Correct grade selection of surgical instrumentation is an important function for the perioperative and central service department teams when providing a safe, efficient, and cost-effective patient care environment. All surgical instruments have an intended purpose, ranging from a disposable type to a performance quality surgical instrument for highly specialized surgery such as a cardiovascular or neurosurgery. Health care facility personnel involved in the selection of surgical instruments must be knowledgeable about the various types of instruments available and the differing descriptions. United States (US) Customs Law provides the requirements for Country of Origin labeling on all surgical instruments; one piece of information health care facility personnel need when selecting surgical instruments. Various “blends” of stainless steel are required for different types of surgical instruments. Manufacturing instruments is a multi-step process with quality requirements determined by each manufacturer. A manufacturer’s commitment to quality within their own processes and what that means to your facility is a key piece of information needed in the surgical instrument selection process. This educational activity will review the steps in the manufacturing process of Premium OR grade surgical instruments, US Customs determination of Country of Origin, clinical considerations used when selecting instruments and the importance of the water quality for processing.