Recommendations for Maximizing the Efficacy of Ultrasonic Surgical Instrument Cleaners include: surgical instruments must be fully immersed, hinged surgical instruments must remain open during treatment, use surgical instrument cleaning trays that do not obstruct the ultrasonic cleaning process or add mass, wire surgical instrument cleaning baskets are preferred, large surface bulky items such as kidney shaped bowls must be positioned not to create anechoic (shadow) zones that will block the efficacy of ultrasonic transducer waveform. Position such items vertically or put them on top of the other items, always sort surgical instruments by similar metals to prevent surgical instrument corrosion, do not overload the ultrasonic surgical instrument cleaning tank with excessive mass as this will reduce the efficacy of surgical instrument cleaning, the soil being removed from the surgical instruments being cleaned adds to the mass within the tank and decreases the efficacy of the ultrasonic surgical instrument cleaner. Review the level of soil and renew the ultrasonic surgical instrument cleaner bath as needed. ALWAYS follow ultrasonic surgical instrument cleaning with separate rinse treatments. Ultrasonic surgical instrument cleaning will fragment and loosen soil but will not necessarily remove the soil from the surface of the surgical instruments being cleaned.The primary purpose of cleaning surgical instruments is to remove all inorganic and organic proteinaceous bioburden material from the internal and external surfaces cleaning surgical instruments inside and out with careful attention to cleaning cannulated surgical instruments. The secondary purpose of cleaning surgical instruments is to maintain and improve the passive Layer of surgical stainless steel. The passive layer is provided by the manufacturer of the surgical instruments, within the surgical stainless steel, to resist (prevent) corrosion. Proper cleaning of the surgical instrument will maintain and improve this passive layer. (for more information go to: Prevent Corrosion ) If the manual cleaning, brushing and rinsing steps are not properly carried out, protein debris can harden and lead to formation of biofilm on the surgical instrument, i.e. the biopsy channel of an endoscope.