The Importance of Wiping and Flushing Instruments During a Procedure to Prevent Biofilms

According to the National Healthcare Safety Network, 42.4% of adult health care–associated infections (HAIs)¹​ ​and 17.7% of pediatric HAIs²​ were categorized as surgical site infections (SSIs). The two most reported pathogens in both adult and pediatric SSIs were Staphylococcus aureus and Escherichia coli,^1,2 both of which are becoming increasingly difficult to treat due to multidrug resistance. These HAIs can be costly to both the patient and the health care system.

Reducing Biofilms

To prevent the development of SSIs, particularly those caused by multidrug-resistant organisms (MDROs), surgical instruments should be kept wiped and flushed during operative and other invasive procedures to reduce the build-up of biofilms on them. Biofilms result when microbes become attached to surfaces, forming a mass that is difficult to remove. According to the Centers for Disease Control and Prevention, “[b]acteria within biofilms are up to 1,000 times more resistant to antimicrobials than are the same bacteria in suspension.”^3(p.36) Biofilms can negatively impact a patient’s immune response, leading to increased antimicrobial resistance and the risk of chronic infections with MDROs.⁴

Point-of-Use Treatment

The surgical technologist or other scrub person should wipe and flush instruments at the point of use to minimize the formation of biofilms and make postoperative decontamination and sterilization more effective. They should use sterile water to wipe and flush the instruments and keep them moist during the procedure. Normal saline should not be used because it is a corrosive fluid; the sodium chloride can cause pitting and rusting on the instruments, creating microscopic spaces where biofilm can form.⁵ Pitting and rusting also decrease the working lifespan of instruments, costing the facility money to replace them more frequently.

Following the Manufacturer's IFU

Scrubbed personnel who are uncertain about how to perform point-of-use wiping and flushing of specific instruments during the procedure should reference the equipment’s instructions for use (IFU). For example, one company’s general cleaning IFU for their reusable medical devices instructs users to avoid solutions with a high-chlorine content and specifies that cannulated devices should be flushed with sterile or purified water.⁶

References

1. Weiner-Lastinger LM, Abner S, Edwards JR, et al. Antimicrobial-resistant pathogens associated with adult healthcare-associated infections: summary of data reported to the National Healthcare Safety Network, 2015–2017. Infect Control Hosp Epidemiol. 2019;41(1):1-18. https://doi.org/10.1017/ice.2019.296
2. Weiner-Lastinger LM, Abner S, Benin AL, et al. Antimicrobial-resistant pathogens associated with pediatric healthcare-associated infections: summary of data reported to the National Healthcare Safety Network, 2015–2017. Infect Control Hosp Epidemiol. 2019;41(1):19-30. https://doi.org/10.1017/ice.2019.297
3. Rutala WA, Weber DJ; Healthcare Infection Control Practices Advisory Committee (HICPAC). Guideline for Disinfection and Sterilization in Healthcare Facilities, 2008. Atlanta, GA: Centers for Disease Control and Prevention; 2019. https://www.cdc.gov/infectioncontrol/pdf/guidelines/disinfection-guidelines-H.pdf
4. Prinzi A, Rohde R. The role of bacterial biofilms in antimicrobial resistance. American Society for Microbiology. March 6, 2023. Accessed February 11, 2024. https://asm.org/articles/2023/march/the-role-of-bacterial-biofilms-in-antimicrobial-re
5. Cowperthwaite L, Holm RL. Guideline implementation: surgical instrument cleaning. AORN J. 2015;101(5):542-552. https://doi.org/10.1016/j.aorn.2015.03.005
6. Synthes USA Products, LLC. Processing Synthes reusable medical devices - instruments, instrument trays and cases. https://synthes.vo.llnwd.net/o16/LLNWMB8/IFUs/JJMDC/DPS/Main%20Page/103509580.pdf

AORN Resources

AORN members can access:

• Instrument Cleaning Guideline Essentials | AORN
• Point‐of‐Use Instrument Cleaning and Steam Sterilization - AORN Journal
• Guidelines in Practice: Instrument Cleaning - AORN Journal
• Guideline Quick View: Instrument Cleaning - AORN Journal
• Instrument cleaning considerations at the point of use - AORN Journal

If your facility subscribes to eGuidelines+, you can access:

• Instrument Cleaning Guideline | AORN eGuidelines+