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What is the optimal instrument cleaning procedure between patients?

Q: What are the best options for instrument cleaning for our outpatient hand clinic? We see a variety of infections on a consistent basis and perform debridement frequently as well. What is the optimal method for instrument cleaning between patients: Use of an instrument soak, disposable instruments, or use of an autoclave after each use or after a specified period of time with soaking in between patients?

A: Any reusable instrument that comes in contact with open tissue or blood must be sterilized between patient usages. Sterilization can be done many ways such as the ones you noted: by use of steam sterilization (autoclave) or with a chemical soak. All of these methods are appropriate as long as you:

1) Follow the instrument manufacturer’s recommendation for sterilization

2) Follow the sterilization method’s protocols with appropriate chemical, physical and biological monitors

In outpatient clinics such as yours, it comes down to what is the easiest, cost effective method for your facility. It might be best to use disposables if the turnaround time would limit the procedures you perform. Chemical soaking sterilization may need specific air monitoring that is not cost effective for you to do in your facility. Steam may take too long.

Many factors can dictate which is best. It’s important to assess all your options first in terms patient safety and compliance with manufacturers instructions, and then for convenience and efficiency.