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BACKGROUND: The outpatient clinic system of about 35 centers, including 4 ambulatory surgery centers (ASCs) with central sterilization (CS) services, was incorrectly handling and transporting soiled instruments. Non-ASC instruments were hand-carried through hallways to collection bins on countertops in clerical areas. Bins did not meet standards. Bins from outreach centers were left in mailrooms for courier collection, and were mixed with clean items. Some bins still contained a portion of the water/enzymatic soak solution. METHODS: A task force was formed to improve the process at the clinic site with the largest ASC first. The other clinic sites with ASCs and then the remaining outreach centers followed suite. New instrument bins were purchased and a new instrument spray replaced soaking. Soiled utility rooms were constructed where there were none. A policy, procedure, checklist, algorithm and training video were made and placed in an online toolkit. Couriers were given turn-by-turn directions to all the soiled utility rooms and were educated on maintaining separation of clean and dirty within the transport vans. RESULTS: With support starting at the executive level, safe soiled instrument handling and transportation resulted system-wide after seven months. Joint Commission accreditation was achieved. I, along with my coworkers, continue to educate staff as necessary to make this process their “new normal” for soiled instrument handling. CONCLUSIONS: Process change across a large healthcare system requires commitment at the executive level including funding and educational tools.