Sponsored by:
Care and Handling of Sharp Instruments
CIS
CIS Self-Study
Lesson Plan
LESSON NO. CIS 211
CRCSTEducation-ICE)
(Instrument Continuing
Lesson Author
Peggy Pittenger, RN, CRCST
Account Executive
Materials Management Microsystems
Instrument Continuing Education (ICE) lessons
provide members with ongoing education in the
complex and ever-changing area of surgical instru-
ment care and handling. These lessons are designed
for CIS technicians, but can be of value to any CRCST
technician who works with surgical instrumentation.
You can use these lessons as an in-service with
your staff, or visit www.iahcsmm.org for online
grading at a nominal fee: $5 per lesson, or
bundled packages of 6 lessons for $25 (save $5)
or 12 lessons for $50 (save $10).
Each lesson plan graded online with a passing score
of 70% or higher is worth one point (contact hour).
You can use these points toward either your re-
certification of CRCST (12 points) or CIS (6 points).
Mailed submissions to IAHCSMM will not be
graded and will not be granted a point value
(paper/pencil grading of the ICE Lesson Plans
is not available through IAHCSMM or Purdue
University; IAHCSMM accepts only online
subscriptions).
LEARNING OBJECTIVES:
1. Explain how to protect sharp instruments at point of use and during transport to Central Service
processing areas.
2. Discuss safety procedures for handling sharp instruments.
3. Review general guidelines to test sharp instruments.
4. Describe how to protect sharp instruments as they are processed for re-use.
The care and handling of sharp instruments can be challenging, but the task is important
because surgeons require them to work effectively. Sharp instruments are used in every
specialty; for example; scissors or trocars in General Surgery, tonometers and picks in
Ophthalmology, and curettes in Gynecology and Otolaryngology (ENT). Orthopedics
and Neurosurgery present even greater challenges because of their extensive use of
osteotomes, curettes, rongeurs, kerrisons, and other sharp instruments which dull very
quickly because they are used on bone. This lesson addresses basic procedures to safely
handle sharp instruments and the important role that Certified Instrument Specialist
(CIS) technicians play in keeping sharp instruments in top working condition.
Operating room (OR) staff and CIS technicians area. This is done by assuring that heavy
handle so many instruments during the day instruments are not placed on top of delicate,
that it is easy to forget their complexity and the sharp ones, and by protecting their sharp edges
care they require. For example, basic Mayo or during transport. Some hospitals have designated
Metzenbaum scissors are commonly used in baskets for sharp instruments, while others simply
many sets, but they should be tested routinely. separate them on a towel so they are visible, yet
protected. Organizing components within the
Operating room personnel have front line
pan can also protect sharp instruments during
responsibilities to begin the process of protecting
transportation. Remember to keep instruments
sharp instruments. Surgical instruments should
moistened between their use in the OR and
be used only for their intended purpose. For
arrival in the Central Service area to expedite the
example, a heavy scissors should not be used as
cleaning process.
a “sterile bottle opener” that can damage the
instrument and contaminate the sterile contents Safety First When Handling Sharp
of the bottle. Scissors should never be used to Instruments
open boxes or to scrape off color code tape,
CIS technicians wearing personal protective
because this practice can damage sharp edges
equipment (PPE) should carefully separate items
and weakens the balance of the instrument’s box
received in Central Service. Accidents can occur
lock.
as box locks and jaws are opened to enable all
All too often sharp instruments used in the OR surfaces to be effectively cleaned manually or by
are piled together with other stainless steel the washer-decontaminator. Staff must take the
instruments used during the procedure, and their time necessary to protect themselves by being
edges may be dulled as they rub against each alert to the dangers posed by sharp contaminated
other. Then if they are placed unprotected in a instruments. Never reach into a set of instruments
case cart for transport to the decontamination submerged in water without a clear view of the
area, friction that occurs as the cart bounces over contents. Ideally, sharp instruments should
uneven floors may further damage their sharp always be separated from non-sharp instruments,
edges. but never assume that this has occurred.
The recommended method of post-op treatment Pay close attention to sharp instrument edges
is to carefully separate instruments after use, and and tips when sets are disassembled for cleaning.
prepare them for transport to the reprocessing Assure that they do not rub against other
 IAHCSMM
CIS Self-Study Lesson Plan

instruments to avoid damage to delicate sharp the left shank is higher, the scissors are too
edges. For the protection of the staff as well as loose. If the right shank is higher, they are
the sharp items, instruments should be handled too tight.
individually, not in a bundle. They should be
cleaned with nylon brushes and non-abrasive To test the “set” or tightness of the box
instrument cleaners. Examine the box locks of lock, open the scissors and, while holding
scissors to assure that no debris remains that onto the bottom ring and shank horizontal
could cause friction and eventually cause the to the floor, drop the top ring. The blades’
instrument to malfunction. distal tips should remain 1/2 to 1/3 open. If
the blade closes completely, the scissors are
too loose. If it closes less than halfway, the
scissors are too tight.

• Trocars. The cutting edges of trocars should

Example of Fretting Corrosion
Debris in the box lock may lead to “fretting
corrosion” which affects the instrument’s
function. This is a result of improper cleaning,
and will lead to micro abrasion and, finally,
a breakdown of the outer passive layer. Left
unchecked and without proper cleaning and
lubrication, corrosion and improper function will
result.
Delicate scissors should be arranged so their tips
are protected when they are manually washed
or placed in the washer decontaminator. One
effective method is to organize instruments
with handles on 5” wide stringers to open
their jaws and expose their box locks to water
and detergents. The strung instruments can be
turned so the tips point upward to expose all
surfaces to jets of water as they go through the
washer-decontaminator.
Cutting instruments such as osteotomes, chisels,
gouges, and bone or gynecological curettes will
ideally be stored in devices that protect the tips
from rubbing on each other, and that provide
protection when they are placed in the washer
decontaminator. Small organizational baskets in
the washer decontaminator are often necessary
for small, delicate items such as picks, fine
curettes, or osteotomes used in hand surgery.
Curette Rack to Protect Cutting Edges
Guidelines for Instrument Testing
• Osteotomes. Osteotomes should be visually
Once instruments have been properly
decontaminated, functional checks are important
to help assure surgeon satisfaction. These checks
are important for patient safety as well. For
example, dull instruments may tear delicate tissue
during a procedure. General testing guidelines
• Rongeurs. A properly sharpened rongeur
include visual inspection of the instrument’s
surfaces. They should be clean, smooth, and
without crevices, rough spots, or grinding marks
that provide an opportunity for corrosion and
that can harbor bacteria. Instrument tips, blades,
handles, box locks, alignment, and working
mechanisms should be carefully examined.
Specific testing procedures are used for different
sharp instruments, and some examples follow.
• Kerrison Rongeurs. Squeeze (close) the
It is important to remember that running your
finger over sharp edges is never recommended.
• Scissors. To test micro or full-size scissors for
sharpness and proper alignment, cut a latex
glove or test material from the mid-point of
the blades to the distal end. The scissors
should cleanly cut the latex or test material
without grabbing or “chewing” it between
the blades. Note: scissors in poor alignment
will not cut smoothly, and the latex will
“bunch up” as the test is performed. Another
way to test scissors for alignment is to hold
them up to light and, while closing, confirm
that the blades contact only at one point on
the lead cutting edge of the scissors. This
indicates that a proper helix curve exists on
the opposing blades, and it will assure that
• Intervertebral Disc Rongeurs. Disc
the surgeon can control the scissors. To test
for tightness, lay the scissors flat on a table,
and look from the rings towards the tip. If
be sharp, and they should not be ground too
short by excessive sharpening. They should
be visually examined for burrs and/or gouges
on their cutting edge.
inspected, and those with obvious nicks or
gouges should be removed from service. Tests
include scraping them on an angle against
a plastic dowel rod which should shave tiny
pieces of plastic from the rod.
should cut a business card cleanly or leave
an even indentation. Close the distal 1/3 to
1/2 of the cup onto a business card. Note: if
a thick business card is used, a clean cut may
not be achieved, but an even indentation will
indicate a sharp instrument. Double action
rongeurs should be free of play in the shanks
and jaws.
Kerrison handle and assure that the action is
smooth with no grinding or catching. When
closed, the moving shaft should touch the
foot plate, but it should not travel so far as
to cause stress to the foot plate. The handle
should spring back quickly when released. If
it does not, check to assure the instrument
has been properly cleaned and lubricated.
Also, confirm that the spring is in place,
and that there are no cracks in the spring,
especially where the screws secure the
spring. Assure that all the screws are in place
and are firmly seated. Hold the Kerrison up
to the light in the closed position. If no light
shines through the jaws, this means the jaws
meet correctly.
rongeurs should grasp a hair firmly and cut
it cleanly. The jaws should meet precisely,

and they should always be sharpened from
the inside of the jaws (not ground or filed from
outside) to maintain proper cutting alignment.
• Curettes. Visually check the cup’s surface. Its
profile should be flat across the top without
nicks or gouges. A properly sharpened curette,
when scraped against a piece of plastic dowel,
should plane off “ribbons” of plastic.
Protecting Sharp Instruments During
Assembly
Do not “pour” clean instruments from a tray or
basket onto hard metal surfaces when assembling
them. Instrument tables should be protected with
towels or mats to prevent damage caused by metal
rubbing on metal. Many supplies are available to
help protect instruments during assembly and
when they are in containers. For example, silicone
mats (some with fingers and others that are more
open) are available for the bottoms of instrument
baskets. Paper pockets approved for steam
penetration may protect instruments if multiple
instruments are not “jammed” into a single
pocket. Placing instruments carefully in the basket
without crowding and the use of protectors for
delicate tips should help assure that instruments
are packaged in a way that allows steam to
penetrate while instruments are protected.
Poor Examples of Instrument Organization
IAHCSMM
CIS Self-Study Lesson Plan
Many container companies provide organizing References
devices for instrument baskets to protect sharps.
For general information about Central Service
Upright pins placed in the bottom of the basket
safety concerns including those applicable to
provide one method of organizing and protecting
sharp instruments, see:
sharps while a large variety of positioning racks
and fingers are another very effective mechanism 1. Managing Safety Hazards in Central Service.
for protection. Exx Cel 2000 Plus: Strategies for Success.
(Manual Six). International Association of
These same devices for organizing instruments can
Healthcare Central Service Materiel Management.
also serve to protect staff from sharp instruments
2000.
floating in sets.
2. Central Service Technical Manual. Seventh
Edition. Chicago, Il. International Association
of Healthcare Central Service Materiel
Management. 2007.
Sample of Protected Micro Scissors
Following set assembly, CIS technicians should
carefully place instrument sets onto sterilizer racks
and assure that the instruments are not jostled
while the sterilizer is loaded. Concerns applicable The author acknowledges Aesculap
to carefully moving instruments from the point-of- Inc. USA, for the photos used in this
use to Central Service areas also apply as sets are
lesson.
placed into storage, loaded onto case carts, and
transported to usage areas. This requires that sets
and/or containers not be bounced over uneven
floors during transportation.
CIS Self-Study Lesson Plans
In Conclusion
Lesson Author
Properly maintaining instruments during daily use
Peggy Pittenger, RN, CRCST
is a key to keeping instruments in top working
Account Executive
order. A quality repair/refurbishment plan is also
essential. Then, as instruments become dull with Materials Management Microsystems
routine usage, a qualified instrument specialist Technical Editor
can bring them back to peak condition. Ideally, Carla McDermott, RN, ACE
an instrument management system will alert CIS Education Specialist
Technicians to the need for periodic maintenance
Morton Plant Mease Healthcare
of sharps. At the minimum, a manual system
Dunedin, FL.
for instrument maintenance may be used to
manage routine sharpening. Whatever system is Series Writer/Editor
in place, knowledgeable and alert staff should pull Jack D. Ninemeier, Ph.D.
instruments that show wear from sets as they are Michigan State University
being assembled. East Lansing, MI.
The quality care of sharp instruments lies in
the hands of competent CIS technicians. Their
attention to detail with routine checks and
instrument maintenance procedures will help
assure that safe and high-quality instruments are
in the surgeons’ hands so patients can have the
best possible outcomes.
 CHL

CIS Self-Study Lesson Plan Quiz

(Instrument Continuing Education-ICE)
Care and Handling of Sharp Instruments
CIS Questions (circle correct answer):

1. Care of sharp instruments is the 6. Testing of scissors can be accomplished by 12. Debris in the scissors box lock can lead to:
responsibility of: a. A drop method to check the “set” of the a. Improper function
a. OR staff box lock b. Micro abrasion
b. CISCRCST
technicians with assembly b. Visual checks of the sharp cutting edges c. Fretting corrosion
responsibilities and tips d. Corrosion
c. CIS technicians working in c. Cutting a piece of latex or test material to e. All the above
decontamination areas assure it cuts cleanly without “bunching
d. All of the above up” 13. When checking screws in rongeurs, be
d. All the above sure:
2. Transportation of surgical instruments is a. They are in place
often overlooked as a potential for damage 7. Rongeurs should be carefully inspected
for a smooth cutting action. b. They are firmly seated
to sharp edges of cutting instruments.
a. True c. The moving shaft does not touch the foot
a. True
plate
b. False b. False
d. a and b
3. In the decontamination area the staff 8. Methods for testing rongeurs include: e. All the above
must protect themselves by a. Checking for smooth action of moving
parts 14. An instrument management system can
a. Wearing personal protective devices alert staff for routine maintenance of
b. Never reaching into a pan of submerged b. Assessing that the springs are in place
sharp items
instruments without a clear view of the c. Assuring that the screws are seated
a. True
contents properly
b. False
c. Working with bundles of instruments d. a and b
d. a and b e. a, b, and c 15. Sharp instruments in poor repair should
e. All the above be:
9. One way to test sharps is to run your
finger over the sharp edge. a. Removed from the set
4. While decontaminating sharps:
b. Sent for repair
a. Use nylon brushes a. True
c. Replaced if un-repairable
b. Carefully examine box locks to be sure b. False
d. All the above
debris is removed
10. Curettes and osteotomes may be checked
c. Handle instruments individually by using a plastic dowel.
d. Use only non abrasive cleaners a. True
e. All of the above b. False Sponsored by:
5. When preparing instruments to go into 11. If you pour instruments from the pan, be
an automated washer, instruments can be sure there is a towel or blanket on the
protected with table to cushion them as they fall.
a. 5” wide stringers for instruments with a. True
handles
b. False
b. Safety pins and rubber bands
c. Small organizational baskets
d. a and c

REQUEST FOR PAPER/PENCIL SCORING (please print or type information below)

REQUEST FOR ONLINE SCORING (payment and scoring made directly online at www.iahcsmm.org using either online check or credit card)

q I have enclosed the scoring fee of $15. (Please make checks

payable to Purdue University. We regret that no refunds can be Name
given.)
Mailing Address (Be sure to include apartment numbers or post office boxes)
q Check here if you have a change of address

q Check here if you wish to have your results emailed to you City State Zip code
( )
Detach quiz, fold, and return to:
Daytime telephone IAHCSMM Membership Number
Purdue University
PEC Business Office
Stewart Center, Room 110 • 128 Memorial Mall Email Address
West Lafayette, IN 47907-2034 If your name has changed in the last 12 months, please provide your former name
(800) 830-0269 Purdue University is an equal access/equal opportunity institution