Impact of transportation environment on contaminated instruments before reprocessing: A study challenging reprocessing practices (In press)

Authors

• Rubak, Peter, Assistant Professor, PhD, MHSc, Clinical Nursing Research Unit, Aalborg University Hospital, Aalborg, Denmark
• Bruun, Niels Henrik, MSc Senior biostatistician, Research Data and Biostatistics, Aalborg University Hospital, Aalborg, Denmark
• Kirmse, Gerhard, Dr. Ing., Senior Expert Reprocessing and Sterile Supply Surgical Asset & Supply Implementation, Aesculap AG, Tuttlingen, Germany
• Bundgaard, Karin, Associate professor, PhD, MScN, RN, Clinical Nursing Research Unit, Aalborg University Hospital, Aalborg, Denmark & Department of Clinical Medicine, Aalborg University, Aalborg, Denmark

Introduction

Timely reprocessing of reusable surgical instruments after procedures is essential for preventing material degradation and ensuring effective cleaning. International recommendations differ regarding transport conditions: the World Health Organization advises maintaining moisture during transfer from the operating theatre to the Central Sterile Services Department (CSSD), whereas other guidelines advocate dry handling. A moist environment may facilitate removal of contaminants but can also accelerate corrosion, while dry conditions may better preserve material integrity. This study investigates how these differing approaches influence cleaning outcomes and instrument condition, with the aim of informing improved reprocessing strategies.

Methods

The study was conducted at Aarhus University Hospital, Denmark. Surgical instruments were transported either in a moist state (wrapped in sterile water-moistened towels) or under dry conditions. All instruments underwent a standardised reprocessing procedure. Residual protein levels were quantified using the bicinchoninic acid (BCA) assay, and corrosion was assessed through systematic visual inspection. Statistical analyses were performed with significance defined as p < 0.05.

Results

Over a 16-month period, 89 instruments transported dry and 84 transported moist were evaluated. Mean residual protein levels were similar between groups: 27.7 µg for dry storage and 26.9 µg for moist storage (p = 0.56). Eight instruments exceeded the threshold of 75 µg. Surface assessment of 880 instruments (530 dry, 350 moist) demonstrated a significantly higher incidence of corrosion among instruments transported in moist conditions (fretting corrosion: p < 0.001; non-fretting corrosion: p = 0.05). No statistically significant differences were observed for pitting (p = 0.29) or staining (p = 0.98). Corrosion patterns varied across instrument types, with scissors showing the highest susceptibility (p < 0.001), independent of transport method.

Conclusion

The findings indicate that transportation conditions primarily affect the surface integrity of surgical instruments rather than residual protein contamination. While cleaning efficacy appeared comparable, corrosion was notably more pronounced in instruments kept moist, particularly those with complex designs. These results highlight the importance of optimising transport practices to minimise corrosion, maintain instrument longevity, and support patient safety.