The Benefits of Point-of-Use Instrument Care

Instrument Reprocessing and Care

By: Casey Czarnowski

Published: 8/10/2020

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Bedside treatments improve workflow, patient care and the relationship between surgical teams and reprocessing techs.


Your OR staff is under enough pressure to achieve excellent outcomes and keep the surgical schedule on track during days packed with cases from early morning to late afternoon. On top of all that, they're expected to take good care of expensive new instruments used during procedures that grow increasingly complex each year. Adding point-of-use instrument care to their already lengthy list of clinical tasks will be as welcome as an add-on case.

The good news is that treating instruments at the bedside with a spray or gel to keep them moist until they reach central sterile can be done in minutes and actually increases overall efficiencies. It's also important to note that we're talking about instrument care, not cleaning. OR staff sometimes say it's not their job to clean instruments. Using the phrase "point-of-use care" is helpful because it takes "cleaning" out of the discussion — and it's more accurate.

Let's explore how properly caring for instruments in the OR creates a partnership between surgical teams and sterile processing techs, keeps your facility running smoothly, saves money by extending the life of instrument sets and ultimately reduces risks of surgical site infections.

Constant instrument care

Treating instruments in the OR immediately after they're used ensures the cleaning process in the sterile processing department is as easy and efficient as possible. A member of the surgical team should use a four-by-four-inch gauze pad to wipe soiled instruments with sterile water each time they're handed back by the surgeon. In addition to this being sound instrument care, it also helps the procedure run smoothly as surgeons appreciate being handed back a pair of non-bloody scissors the second they're needed. A point of emphasis: Saline should never be used to wipe down instruments. It degrades stainless steel over time and, like blood, can eat through the top passivation layer to cause pitting.

WORKING AHEAD Instruments that are treated in the OR are easier to clean when they arrive in central sterile.   |  Penn State Milton S. Hershey Medical Center

In a larger OR setting, set up a draped Mayo stand with a basin of water and gauze pads. When handed an instrument, simply turn to the table, wipe the instrument clean and return it to where it's kept until it's needed again. If you work in a smaller OR with limited space to move, draw a square on the back table with a marker and label it "water for cleaning." Place a silver or plastic basin and gauze pads in the area. Either setup ensures you're not mixing soiled instruments with tools that have not yet been used.

At the end of the procedure, the surgical assistant, surgical tech or nurse who wiped down the instruments during the case simply wipes them down again using the same water and the same gauze, and places them in a discard pan, back on the surgical tray or in a biohazard box — whatever container is used to transport instruments to the sterile processing department. There aren't a lot of requirements for the type of containers to use. They should be big enough and high enough to completely contain the instruments they hold. They should also be puncture resistant and affixed with a biohazard label if they're transported through a common hallway.

Soiled instruments should be sprayed with a pre-treatment gel or spray before transport to sterile processing. Although transport gel is preferred, using a damp towel to cover the instruments is accepted practice. This step is particularly important in surgery centers with smaller sterile processing departments where delays between a set's arrival and when the decontamination process begins are relatively common. Keeping tools moist makes stuck-on blood and other bodily fluids easier to remove when manual cleaning ultimately begins.

There is some concern about aerosolizing biohazardous bodily fluids in the OR. For this reason, some hospitals insist that instruments are taken to a dirty instant room for treatment before transport to sterile processing. I don't recommend this practice, however. Instead, purchase a non-aerosolizing moisturizer and, after the patient has left the room, spray the instruments as they're spread out in the OR. This is a better option for a couple of reasons. One, application of the moisturizer takes place soon after the case ends, and the sooner it's applied the better. Two, it's more likely that the surfaces of all the instruments will be treated. After an instrument set has been put into a closed cart and taken to a dirty room, whoever is doing the spraying will likely just open the cart's doors and blindly spray inside. This means that only the instruments at the very top of the heap get treated. You're much more likely to get even coverage when you apply the gel or spray while the instruments are still in the OR and before they're placed in the transport container.

A successful partnership

Surgical staff members understandably have an expectation that they will receive clean and sterile instruments from sterile processing. For a true partnership to exist between the two areas, however, you need to instill an expectation that sterile processing techs will receive instruments from ORs that have been wiped down during and immediately after procedures, and shipped to them moist. Creating that partnership and making sure it's a two-way street not only makes it easier for the OR staff to get the clean instruments they want, it also means instruments are properly cared for and patients will receive the quality care they deserve.

The primary reasons facilities skip point-of-use instrument care are related to time and money. The pitch to OR staff is that the rewards and benefits outweigh the few extra minutes pre-cleaning takes. A well-cared-for stainless steel surgical instrument can last more than 10 years, which helps your facility's bottom line because you won't have to replace pitted instruments that are no longer usable. Pre-treatments also shorten the time sets spend in decontamination, which saves money and results in fewer late case starts that waste expensive OR time.

Wiping instruments with water and gauze during procedures and making sure they remain moist until they reach sterile processing should be a no-brainer. The extra steps will add a few minutes to room turnover times, but overall efficiencies will improve because instruments arrive at sterile processing with no bioburden on their surfaces, making them easier to clean and sterilize. Reprocessing techs will therefore be able to return sets of properly cared-for instruments to ORs at a faster clip. Point-of-use instrument care is particularly important for instrument sets used multiple times a day for high-volume procedures. It's important during the introduction of point-of-use care to help OR staff understand the "why" behind what they're being asked to do. When rolling the concept out, include point-of-use protocols in your facility's policies and enlist members of the surgical staff to deliver the message to their colleagues. Be sure the OR staff knows that national, evidence-based standards recommend the point-of-use care of surgical instruments. Ongoing compliance review is equally important to ensure the protocols are followed consistently. I recommend that point-of-use care be included in your facility's annual competency assessments.

Point-of-use care isn't yet universal, but it's heading in that direction. The Joint Commission updated their standards two years ago to make the practice a requirement (IC.02.02.01.02) and surveyors are checking for compliance. During your next survey, don't be surprised if the surveyor walks into the decontamination area and opens a case cart to see if instruments have been sprayed with pre-treatment gel.

I've worked in three hospitals over the last 12 years, and they followed the same track: They learned about point-of-use instrument care, then trained their employees on how to do it and now it's a mandatory policy. As your facility gets on the same trajectory, you'll have a smoother running OR schedule, will pay less for instrument repairs and keep your patients as safe as possible. OSM