HSPA Surgical Instrument Tray Assembly 1 — Questions and Answers
Question 1: What is the primary reference document used when assembling a surgical instrument tray?
- The hospital's purchasing catalog
- The count sheet or pick list that specifies every instrument required for the tray (Correct answer)
- The surgeon's verbal preference from memory
- The instrument manufacturer's marketing brochure
Correct answer: The count sheet or pick list that specifies every instrument required for the tray
Count sheets (also called pick lists or tray lists) are the authoritative reference for tray assembly. They specify every instrument by name, quantity, and often by position within the tray. Using the count sheet ensures consistency and completeness, preventing missing or extra instruments that could affect surgical procedures.
Question 2: Why must instruments with box locks be opened before sterilization?
- To make them easier to count
- To allow sterilant to contact all surfaces including the concealed areas within the box lock mechanism (Correct answer)
- To prevent the handles from breaking during the cycle
- Opening instruments is optional if they are properly cleaned
Correct answer: To allow sterilant to contact all surfaces including the concealed areas within the box lock mechanism
Box lock joints (such as those on hemostats and scissors) have overlapping metal surfaces that trap moisture and create areas inaccessible to sterilant when closed. Opening or placing instruments on the first ratchet position allows steam or chemical sterilant to penetrate all surfaces. Instruments sterilized in the closed position may not be sterile at the box lock.
Question 3: What is the maximum recommended weight for a wrapped instrument tray?
- 15 pounds
- 25 pounds (Correct answer)
- 50 pounds
- There is no weight limit
Correct answer: 25 pounds
AAMI ST79 recommends a maximum instrument set weight of 25 pounds to ensure adequate steam penetration, drying, and safe handling. Excessively heavy trays can cause wet packs due to condensation that cannot adequately evaporate, and they increase the risk of musculoskeletal injuries to staff during handling and transport.
Question 4: What is the purpose of an instrument stringer during tray assembly?
- To tie instruments together for disposal
- To organize and secure instruments with ring handles in an open position, keeping them orderly and allowing sterilant access (Correct answer)
- To label each instrument with a barcode
- To measure the length of instruments
Correct answer: To organize and secure instruments with ring handles in an open position, keeping them orderly and allowing sterilant access
Instrument stringers (or pin racks) hold ringed instruments in an organized, open position within the tray. This organization prevents instruments from stacking on top of each other, facilitates counting and verification, and ensures each instrument is in the proper position for sterilant contact. Stringers also prevent damage from instrument-to-instrument contact.
Question 5: What inspection should be performed on each instrument during tray assembly?
- Visual and functional inspection for cleanliness, damage, proper function, and correct alignment (Correct answer)
- Only a visual check that the instrument is the right size
- No inspection is needed if the instrument came from the washer
- Only instruments older than 5 years need inspection
Correct answer: Visual and functional inspection for cleanliness, damage, proper function, and correct alignment
Every instrument must be individually inspected during assembly for residual soil, staining, corrosion, damage to tips or jaws, proper alignment, sharpness (for cutting instruments), and smooth ratchet function. Defective instruments must be removed from the tray and replaced. This quality check is the last opportunity to catch problems before the tray enters sterilization.
Question 6: What is the correct orientation for placing heavy instruments in a tray?
- On top to make them easier to find
- On the bottom of the tray to provide stability and prevent damage to lighter instruments (Correct answer)
- Randomly distributed throughout the tray
- Heavy instruments should be placed in a separate tray
Correct answer: On the bottom of the tray to provide stability and prevent damage to lighter instruments
Heavy instruments are placed on the bottom of the tray to create a stable base and prevent them from crushing or damaging lighter, more delicate instruments stacked above. This arrangement also promotes better steam penetration as the heaviest metal mass is closest to the sterilizer drain where condensate collects.
HSPA Surgical Instrument Tray Assembly 1
What is the primary reference document used when assembling a surgical instrument tray?