The proper handling of surgical instruments after a procedure is a series of steps designed to protect patient health and preserve the specialized tools. This reprocessing cycle begins the moment an instrument leaves the surgical field, making the first actions performed outside the Operating Room (OR) crucial. If organic material like blood and tissue is allowed to dry, it severely compromises the effectiveness of later cleaning and sterilization steps. A strict protocol for cleaning, inspection, and sterilization is essential for preventing surgical site infections and ensuring instruments remain functional.
Point-of-Use Treatment and Safe Transport
Immediate treatment at the point of use is the first barrier against reprocessing failure. As soon as a procedure is complete, instruments should be rinsed under cool or lukewarm water to remove gross debris and fluids. This step prevents organic soil from coagulating and hardening onto the metal surfaces. Saline should never be used for this initial rinse because its corrosive nature can damage the instrument’s protective layer, leading to pitting and rust.
After the initial rinse, specialized enzymatic sprays, gels, or foams are applied to keep the instruments moist during transport. These non-aerosol agents contain enzymes, such as protease, which begin to break down proteins like blood and mucus into smaller, water-soluble molecules. Maintaining a humid environment is necessary to prevent the formation of biofilm, a resistant layer of soil that is extremely difficult to remove once adhered to the surface.
Once pre-treated, the soiled instruments must be secured for safe movement to the Central Sterile Processing Department (CSPD). They are placed into rigid, leak-proof containers that are clearly labeled with a biohazard symbol. The purpose of these closed containers is twofold: to contain any potential spills and to protect personnel from exposure to pathogens and sharps during transit. This containment and immediate transport minimizes the time bioburden has to dry and ensures that the instruments reach the decontamination area quickly.
Comprehensive Decontamination Processes
Upon arrival in the CSPD, instruments enter the decontamination area, where the goal is cleaning—the physical removal of all visible and microscopic organic and inorganic material. Technicians wear extensive personal protective equipment due to the high risk of exposure to bloodborne pathogens and cleaning chemicals. Every instrument must be disassembled, opened, and thoroughly brushed to ensure all surfaces, hinges, and lumens are exposed to the cleaning agents.
Manual cleaning is often the first step, especially for delicate instruments, such as endoscopes, or those with complex parts, like microsurgical tools. Technicians use specialized detergents, typically with a neutral pH, formulated to be effective without damaging the instruments. The physical action of brushing and flushing lumens with cleaning solution is necessary for dislodging debris that automated methods may miss.
Following manual cleaning, many instruments proceed to automated processing in a washer-disinfector unit, which is similar to a large, industrial-grade dishwasher. These machines subject instruments to high-temperature washing, specific chemical concentrations, and controlled flow rates to achieve a consistent and repeatable cleaning result. The final rinse phase often uses high-temperature water to achieve thermal disinfection, rendering the instruments safe to handle for the next phase, but not yet sterile.
Ultrasonic Cleaning
For instruments with intricate designs, serrations, or narrow channels, ultrasonic cleaning is employed to achieve a deeper clean. This process uses high-frequency sound waves transmitted through a cleaning solution to create microscopic bubbles, a phenomenon known as cavitation. When these bubbles rapidly implode on the instrument’s surface, they generate a powerful scrubbing action that dislodges soil from hard-to-reach areas, such as box locks. Proper use requires submerging instruments fully in an open position for a specific duration, typically five to ten minutes. Dissimilar metals must not be processed together to prevent galvanic corrosion.
Inspection, Assembly, and Terminal Sterilization
Once instruments are thoroughly cleaned and dried, they move to the assembly area for a detailed quality check and preparation for sterilization. Technicians meticulously inspect each instrument under lighted magnification to verify the complete removal of bioburden and to check for physical damage. This inspection includes checking that hinges open and close smoothly, ratchets lock securely, and that tips and jaws are correctly aligned.
Any instrument found to have residual soil or damage, such as pitting, cracking, or corrosion, must be pulled from the set. Instruments with moving parts, like scissors and needle holders, are lubricated with a water-soluble instrument milk to ensure smooth functionality before the final sterilization process. The instruments are then placed onto procedure-specific trays according to a standardized count sheet, with heavy items positioned on the bottom to protect delicate tools.
The assembled trays are prepared for terminal sterilization by packaging them to allow sterilant penetration while maintaining sterility until the package is opened at the point of use. Common packaging materials include specialized non-woven wraps, rigid sterilization containers, or peel packs. The choice of the terminal sterilization method depends on the instrument’s material and its tolerance for heat and moisture.
Steam sterilization, or autoclaving, is the most common method, utilizing moist heat under pressure, typically at temperatures between 121°C to 134°C, to kill all microorganisms and spores. For instruments sensitive to high temperatures or moisture, such as certain scopes or devices containing plastic components, low-temperature methods are used. These alternatives include ethylene oxide (EtO) gas or hydrogen peroxide gas plasma, which achieve sterility through chemical reactions rather than extreme heat.