Creating and Maintaining Correct
Instrument Sets
CIS
CIS Self-Study
Lesson Plan
CRCSTLESSON NO. CIS 216
(Instrument Continuing Education-ICE)
Lesson Author
Steven J. Adams, RN, BA, CRCST
Nurse Manager, Sterile Processing
Greater Baltimore Medical Center
Baltimore, MD
Instrument Continuing Education (ICE)
lessons provide members with ongoing
education in the complex and ever-changing
area of surgical instrument 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.
Each lesson plan graded online with a passing
score of 70% or higher is worth two points
(2 contact hours). 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).
Sponsored by:
LEARNING OBJECTIVES:
1. Discuss common reasons why changes in current instrument sets may be necessary.
2. Present basic tactics to evaluate and maintain current instrument sets.
3. Review a case study illustrating how Central Service staff can communicate with and learn
about the instrument set needs of their customers.
4. Explain the need for an effective and ongoing instrument set maintenance and repair program.
5. State the importance of developing and maintaining an appropriate budget for instrument
set inventories.
There are, seemingly, innumerable surgical instrument sets used everyday in healthcare surgical
suites. The processes required to develop and maintain them are vital to the success of every
surgical team and are among the critical responsibilities of Certified Instrument Specialist
(CIS) technicians. Developing the correct configuration of specific instruments in the correct
quantities requires considerable thought and significant input from a variety of surgical
team members.
Many questions must be asked as new sets are developed and as existing sets are maintained
and utilized. How are surgical instrument sets developed? Who is responsible for their
development? How are they evaluated and updated? These are among the questions to be
addressed in this lesson to help CIS technicians consistently ensure that the instrument sets
being used are the “right” ones for their facility.
Why, with all the instrument sets currently count sheets and preference cards used by
used in most healthcare facilities, must new new surgeons at their previous hospitals is
sets be developed? One common reason is an excellent way to establish a baseline for
that new surgeons may provide services not their needs. This planning and preparation
previously offered, and/or they may prefer is needed to prevent the delays and
to use new or different instrument sets for frustrations that can otherwise occur when
currently offered medical services. Surgeons instrument sets are distributed for initial
are customers of the hospital, regardless use in surgical procedures by new surgical
of whether they are employees or self- personnel.
employed. Like CIS technicians, nurses and
Existing surgical staff may also begin to
other staff members, they may move from
offer medical interventions for which new
one hospital to another.
instrument sets must be made available.
Gathering this information can be The same protocols noted above, including
troublesome, but a variety of techniques may detailed discussions to learn about the
be used. Meetings between new surgeons required content of instrument sets for
and the Central Service leadership team these services, are important. Review of
can help identify their set preferences. Also, instrument count sheets used by other
every facility uses instrument count sheets facilities where the new surgeries are
that outline the exact type and number performed—and from applicable instrument
of instruments in a specific set. Obtaining vendors—can be very beneficial.

In today’s fast-paced world of healthcare,
surgical procedures can change very quickly.
Consider, for example, changes that
occurred in the mid-to-late 1980s, when
laparoscopic surgery became the technique
of choice to perform cholecystectomies
(gall bladder removals). Traditional open
surgical techniques required instrument
sets containing the typical hand-held
instruments used for cutting, grasping and
suturing. In contrast, laparoscopic surgery
required vastly different instrument sets
containing new devices to support these
new techniques.
After instrument sets are initially developed,
an ongoing assessment process will ensure
that the sets address the surgeons’ and
the facility’s current needs. Although an
existing set may be used extensively, certain
items within the set may not be used, while
others might be needed to meet current
demands.
Continuous assessment and communication
must occur to properly develop and
maintain the facility’s inventory of surgical
instruments. Effective written and/or oral
communication with end users is essential
for this to occur. The required input for
set maintenance must be generated
from surgical team members, including
nurses, surgical technicians, surgeons, CS
managers, CIS technicians, and facility
administrators. Surveys, e-mails, and
interviews involving those from each of
these specialties will be very helpful. The
result will be different perspectives useful
in determining the necessary types and
number of instruments, along with their
quantity, set configuration (how tray
contents are arranged), maintenance,
packaging and sterilization requirements,
and associated costs.
IAHCSMM
CIS Self-Study Lesson Plan
A note of caution: interviews, meetings and
other discussions require a good memory
and carefully constructed notes and files
to help ensure that nothing is forgotten or
misunderstood. Unfortunately, sometimes
promises are made, but not fully delivered,
which may yield decreased customer
satisfaction.
Communication in Action
Numerous tactics can be included in a
planned and organized communication
program to educate customers about and
learn their exact needs for instrument
sets. Many examples are used during a
month-long instrument fair at the Greater
Baltimore Medical Center. Surgeons receive
e-mail announcements from the facility’s
Surgical Services Director and Medical
Director, and signs are posted throughout
operating room areas. Note: The length
of time for the fair is based on the size of
the facility’s instrument inventory and the
types of surgeries it offers. The instrument
fair features different surgical specialties
on specific days that are scheduled well
in advance. CS technicians help set-up,
organize, gather information, and return
items to inventory at the completion of
each day during the instrument fair.
For example, on the day of the Orthopedic
Fair, items applicable to orthopedic surgery
—including instrument sets and individual
items, such as retractor sets and power
equipment—are displayed, as are items
currently included on count lists that are
rarely, if ever, used. Advance notices are
sent to orthopedic OR team members
and surgeons inviting them to inspect and
assess the facility’s current instrumentation
available for this surgical specialty.
Instrument set lists are displayed with
the instrument sets, and opinion sheets
allow the attendees to provide written
comments about the accuracy of each set.
CS personnel greet the visitors as they enter
the display area and walk with them as they
view the displays.
Orthopedic team members and surgeons
are encouraged to make oral and written
comments about whether:
• Each set meets current needs.
• Any set should be removed from service.
• Items should be added to or deleted
from each set.
• The current quantity of sets is adequate
to meet demand.
• The quality of instrument maintenance
meets their needs.
During each specialty fair, CS professionals
provide information about the required
number of trays needed daily, based upon
their experience with requests made for
the trays. This provides an opportunity for
surgeons, OR and CS staff to discuss the
challenges encountered when turnover
requests permit only minimal processing
time. For example, CS professionals discuss
required decontamination protocols and
the advantages and disadvantages of flash
sterilization as an alternative to preferred
sterilization methods. Note: The Association
of periOperative Registered Nurses (AORN)
and the Association for the Advancement
of Medical Instrumentation (AAMI)
recommend that flash sterilization only
be performed when absolutely necessary
or in an emergency situation.1 Neither
organization supports flash sterilization
of implant sets. CS personnel also explain
the lack of approved validation for flash
sterilization from loaner orthopedic and
spine set manufacturers based on receipt
of current instructions from manufacturers.
 IAHCSMM
CIS Self-Study Lesson Plan

This discussion may prompt physicians refurbishment will likely require sending sets Still, the most vital element in the
and other OR staff to express the need for off-site service. Instrument repair vendors management of instrument sets is a
for additional quantities of applicable must be carefully chosen because their work good working relationship with—and
instruments in an effort to avoid flash impacts the ability of CS technicians to effective communication amongst—
sterilization. deliver what they promise: the availability surgeons, OR staff, and CS personnel.
of the appropriate instruments properly With these components in place, challenges
After the instrument fairs are completed
processed in the correct number, and in the relating to surgical instrument sets will be
for each surgical specialty, comments are
required working condition. minimized, and healthcare facility personnel,
documented and action plans are developed
including CIS technicians, will be able
to address improvements required for Finally, it is important to recognize the
to focus their activities on ensuring that
each specialty. The action plans address importance of developing and maintaining
patients’ needs are consistently met.
specific needs, and they provide helpful an appropriate budget to support the
information to develop a comprehensive facility’s surgical instrument inventory. References:
and prioritized list of capital and operational Funding will be required in both the capital 1. AORN Standards & Recommended Practices:
budget requests. This will help build and budget (for purchase of new instruments) Recommended Practices for Sterilization in the
maintain instrument inventories to meet the and in operating budgets to maintain Peri-Operative Practice Setting. 2008, pp. 575-
needs of surgical customers. existing instruments. The amount required 598, and ANSI/AAMI Standards ST79:2006,
differs for each facility and will be based Sections 1-2, pp. 2-3.
Ongoing Maintenance Required
upon numerous factors. These include the
After components of instrument sets are introduction of new technology, changes in
agreed upon and new sets are created, the volume of certain specialties, and the
procedures for their continuous assessment extent of repair and replacement required
and maintenance become important. for existing inventory items.
Without this emphasis, the efforts required
Most instrument manufacturers and vendors CIS Self-Study Lesson Plans
to develop the ideal instrument sets will
can provide an average annual cost of
be wasted because of changing needs
repair and replacement, based on specific Lesson Author
that can often occur very quickly. It is very
inventory volumes and usage intervals that Steven J. Adams, RN, BA, CRCST
important that the recommendations of
can be used as a benchmark for a facility’s Nurse Manager, Sterile Processing
each instrument manufacturer be obtained
specific budget estimates. Involving facility Greater Baltimore Medical Center
and studied. These recommendations
administrators throughout the entire Baltimore, MD
describe routine maintenance, lubrication
process of instrument set determination
and cleaning techniques, along with Technical Editor
and maintenance can be very helpful when
sterilization instructions. Failure to follow Carla McDermott, RN, ACE
funding must be requested. Those who
these instructions can lead to damaged Education Specialist
understand the importance of developing
equipment or shortened instrument life. Morton Plant Mease Healthcare
and maintaining the proper instrument sets
The perfect set of instruments, based on Dunedin, FL
based on surgeon and staff needs are more
customers’ recommendations, will not be Series Writer/Editor
likely to offer the needed support.
satisfactory if they are supplied with devices Jack D. Ninemeier, Ph.D.
that are rusty, dull, broken, or unsterilized. In Conclusion Michigan State University
Reliable and professional service provided East Lansing, MI
This lesson has explored ideas helpful
by the CS processing team will go a long
in developing and maintaining surgical
way in reducing or preventing frustration for IAHCSMM is looking for volunteers to write or
instrument sets. It is important to have the
end users. contribute information for our CIS Self-Study
proper number of necessary instrument Lessons. Doing so is a great way to contribute
It is important to plan, implement and sets, with the proper quantity and contents to your own professional development, to your
association, and to your Central Service peers.
maintain an effective repair and maintenance of instruments within each set. Additionally,
Our team will provide guidelines and help you
program for all instrument sets. Mobile an effective repair and maintenance plan, with the lesson to assure it will be an enjoyable
instrument repair vendors may be able along with appropriate funding, is needed to process. For more information, please contact
Elizabeth Berrios (elizabeth@iahcsmm.org).
to repair devices on-site, but complete support the demand for surgical instruments.
 CHL

CIS Self-Study Lesson Plan Quiz

(Instrument Continuing Education-ICE)
Lesson No. CIS 216: Creating and Maintaining Correct Instrument Sets
CIS Questions (circle correct answer):

1. Developing the correct configuration 6. Input for instrument set maintenance 12. After new instrument sets are created:
of specific instruments in the correct should be generated from: a. No further evaluation will be needed
quantities is easy because CIS technicians a. Nurses b. The number of similar sets must normally
prepare sets according to surgeons’
CRCST b. Surgeons be increased
preferences.
c. Central Service managers c. Ongoing assessment and maintenance
a. True become important
d. “A” and “B” above
b. False d. No changes will be required until there is
e. All the above
2. New instrument sets most commonly surgeon turnover
need to be developed because: 7. The most important factor to determine
the length of a facility’s instrument fair 13. Instruments requiring complete
a. New surgeons provide services not
is the amount of time that Central Service refurbishment typically ________ be
previously offered
personnel have for the task. processed by mobile instrument
b. Surgeons may prefer to use different sets
a. True repair vendors.
c. The Joint Commission requires specific
b. False a. Can
instruments for specific surgical procedures
b. Cannot
d. “A” and “B” above 8. Typically, only surgeons attend instrument
e. All the above fairs because they have the final decision 14. A facility’s surgical instrument inventory
in instrument set selection. will likely impact the:
3. The best way(s) to determine set
a. True a. Capital budget
preferences of new physicians is to:
b. False b. Operating budget
a. Review their count sheets
b. Obtain their preference cards 9. Input from surgeons about currently c. Depreciation budget
c. Tell them what other surgeons at used instrument sets should address all d. “A” and “B” above
the facility use of the following, except:
d. “A” and “B” above a. Whether any set should be removed 15. The average annual cost of instrument
from service repair and replacement is typically
e. All the above
b. Whether the quantity of sets is based upon:
4. If a facility begins to offer new surgical a. Specific inventory volumes
adequate for demand
procedures, an analysis of instrument count b. Usage intervals
sheets used by other facilities already c. The brand of each instrument to be
included in the set c. Both of the above
performing the procedures ______ a good
way to learn about instrument sets that d. If items should be deleted from each set d. Neither of the above
are needed. 10. Flash sterilization should only be
a. Is performed when absolutely necessary
b. Is not or in an emergency situation.
5. When an existing instrument set is a. True
Sponsored by:
extensively used: b. False
a. Never make changes in the set
11. Flash sterilization ________ used for
b. Include the set within an ongoing sterilization of implant sets.
assessment process
a. Should
c. Use a “zero-based” system annually to
b. Should not
define needs for each item in the set
d. Refer to guidelines from the AORN
about instrument needs

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