The Journal of hospital infection
July 8, 2026 · via Europe PMC
Study on the removal efficacy and influencing factors of bacterial endotoxin on reusable surgical instruments.
Chen M, Xu W, Sun X, Yang F.
AI summary — for doctors, generated from the abstract only
Leaving used surgical instruments more than six hours before cleaning led to heavy endotoxin contamination that sterilization could not fully remove.
What was studied
Three hundred reusable surgical instruments from 50 infectious and 50 clean surgeries (March-August 2023) were divided by post-use placement time (0-2h, 2-6h, 6-12h) and tested for endotoxin by kinetic chromogenic LAL assay at precleaning, postcleaning, postdisinfection and poststerilization stages.
Key findings
- Mean endotoxin levels fell across stages: 131.67, 33.17, 8.42 and 5.07 EU per instrument
- Positive rates were 54.33%, 11.67%, 4.33% and 3.67% respectively
- All samples still positive after sterilization came from the 6-12 hour group
- Precleaning endotoxin was significantly higher in the 6-12 hour group; specific statistic not fully captured in the abstract
Clinical relevance
The results support prompt, standardized cleaning of instruments within six hours of use, since heat-stable endotoxin is not reliably inactivated by conventional sterilization; this is a single-institution instrument study without patient outcomes.
Who should care
Limitations
Single-setting study of 300 instruments without clinical outcome data such as postoperative fever or infection, and some statistics truncated in the abstract.
Cleaning instruments soon after use matters, because sterilization alone will not clear endotoxin left to accumulate.
This is an AI-generated summary of the published abstract, not a clinical recommendation. It may not reflect the full text or subsequent updates — verify against the original source before acting on it.
Abstract
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.
DOI
10.1016/j.jhin.2026.06.031
PMID
42419430
Research metadata (titles, abstracts, authors, publication dates) is sourced from Europe PMC, which aggregates content from PubMed/MEDLINE, PubMed Central, and other providers under the U.S. National Library of Medicine (NLM/NCBI). NLM does not claim copyright on abstracts; the original journal publishers or authors may hold rights to the full articles. AI-generated summaries are derived only from the abstract, never the full text, and are always labeled as AI-generated.
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