The Journal of hospital infection · 2026
Study on the removal efficacy and influencing factors of bacterial endotoxin on reusable surgical instruments.
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Chen Meng, Xu Weiyang, Sun Xiaohui, Yang Feng
Аннотация
BACKGROUND: Bacterial endotoxins from reusable surgical instruments are key risk factors for postoperative fever and nosocomial infections, with unclear contamination and removal features. Conventional disinfection/sterilization has limited effects due to the endotoxins' strong thermal stability, threatening clinical safety.
AIM: To investigate the effects of different postuse placement times and processing procedures (cleaning, disinfection, and sterilization) on endotoxin contamination and removal efficiency of reusable surgical instruments, and to provide a scientific basis for optimizing clinical instrument handling protocols.
METHODS: Three hundred reusable surgical instruments were randomly collected from 50 infectious and 50 clean surgeries (March-August 2023), and divided into three groups by postuse placement time: 0-2 h, 2-6 h, 6-12 h (N = 50 per group). A kinetic chromogenic limulus amoebocyte lysate assay was used to detect endotoxin levels at precleaning, postcleaning, postdisinfection and poststerilization stages.
FINDINGS: Mean endotoxin levels at the four stages were 131.67, 33.17, 8.42, and 5.07 EU/i.e. with positive rates of 54.33%, 11.67%, 4.33%, and 3.67%, respectively. All positive samples after sterilization were from the 6-12 h group. Precleaning endotoxin levels in this group were significantly higher than those in the other two groups (P < 0.05). Endotoxin levels decreased gradually through processing, and the cleaning step achieved the highest removal rate (74.81%).
CONCLUSION: Postuse placement for more than 6 h leads to severe endotoxin contamination of reusable surgical instruments. Timely and standardized cleaning within 6 h is the core step for effective endotoxin removal. Conventional sterilization cannot fully inactivate heat-stable endotoxins, and medical institutions should optimize instrument-management protocols to strengthen clinical endotoxin control.
AIM: To investigate the effects of different postuse placement times and processing procedures (cleaning, disinfection, and sterilization) on endotoxin contamination and removal efficiency of reusable surgical instruments, and to provide a scientific basis for optimizing clinical instrument handling protocols.
METHODS: Three hundred reusable surgical instruments were randomly collected from 50 infectious and 50 clean surgeries (March-August 2023), and divided into three groups by postuse placement time: 0-2 h, 2-6 h, 6-12 h (N = 50 per group). A kinetic chromogenic limulus amoebocyte lysate assay was used to detect endotoxin levels at precleaning, postcleaning, postdisinfection and poststerilization stages.
FINDINGS: Mean endotoxin levels at the four stages were 131.67, 33.17, 8.42, and 5.07 EU/i.e. with positive rates of 54.33%, 11.67%, 4.33%, and 3.67%, respectively. All positive samples after sterilization were from the 6-12 h group. Precleaning endotoxin levels in this group were significantly higher than those in the other two groups (P < 0.05). Endotoxin levels decreased gradually through processing, and the cleaning step achieved the highest removal rate (74.81%).
CONCLUSION: Postuse placement for more than 6 h leads to severe endotoxin contamination of reusable surgical instruments. Timely and standardized cleaning within 6 h is the core step for effective endotoxin removal. Conventional sterilization cannot fully inactivate heat-stable endotoxins, and medical institutions should optimize instrument-management protocols to strengthen clinical endotoxin control.