Borescope inspections reveal widespread contamination in lumened surgical instruments

Editor's Note

Conventional cleaning protocols fail to remove visible soil and debris from lumened surgical instruments, raising urgent concerns about patient safety and sterilization efficacy. That’s the central finding of a study published February 11 in The American Journal of Infection Control, which used borescopes to inspect the lumens of 40 commonly used instruments in orthopedic, neurosurgical, and ENT procedures—and found visible debris in 100% of them, even after multiple rounds of reprocessing.

The study, conducted in the sterile processing department of a large academic medical center, involved 117 total inspections: 40 initial inspections and 77 follow-up inspections after up to three rounds of recleaning. Researchers selected instruments with complex internal architecture—including shavers, suction tips, and attachments—that could hinder brush access and visual confirmation during cleaning. Instruments were processed according to manufacturer instructions using standard manual cleaning, enzymatic detergent, automated washer-disinfectors, and steam sterilization.

Key findings include:

• 100% of instruments had visible discoloration or debris upon initial inspection
• 95% had rust-colored patches; 60% had black discoloration; 33% had white residue
• 88% had visible chunks of brown, yellow, orange, or white debris
• 73% had fibrous contaminants resembling lint or brush bristles
• 100% still showed visible soil or debris after recleaning, including newly introduced lint or bristle fragments
• Fluid droplets were observed even after forced-air drying

Recleaning in strict adherence to instructions for use (IFU) did not eliminate soil researchers write. In some cases, new debris appeared during reprocessing. Complex features such as grooves, ledges, and variable lumen diameters made thorough cleaning nearly impossible without real-time borescope guidance. Swab testing under borescope visualization confirmed the persistence of removable debris even after repeated cleaning.

The study aligns with prior research showing high rates of retained debris and biofilm in lumened instruments, and highlights a critical gap between IFU recommendations and real-world feasibility, researchers write. They recommend routine borescope use for lumened instrument inspection, expanded training on instrument-specific cleaning requirements, and collaborative revision of IFUs with manufacturers. They also suggest design innovations to support cleanability and call for further research into links between retained debris and surgical site infections. In some cases, transitioning to disposable instruments may be necessary to ensure safety.

test