Why Do We Perform Point-of-Use Instrument Care?

Developing Your Skills Do You Know Why? The Stitch

By: Sara Angelilli, DNP, MS, RN, CNOR, NPD-BC

Published: 8/30/2023

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You might notice the surgical scrub wiping down instruments every time a surgeon hands an instrument back to the table. Keeping instruments clean seems like a nice thing to do, but do you know why we perform point-of-use (POU) instrument care?

What is POU Instrument Care?

POU instrument care refers to the process of wiping down instruments and flushing instrument lumens with sterile water when the instrument is passed from the surgical field to the back table. POU care also includes the proper handling of instruments at the conclusion of the procedure. The Association for the Advancement of Medical Instrumentation, Association of Surgical Technologists, and AORN (Sidebar 1) provide recommendations and practice guidelines supporting POU instrument care.

Sidebar 1. Point-of-Use Instrument Care Best Practices1

  • Wipe instruments clean at the point of use with a surgical sponge and sterile water to remove blood and debris from the surface of the instrument.
  • Irrigate instrument lumens with sterile water periodically during the case.
  • Soak instruments that are difficult to clean (such as acetabular reamers) and will not be used during the remainder of the case in sterile water.
  • At the end of the case, segregate sharp instruments, disassemble instruments that have multiple parts, contain all instruments, discard single-use items, and use a surfactant-based or enzymatic spray to prevent bioburden from drying on instruments before decontamination processes start.
  • Transport instruments in a closed container that is marked as a biohazard.

Do You Know Why We Perform POU Instrument Care?

POU instrument care is performed to decrease the number of microorganisms on the surface of instruments, prevent the formation of biofilm, decrease the risk of surgical site infection, support the efficiency of decontamination processes, and maintain instruments in good working condition. The surgical scrub will remove gross contamination from the surface of the instruments during and at the end of the case to prevent organic material from drying on the instrument, which increases the likelihood that biofilm will form on the surface of the instrument. Biofilm refers to a mass of bioburden that adheres to the surface of an instrument, making it difficult to effectively decontaminate and sterilize the instrument. When instruments are not effectively cleaned and decontaminated, the risk of surgical site infections increases. Sterile water is used to prevent instrument corrosion or pitting, which impacts instrument spending and the department budget.

Proper instrument preparation for transport supports staff safety and prevents instrument damage. The surgical scrub will remove all sharps and segregate sharp instruments to prevent staff injuries when instruments are received and prepared for decontamination. The surgical scrub will arrange instruments in a way that prevents damage to delicate instruments; for example, they may place them into different containers or put them on top of heavier items. Used surgical instruments are transported in closed containers that are marked as a biohazard.

Reference

  1. Guideline for care and cleaning of surgical instruments. In: Guidelines for Perioperative Practice. AORN, Denver: CO; 2023:407-446.

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