The part of the instrument reprocessing cycle performed intraoperatively is point-of-use cleaning, sometimes called point-of-use instrument care. This is the practice of wiping, rinsing, and flushing surgical instruments with sterile water while the procedure is still underway, before the instruments ever leave the operating room. It is the very first step in the reprocessing cycle, and skipping it makes every downstream step less effective.
What Point-of-Use Cleaning Involves
Point-of-use cleaning happens right at the sterile field. When an instrument is passed from the surgical site back to the back table, it gets wiped down with a surgical sponge moistened with sterile water to remove blood, tissue, and other organic debris from its surface. Instruments with hollow channels (lumens) are periodically flushed with sterile water to keep those channels clear. Instruments that are difficult to clean, such as acetabular reamers, and won’t be needed again during the case should be soaked in sterile water for the remainder of the procedure.
One important detail: every instrument opened onto the sterile field must go through the full reprocessing cycle afterward, even if it was never actually used during surgery. Point-of-use care applies to all of them.
Why It Has to Happen During Surgery
The reason point-of-use cleaning can’t wait is biology. Bacteria begin adhering to surgical instrument surfaces in layers within the first hour of contact with blood and tissue. Research published in the American Journal of Infection Control found that bacterial loads on surgical forceps reached measurable levels after just one hour and climbed to significantly higher concentrations by twelve hours. The protective slime layer that bacteria produce (the early stage of biofilm) was detectable within two hours and continued building from there. Fully formed biofilm structures appeared on instrument surfaces between eight and twelve hours.
Once organic material dries onto stainless steel and bacteria establish a biofilm, it becomes far more difficult to remove, even with chemical disinfectants and mechanical scrubbing. Cleaning agents that work well on fresh contamination can fail against biofilm, especially when dried organic soil is also present. Wiping instruments during the procedure keeps soil wet and loose, giving the sterile processing department a realistic chance of getting instruments truly clean.
Sterile Water, Not Saline
A common and important rule: never use saline (normal saline, 0.9% sodium chloride) to wipe instrument surfaces. The sodium chloride in saline is corrosive to surgical steel. It causes pitting and rusting on the metal, creating microscopic crevices where bacteria can hide and biofilm can establish itself. Beyond the infection risk, pitting shortens the working life of expensive instruments, increasing replacement costs for the facility. Sterile water is the only fluid that should contact instrument surfaces during point-of-use care.
Special Handling for Lumened Instruments
Cannulated and lumened instruments need extra attention because their narrow internal channels are especially prone to clogging with blood and debris. These instruments should be flushed with sterile water periodically throughout the case. At the end of the procedure, they should be flushed again on the surgical field before being sent for reprocessing. When flushing, holding a gauze sponge around the tip of the cannula prevents sterile water from spraying into the air or toward other team members. Using Luer lock syringes keeps cannulas and needles securely attached during flushing.
What Happens After the Case Ends
Once point-of-use cleaning is complete and the procedure is over, instruments transition to the next phases of the reprocessing cycle. Reusable contaminated instruments are placed in a lidded bin with a red biohazard sticker so that anyone who handles them can immediately identify the contents as contaminated. Single-use items are separated from reusable ones before anything leaves the operating room.
Instruments are then transported to the decontamination area, where they go through enzymatic soaking (following the manufacturer’s specific dilution and contact time instructions), thorough manual or automated cleaning, inspection, packaging, and finally sterilization. The CDC recommends that instruments be presoaked or rinsed promptly after use to prevent any remaining blood from drying further.
Point-of-use cleaning doesn’t replace any of these later steps. It is the foundation that makes them work. An instrument that arrives at sterile processing with dried, caked-on bioburden is starting the reprocessing cycle at a disadvantage that later cleaning may not fully overcome.