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Unseen threats: Lumens 2.0 study reveals the hidden challenges of cleaning lumened surgical instruments
Cori L Ofstead1, Abigail G Smart1, Jill E Holdsworth2
1Ofstead & Associates, Inc., Bloomington, MN.
Background:
Surgical site infections can cause significant morbidity requiring lengthy antimicrobial treatment. Infections have been linked to surgical instruments with retained tissue and foreign debris, as the presence of blood or soil interferes with sterilization effectiveness. This study aimed to determine the prevalence of visible soil or debris inside instruments and evaluate the impact of recleaning efforts.
Methods:
Borescopes were used to inspect lumens of instruments used for orthopedic, neurologic, or ear-nose-throat procedures. Whenever visible soil or debris was observed, the instrument was recleaned up to 3 times and reinspected to assess the impact of additional cleaning.
Results:
Researchers performed 117 inspections (40 unique instruments, 77 reinspections). All instruments had complex lumens that impede access by brushes. Debris and discoloration or residues were observed inside 100% of instruments, with rusty patches in 95%. Some soil was removed by recleaning, but visible soil remained in most lumens and fragments of lint or brush bristles were visible upon repeat inspection.
Conclusions:
Cleaning in accordance with the manufacturer's instructions was not effective for lumened surgical instruments. Solutions will require collaboration between infection prevention, sterile processing, and manufacturers to evaluate risk and develop strategies for improving processing outcomes.
Insights
Surgical instrument cleaning failed to remove debris, increasing infection risk. Even after repeated cleaning, visible soil and foreign materials remained, highlighting a critical need for improved sterilization methods.
Area of Science:
- Medical device reprocessing
- Infection prevention
- Sterile processing
Background:
- Surgical site infections (SSIs) contribute to patient morbidity and prolonged antimicrobial therapy.
- Contaminated surgical instruments, particularly those with retained tissue or debris, compromise sterilization efficacy.
- Blood or soil on instruments can significantly hinder effective sterilization.
Purpose of the Study:
- To determine the prevalence of visible soil or debris within surgical instruments.
- To evaluate the effectiveness of recleaning efforts on removing internal debris.
Main Methods:
- Borescopes were utilized to inspect the lumens of surgical instruments from orthopedic, neurologic, and ENT procedures.
- Instruments with visible soil underwent up to three recleaning cycles followed by reinspection.
- The impact of additional cleaning on debris removal was assessed.
Main Results:
- 100% of inspected instruments (n=40) showed internal debris, discoloration, or residues.
- 95% of instruments exhibited rusty patches within their lumens.
- Recleaning removed some soil, but visible debris persisted in most lumens; lint and brush fragments were also noted.
Conclusions:
- Current cleaning methods, following manufacturer instructions, are ineffective for lumened surgical instruments.
- Improving surgical instrument reprocessing requires collaboration among infection prevention, sterile processing departments, and manufacturers.
- Developing new strategies is essential to enhance the outcomes of surgical instrument processing and reduce SSIs.
