Pre-cleaning Complex Instruments and Its Impact on Patient Safety

Inadequate cleaning before sterilization accounts for 34% of surgical site infections.1 Patient safety is a top priority for every hospital across the country and sterile processing departments play a vital role in maintaining the integrity of patient safety during surgical procedures.

The advancements in healthcare technology have birthed innovative surgical instruments that often have complex designs. Sterile processing departments are faced with the new challenge of properly cleaning those complex instruments in a fast paced and high-pressure environment.

We’ve outlined three essential steps in pre-cleaning complex instruments to ensure it’s done correctly and without compromising patient safety.

1. Always follow the instructions for use (IFU)

Each instrument comes with Instructions for Use. The term “instructions for use” refers to the information provided by the manufacturer to inform the user of a device’s intended purpose and proper use and of any precautions to be taken.2

A portion of each IFU details how to properly clean the instrument prior to use in surgery. The IFU will outline what steps need to be taken during cleaning, what cleaning technologies should be utilized and under what conditions. It is always critical to become familiar with the instrument’s IFU and follow it step-by-step. Omitting any of the cleaning steps in the reprocessing protocol can lead to deadly infections.1

2. Utilize pre-cleaning technologies

Sterile processing departments rely on modern technologies every day to aid in instrument reprocessing. Instrument IFUs often require the use of these technologies to clean complex instruments effectively. Many complex instruments have small channels, moving parts and little nooks and crannies. Lumened or cannulated instruments account for 35% of cases where inadequate cleaning before sterilization was identified.1

flushing robotics 004The use of automated flushing systems assures copious flushing of internal device channels and lumens during pre-cleaning. Unlike traditional methods of flushing, automated flushing will ensure departments stay compliant with industry guidelines and IFUs by consistently flushing the same volume and pressure each time.

The use of cavitation will also improve the quality of your pre-cleaning process tremendously. Cavitation creates bubbles induced by high frequency pressure (sound) waves to agitate a liquid. The agitation produces high forces on contaminants adhering to substrates like metals, plastics, glass, rubber, and ceramics.3 Ultra-sonic cleaners in sterile processing departments utilize the process of cavitation and help clean complex instruments’ hard-to-reach places.

3. Support from direct leadership and supporting departments

Cleaning and preparing each instrument for an entire hospital’s surgical procedures is no easy task. Sterile processing departments are under immense pressure to ensure each instrument is cleaned thoroughly and in a timely manner in preparation for the next surgery. It’s important for the organization’s leadership to ensure the SPD staff has the proper equipment and workflow to meet these high expectations.

Pre-cleaning complex instruments often involves multiple steps that require time and attention-to-detail. SPD leadership must take this into consideration for their staff to be compliant and get the job done correctly. The support from surgeons that work in conjunction with SPD will also help this process tremendously. Their understanding of the pre-cleaning process will prevent productivity pressures from forcing staff to deviate from the cleaning instructions for the instruments at hand.

These three essential steps ensure correct processes and patient safety. You can elevate your department’s influence on the reduction of surgical infections by following IFUs, taking advantage of pre-cleaning technologies, and ensuring support from direct leadership. Implementing such recommendations takes a commitment to action and follow through but are well worth the effort.


Learn more about the Pure Processing FlexiPump Independent Flushing System which helps assure copious flushing of internal device channels and lumens during pre-cleaning, and can flush up to three instruments at once.


  1. ECRI (2017). If it’s not clean, it’s not sterile: Reprocessing contaminated instruments. Event Reporting and Analysis Alerts. Accessed online August 27, 2021.
  2. Schuh, M. (2020). MDR: requirements for instructions for use for medical devices. Reusch Law website. Accessed online August 27, 2021.
  3. Todd, bert H., Allen, ll K., & Alting, O. (1994). Manufacturing processes reference guide. Industrial press


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