How to clean surgical instruments: manual and automated cleaning

Start at the point of use

Cleaning begins in the theatre. Wipe gross soil with a damp lint-free cloth, flush lumens with sterile water and keep instruments moist or sprayed with a pre-cleaning foam or gel. Do not use saline for long soaking, since it can pit stainless steel. Dry blood is the hardest soil to remove and the commonest cause of residue.

In the decontamination room, open all hinged instruments, disassemble multi-part items according to the IFU and sort by cleaning route. Fragile items, such as micro scissors or optics, are cleaned separately from heavy general surgery instruments. The place of cleaning in the full cycle is shown in instrument reprocessing steps.

Manual cleaning: brushes, detergents and technique

Manual cleaning is needed for items that cannot go into a machine and for pre-cleaning heavily soiled instruments. Use soft nylon brushes sized for serrations, box locks and lumens, never steel wool or metal brushes, which scratch the surface and promote corrosion. Brush under the surface of the solution to avoid aerosols, work through every joint and channel and use a dedicated, replaceable brush for lumens.

Choose a neutral or mildly alkaline enzymatic detergent approved for instruments, dilute exactly as the label states and replace it when visibly soiled. Avoid chloride-containing products and strongly acidic or alkaline cleaners unless the IFU permits them. After brushing, rinse thoroughly with water of the quality specified, then dry. Pre-soaking is covered in the instrument disinfectant tray article.

Ultrasonic baths

Ultrasonic cleaning uses cavitation to dislodge soil from crevices, box locks, serrations and ratchets where brushes struggle. It does not replace manual removal of gross soil. Use a detergent designed for ultrasonic baths, degas the solution before starting, do not overload the basket and run for the time recommended by the bath and detergent makers.

Some instruments are not suited to ultrasound, including certain optics, cameras, powered items and instruments with adhesives or specific coatings. Check the IFU; REDA's laparoscopes, for example, have sapphire windows and integrated fibre-optic illumination (REDA laparoscopy instruments), so follow the manufacturer's instructions for each component. Rinse and dry after the bath.

Washer-disinfectors and the machine process

A surgical instrument cleaning machine, normally a washer-disinfector, runs a validated programme: pre-rinse with cold water, cleaning with detergent at the defined temperature, rinses, thermal disinfection and drying. It gives reproducible results and a cycle record, and reduces staff exposure. Load baskets and racks so that spray reaches all surfaces: open box locks, separate instruments, place bowls with the opening down, and use lumen connections where the washer provides them.

General-surgery sets, such as the probes, needles, forceps and instrument trays in REDA's range (REDA general surgery), suit machine cleaning in perforated baskets, while items for hand cleaning are separated. Verify the washer through validation and routine tests such as soil and residue checks, in line with your quality programme.

Inspection, common mistakes and next steps

After cleaning, inspect each instrument under good light, then pack it; stains and corrosion are discussed in corrosion and stains on instruments. Beckfinity's specialists can help you plan instrument sets and container systems around your cleaning process; request a consultation.

• Using saline, chlorides or abrasive pads that cause pitting and scratches.
• Letting instruments dry before cleaning.
• Overloading baskets or leaving hinged instruments closed.
• Mixing incompatible metals in the same load.
• Skipping magnified inspection of box locks and serrations.
• Leaving instruments wet after cleaning.