Surgical site infections can cause significant morbidity requiring lengthy antimicrobial treatment. Infections have been linked to surgical instruments with retained tissue and foreign debris, as the presence of blood or soil interferes with sterilization effectiveness. This study aimed to determine the prevalence of visible soil or debris inside instruments and evaluate the impact of recleaning efforts.

Borescopes were used to inspect lumens of instruments used for orthopedic, neurologic, or ear-nose-throat procedures. Whenever visible soil or debris was observed, the instrument was recleaned up to 3 times and reinspected to assess the impact of additional cleaning.

Researchers performed 117 inspections (40 unique instruments, 77 reinspections). All instruments had complex lumens that impede access by brushes. Debris and discoloration or residues were observed inside 100% of instruments, with rusty patches in 95%. Some soil was removed by recleaning, but visible soil remained in most lumens and fragments of lint or brush bristles were visible upon repeat inspection.

Cleaning in accordance with the manufacturer's instructions was not effective for lumened surgical instruments. Solutions will require collaboration between infection prevention, sterile processing, and manufacturers to evaluate risk and develop strategies for improving processing outcomes.

Current disinfection methods for gastrointestinal endoscopes consume a significant amount of water resources and produce a large volume of waste.

To achieve the objectives of efficiency, speed, and cost-effectiveness, this study utilized vaporized hydrogen peroxide (VHP) generated from sodium percarbonate granules to conduct an anhydrous disinfection test on gastrointestinal endoscopes.

The experimental device rapidly converts sodium percarbonate granules into VHP, and performs disinfection experiments on gastrointestinal endoscope models, disposable endoscopes, and various types of reusable gastrointestinal endoscopes. Variables such as the intraluminal flow rate (FR), relative humidity (RH), exposure dosage, and organic burden are used to explore the factors influencing the disinfection of long and narrow lumens with VHP.

The device generates a certain concentration of VHP that can achieve high-level disinfection of endoscope models within 30 minutes. RH, exposure dosage, and organic burden significantly affect the disinfection efficacy of VHP, whereas the intraluminal FR does not significantly impact disinfection efficacy. All ten artificially contaminated disposable endoscopes achieved satisfactory disinfection results. Furthermore, when this device was used to treat various types of reusable endoscopes, the disinfection and sterilization effects were not significantly different from those of automatic endoscope disinfection machines (using peracetic acid disinfectant solution) (P > 0.05), and the economic cost of disinfectant required per endoscope was lower (1.5 China Yuan), with a shorter disinfection time (30 minutes).

The methods and results of this study provide a basis for further research on the use of VHP for the disinfection of gastrointestinal endoscopes, as well as for the development of anhydrous disinfection technology for gastrointestinal endoscopes.

In laboratory testing, a novel hydrogen peroxide gas plasma endoscope sterilizer consistently reduced vegetative organisms, but not bacterial spores, to undetectable levels in the presence of high organism load (≥6.5 log10) and organic material and salts. These findings highlight the importance of meticulous cleaning of endoscopes prior to sterilization.

Biofilms are surface-attached communities of bacteria embedded in an extracellular matrix. This matrix shields the resident cells from desiccation, chemical perturbation, invasion by other bacteria, and confers reduced susceptibility to antibiotics and disinfectants. There is growing evidence that biofilms on medical instruments (especially endoscopes) and environmental surfaces interfere with cleaning and disinfection.

The English literature on the impact of biofilms in medicine was reviewed with a focus on the impact of biofilms on reusable semicritical medical instruments and hospital environmental surfaces.

Biofilms are frequently present on hospital environmental surfaces and reusable medical equipment. Important health care...associated pathogens that readily form biofilms on environmental surfaces include Staphylococcus aureus, Pseudomonas aeruginosa, and Candida auris. Evidence has demonstrated that biofilms interfere with cleaning and disinfection.

New technologies such as ..úself-disinfecting..Ñ surfaces or continuous room disinfection systems may reduce or disrupt biofilm formation and are under study to reduce the impact of the contaminated surface environment on health care...associated infections.

Future research is urgently needed to develop methods to reduce or eliminate biofilms from forming on implantable medical devices, reusable medical equipment, and hospital surfaces.

There are several sources of pathogens that cause surgical site infections (SSI) to include the patients endogenous microflora and exogenous sources (e.g., air, surfaces, staff, surgical equipment).

We searched the published English literature (Google, Google Scholar, PubMed) for articles on reprocessing surgical instruments, effectiveness of sterilization methods, microbial load on surgical instruments, frequency of "contaminated" instruments, and the infection risk associated with "contaminated" surgical instruments and immediate use steam sterilization.

There is substantial redundancy in instrument reprocessing to include: even if a patient was exposed to a "contaminated" instrument, the decontamination and sterilization process would have removed and/or inactivated the contaminating pathogens due to the exceptional effectiveness of the manual and mechanical cleaning (i.e., washer-disinfector) and the remarkable robustness of sterilization technology; and the low-level of microorganisms on surgical instruments after use and before cleaning.

A critical review of the literature suggests that the risk of acquiring an SSI from instruments used in surgery is essentially zero if the sterilization cycle is validated.