Guideline for cleaning and care of surgical instruments
The AORN Guideline for Cleaning and Care of Surgical Instruments provides guidance for the safe cleaning, decontamination, transport, inspection, and general care of reusable surgical instruments. It also addresses cleaning chemistry, water quality, PPE, ophthalmic instruments, laryngoscopes, and special precautions for instruments potentially contaminated with prions.
A central principle is that instruments should be processed according to the manufacturer’s validated instructions for use (IFU). Facilities should evaluate these requirements before purchasing instruments to ensure they have the appropriate utilities, equipment, cleaning agents, accessories, and personnel needed to perform the validated process.
The guideline emphasizes point-of-use treatment and prompt cleaning. Gross soil should be removed during and immediately after procedures, instruments should be kept moist, and contaminated items should be transported to decontamination as soon as possible. Preventing blood and other organic material from drying helps reduce biofilm formation and improves subsequent cleaning and sterilization effectiveness.
Contaminated instruments should be transported in closed, leak-proof, puncture-resistant, biohazard-labeled containers or carts. Decontamination activities should take place in an area separated from clean work to minimize cross-contamination, with appropriate sinks, cleaning equipment, ventilation, eyewash facilities, and PPE.
The document covers both manual and mechanical cleaning. Instruments should be disassembled and opened so cleaning solutions can reach all surfaces, while lumens and difficult-to-clean areas require appropriately sized brushes and flushing. Mechanical cleaning is preferred when compatible because it provides more consistent and reproducible cleaning conditions and reduces occupational exposure.
Water quality and cleaning chemistry are also important. The type of water and detergent should conform to manufacturer instructions, and treated water is recommended for final rinsing to help prevent staining, corrosion, deposits, endotoxin contamination, and recontamination.
After decontamination, instruments should undergo careful inspection for cleanliness, damage, and functionality. The guideline recommends checking areas such as cutting edges, joints, insulation, lumens, seals, lenses, and moving parts, with magnification or internal visualization where necessary. Defective or contaminated instruments should be removed from service until cleaned or repaired.
Personnel responsible for instrument care should receive initial and ongoing education and competency verificationcovering cleaning methods, chemistries, equipment, PPE, contamination risks, prions, cleaning verification, and corrective actions. Facilities should also maintain documentation that supports traceability of cleaning, equipment testing, personnel, cleaning agents, and instrument condition.
Finally, organizations should maintain formal policies and quality-management programs covering the complete cleaning and care process. Quality assurance should monitor both manual and mechanical cleaning, equipment performance, compliance with IFUs, and opportunities for corrective action and continuous improvement.
In short: the guideline provides a comprehensive framework for ensuring surgical instruments are promptly cleaned, safely transported, properly decontaminated, carefully inspected, handled by trained personnel, and monitored through documentation and quality-control processes before they move on to subsequent disinfection or sterilization.