Have you ever wondered how a surgical instrument gets to the operating room (OR) or what happens to it once the surgery is over? How does it get cleaned and sterilized so that it’s ready for another surgery? Let’s follow an instrument on its journey from one procedure to the next.

As soon as an instrument is no longer needed during surgery, any accessories are removed and large debris is wiped from the instrument. Some instruments, like robotic instruments, have a maximum use indicator that must be checked. If the instrument is at its maximum, it is discarded.

Rinsed and kept moist

The instrument is then rinsed with a neutral pH solution or water and kept moist by placing it in a tray of solution, spraying it with a transport gel, or wrapping it in a moistened cloth. This is done to keep blood and bioburden from drying on the instrument, making cleaning quicker and easier once it gets to the sterile processing department (SPD). From here, it is placed in a bin on a case cart.

Once the surgery is complete, the case cart is taken to the decontamination area of the SPD. There, the instruments are sorted by type of metal (to avoid cross-plating during ultrasonic cleaning) and soaked to soften or remove debris. Robotic instruments are primed (solution is injected into the shaft) before being placed in the soaking solution.

After softening the bioburden, an SPD tech manually scrubs soil from the exterior and interior of the instrument with any of a variety of brushes. Channels too narrow to accommodate a brush are flushed with pressurized water.


infographic showing the path of a surgical instrument between SPD and OR

Ultrasonic cleaning

Ultrasonic cleaning takes place after manual brushing. It is especially helpful in removing finer debris from narrow shafts, hinges, and small crevices. Laparoscopic and robotic instruments are irrigated during the process. Instruments are rinsed and dried after cleaning. Water left on instruments to air dry can cause corrosion.

As a final step in the decontamination area, instruments often are run through a washer-disinfector. It uses a pressurized water and detergent spray to wash the instruments and uses a thermal rinse phase to provide some disinfection.

At the end of both the ultrasonic cleaning cycle and the washer-disinfector cycle, the instrument is inspected under magnification to verify that no bioburden is present and there is no damage to the instrument.

Clean side

If it passes inspection, the instrument is taken from the decontamination area to the sterilization area, often referred to as the “clean side,” for prepping and packaging. Clean instruments are readied for sterilization.

Instruments are sorted and counted to fill trays for specific surgeries. A tray should have the instruments needed for that surgery or specifically requested by a surgeon doing an upcoming procedure. The trays are wrapped with special cloths and taped closed with indicator tape, which changes color after steam sterilization.

Once they have been through sterilization, the trays are placed in sterile storage until needed. Each day, case carts are prepped with the trays requested by each surgeon for each procedure. They are delivered to the OR prior to surgery. If an item is missing or found to be contaminated, another will be located and delivered to the OR, where the cycle begins again.