them.

Allow instruments to dry fully, as moisture trapped in connectors and under insulation affects both sterility and electrical safety. Check labelling and traceability on the pack, and keep records so each instrument can be tracked from patient to patient.

• Use only validated cleaning agents and cycles
• Protect fine tips in trays or holders
• Dry connectors thoroughly before packing
• Record cycles and use counts per instrument

Common mistakes and CSSD set-up

The mistakes we see most often are letting tissue dry on tips, using abrasive cleaners, mixing heavy instruments over fine ones, skipping insulation inspection, and exceeding the number of validated uses. A simple bench checklist with visual inspection steps, a magnifier and a good light solves most of them.

Train staff for each instrument family, keep the instructions at the workstation, and ask the supplier for training when new items arrive. Ask your distributor about compatible trays and the availability of spare instruments, then contact Beckfinity via our contact page for guidance on your instrument range.