Point-of-Use Treatment & Transport

Point-of-use (POU) treatment is the first step in instrument reprocessing and occurs where the instruments are used — most often the operating room. This critical step is primarily performed by OR staff but directly impacts the effectiveness of every subsequent reprocessing step in Central Service.

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Why Point-of-Use Treatment Matters

When blood, tissue, and body fluids dry on instruments, several problems occur:

1. Biofilm begins forming within minutes of exposure
2. Dried organic matter becomes hardened and adherent, making cleaning much more difficult
3. Proteins denature and bond to instrument surfaces — even aggressive cleaning may not remove them
4. Sterilization cannot penetrate dried organic debris — a dirty instrument cannot be sterilized

Critical principle: The longer soil remains on an instrument, the harder it is to remove. Time is the enemy.

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POU Treatment Steps

At the Surgical Field:

1. Wipe instruments with a non-linting, lint-free cloth or sponge moistened with sterile water throughout the procedure
2. Flush lumened instruments (suction tips, cannulas, endoscopes) with sterile water to prevent soil from drying in channels
3. Keep instruments moist — do not allow them to sit uncovered and dry

After the Procedure:

1. Remove gross debris — wipe or rinse instruments at the point of use
2. Apply enzymatic foam or gel to instruments if transport will be delayed
3. Place instruments in a designated transport container — do not stack or pile sharps unsafely
4. Separate delicate instruments from heavy instruments to prevent damage
5. Open all hinged instruments (hemostats, needle holders) to allow solution to contact all surfaces
6. Cover with a moist towel or apply enzymatic spray to keep instruments wet during transport

Transport Requirements:

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Special Considerations

Lumened Instruments

• Channels and lumens are the most difficult areas to clean and most prone to biofilm formation
• Flush all lumens with sterile water or enzymatic solution immediately after use
• Use appropriate-sized brushes or cleaning adapters during subsequent cleaning steps

Powered Instruments

• Remove batteries or disconnect power sources before transport
• Protect delicate components from impact damage
• Follow manufacturer IFU for any special POU requirements

Contaminated Sharps

• Place blades, needles, and broken instruments in designated sharps containers at the point of use
• Never transport loose sharps in open containers
• Sharps should be separated and contained before reaching the CS department

Robotic Instruments

• Follow manufacturer-specific POU instructions precisely
• Some robotic instrument components require immediate flushing and specific positioning
• Improper POU treatment can cause permanent damage to precision components