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Zimmer Biomet

Zimmer Instrument Care , Cleaning and Sterilization Quick Reference Guide

Revision n/a

Zimmer Orthopaedic Systems

2 Pages

• The total weight of a wrapped instrument tray or case should not exceed 11... g/25lbs... hen placed in a sterilization container with gasketed lid the total sterilization package should not exceed 16kg/35lbs...  Any device capable of disassembly must be disassembled prior to placement in the case...  All devices must be arranged to ensure steam penetration to all instrument surfaces... nstruments should not be stacked or placed in close contact...  The user must ensure that the instrument case is not tipped or the contents shifted once the devices are arranged in the case... ilicon mats may be used to keep devices in place...  Only devices manufactured and/or distributed by Zimmer should be included in Zimmer instrument trays... immer validated reprocessing instructions are not applicable to Zimmer trays that include devices that are not manufactured and/or distributed by Zimmer... Sterilization • Disinfection is only acceptable as a precursor to full sterilization for reusable surgical instruments... ee Table 6 for recommended minimum sterilization parameters that have been validated by Zimmer to provide a 10-6 sterility assurance level (SAL)...  The hospital is responsible for in-house procedures for the reassembly, inspection, and packaging of the instruments after they are thoroughly cleaned in a manner that will ensure steam sterilant penetration and adequate drying... rovisions for protection of any sharp or potentially dangerous areas of the instruments should also be recommended by the hospital...  Moist heat/steam sterilization is the preferred and recommended method for Zimmer orthopaedic instrument sets...  Sterilizer manufacturer recommendations should always be followed... hen sterilizing multiple instrument sets in one sterilization cycle, ensure that the manufacturer’s maximum load is not exceeded...  Instrument sets should be properly prepared and packaged in trays and/or cases that will allow steam to penetrate and make direct contract with all surfaces...  Ethylene oxide or gas plasma sterilization methods should not be used unless package inserts for the applicable product specifically provide instructions for sterilization using these methods...  Gravity displacement sterilization cycles are not recommended because cycle times are too long to be practical... Storage • Sterile, packaged instruments should be stored in a designated, limited access area that is well ventilated and provides protection from dust, moisture, insects, vermin, and temperature/ humidity extremes... Hospital Responsibilities for Zimmer Loaner Instruments • Orthopaedic surgical instruments generally have a long service life; however, mishandling or inadequate protection can quickly diminish their life expectancy... nstruments which no longer perform properly because of long use, mishandling, or improper care should be returned to Zimmer to be discarded... otify your Zimmer representative of any instrument problems...  Loaner sets should undergo all steps of decontamination, cleaning, disinfection, inspection, and terminal sterilization before being returned to Zimmer... ocumentation of decontamination should be provided with instruments being returned to Zimmer... Instrument Care, Cleaning and Sterilization  Table 6... ecommended Steam Sterilization Parameters Cycle Type  2 3  4  Pressure  6  Exposure Time  7  Dry Time  UK Prevacuum  134°C 273°F  3bar 28... si  3 minutes  30 minutes  1,3  Prevacuum  132°C 270°F  1... bar 27psi  4 minutes  30 minutes  3,4  Prevacuum  134°C 273°F  3bar 28... si  18 minutes  30 minutes  132°C 270°F  1... bar 27psi  8 minutes  30 minutes  1,3  1  Temperature  5  8  Prevacuum  9  Gravity  In accordance with ISO 17664  • Additional information is available in Zimmer document 97-5000-170-00 R3 which should be used in conjunction with this Quick Reference Guide...  This guide pertains to all Zimmer reusable instruments and should be studied carefully... his manual supercedes Zimmer and Centerpulse instrument manuals published prior to January 2006...  This guide includes processing instructions for all Zimmer reusable devices including legacy Centerpulse instruments marked with processing category codes [a, a+, b, b+, c]... ll Zimmer devices may be safely and efficiently reprocessed using the manual or combination manual/ automated cleaning instructions outlined in this manual...  The user/processor should comply with local laws and ordinances in countries where reprocessing requirements are more stringent than those detailed in this manual...  New and used instruments must be thoroughly processed according to these instructions prior to use... Not recommended due to excessively long sterilization cycles which are not practical... Minimum validated steam sterilization time required to achieve a 10-6 sterility assurance level (SAL)... inimum validated steam sterilization temperature required to achieve a 10-6 sterility assurance level (SAL)... ocal or national specifications should be followed where steam sterilization requirements are stricter or more conservative than those listed in this table... isinfection/steam sterilization parameters recommended by the World Health Organization (WHO) for reprocessing instruments where there is concern regarding TSE/CJD contamination... 5 6 7 8 9  Quick Reference Guide  Considerations  Sea level AAMI/AORN steam sterilization cycles with longer times than those listed are also acceptable... rying times vary according to load size and should be increased for larger loads... or Universal Instrument Cases without defined load configurations... ravity cycle parameters are available on request from Customer Service... Warnings & Precautions  Note: The Sterilizer Manufacturer’s instructions for operation and load configuration should be followed explicitly... Important Notice • The instructions provided in this Quick Reference Guide have been validated by Zimmer as being capable of preparing orthopaedic devices for use... t is the responsibility of the Hospital to ensure that reprocessing is performed using the appropriate equipment and materials, and that personnel in the reprocessing facility have been adequately trained in order to achieve the desired result... quipment and processes should be validated and routinely monitored... ny deviation by the processor from these instructions should be properly evaluated for effectiveness to avoid potential adverse consequences... Customer Service Information Address  Telephone  Zimmer, Inc... 800 West Center Street Warsaw, Indiana 46580, USA  Inside USA: 1-800-348-2759 Outside USA: Local International Access Code +1-574-367-6131  Zimmer GmbH Sulzer-Allee 8 CH-8404 Winterthur, Switzerland  +41 (0)52 262 60 70  This Zimmer reprocessing manual and the associated Quick Reference Guide can be found at www... mmer... m under the “Medical Professional” heading... Page 1 of 2  Contact your Zimmer representative or visit us at www... mmer... m  97-5000-701-00 5ML Printed in USA ©2006 Zimmer, Inc... • Trays and cases with lids may be wrapped in standard medical grade, steam sterilization wrap using the AAMI double wrap method or equivalent...  Trays and cases with lids may also be placed in an approved sterilization container with gasketed lid for sterilization... ollow the sterilization container manufacturer’s instructions for inserting and replacing sterilization filters in sterilization containers... ote: Areas designated for specific devices shall contain only devices specifically intended for these areas... ote: These validated reprocessing instructions are not applicable to Zimmer trays that include devices that are not manufactured and/or distributed by Zimmer... nstrument trays and cases without defined, preconfigured layouts or containing undefined universal spaces or compartments should only be used under the following conditions:  • Universal Precautions should be observed by all hospital personnel that work with contaminated or potentially contaminated medical devices... aution should be exercised when handling devices with sharp points or cutting edges...  Personal Protective Equipment (PPE) should be worn when handling or working with contaminated or potentially contaminated materials, devices and equipment... PE includes gown, mask, goggles or face shield, gloves and shoe covers...  Do not place heavy instruments on top of delicate devices...  Metal brushes or scouring pads must not be used during manual cleaning procedures... hese materials will damage the surface and finish of instruments... oft-bristled, nylon brushes and pipe cleaners should be used...  Do not allow contaminated devices to dry prior to reprocessing... ll subsequent cleaning and sterilization steps are facilitated by not allowing blood, body fluid, bone and tissue debris, saline, or disinfectants to dry on used devices...  Saline and cleaning/disinfection agents containing aldehyde, mercury, active chlorine, chloride, bromine, bromide, iodine or iodide are corrosive and should not be used... nstruments must not be placed or soaked in Ringers Solution...  Mineral oil or silicone lubricants should not be used because they: 1) coat microorganisms; 2) prevent direct contact of the surface with steam; and 3) are difficult to remove... imitations & Restrictions • Automated cleaning using a washer/disinfector alone may not be effective for orthopaedic instruments...  thorough, manual or combination manual/automated cleaning process is recommended...  Neutral pH enzymatic and cleaning agents are recommended and preferred for cleaning Zimmer reusable devices... lkaline agents with pH < 12 may be used to clean stainless steel and some polymer instruments in countries where required by law or local ordinance; or where prion diseases such as Transmissible Spongiform Encephalopathy (TSE) and Creutzfeldt-Jakob Disease (CJD) are a concern... t is critical that alkaline cleaning agents be completely and thoroughly neutralized and rinsed from devices... ote: Drill bits, reamers, rasps and other cutting devices should be carefully inspected after processing with alkaline detergents to ensure that cutting edges are fit for use...  Instruments must be removed from metal or polymer trays for manual and/or automated cleaning procedures... nstrument trays, cases and lids must be cleaned separately... on-sterile, single-use plate and screw implants are an exception to this rule... lates and screws may remain in the tray or caddy for reprocessing...  • Repeated processing, according to the instructions in this manual has minimal affect on Zimmer reusable manual instruments unless otherwise noted... nd of life for stainless steel or other metal surgical instruments is normally determined by wear and damage due to the intended surgical use and not to reprocessing...  Use of hard water should be avoided... oftened tap water may be used for initial rinsing... urified water should be used for final rinsing to eliminate mineral deposits on instruments... ne or more of the following processes may be used to purify water: ultra-filter (UF), reverse-osmosis (RO), deionized (DI), or equivalent...  Ethylene oxide (EO), gas plasma and dry heat sterilization methods are not recommended for sterilization of Zimmer reusable instruments... team (moist heat) is the recommended sterilization method for Zimmer instruments... Instructions Point of Use • Remove excess body fluids and tissue from instruments with a disposable, non-shedding wipe... lace devices in a tray of distilled water or cover with damp towels...  Instruments should be cleaned within 30 minutes of use to minimize the potential for drying prior to cleaning...  Used instruments must be transported to the central supply in closed or covered containers to prevent unnecessary contamination risk... Preparation Before Cleaning • Symbols or specific instructions etched on instruments or instrument trays and cases should be strictly followed...  Where applicable, multi-component instruments should be disassembled for appropriate cleaning... isassembly, where necessary is generally self-evident... are should be exercised to avoid losing small screws and components... Manual Cleaning/Disinfection Procedure  Inspection, Testing, Maintenance & Lubrication  Note: If stainless steel instruments are stained or corroded, an acidic, anti-corrosion agent in an ultrasonic cleaner may be sufficient to remove surface deposits... are must be taken to thoroughly rinse acid from devices... cidic, anti-corrosion agents should only be used on an as needed basis... Step 1  Completely submerge instruments in enzyme solution and allow to soak for 20 minutes... crub using a soft-bristled, nylon brush until all visible soil has been removed... Step 2  Remove the device from the enzyme solution and rinse in tap water for a minimum of 3 minutes... hroughly and aggressively flush lumens, holes and other difficult to reach areas... • Carefully inspect each device to ensure that all visible contamination has been removed... f contamination is noted, repeat the cleaning/disinfection process...  Check the action of moving parts (e...  hinges, box-locks, connectors, sliding parts, etc... to ensure smooth operation throughout the intended range of motion...  Check instruments with long slender features (particularly rotating instruments) for distortion...  Where instruments form part of a larger assembly, check that devices assemble readily with mating components...  Hinged, rotating, or articulating instruments should be lubricated with a water soluble product (e...  Instrument Milk or equivalent lubricant) intended for surgical instruments that must be sterilized... ome water-based instrument lubricants contain bacteriostatic agents which are beneficial... anufacturer’s expiration dates should be adhered to for both stock and use-dilution concentrations... Step 3  Place prepared cleaning agents in a somication unit... ompletely submerge device in cleaning solution and sonicate for 10 minutes at 45-50 kHz... Processing Category Codes  Step 4  Rinse instrument in purified water for at least 3 minutes or until there is no sign of blood or soil on the device or in the rinse stream... horoughly and aggressively flush lumens, holes and other difficult to reach areas... Step 5  Repeat the sonication and rinse steps above... Processing codes listed in Table 5... re etched on some instruments and provide information useful in the selection of cleaning agents with appropriate pH... immer recommends that all devices (regardless of etching) are processed in accordance with the manual or combination manual/automated cleaning instructions contained in this reprocessing guide... Step 6  Remove excess moisture from the instrument with a clean, absorbent and non-shedding wipe... Table 2... anual Cleaning Steps  Manual Cleaning/Disinfection Procedure  Table 1... leaning/Disinfection Options Method  Description  Manual (Table 2)  Enzymatic soak and scrub followed by sonication... Combination Manual/Automated (Table 3)  Enzymatic soak and scrub followed by an automated washer/disinfector cycle... Automated (washer/disinfector) (Table 4)  Automated cycle – Not recommended without manual pre-cleaning... a  Steel/metal Instruments without cannulated bores/ lumens or non-metal/ polymer handles, or other components... hese devices are tolerant of alkaline cleaning agents when followed by acidic neutralization and thorough rinsing... hese devices may be cleaned with rust-removal agents... a+  Steel/metal instruments with cannulated bores/lumens but without non-metal/polymer handles or other components... hese devices are tolerant of alkaline cleaning agents when followed by acidic neutralization and thorough rinsing... hese devices can be cleaned with rust-removal agents... annulations and hollow spaces must be cleaned manually... Table 3... ombination Manual/Automated Cleaning Steps Step 1  Completely submerge the instruments in enzyme solution and allow to soak for 10 minutes... se a soft nylon-bristled brush to gently scrub the device until all visible soil has been removed... articular attention must be given to crevices, lumens, mated surfaces, connectors and other hard-to-clean areas... umens should be cleaned with a long, narrow, soft nylon-bristled brush... Step 2  Remove devices from the enzyme solution and rinse in purified water for a minimum of 1 minute... horoughly and aggressively flush lumens, holes and other difficult to reach areas... Step 3  Place instruments in a suitable washer/disinfector basket and process through a standard washer/disinfector instrument cycle... Preparation Before Cleaning • All cleaning agents should be prepared at the use-dilution and temperature recommended by the manufacturer... oftened tap water may be used to prepare cleaning agents... se of recommended temperatures is important for optimal performance of cleaning agents... ote: Fresh cleaning solutions should be prepared when existing solutions become grossly contaminated (bloody and/or turbid)... Table 5... rocessing Category Codes  Note: Use of a sonicator at 45-50kHz will aid in thorough cleaning of devices... ote: Use of a syringe or water jet will improve flushing of difficult to reach areas and closely mated surfaces... Automatic Washer/Disinfector Cycle Table 4... utomated Washer/Disinfector Cycle Steps  b b+ c  Instruments made of polymers or metal instruments paired with polymer components... hese devices are tolerant of alkaline cleaning agents when followed by acidic neutralization and thorough rinsing... nstruments with cannulated bores, made of polymers or metal instruments paired with polymer components... hese devices are tolerant of alkaline cleaning agents when followed by acidic neutralization and thorough rinsing... annulations and hollow spaces must be cleaned manually... nstruments made of titanium or aluminum alloys and/or having assembly/ disassembly or other reprocessing aids... hese devices should be cleaned using the manual or combination manual/automated cleaning procedures provided in this manual... hese devices should not be exposed to alkaline cleaning agents... Step 1  Pre Wash; Cold Softened Tap Water; 2 minutes  Step 2  Enzyme Spray, Hot Softened Tap Water; 20 seconds  Sterile Packaging  Step 3  Enzyme Soak; 1 minute  Packaging Individual Instruments  Step 4  Rinse (X2); Cold Softened Tap Water; 15 seconds  Step 5  Detergent Wash; Hot Softened Tap Water; (64-66°C/146-150°F); 2 minutes  • Commercially available, medical grade steam sterilization pouches or wrap may be used to package individual instruments... he package should be prepared using the AAMI double wrap or equivalent method... Step 6  Rinse (X2); Hot Softened Tap Water; 15 seconds  Step 7  Thermal Rinse; Hot Softened Tap Water; (80-93°C/176-200°F); 2 minutes  Step 8  Purified Water Rinse; (64-66°C/146-150°F), 10 seconds  Step 9  Hot Air Dry; (116°C/240°F); 7 to 30 minutes  Page 2 of 2  Packaging instrument sets in rigid trays and cases with lids and defined, preconfigured layouts... afety Precaution: The total weight of a wrapped instrument tray or case should not exceed 11... g/25lbs for the safety of the personnel handling instrument sets... hen placed in a sterilization container with gasketed lid, the total package should not exceed 16kg/35lbs...
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Page 1

• The total weight of a wrapped instrument tray or case should not exceed 11.4kg/25lbs. When

placed in a sterilization container with gasketed lid the total sterilization package should not

exceed 16kg/35lbs.

• Any device capable of disassembly must be disassembled prior to placement in the case.

• All devices must be arranged to ensure steam penetration to all instrument surfaces.

Instruments should not be stacked or placed in close contact.

• The user must ensure that the instrument case is not tipped or the contents shifted once the

devices are arranged in the case. Silicon mats may be used to keep devices in place.

• Only devices manufactured and/or distributed by Zimmer should be included in Zimmer

instrument trays. Zimmer validated reprocessing instructions are not applicable to Zimmer trays

that include devices that are not manufactured and/or distributed by Zimmer.

Sterilization

• Disinfection is only acceptable as a precursor to full sterilization for reusable surgical

instruments. See Table 6 for recommended minimum sterilization parameters that have been

validated by Zimmer to provide a 10-6 sterility assurance level (SAL).

• The hospital is responsible for in-house procedures for the reassembly, inspection, and

packaging of the instruments after they are thoroughly cleaned in a manner that will ensure

steam sterilant penetration and adequate drying. Provisions for protection of any sharp or

potentially dangerous areas of the instruments should also be recommended by the hospital.

• Moist heat/steam sterilization is the preferred and recommended method for Zimmer

orthopaedic instrument sets.

• Sterilizer manufacturer recommendations should always be followed. When sterilizing multiple

instrument sets in one sterilization cycle, ensure that the manufacturer’s maximum load is not

exceeded.

• Instrument sets should be properly prepared and packaged in trays and/or cases that will allow

steam to penetrate and make direct contract with all surfaces.

• Ethylene oxide or gas plasma sterilization methods should not be used unless package inserts

for the applicable product specifically provide instructions for sterilization using these methods.

• Gravity displacement sterilization cycles are not recommended because cycle times are too long

to be practical.

Storage

• Sterile, packaged instruments should be stored in a designated, limited access area that is well

ventilated and provides protection from dust, moisture, insects, vermin, and temperature/

humidity extremes.

Hospital Responsibilities for Zimmer Loaner Instruments

• Orthopaedic surgical instruments generally have a long service life; however, mishandling or

inadequate protection can quickly diminish their life expectancy. Instruments which no longer

perform properly because of long use, mishandling, or improper care should be returned to

Zimmer to be discarded. Notify your Zimmer representative of any instrument problems.

• Loaner sets should undergo all steps of decontamination, cleaning, disinfection, inspection,

and terminal sterilization before being returned to Zimmer. Documentation of decontamination

should be provided with instruments being returned to Zimmer.

Instrument Care, Cleaning

and Sterilization

Table 6. Recommended Steam Sterilization Parameters

Cycle Type

2

3

4

Pressure

6

Exposure Time

7

Dry Time

UK Prevacuum

134°C

273°F

3bar

28.5psi

3 minutes

30 minutes

1,3

Prevacuum

132°C

270°F

1.86bar

27psi

4 minutes

30 minutes

3,4

Prevacuum

134°C

273°F

3bar

28.5psi

18 minutes

30 minutes

132°C

270°F

1.86bar

27psi

8 minutes

30 minutes

1,3

1

Temperature

5

8

Prevacuum

9

Gravity

In accordance with ISO 17664

• Additional information is available in Zimmer document 97-5000-170-00 R3 which should

be used in conjunction with this Quick Reference Guide.

• This guide pertains to all Zimmer reusable instruments and should be studied carefully.

This manual supercedes Zimmer and Centerpulse instrument manuals published prior to

January 2006.

• This guide includes processing instructions for all Zimmer reusable devices including legacy

Centerpulse instruments marked with processing category codes [a, a+, b, b+, c]. All Zimmer

devices may be safely and efficiently reprocessed using the manual or combination manual/

automated cleaning instructions outlined in this manual.

• The user/processor should comply with local laws and ordinances in countries where

reprocessing requirements are more stringent than those detailed in this manual.

• New and used instruments must be thoroughly processed according to these instructions

prior to use.

Not recommended due to excessively long sterilization cycles which are

not practical.

Minimum validated steam sterilization time

required to achieve a 10-6 sterility assurance

level (SAL).

Minimum validated steam sterilization

temperature required to achieve a 10-6 sterility

assurance level (SAL).

Local or national specifications should

be followed where steam sterilization

requirements are stricter or more conservative

than those listed in this table.

Disinfection/steam sterilization parameters

recommended by the World Health

Organization (WHO) for reprocessing

instruments where there is concern regarding

TSE/CJD contamination.

5

6

7

8

9

Quick

Reference

Guide

Considerations

Sea level

AAMI/AORN steam sterilization cycles with

longer times than those listed are also

acceptable.

Drying times vary according to load size and

should be increased for larger loads.

For Universal Instrument Cases without

defined load configurations.

Gravity cycle parameters are available on

request from Customer Service.

Warnings & Precautions

Note: The Sterilizer Manufacturer’s instructions for operation and load configuration should be followed explicitly.

Important Notice

• The instructions provided in this Quick Reference Guide have been validated by Zimmer as

being capable of preparing orthopaedic devices for use. It is the responsibility of the Hospital

to ensure that reprocessing is performed using the appropriate equipment and materials,

and that personnel in the reprocessing facility have been adequately trained in order to

achieve the desired result. Equipment and processes should be validated and routinely

monitored. Any deviation by the processor from these instructions should be properly

evaluated for effectiveness to avoid potential adverse consequences.

Customer Service Information

Address

Telephone

Zimmer, Inc.

1800 West Center Street

Warsaw, Indiana 46580, USA

Inside USA: 1-800-348-2759

Outside USA: Local International Access Code

+1-574-367-6131

Zimmer GmbH

Sulzer-Allee 8

CH-8404 Winterthur, Switzerland

+41 (0)52 262 60 70

This Zimmer reprocessing manual and the associated Quick Reference Guide can be found at

www.zimmer.com under the “Medical Professional” heading.

Page 1 of 2

Contact your Zimmer representative or visit us at www.zimmer.com

97-5000-701-00 5ML Printed in USA ©2006 Zimmer, Inc.

• Trays and cases with lids may be wrapped in standard medical grade, steam sterilization

wrap using the AAMI double wrap method or equivalent.

• Trays and cases with lids may also be placed in an approved sterilization container with

gasketed lid for sterilization. Follow the sterilization container manufacturer’s instructions for

inserting and replacing sterilization filters in sterilization containers.

Note: Areas designated for specific devices shall contain only devices specifically intended for

these areas.

Note: These validated reprocessing instructions are not applicable to Zimmer trays that include

devices that are not manufactured and/or distributed by Zimmer. Instrument trays and cases

without defined, preconfigured layouts or containing undefined universal spaces or

compartments should only be used under the following conditions:

• Universal Precautions should be observed by all hospital personnel that work with

contaminated or potentially contaminated medical devices. Caution should be exercised when

handling devices with sharp points or cutting edges.

• Personal Protective Equipment (PPE) should be worn when handling or working with

contaminated or potentially contaminated materials, devices and equipment. PPE includes

gown, mask, goggles or face shield, gloves and shoe covers.

• Do not place heavy instruments on top of delicate devices.

• Metal brushes or scouring pads must not be used during manual cleaning procedures. These

materials will damage the surface and finish of instruments. Soft-bristled, nylon brushes and

pipe cleaners should be used.

• Do not allow contaminated devices to dry prior to reprocessing. All subsequent cleaning and

sterilization steps are facilitated by not allowing blood, body fluid, bone and tissue debris,

saline, or disinfectants to dry on used devices.

• Saline and cleaning/disinfection agents containing aldehyde, mercury, active chlorine,

chloride, bromine, bromide, iodine or iodide are corrosive and should not be used.

Instruments must not be placed or soaked in Ringers Solution.

• Mineral oil or silicone lubricants should not be used because they: 1) coat microorganisms;

2) prevent direct contact of the surface with steam; and 3) are difficult to remove.

Limitations & Restrictions

• Automated cleaning using a washer/disinfector alone may not be effective for orthopaedic

instruments. A thorough, manual or combination manual/automated cleaning process is

recommended.

• Neutral pH enzymatic and cleaning agents are recommended and preferred for cleaning Zimmer

reusable devices. Alkaline agents with pH < 12 may be used to clean stainless steel and some

polymer instruments in countries where required by law or local ordinance; or where prion

diseases such as Transmissible Spongiform Encephalopathy (TSE) and Creutzfeldt-Jakob

Disease (CJD) are a concern. It is critical that alkaline cleaning agents be completely and

thoroughly neutralized and rinsed from devices.

Note: Drill bits, reamers, rasps and other cutting devices should be carefully inspected after

processing with alkaline detergents to ensure that cutting edges are fit for use.

• Instruments must be removed from metal or polymer trays for manual and/or automated

cleaning procedures. Instrument trays, cases and lids must be cleaned separately. Non-sterile,

single-use plate and screw implants are an exception to this rule. Plates and screws may

remain in the tray or caddy for reprocessing.

Page 2

• Repeated processing, according to the instructions in this manual has minimal affect on

Zimmer reusable manual instruments unless otherwise noted. End of life for stainless

steel or other metal surgical instruments is normally determined by wear and damage due

to the intended surgical use and not to reprocessing.

• Use of hard water should be avoided. Softened tap water may be used for initial rinsing.

Purified water should be used for final rinsing to eliminate mineral deposits on

instruments. One or more of the following processes may be used to purify water:

ultra-filter (UF), reverse-osmosis (RO), deionized (DI), or equivalent.

• Ethylene oxide (EO), gas plasma and dry heat sterilization methods are not recommended

for sterilization of Zimmer reusable instruments. Steam (moist heat) is the recommended

sterilization method for Zimmer instruments.

Instructions

Point of Use

• Remove excess body fluids and tissue from instruments with a disposable, non-shedding

wipe. Place devices in a tray of distilled water or cover with damp towels.

• Instruments should be cleaned within 30 minutes of use to minimize the potential for

drying prior to cleaning.

• Used instruments must be transported to the central supply in closed or covered

containers to prevent unnecessary contamination risk.

Preparation Before Cleaning

• Symbols or specific instructions etched on instruments or instrument trays and cases

should be strictly followed.

• Where applicable, multi-component instruments should be disassembled for appropriate

cleaning. Disassembly, where necessary is generally self-evident. Care should be

exercised to avoid losing small screws and components.

Manual Cleaning/Disinfection Procedure

Inspection, Testing, Maintenance & Lubrication

Note: If stainless steel instruments are stained or corroded, an acidic, anti-corrosion agent

in an ultrasonic cleaner may be sufficient to remove surface deposits. Care must be taken to

thoroughly rinse acid from devices. Acidic, anti-corrosion agents should only be used on an

as needed basis.

Step 1

Completely submerge instruments in enzyme solution and allow to soak for 20

minutes. Scrub using a soft-bristled, nylon brush until all visible soil has been

removed.

Step 2

Remove the device from the enzyme solution and rinse in tap water for a minimum of 3 minutes. Throughly and aggressively flush lumens, holes and other

difficult to reach areas.

• Carefully inspect each device to ensure that all visible contamination has been removed. If

contamination is noted, repeat the cleaning/disinfection process.

• Check the action of moving parts (e.g. hinges, box-locks, connectors, sliding parts, etc.) to

ensure smooth operation throughout the intended range of motion.

• Check instruments with long slender features (particularly rotating instruments) for

distortion.

• Where instruments form part of a larger assembly, check that devices assemble readily

with mating components.

• Hinged, rotating, or articulating instruments should be lubricated with a water soluble

product (e.g. Instrument Milk or equivalent lubricant) intended for surgical instruments

that must be sterilized. Some water-based instrument lubricants contain bacteriostatic

agents which are beneficial. Manufacturer’s expiration dates should be adhered to for

both stock and use-dilution concentrations.

Step 3

Place prepared cleaning agents in a somication unit. Completely submerge

device in cleaning solution and sonicate for 10 minutes at 45-50 kHz.

Processing Category Codes

Step 4

Rinse instrument in purified water for at least 3 minutes or until there is no sign

of blood or soil on the device or in the rinse stream. Thoroughly and aggressively

flush lumens, holes and other difficult to reach areas.

Step 5

Repeat the sonication and rinse steps above.

Processing codes listed in Table 5. are etched on some instruments and provide information

useful in the selection of cleaning agents with appropriate pH. Zimmer recommends that all

devices (regardless of etching) are processed in accordance with the manual or combination

manual/automated cleaning instructions contained in this reprocessing guide.

Step 6

Remove excess moisture from the instrument with a clean, absorbent and

non-shedding wipe.

Table 2. Manual Cleaning Steps

Manual Cleaning/Disinfection Procedure

Table 1. Cleaning/Disinfection Options

Method

Description

Manual (Table 2)

Enzymatic soak and scrub followed by sonication.

Combination Manual/Automated

(Table 3)

Enzymatic soak and scrub followed by an

automated washer/disinfector cycle.

Automated (washer/disinfector)

(Table 4)

Automated cycle – Not recommended

without manual pre-cleaning.

a

Steel/metal Instruments without cannulated bores/ lumens or non-metal/

polymer handles, or other components. These devices are tolerant of

alkaline cleaning agents when followed by acidic neutralization and

thorough rinsing. These devices may be cleaned with rust-removal agents.

a+

Steel/metal instruments with cannulated bores/lumens but without

non-metal/polymer handles or other components. These devices are

tolerant of alkaline cleaning agents when followed by acidic neutralization

and thorough rinsing. These devices can be cleaned with rust-removal

agents. Cannulations and hollow spaces must be cleaned manually.

Table 3. Combination Manual/Automated Cleaning Steps

Step 1

Completely submerge the instruments in enzyme solution and allow to soak for

10 minutes. Use a soft nylon-bristled brush to gently scrub the device until all

visible soil has been removed. Particular attention must be given to crevices,

lumens, mated surfaces, connectors and other hard-to-clean areas. Lumens

should be cleaned with a long, narrow, soft nylon-bristled brush.

Step 2

Remove devices from the enzyme solution and rinse in purified water for a minimum of 1 minute. Thoroughly and aggressively flush lumens, holes and other

difficult to reach areas.

Step 3

Place instruments in a suitable washer/disinfector basket and

process through a standard washer/disinfector instrument cycle.

Preparation Before Cleaning

• All cleaning agents should be prepared at the use-dilution and temperature recommended

by the manufacturer. Softened tap water may be used to prepare cleaning agents. Use of

recommended temperatures is important for optimal performance of cleaning agents.

Note: Fresh cleaning solutions should be prepared when existing solutions become

grossly contaminated (bloody and/or turbid).

Table 5. Processing Category Codes

Note: Use of a sonicator at 45-50kHz will aid in thorough cleaning of devices.

Note: Use of a syringe or water jet will improve flushing of difficult to reach areas and closely

mated surfaces.

Automatic Washer/Disinfector Cycle

Table 4. Automated Washer/Disinfector Cycle Steps

b

b+

c

Instruments made of polymers or metal instruments paired with polymer

components. These devices are tolerant of alkaline cleaning agents when

followed by acidic neutralization and thorough rinsing.

Instruments with cannulated bores, made of polymers or metal instruments

paired with polymer components. These devices are tolerant of alkaline

cleaning agents when followed by acidic neutralization and thorough

rinsing. Cannulations and hollow spaces must be cleaned manually.

Instruments made of titanium or aluminum alloys and/or having assembly/

disassembly or other reprocessing aids. These devices should be cleaned

using the manual or combination manual/automated cleaning procedures

provided in this manual. These devices should not be exposed to alkaline

cleaning agents.

Step 1

Pre Wash; Cold Softened Tap Water; 2 minutes

Step 2

Enzyme Spray, Hot Softened Tap Water; 20 seconds

Sterile Packaging

Step 3

Enzyme Soak; 1 minute

Packaging Individual Instruments

Step 4

Rinse (X2); Cold Softened Tap Water; 15 seconds

Step 5

Detergent Wash; Hot Softened Tap Water; (64-66°C/146-150°F); 2 minutes

• Commercially available, medical grade steam sterilization pouches or wrap may be used

to package individual instruments. The package should be prepared using the AAMI

double wrap or equivalent method.

Step 6

Rinse (X2); Hot Softened Tap Water; 15 seconds

Step 7

Thermal Rinse; Hot Softened Tap Water; (80-93°C/176-200°F); 2 minutes

Step 8

Purified Water Rinse; (64-66°C/146-150°F), 10 seconds

Step 9

Hot Air Dry; (116°C/240°F); 7 to 30 minutes

Page 2 of 2

Packaging instrument sets in rigid trays and cases with lids and defined, preconfigured

layouts.

Safety Precaution: The total weight of a wrapped instrument tray or case should not exceed

11.4kg/25lbs for the safety of the personnel handling instrument sets. When placed in a

sterilization container with gasketed lid, the total package should not exceed 16kg/35lbs.

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