Highlights
- •Extensive protein deposits were found on multiply processed surgical stainless steel instruments.
- •Despite repeated sterilisation by moist heat, biofilm was detected on half the instruments tested.
- •Microscopic damage to instruments including pitting was evident.
- •The number of times individual instruments can be processed safely needs to be determined.
Abstract
Background
To determine the effect of multiple use and processing cycles on instrument quality
over the life of stainless steel, complex designed clinical surgical instruments.
Methods
Steam sterilised surgical instruments due to be discarded from Australian hospitals,
because of loss of functionality, were assessed for contaminating protein and bacteria
using the bicinchoninic acid protein assay and microbial culture, respectively. Biofilm
presence and instrument damage were visually confirmed by scanning electron microscopy
(SEM). Instruments were categorised into hinged/serrated, screw, cannulated, flexible,
and irregular surfaced (but not hinged) according to their design.
Results
Protein contamination ranged from 24 μg on the new screw to 3,756,046 μg contaminating
a discarded forceps. The more complex the instrument design the higher the protein
contamination. All samples were culture negative, however, biofilm was visually confirmed
on 4/8 instruments tested using SEM. SEM also detected soil, holes or black stains
on all the instruments.
Conclusion
“Ready to use” surgical instruments that underwent multiple uses and processing cycles
were contaminated with high amounts of protein, and microscopy revealed the presence
of soil, structural damage, black stains and biofilm. While less affected new but
multiply processed screws also showed soil and biofilm contamination. These findings
highlight the need for further research into determining what is the “life” of stainless
steel instruments and development of standard criteria for evaluating when to “retire”
an instrument.
Keywords
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Article Info
Publication History
Published online: September 28, 2017
Accepted:
August 22,
2017
Received in revised form:
August 22,
2017
Received:
May 26,
2017
Identification
Copyright
© 2017 Australasian College for Infection Prevention and Control. Published by Elsevier B.V. All rights reserved.

