Better Alerts, Better Cleaning: Why IFU Updates and Borescope Protocols Must Be Built Into SPD Workflows

Cori L. Ofstead, MSPH; Brandon M. Gantt, MHA, CRCST, CHL, CER, LSSGBH; and Jill E. Holdsworth, MS, CIC, FAPIC, NREMT, CRCST, CHL, an infection preventionist in Atlanta, Georgia.

Timely manufacturer instructions for use (IFUs), updates, hands-on training, and integration of borescope evaluations into daily routines are essential for sterile processing success. At HSPA 2025, Jill Holdsworth, Brandon Gantt, and Cori Ofstead shared practical, scalable solutions that align quality control with frontline realities, without overwhelming the workflow.

Jill E. Holdsworth, MS, CIC, FAPIC, NREMT, CRCST, CHL, is an infection preventionist in Atlanta, Georgia. Brandon M. Gantt, MHA, CRCST, CHL, CER, LSSGBH, manager of the sterile processing department education and training at Emory Healthcare; and Cori L. Ofstead, MSPH, the president and CEO of Ofstead & Associates, Inc, and lead author, presented this research at the 2025 Healthcare Sterile Processing Association Annual Conference & Expo, held in Louisville, Kentucky, from April 26 to 29.

Another presentation by Ofstead and Holdsworth was also presented at the 2025 Association for Professionals in Infection Control and Epidemiology held in Phoenix, Arizona, from June 16 to 18.

In the study, the researchers performed 117 borescope inspections on 40 unique surgical instruments and 77 follow-up inspections after up to 3 rounds of recleaning. Despite following the IFUs, 100% of instruments had visible debris or discoloration on initial inspection.

Architectural complexity was a significant factor. Instruments had changing lumen diameters, ridges, grooves, dead ends, suction valves, and inaccessible internal chambers—features that prevent brushes from reaching all surfaces and make visual inspection impossible without a borescope.

Even when recleaning included soaking with enzymatic detergent, brushing under supervision, and forced air drying, new debris was often introduced (including bristles from the brushes), and existing soil frequently remained. Swab testing guided by borescope inspection confirmed the presence of retained organic material that standard processes could not remove.

These findings suggest that even with diligent adherence to IFUs, current reprocessing methods may not be sufficient to ensure instrument cleanliness. The results underscore the need for improved instrument design, enhanced IFU accuracy, and the integration of borescope inspections as a routine practice in sterile processing departments.

This is the final installment of 4 interviews conducted by Infection Control Today^® (ICT^®) with the authors to learn more about the study. Please find the first installment here. The second is here. The third is here.

ICT: One comment at the 2025 HSPA Annual Conference & Expo was that facilities with instruments with updated IFUs should be notified automatically through email, snail mail, etc. Would this help with sterile processing technicians following the manufacturer’s instructions for use (IFU)? 

Jill E. Holdsworth, MS, CIC, FAPIC, NREMT, CRCST, CHL: This would be one step to being more compliant with instrument IFUs. When IFUs change for anything, appropriate training should also occur. The manufacturer’s representative should be present to train, demonstrate, and answer questions, ensuring continual competency training on these devices. Easy and ready access to the IFUs is also imperative to being compliant, in addition to being notified and trained on important changes.

ICT: How can sterile processing teams practically implement borescope and swab evaluations without severely disrupting their daily workflows?

Brandon M. Gantt, MHA, CRCST, CHL, CER, LSSGBH: Sterile processing departments (SPD) can effectively integrate borescope and swab evaluations into their workflows by aligning these practices with existing quality control initiatives. A well-structured quality program in 2025 should encompass robust cleaning verifications, tray audits, and standardized quality control measures. At Emory Healthcare, we have established comprehensive policies and procedures that provide clear guidelines for implementing these evaluations without significantly disrupting daily operations.

Through close collaboration between sterile processing managers and the Infection Prevention SPD subgroup, we have developed protocols that seamlessly integrate borescope and swab evaluations into routine workflows. These policies outline specific roles for managers, educators, quality coordinators, and frontline staff, ensuring that quality checks become a natural part of daily operations rather than an additional task. By embedding these quality measures into existing processes, SPDs can maintain operational efficiency while reinforcing high standards of instrument cleanliness and patient safety.

ICT: How can sterile processing teams practically implement borescope and swab evaluations without severely disrupting their daily workflows?

Cori L. Ofstead, MSPH: The talk that Jill and I are giving at the 2025 APIC conference is, “Infection Preventionists Using Borescopes: New Discoveries in Ortho and Neurosurgery Instruments.” We're focusing on empowering the IP to get involved, and the first step in that is to go down to sterile processing and start a dialogue about what instruments have these lumens, dead ends, or complex characteristics, like those discussed by Terra Kremer, PhD, that make them difficult to clean. The only way to do that is to visit the SPD and observe sterile processing, ask them what's challenging to clean and how they currently verify cleanliness, and then examine the most high-risk instruments. And this is what Jill and Brandon, along with Jill's team, consisting of Aaron and Amanda, are all diving into.

When you use a borescope, you will rapidly see that the architecture doesn't match up with the IFU. Then you have to figure out how you will support your sterile processing team because you've got the weird architecture and retained tissue and blood.

IPs should use these insights to collaborate with the sterile processing departments to develop more effective cleaning protocols and then train their staff. For the techs to know how to clean these complex instruments, they need to know what's inside first. The first step is, “Let's look inside some instruments. Does the brush get in there, and if the brush gets in there, let’s make sure it doesn't leave behind brush bristles. “I wouldn't jump to, “Hey, let's have everybody using borescopes on every instrument every time.” It’s important to take small steps and have strategies for implementing these exams.

It's about building your own awareness and having “aha” moments to support the sterile processing team in a different way. I think absolutely, technicians need to be trained to know that the inside of instruments are not smooth tubes, but rather a complex network of different nooks and crannies, so that they understand why they're being asked to use a water pistol for 60 seconds. Or why is it that just putting a brush in there quickly isn't going to do it? Why are they being asked to use certain detergents? Because we need those detergents to help us remove the soil from the surface, these are not simple components. It's about building awareness, which is the first step.