Skytron Blog

AORN updated its Guideline for Instrument Cleaning for 2026, with changes addressing complex lumened devices, water quality, PPE, ergonomics, and cleaning verification.

In this edition of The Sky is the Limit, we’re looking at four of those changes, what’s different from the previous 2021 update, and their everyday impact on your SPD.
 

Cleaning Lumened & Cannulated Devices

Lumened and cannulated instruments and devices have always been challenging to clean and verify. The new guidance adds a conditional recommendation for mechanical perfusion to support manual brushing and flushing of complex lumened devices, using cleaning equipment such as an ultrasonic washer-disinfector with lumen attachments to irrigate cleaning solution through an instrument’s internal channels.

A 2026 review published in the American Journal of Infection Control points to research documenting persistent contamination inside lumened devices after standard cleaning.

The review cites the 2025 Lumens 2.0 study, which examined lumened surgical instruments used in clinical practice and found retained debris and other evidence of inadequate cleaning inside internal channels. The findings reinforce why external visual inspection alone cannot tell departments whether these devices have been effectively cleaned.

For departments, this may mean identifying which complex lumened and cannulated devices require irrigation, confirming that the necessary equipment and attachments are available, and reviewing cleaning procedures and staff competencies against the new guidance and applicable IFUs.
 

Critical Water for Final Rinse

Critical water isn’t new. Previous guidance already called for access to critical water for instrument rinsing and for facilities to monitor water quality. What’s different now is the specificity around critical water for the final rinse and trending water-quality metrics.

ANSI/AAMI ST108 defines critical water as water that has been extensively treated to remove microorganisms and inorganic and organic material. Treatment methods can include reverse osmosis, deionization, distillation, or a combination of technologies.

A recent review of instrument-processing standards also notes that increasingly specific water-quality requirements often require coordinated ownership among sterile processing, infection prevention, and facilities or engineering.

That raises a few operational questions: where critical water is used for the final rinse, how water-quality measurements get documented and trended, who reviews the results, and what happens when readings fall outside established limits.

Through our partnership with Advantage Support Services (ASSI), you have access to Water Management & Utility Oversight to evaluate water quality testing protocols, assess alignment with AAMI ST108, and identify gaps in documentation and remediation planning.
 

Body Temperature Regulation & Ergonomic Considerations

Ergonomics was also part of the previous instrument-cleaning guidance.

The latest revision continues to emphasize adjustable sinks, adequate space, and anti-fatigue mats, but it also addresses body temperature while working in PPE.

Cooling devices worn under PPE are now conditionally recommended to reduce heat stress. Fans should not be used because they can disrupt airflow and aerosolize contaminants.

Research supports the concern. A 2024 study found that wearing PPE increased both body and skin temperature, with higher environmental temperatures increasing them further.

Cooling devices worn under PPE need to make it onto the approved list, and into purchasing and inventory. If fans are the current fallback in decontamination, that’s the first thing to replace.
 

Cleaning Verification & Inspection

The latest guidance strengthens previous recommendations around borescope inspection and cleaning verification.

Borescopes allow technicians to inspect internal channels that cannot be evaluated through external visual inspection. Their use is specifically highlighted when evaluating new, repaired, refurbished, and loaned instruments, in addition to routine cleaning verification.

A 2026 review of cleaning effectiveness describes a layered approach that can include visual inspection with lighted magnification, internal inspection with borescopes, and biochemical tests such as ATP or protein testing.

The practical question: are current verification processes sufficient for the devices being processed, and are failures documented in a way that actually surfaces recurring problems?

What Does This Mean for Equipment Planning?

These changes give us four questions to ask as we plan future equipment investments:

1. Can we irrigate the internal channels of our complex lumened and cannulated devices?
2. Do we have access to critical water for the final rinse and a process for monitoring its quality?
3. Does our decontamination space support staff ergonomics and the additional cooling needs created by PPE?
4. Do we have the tools needed to verify cleaning on the instruments we process?

Skytron’s Flex Ultrasonic Washer Disinfector provides sonic irrigation for cannulated instruments and a critical-water final rinse, and our adjustable-height processing sinks can support ergonomic positioning in decontamination.

The complete recommendations are available in AORN’s 2026 Guidelines for Perioperative Practice. The resources below provide additional information on these changes and the supporting research.
 

 
Resources
1. AORN. 2026 Instrument Cleaning Guideline Updates.
2. AORN. Previous Instrument Cleaning Guideline Key Takeaways.
3. Drosnock MA. Monitoring and Improving the Effectiveness of Cleaning Medical and Surgical Devices: A Practical Verification Framework. American Journal of Infection Control. 2026.
4. Drosnock MA. Updates to Instrument Processing Standards and Guidelines: Practical Implications for Sterile Processing, Endoscopy, and Infection Prevention Programs. American Journal of Infection Control. 2026.
5. PPE and Heat-Strain Research. PubMed.