If you use enzyme solutions to clean surgical instruments, use them in accordance with the manufacturer’s instructions, which should include instruction regarding proper dilution of the enzymatic detergent, and address contact with surgical instruments, specified on its label. Neutral pH detergent solutions that contain enzymes are compatible with metals and other materials used to create surgical instruments, and are clearly the best option when cleaning delicate surgical instruments. Alkaline-based agents are used for cleaning certain medical devices because the agent efficiently dissolves protein and fat residues, but do carry a corrosive element, so one must be careful when cleaning with this method. Determining a superior cleaning solution is inconclusive, because some data proves that enzymatic cleaners are more effective than neutral detergents when removing microorganisms from the surface of surgical instruments, while recent contrary studies found no difference in cleaning efficiency between enzymatic and alkaline-based cleaners.
Although the Center for Disease Control mandates effective high level disinfection and sterilization for surgical instruments, there is no “real-time” testing that currently exist that can be placed in a clinical setting to verify effective cleaning. Having stated that, tests that can verify high level sterilization and disinfection of surgical instruments need to become commercially available to ensure, at the very least, an adequate level of cleaning. As it stands now, and until this gross lack of cleaning testing for surgical instruments is made available, at a minimum, all surgical instruments should be individually inspected and be visibly clean to prevent any chance of infection.