Point of Use Treatment is a Recurring OR Theme

Why Point-of-Use Treatment Keeps Coming Up, According to a 20-Year Perioperative Veteran

Robin Evans has heard the same argument for two decades, in one hospital after another. Sterile Processing says the OR isn't doing point-of-use care. The OR says cleaning instruments is Sterile Processing's job. Neither side is entirely wrong, and neither side is entirely right.

Evans, BSN, RN, RNFA, CRCST, CHL, has worked nearly every side of the instrument reprocessing chain. She has received trays in decontamination, managed Sterile Processing departments, trained technicians, and walked hospitals as a consultant from the operating room through decontamination, sterilization, and back to the patient. Lately, she said, the conversation around point-of-use care keeps resurfacing, in hospital hallways and on LinkedIn alike, so she called to talk it through.

"I've seen trays arrive in decontamination with blood dried onto instruments," Evans said. "Tissue and bone left behind. Bloody box locks and serrations. I've seen saline used on instruments when it shouldn't be, and I've seen the frustration it creates between the OR and Sterile Processing when nobody can agree on why."

- Robin Evans, BSN, RN, RNFA, CRCST, CHL

Here's the kicker:

"Arguing about fault doesn't get instruments any cleaner," she said. "The better question is why the process is failing and what a hospital plans to do about it."

- Robin Evans, BSN, RN, RNFA, CRCST, CHL

What Point of Use Treatment Truly Covers

Point-of-use treatment is the initial care of reusable instruments during and immediately after a procedure, not a separate decontamination step performed in the OR. The FDA describes reprocessing as beginning at the point of use, where initial measures prevent blood, tissue, and other contaminants from drying before thorough cleaning happens later in decontamination. AORN describes the same window as wiping instruments and flushing applicable lumens with sterile water during the procedure, along with proper handling afterward.

Depending on the device, manufacturer's instructions for use and facility policy, that can include removing gross soil, keeping instruments moist, protecting sharps and delicate devices, and timely transport to decontamination. None of it replaces the cleaning that happens downstream. It sets that cleaning up to succeed.

The Saline Problem Nobody Explains Well

Evans said one issue comes up more than any other: saline used on instruments because it's safe for the patient, without anyone connecting it to what happens to the metal.

Normal saline contains sodium chloride, and chloride exposure can contribute to localized corrosion of susceptible stainless steel under the wrong conditions. Stainless steel resists corrosion because chromium at its surface forms a thin protective oxide film, often called the passive layer. Chlorides, present in both blood and saline, can break that layer down over time and contribute to pitting.

A single drop of saline will not instantly destroy an instrument's passive layer. Corrosion depends on the alloy, surface condition, chloride concentration, moisture, temperature, exposure time, and cleaning chemistry. But the practical lesson holds regardless, Evans said: don't assume that something appropriate for a patient is automatically appropriate for an instrument, and a small dark spot dismissed as "just a stain" may be corrosion that warrants a closer look. Instrument condition isn't a cosmetic issue. It affects longevity, cleanability and, eventually, patient safety.

Training Gaps Aren't Anyone's Fault, Until They're a Pattern

Evans is careful to note that undertrained OR staff aren't the villain of this story.

"A new surgical technologist may know instruments should be wiped without understanding why. Someone may have learned years ago to use saline and never been told what it does to metal over time."

- Robin Evans, BSN, RN, RNFA, CRCST, CHL

The FDA identifies staff training and periodic retraining as factors affecting reprocessing quality, and AORN places point-of-use care within perioperative practice, meaning OR staff need real education and demonstrated competency, not an annual slideshow.

"Education has to travel in both directions," Evans said. "Let OR staff see decontamination. Let Sterile Processing see the OR. Most of the friction disappears once each side understands what the other is actually dealing with."

Who Owns It, and How Surgical Solutions Closes the Gap

Evans' answer to "who owns point-of-use treatment" is straightforward: the OR owns its responsibilities, Sterile Processing owns its responsibilities, and leadership owns the system connecting them. The instrument belongs to the patient, and reprocessing is one continuous process shared by everyone who touches it.

That is exactly the gap Surgical Solutions' OR Liaisons are built to close. Rather than leaving point-of-use compliance to hallway conversations and annual training, OR Liaisons work inside the operating room alongside surgical teams, verifying instruments are handled correctly at the point of use, equipment is used according to the manufacturer's instructions for use, and errors are caught before they become downstream problems for Sterile Processing or, worse, the patient. It's the same bridge Evans describes as needed between departments, built into a standing role rather than left to chance.

Hospitals don't need another meeting about whose fault it is. They need a system that catches problems before they start, measures whether fixes work, and keeps both departments accountable to the same standard. That's the problem Evans has spent a career describing, and it's the solution Surgical Solutions builds into every OR it supports.

Frequently Asked Questions

What is point of use treatment for surgical instruments?
Point-of-use treatment is the initial care given to reusable surgical instruments during and immediately after a procedure. It includes removing gross soil, preventing blood and tissue from drying, flushing applicable lumens, and handling instruments properly before transport to decontamination. It is not a substitute for the cleaning and sterilization performed later in Sterile Processing.

Why is saline bad for surgical instruments?
Saline contains sodium chloride, and exposure to chloride can contribute to corrosion of stainless steel instruments under certain conditions. Over time, chlorides can break down the passive layer, a thin protective oxide film on stainless steel, and contribute to pitting. Sterile water is generally recommended over saline for keeping instruments moist between use and cleaning.

Who is responsible for point of use care, the OR or Sterile Processing?
Both departments share responsibility. The OR is responsible for initial point-of-use treatment during and after the procedure, and Sterile Processing is responsible for cleaning, sterilization, and reprocessing once instruments arrive. Leadership is responsible for building the training, supplies, and accountability systems connecting the two, which is where programs like OR Liaisons help close the gap.

How can hospitals improve point-of-use compliance?
Hospitals can improve compliance by tracking point-of-use deficiencies as data rather than complaints, providing joint OR and Sterile Processing training, standardizing supplies at the point-of-use, and auditing compliance regularly with measurable follow-up. A dedicated OR Liaison role can help verify correct instrument handling and compliance with the manufacturer's instructions for use in real time.

Sources: U.S. Food and Drug Administration guidance on reusable medical device reprocessing and factors affecting reprocessing quality; Association of periOperative Registered Nurses (AORN) guidance on point of use instrument care and the 2026 Guidelines for Perioperative Practice; ANSI/AAMI ST79:2017/(R)2022; AAMI TIR12:2020/(R)2023.