Key Takeaways: 3 New Instrument Cleaning Guideline Updates to Improve Sterilization & Safety

What perioperative nurses need to know about updates in instrument cleaning, staff safety, and patient protection

The 2026 Guideline for the Care and Cleaning of Surgical Instruments updates PPE recommendations for periop staff working in the decontamination area, expanding guidance on inspection, transport, and cooling practices to improve staff comfort while staying safe and focused.

Amber Wood, MSN, RN, CNOR, CIC, EBP-C, FAPIC, is a senior perioperative practice specialist at AORN, and the guideline’s lead author. Wood says the research is clear: even during routine cleaning, fluids can end up where you least expect them.

Enhanced PPE for Decontamination Safety

“We know there’s a high risk of fluid exposure in decontamination,” says Wood, citing studies that found droplets—possibly even blood and body fluids—on PPE during manual cleaning.

That’s why the new recommendations call for PPE with the highest level of fluid protection possible:

• Fluid-resistant surgical mask
• Face shield
• Fluid-resistant gown with thumb loops attached to the cuff
• General purpose utility gloves with extended fitted cuffs
• Fluid-resistant shoe covers or boots

“The area where the gown and the glove meet is easily exposed to fluid,” Wood says. “Having an extended cuff—up to the elbow, when possible—helps prevent water from getting inside the glove when your hands are below the water surface.”

She adds that comfort matters, too. “It’s easy to overheat while working in ‘decontam,’” Wood notes, supporting the new guidance on cooling devices under PPE and ergonomic improvements—like adjustable sinks, adequate space, and anti-fatigue mats—to keep staff focused and safe.

Comfort matters too.

Conditional recommendation: Cooling devices may be worn under PPE to reduce heat stress.

Important safety notes:

• Fans should NOT be used because they can disrupt airflow and aerosolize contaminants.
• For cooling devices with a water source, follow the manufacturer’s IFU for water type, replacement frequency, cleaning, and disinfection.

Ergonomic improvements—like adjustable sinks, adequate space, and anti-fatigue mats—are also emphasized to keep staff focused and safe.

Borescope Inspections & Cleaning Verification

The guideline strengthens recommendations for borescope inspections—not only for routine verification but also when evaluating new, repaired, refurbished, or loaned instruments to catch internal damage or residue before use.

Complex tools, like robotic instruments, arthroscopic shaver hand pieces, and suction cannulas, can hide soil deep inside narrow channels, making them difficult to clean and inspect.

“We know borescopes can allow for visual inspection of internal channels, and they can identify damage and debris that would otherwise be undetected,” says Wood. “We have these tools—we need to use them.”

Still, she adds a note of caution: “There can be challenges with identification and interpreting the findings.”

The guideline advises facilities to develop protocols and competencies for borescope inspection and to use cleaning verification tests (e.g., ATP, protein) and focus on manufacturer-specified test points:

• Lumens
• Dead ends
• Rough surfaces
• Crevices
• Junctions
• Articulations

Together, these tools strengthen a facility’s ability to verify cleaning effectiveness and maintain instrument integrity.

Standardizing Off-Site Instrument Transport

The 2026 guideline also introduces new direction on transporting contaminated instruments off-site—bringing consistency and safety to every step of the journey.

“Some organizations use off-site processing centers or multisite systems that centralize sterile processing functions,” explains Wood. “It’s important to have standardization and oversight to maintain a consistent standard of care.”

The update emphasizes compliance with federal, state, and local regulations, including those from the U.S. Department of Transportation for transport and OSHA for handling materials contaminated with blood and body fluids. It also highlights ways to minimize shock and vibration during transport to help prevent instrument damage.

“Manufacturers ship instruments in specialized packaging,” Wood notes. “But once they arrive in facilities, we often don’t take the same precautions when they’re transported over roadways.”

The guideline also clarifies that temperature and humidity may be monitored during transport to reduce soil drying and manage microbial risk—steps that help protect both instrument integrity and patient safety long before reprocessing begins.

Additional Key Updates in the 2026 AORN Instrument Cleaning Guideline

In addition to these new sections and guidance, other critical updates include:

• Clearer point-of-use treatment (defining “gross soil” and keeping instruments moist until cleaning)
• Delayed cleaning steps that follow the device IFU when soil has dried
• Water quality expectations (use critical water for final rinse and trend water metrics), a pre-rinse visual inspection step to catch residual soil
• A conditional recommendation for mechanical perfusion to supplement manual brushing and flush lumens in complex devices.

Guideline Resources for Implementing the New Standards

You’ll find these updates explained in AORN Journals’ First Look article “Guideline for Care and Cleaning of Surgical Instruments.” Members can also download the related Key Takeaways PDF and watch the full webinar about the 2026 updated guideline.

• Guideline Webinar: Members can watch the on-demand webinar with Amber Wood.
• AORN Journal: Members can log in to read the Guideline First Look.
• Guidelines Essentials offers a concise overview of each guideline, along with practical tools to implement within your hospital or ASC - members log in to view.
• eGuidelines Plus is an online facility subscription providing access to the most current AORN Guidelines for Perioperative Practicecomplete with tools, customizable templates and resources to empower your team to apply standardized techniques facility-wide. Have a subscription? Log in to access the full updated guideline.