Purchased in November 2023 and used for only two weeks, so it's relatively clean. I'll also include milk storage bags! I haven't used this nipple with a bottle, so the nipple part is brand new. I threw away the instruction manual, so I apologize for the inconvenience, but please download it from the internet and refer to it m(_ _)m Although it has been washed, please be sure to wash and sterilize it before use. Since this is a used item, please refrain from purchasing if you are concerned. I look forward to your purchase if you understand.