Can ultrasonic cleaning increase patient safety and value preservation of surgical instruments?

Introduction

The reprocessing of surgical instruments is essential for patient safety and infection prevention. However, much of the foundational research informing current practices is outdated and fails to reflect modern technologies. Ultrasonic cleaning, though widely recommended, lacks consistent evidence regarding its effectiveness and potential long-term impact on instrument integrity. This PhD project addresses these knowledge gaps by systematically evaluating ultrasonic cleaning as part of surgical instrument reprocessing. The study aims to enhance cleaning outcomes, extend instrument lifespan, and promote sustainable, cost-effective sterilization workflows that minimize resource consumption and environmental impact.

Aim

To determine whether ultrasonic cleaning improves contaminant removal, preserves instrument integrity, and enhances the overall safety and efficiency of surgical instrument reprocessing. The study seeks to develop standardized, evidence-based guidelines for the use of ultrasonic cleaning within hospital sterilization practices.

Summary of Methods and Key Findings (Planned Studies)

The research follows a modified Medical Research Council (MRC) framework encompassing four stages: develop–test–evaluate–implement.

• Study 1 – Mapping of Reprocessing Practices:
  A multinational survey of Central Sterile Services Departments (CSSDs) in Denmark, Germany, and the Netherlands will assess current cleaning, disinfection, and sterilization practices. Preliminary Danish data reveal high variability in ultrasonic cleaning use, duration (3–20 min), and temperature (30–42°C), underscoring the need for standardization.
• Study 2 – Comparative Laboratory Study:
  A controlled comparison will evaluate ultrasonic versus non-ultrasonic pre-cleaning methods using protein residue analyses (OPA, BCA, LC-MS/MS) and corrosion assessments (microscopy, SEM, EDS). Statistical analyses will test associations between ultrasonic cleaning, residue reduction, and material preservation.
• Study 3 – Implementation Science:
  Findings will inform the development of a standardized ultrasonic cleaning protocol and implementation strategy based on the Quality Implementation Framework, emphasizing sustainability, feasibility, and real-world applicability.

Perspectives

This research will generate robust evidence on whether ultrasonic cleaning enhances the cleanliness and longevity of reusable surgical instruments. Clinically, it may reduce postoperative infection risks, instrument replacement costs, and environmental burden from manufacturing new tools. The resulting evidence-based protocol will strengthen international collaboration and support harmonized best practices in surgical instrument reprocessing, contributing to improved patient safety and healthcare sustainability.