Central Service Professionals know that high bioburden can inhibit sterilization and we all know that bone and gross proteins cannot be sterilized. What do we do about instruments such as Kerrison Rongeurs that do not EASILY come apart, but that we know harbor gross debris? We all try to sonic more, but aren't we just masking a potential surgical site infection?

I look forward to hearing from anyone. Thank you!

Tracey J. Rapp

Dear Tracey

Yes how right you are. The presence of organic material such as blood, dirt, or body fluids following the cleaning process means there is very little chance that the microbes will be killed and even if they are, this "leftovers" are foreign body's put into the patient. My first thought by reading your question was, (as so often), instruments witch cannot be cleaned and sterilized for the safe reuse on the patient should not be on the market at all.

Ideally, reprocessing considerations should be addressed before an instrument is selected and purchased. Part of the decision should be the instrument's cleaning and sterilization requirements and the ability to meet those requirements.

The manufacturer is obliged to give detailed instructions for the cleaning and sterilization of the items he brings on the market.

Punches and Rongeures are problem instruments, but they are here, are needed and, they can be a "challenge" for safe reprocessing.

Whether Punches, Rongeurs ect, are cleaned in the sonic-washer or manually, pre-soaking in an enzymatic solution is very effective in the removal of protein, blood, mucus and other protein materials. Detergent manufacturers have introduced enzymatic sprays, foams, and soaks to assist in the pre-cleaning stage. The most important feature of an enzymatic cleaning solution is its enzyme formulation. There is seldom only one type of enzyme sufficient. The inclusion of an enzyme that attacks only proteins may be of little value if the protein structure is encapsulated in carbohydrate structure, which must be eliminated first. Therefore, multiple enzyme formulations are always preferred. For Enzyme products, see our industrial partners on the website

Kind regards
Josy Holdener