Surgical Instruments: Point of Use Cleaning and Containment Prior to Transportation



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Decontamination of surgical instruments begins in the operating room. The Association of periOperative Registered Nurses (AORN) guideline for Cleaning and Care of Surgical Instruments, and the Association for the Advancement of Medical Instrumentation (AAMI) in Comprehensive guide to steam sterilization and sterility assurance in health care facilities ST79:2010 & A1:2010 & A2:2011 & A3:2012 & A4:2013, sections six and seven, recommend keeping instruments moist and wiped down at the point of use.1,2

The effectiveness of cleaning and decontamination is enhanced when the scrub personnel removes gross bioburden at the point of use both on surfaces and inside lumens. Therefore, during the surgical procedure, the scrub personnel should keep instruments and equipment free of gross soil by wiping the surfaces with a sterile surgical sponge moistened with sterile water (not saline). Lumens should also be irrigated with sterile water throughout the procedure in order to keep them clear and discourage the formation of biofilm. 1,2,3,4

Preparation for transportation
Following the procedure, instruments should be properly prepared for transportation to the decontamination area. Prior to transportation, waste, linen and disposables should be separated from instrumentation, sharps should be segregated, multipart instruments should be taken apart, delicate items should be protected, instruments should be arranged in an orderly fashion and instrument sets should be kept together. 1,2,3,4

In order to help prevent bioburden from drying and adhering, instruments should be kept moist until they are decontaminated. This can be accomplished by placing a wet towel over the instrument or using an instrument treatment such as an enzymatic or disinfectant spray, foam or gel, or placing the instruments inside a container designed to maintain humid conditions. 1,2,3

OSHA regulations require soiled instruments to be transported in a closed container or enclosed cart that is leak-proof, puncture resistant, large enough to contain all of the contents, and labeled with a biohazard label.4,5  Instead of a biohazard label, a red bag or red container may be used to indicate contaminated waste if it is suitable to the configuration of the contents.5

Healthcare facilities should establish policies and procedures using current standards and guidelines for handling contaminated instruments for the protection of patients, personnel, and the environment from contamination and to comply with OSHA regulations requiring the limiting of occupational exposure to bloodborne pathogens.3,4,5







  • Guidelines for Cleaning and Care of Surgical Instruments. In: AORN Guidelines and Tools for the Sterile Processing Team. Association of periOperative Registered Nurses Denver, CO: AORN 2015
  • Association for the Advancement of Medical Instrumentation. Comprehensive guide to steam sterilization and sterility assurance in health care facilities, ANSI/AAMI ST79:2010 & A1:2010 & A2:2011 & A3:2012 & A4:2013 (Consolidated Text)
  • Seavey R. OSHA Regulatory Requirements: Instrument decontamination begins at the point of use. In Healthcare Purchasing News, Feb. 2015
  • United States Department of Labor. Occupational Health and Safety Administration. Inspection 974812.015 – Hallmark Health – Melrose WakefielD Hospital. Accessed December 13, 2014
  • 29 CFR 1910.1030. Occupational exposure. Bloodborne pathogens. 2009. Accessed February 17, 2015