The main background is a lack of proper standards how such implants should be reprocessed.

Manufacturers instructions vary and an official guideline similar to instruments does not exist. It can be imagined that an implant with a long term contact would impose a higher risk than an instrument and the question is asked how this risk can be reduced.

Suggestions are:

• Processing only in special trays

• No cleaning in a washer disinfector together with contaminated instruments

• Control of bioburden

• Control of endotoxin

• Limited number of reprocessing cycles

It again comes back to the question, what is clean enough. Supplying sterile improves traceability but will certainly change processes in the OR completely.