What Happens to Surgical Instruments After Surgery? Inside the Sterile Processing Process

Sterile Processing: The Journey of Surgical Instruments After Surgery

What do you think happens to surgical instruments after an operation? Are they simply placed in a large hospital washing machine, cleaned, and returned to the operating room?

The reality is far more complex. Each reusable instrument begins a carefully controlled journey through decontamination, cleaning, inspection, assembly, packaging, sterilization, storage, and eventual return to the surgical team. This multistep process is known as reprocessing, and it takes place largely behind the scenes. Sterile Processing professionals help ensure that instruments are clean, functional, correctly prepared, and ready when they are needed for another procedure.

The Journey Begins in the Operating Room

The Sterile Processing process may begin before an operation has even ended.

During a procedure, surgical instruments can be exposed to blood, tissue, and other material. Members of the surgical team may perform initial point-of-use care to keep this material from drying onto instrument surfaces. Depending on the instrument and the manufacturer’s instructions, this may include wiping away visible material, keeping instruments moist, or flushing certain channels.

This initial step does not sterilize the instruments. It helps prevent material from drying and becoming more difficult to remove later.

After the procedure, reusable instruments are separated from disposable items and prepared for transportation. They are placed in designated containers or carts so contaminated items can be moved safely from the operating room to the Sterile Processing department.

At this point, the instruments are not ready to be handled as ordinary equipment. Their journey is only beginning.

First Stop: Decontamination

Used instruments enter the decontamination area, sometimes informally called the “dirty side” of the Sterile Processing department. This area is physically separated from the clean areas where instruments will later be inspected, assembled, and packaged.

Sterile Processing technicians working in decontamination wear appropriate personal protective equipment. Depending on the work being performed, this may include gloves, protective gowns, masks, face shields, and other protection against splashes or contact with contaminated material.

The instruments must then be sorted and prepared for cleaning. Multi-part instruments may need to be opened or disassembled so that every surface can be reached. Hinged instruments are generally opened, and devices with narrow channels or hollow spaces may require special attention.

Technicians must follow the device manufacturer’s instructions for use, often called the IFU. These instructions explain how a particular instrument should be taken apart, cleaned, treated, inspected, sterilized, and reassembled. There is no single cleaning method that is appropriate for every medical device.

Are Surgical Instruments Put in a Washing Machine?

In a sense, some of them are—but this is not the kind of machine used for dishes or laundry.

Sterile Processing departments may use specialized medical washer-disinfectors designed to clean, rinse, thermally disinfect, and dry compatible instruments. These machines use controlled cycles, water temperatures, detergents, spray pressure, and racks designed for medical equipment.

Other equipment may also be used. An ultrasonic cleaner, for example, uses high-frequency sound waves to create microscopic bubbles in a cleaning solution. The action of those bubbles can help remove material from joints, grooves, serrations, and other difficult-to-reach areas.

Some instruments must be cleaned manually, either because of their design or because the manufacturer requires it. Manual cleaning may involve carefully brushing surfaces, flushing channels, and using cleaning solutions formulated for medical instruments.

Most importantly, cleaning and sterilization are not the same thing. Cleaning removes visible and invisible material that could interfere with later processing. An instrument must be properly cleaned before it can be reliably disinfected or sterilized.

Inspection: Is the Instrument Actually Clean?

After cleaning, instruments move to the clean side of the department. However, technicians do not simply assume that the cleaning equipment did its job. Each instrument must be inspected.

Under appropriate lighting—and sometimes magnification—a Sterile Processing technician checks for remaining soil, stains, corrosion, cracks, chips, and other problems. Box locks, hinges, teeth, grooves, and narrow openings may require especially close examination.

An instrument can look clean at a glance while still having material hidden in a joint or recessed surface. If contamination remains, the instrument may need to return to decontamination and go through the cleaning process again.

Cleanliness is only part of the inspection. The instrument must also function correctly. Scissors may be tested to determine whether they cut properly. Clamps may be checked to ensure they close and hold as intended. Hinges should move smoothly. Sharp tips must be intact, and delicate instruments must not be bent or misaligned.

A damaged or malfunctioning instrument should not simply be placed back into a surgical set. It may need to be removed from service, repaired, or replaced. This makes inspection a form of quality control as well as infection prevention.

Reassembling the Surgical Set

Surgical instruments are often organized into sets or trays created for particular procedures. A basic set may contain familiar instruments such as scissors, clamps, forceps, and retractors. More specialized procedures may require complex collections of instruments arranged in a specific way.

Sterile Processing technicians use count sheets, digital records, photographs, or other instructions to rebuild each set. They must identify the instruments, confirm the correct quantity, and place them in the proper arrangement.

This can require considerable attention to detail. Two instruments may look nearly identical while differing in size, curvature, tip design, or intended purpose. Placing the wrong instrument in a set could create delays when the surgical team opens the tray and discovers that the tool it needs is missing.

The technician must also arrange the instruments so that the sterilizing agent can reach the necessary surfaces. Hinged instruments may need to remain open, while heavier items must be positioned so they do not damage more delicate instruments.

When the set is complete, it is placed in an approved container or wrapped in material designed to allow sterilization while protecting the contents afterward.

Sterilization: More Than Making Something Very Clean

In everyday conversation, people sometimes use “clean,” “disinfected,” and “sterile” as though they mean the same thing. In healthcare, they describe different levels of processing.

Cleaning removes soil and other material from an object. Disinfection destroys many disease-causing microorganisms, but it may not eliminate every form of microbial life. Sterilization is a validated process intended to make a product free of viable microorganisms.

Because surgical instruments enter sterile tissue or come into contact with the vascular system, they are considered critical medical devices. They must be sterile when used.

For many heat-resistant surgical instruments, steam sterilization is the preferred method. A steam sterilizer—often called an autoclave—uses saturated steam under pressure for a controlled combination of time and temperature.

However, not every medical device can tolerate high heat or moisture. Depending on the device and its manufacturer’s instructions, a healthcare facility may use another method, such as vaporized hydrogen peroxide or ethylene oxide gas. The sterilization process must be compatible with the device, its packaging, and its validated instructions.

How Does the Department Know Sterilization Worked?

Sterile Processing departments use multiple forms of monitoring to evaluate sterilization processes. The sterilizer records physical information such as time, temperature, and pressure. Chemical indicators respond to one or more conditions inside the sterilizer and help show that an item was exposed to the process. Biological indicators use highly resistant microorganisms to test whether the sterilization process was capable of destroying them.

These methods provide different types of information. Together, they help professionals determine whether a sterilization cycle met its required conditions.

Sterilization records may document the sterilizer used, cycle number, date, load contents, monitoring results, and the person responsible for the load. Instrument-tracking systems may also connect a set to its processing history and, in some facilities, to the procedure in which it was used.

Cooling, Storage, and Maintaining Sterility

After sterilization, packages and containers must be handled carefully.

Items may need to cool before they are moved or stored. Handling a package incorrectly—especially while it is still hot or moist—can compromise its protective barrier. A package that becomes wet, torn, punctured, crushed, or otherwise damaged may no longer be considered suitable for use.

Sterile items are stored in a controlled area designed to protect them from moisture, dust, excessive handling, and physical damage. Before a tray or package is sent to the operating room, its condition and labeling may be checked again.

Sterility is not protected by the sterilization cycle alone. It also depends on what happens to the package after the cycle is complete.

Returning to the Operating Room

When another procedure is scheduled, the requested instrument sets are selected from storage and delivered to the appropriate clinical area.

Before the instruments are used, members of the surgical team also inspect the package, review indicators, and confirm that the correct set has arrived. The package is then opened using practices intended to preserve the sterile field.

The instruments have now completed their journey:

Operating room. Transportation. Decontamination. Cleaning. Inspection. Assembly. Packaging. Sterilization. Monitoring. Storage. Return to surgery.

After the procedure, the cycle begins again.

Sterile Processing Is a Team Effort

Although the Sterile Processing department works behind the scenes, it is closely connected to the operating room and many other areas of a healthcare facility.

Technicians must communicate with surgical teams about missing instruments, damaged equipment, urgent cases, changes to procedure schedules, and sets that require special handling. They may also work with infection prevention professionals, nurses, biomedical equipment specialists, manufacturers, and department leaders.

The work combines science, technology, organization, manual skill, and detailed documentation. It also requires technicians to follow exact procedures even when the department is busy and surgical teams are waiting for instruments.

References

This article was developed using guidance and educational resources from the following healthcare and medical-device authorities:

• U.S. Food and Drug Administration: How Are Reusable Medical Devices Reprocessed?
• U.S. Food and Drug Administration: Reprocessing of Reusable Medical Devices
• Centers for Disease Control and Prevention: Disinfection and Sterilization Guideline
• Centers for Disease Control and Prevention: Cleaning of Medical Equipment
• Centers for Disease Control and Prevention: Steam Sterilization
• Association for the Advancement of Medical Instrumentation: Sterile Processing Resources

Learn More About Sterile Processing

• About the Sterile Processing Career
  • What Are the Job Prospects of a Sterile Processing Technician?
  • 6 Personal Qualities You Need to Be Successful in Sterile Processing
  • Sterile Processing Through Time: The History of Sterilization of Medical Instruments
  • Exploring Autoclaves in Sterile Processing: History, Uses, and Technician Insights
  • The Clean Core of Surgery: Why Sterile Processing Technicians Are Essential to Patient Safety
  • The Invisible Decisions: What Sterile Processing Technicians Know That Keeps Surgery Safe
  • What Does a Sterile Processing Technician Do?
  • What Happens to Surgical Instruments After Surgery? Inside the Sterile Processing Process