Cleaning and disinfection protocol for medical instruments in the operating room

Proper cleaning and disinfection of medical instruments is the fundamental pillar for preventing healthcare-associated infections and ensuring patient safety in the operating room. Adhering to a clear and precise protocol is essential for maintaining a safe environment and for the optimal functioning of medical equipment. In this article, we detail the essential steps and recommended products for cleaning, disinfecting, and sterilizing medical instruments, according to industry best practices.

Essential steps and suggested products

Cleaning (Phase 1)

Immediately after use, the instruments must be cleaned to remove organic soil and other residues. Use Klinozyme tri-enzymatic detergent in a concentration between 0.25% and 0.5%, prepared by diluting the product with water (for example, 5 ml of Klinozyme to 995 ml of water for 1 liter of 0.5% solution).

The instruments, including detachable parts, are completely submerged in the prepared solution, ensuring that all surfaces and cavities are covered. The recommended contact time is 5-15 minutes at a temperature of 25-30°C, depending on the degree of contamination. After this interval, the instruments are rinsed with warm water and gently cleaned with a soft cloth or sponge.

The solution can be reused for up to 72 hours but must be replaced if it becomes too soiled.

Usage details:

• Manual cleaning / ultrasonic baths:
  • 0.25%-0.5%, 5 minutes (medium contamination level)
  • 0.25%-0.5%, 15 minutes (high contamination level)
• Automatic cleaning:
  • 0.25%-0.5%, 50 minutes

Klinozyme Automate is specially designed for automatic reprocessing equipment, formulated without foaming and fragrance to protect the machinery.

This stage must be carried out immediately to prevent drying and the fixation of residues, which could compromise the efficiency of the disinfection. Drying the instruments after rinsing is a critical step: it is recommended to dry them with clean, indirect air to prevent corrosion and the dilution of subsequent disinfectant solutions.

Intermediate-level disinfection (Phase 2)

After cleaning, the intermediate-level disinfection phase follows. The instruments are submerged in a 1% Deziamino solution (10 ml Deziamino to 990 ml of tap or distilled water) for 60 minutes. After this time, the instruments are rinsed with tap water in accordance with the medical facility's internal protocol.

High-level disinfection (Phase 3)

For critical instruments or those requiring a higher level of safety, high-level disinfection is applied (e.g., with Dezicon or Peroklin). Heat-sensitive instruments may undergo cold chemical sterilization (e.g., with Oxoklin) as an alternative to thermal sterilization by autoclaving (Phase 4).

Dezicon is used in a 2% concentration (20 ml Dezicon + 980 ml tap/distilled water), with an action time of 60 minutes. The cleaned and dried instruments must be completely submerged in the solution, then rinsed with tap or sterile water after use. It is recommended to use an opaque plastic container for storage.

Alternatively, Peroklin, a high-level disinfectant, can be used as is, with an action time of 60 minutes, through a cellular oxidation mechanism.

Cold chemical sterilization can be achieved with Oxoklin at a 5% concentration (50 ml Oxoklin + 950 ml tap/distilled water), with a contact time of 15 minutes. After sterilization, the instruments are rinsed with sterile water to remove any product residue.

Note: Strict adherence to concentrations and contact times is mandatory to ensure the efficacy of the chemical disinfection and sterilization.

Thermal sterilization (Phase 4)

This represents the final stage of reprocessing and ensures the complete destruction of all microorganisms, including bacterial spores, thus guaranteeing the use of the instruments under conditions of maximum safety during surgical procedures.

This method is applied exclusively to instruments resistant to high temperatures and is performed in a steam sterilizer (autoclave).

Beyond the protocol: responsibility, ethics, and patient care

Rigorous compliance with the protocol for cleaning, disinfecting, and sterilizing medical instruments is not just a legal obligation, but a moral responsibility of every specialist in the operating room. A perfectly clean and sterilized set of instruments is the first step toward patient safety and the success of the surgical procedure, ensuring the highest standards of hygiene and protection through correct methods and compliant products.

More than just a routine, rigorous hygiene conveys to patients that they are being cared for in an environment where every detail matters. They are protected not only against the condition for which they presented but also against possible complications associated with hospitalization. In such a safe and controlled setting, trust in the medical system grows, and healing becomes a complete process, supported by professionalism, care, and respect.

Bibliography

Ministry of Health. (2021). Technical standards regarding cleaning, disinfection, and sterilization in public and private health units (Ministry of Health Order No. 1761/2021).

Rutala, W.A., & Weber, D.J. (2020). Disinfection and sterilization in healthcare facilities: An overview and current issues. Clinical Microbiology Reviews, 33(2), e00053-19.

National Institute of Public Health. (2016). Technical standard of 19.08.2016 regarding cleaning and disinfection in health units.

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