1. Section Editor(s): Thompson, Elizabeth M. MSN, RN, CNOR

Article Content

One of the hot topics in the news is cleaning and sterilization of instrumentation, and patients who are exposed to and suffer adverse outcomes from dirty instrumentation. Consider the following examples:

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At a hospital in Houston, Tex., a patient underwent a routine surgery to repair a damaged rotator cuff. A few weeks postoperatively, the patient experienced severe pain and discomfort at the incision scar, as well as redness and thick drainage. Exploratory surgery revealed that infection had destroyed part of the bone and loosened the screws and sutures that surgeons had placed just weeks earlier.1 After 2.5 years and seven surgeries, the patient reports that his shoulder is worse than before. Six other patients who underwent joint surgery at the same hospital developed serious infections, prompting a temporary closure of the hospital's ORs.1 An investigation revealed dirty arthroscopic shavers with human tissue and bone, although the instruments used for the procedure were cleaned after each procedure and were considered ready for surgery.1


At the University of Michigan Health System, researchers examined 350 suction tips and found that "every single one of the tips contained blood, bone, tissue, and in some cases rust."2 The researchers reprocessed all of the 350 instruments following manufacturer's directions and reexamined them. Only 7 of the 350 instruments were free from debris.2


When I started my surgical career in 1972, the most challenging instruments I had to clean was the stainless steel surgical stapler. The stapler had a few pieces that needed to be taken apart and reassembled. They were difficult to assemble, and difficult to clean because of the narrow lumens and grooves. Since then technology has advanced exponentially, and the instruments supporting this technology have more pieces and are more complicated.


The complexity of the instruments and of their cleaning, sterilization, and processing requires technicians with specialized knowledge and skills. This may not be an entry-level position. Many of the articles I read suggested these workers should be certified in working in medical facilities. Yet many hospitals hire untrained individuals, consider this an entry-level position, and provide on-the-job training with educational support. Only New Jersey requires professional certification.1 Although I agree that technicians might benefit from a more formalized education, I don't believe this would completely solve the problem. In the example discussed earlier, even when researchers reprocessed instruments, the instruments continued to be unclean. Poor product design and the materials used in manufacturing instruments contribute to the problem.


The instrument cleaning process begins in the OR. Ensuring instruments are kept relatively clean during the procedure and preventing blood and body debris from drying on instruments are small steps that perioperative nurses can take to provide clean instruments for our patients. Although some perioperative nurses may not be directly involved in instrument cleaning, sterilization, and processing, dirty instruments are everyone's problem. The perioperative nurse advocates to provide a safe environment for our patients. Including the sterilization and processing technician in the surgical team will help to accomplish this goal.


Elizabeth M. Thompson, MSN, RN, CNOR

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Editor-in-Chief Nursing Education Specialist Mayo Clinic, Rochester, Minn. [email protected]




1. Takeda A. Dirty surgical tools: a hidden, deadly danger. 2012. [Context Link]


2. Single Use Surgical. The hidden threat of dirty surgical instruments. [Context Link]