Healthcare Purchasing News - September 2025 by Endeavor Digital Editions

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SEPTEMBER 2025

Surgical/Critical Care

8 > Two Decades Later, Are We Safer? Revisiting Sharps Injury Prevention in U.S. Healthcare

KARA NADEAU

Infection Prevention

14 > Preparing for Respiratory Illness Season

MATT MACKENZIE

Sterile Processing

18 > Taming the Beast: Best Practices for Managing HLD Inside and Outside the SPD

KARA NADEAU

24 > What Is an Indicator?

VANESSA FRANK, NELSON WINTER

26 > Automatic Equipment and Productivity in a Sterile Processing Department

WILLIAM LEIVA

30 > Great SP Leaders Turn Mistakes Into Valuable Lessons

DAVID TAYLOR

32 > Visual Communication

ADAM OKADA

Sourcing & Logistics

34 > Linking Sustainability Investments to Organizational Priorities

KAREN CONWAY

New Frontiers at HPN

BY MATT MACKENZIE

You may notice there’s a new name under the title of this month’s editorial. However, if you’re an avid reader of the magazine, you’ve seen me before! I joined Healthcare Purchasing News at the start of 2024 as the associate editor, writing a feature per month in the magazine and holding down some of the backend duties.

This is as good a time as any to reflect on what I’ve noticed over the course of my tenure so far here at HPN. Perhaps the biggest escalation I have noticed is the increase in AI (artiﬁcial intelligence) implementation in practically every area we cover in the healthcare industry. There is a preponderance of studies aiming to capture its efficacy (or shortcomings), and new products are constantly being introduced and workshopped as companies and health systems try to balance innovation with proven eﬀectiveness.

While new technology may be alluring, there are also constant developments happening in the worlds of sterile processing, infection prevention, surgical and critical care, and supply chain. These things inevitably intertwine and work in tandem such that the old (and ever-relevant) topics are constantly shifting and changing. It’s part of what I love so much about the areas we cover – innovation in all facets of healthcare never stops, and it’s fascinating to see which ways

the tides turn. I’ve been focused on bringing you relevant and topical information from all sides of the healthcare ecosystem, and all of us here at Healthcare Purchasing News remain dedicated to that mission as things change.

We have some exciting developments coming in the near (and far) future at HPN, and in the meantime, I’m excited to be able to present this edition of the magazine. With respiratory illness season encroaching and autumn just around the corner, my feature this month tackles what hospitals and health systems learned from last year’s annual rise in illness rates before cases reach their seasonal peaks this year.

This month’s magazine also features Part One of a two-part feature on high-level disinfection. This opening feature acts as a broader perspective on the topic before we dive deeper into specific tips and best practices in the October issue. In addition, we’ve taken a look at sharps safety and examined the strides taken there over the past several years, as well as the steps we still must take to provide a safer environment for clinicians and patients alike.

As we prepare for 2026, we also want to ask you, our readers, what topics you’re most interested in seeing us cover. We always want to ensure we reﬂect what’s top of mind for all of you. My line is always open.

September 2025, Vol. 49, No. 8

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Editorial Advisory Board

Jimmy Chung, MD, MBA, FACS, FABQAURP, CMRP, Chief Medical Officer, Advantus Health Partners and Bon Secours Mercy Health, Cincinnati, OH

Joe Colonna, Chief Supply Chain and Project Management Officer, Piedmont Healthcare, Atlanta, GA; Karen Conway, Vice President, Healthcare Value, GHX, Louisville, CO

Dee Donatelli, RN, BSN, MBA, Senior Director Spend symplr and Principal Dee Donatelli Consulting LLC, Austin, TX

J. Hudson Garrett Jr., PhD, FNAP, FSHEA, FIDSA, Adjunct Assistant Professor of Medicine, Infectious Diseases, University of Louisville School of Medicine

Melanie Miller, RN, CVAHP, CNOR, CSPDM, Value Analysis Consultant, Healthcare Value Management Experts Inc. (HVME) Los Angeles, CA Dennis Orthman, Consulting, Braintree, MA

Janet Pate, Nurse Consultant and Educator, Ruhof Corp.

Richard Perrin, CEO, Active Innovations LLC, Annapolis, MD

Jean Sargent, CMRP, FAHRMM, FCS, Principal, Sargent Healthcare Strategies, Port Charlotte, FL

Richard W. Schule, MBA, BS, FAST, CST, FCS, CRCST, CHMMC, CIS, CHL, AGTS, Senior Director Enterprise Reprocessing, Cleveland Clinic, Cleveland, OH

Barbara Strain, MA, CVAHP, Principal, Barbara Strain Consulting LLC, Charlottesville, VA

Deborah Petretich Templeton, RPh, MHA,Chief Administrative Officer (Ret.), System Support Services, Geisinger Health, Danville, PA

Ray Taurasi, Principal, Healthcare CS Solutions, Washington, DC

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What’s on the Web

Vizient Announces Expansion of Partnership With Baxter to Include IV Fluids

The program will provide “participating healthcare organizations with dedicated, on-demand manufacturer inventory, warehoused in the U.S., along with comprehensive support to safeguard continuity of care.” This expansion of Vizient Reserve comes less than a year a er “Hurricane Helene hit the east coast, temporarily disrupting supply of this critical product,” which HPN reported on at the time. IV ﬂuids are a uniquely complex category “due to their essential nature, high utilization, and complex manufacturing requirements.”

Read on: www.hpnonline.com/55305083

Instrumentum Announces Acquisition of Two Sterile Processing Companies

These acquisitions “expand Instrumentum’s footprint to ﬁve facilities across four states.” The company aims to help SPD facilities “broaden and retool…amidst budgetary concerns, limited space, staﬀing challenges, and outdated equipment.” This is especially important in the wake of “increased demand for elective surgeries.”

Read on: www.hpnonline.com/55303097

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University of Colorado Hospital Reduces Capacity of SPD Because of Complaint Investigation

The Colorado Department of Public Health and Education (CDPHE) conﬁrmed that it is “conducting a ‘complaint investigation’ at the UCHealth University of Colorado Hospital on the Anschutz Medical Campus.” The hospital’s SPD is “currently operating at reduced capacity,” which is leading to the postponement of some elective cases to “ensure [they] have the instruments needed to provide all urgent and emergent surgeries and procedures.”

Read on: www.hpnonline.com/55305700

The Joint Commission Announces Accreditation 360: The New Standard

The Joint Commission introduces Accreditation 360, focusing on outcomes, collaboration, and streamlining requirements.

The new approach eliminates more than 700 additional requirements and introduces tools such as a Continuous Engagement Model, and new National Performance Goals (NPGs).

Read on: www.hpnonline.com/55300426

Two Decades Later, Are We Safer?

Revisiting Sharps Injury Prevention in U.S. Healthcare

BY KARA NADEAU

This fall marks the anniversary of legislative milestones that have undoubtedly served to protect healthcare workers from sharps injuries and exposure to bloodborne pathogens.

On December 6, 1991, the Occupational Safety and Health Administration (OSHA) published its Final Rule on Occupational Exposure to Bloodborne Pathogens. This was followed nearly nine years later (on November 6, 2000) by the federal

Needlestick Safety and Prevention Act, which mandated OSHA to add safety provisions to the Bloodborne Pathogens Standard.

I’ll take this opportunity to age myself by noting how in 2001, soon after the Needlestick Safety and Prevention Act passed, I was in the thick of the “safety needle” launch frenzy, serving as a public relations consultant for a manufacturer in this space (side note: I was in high school when OSHA published its Bloodborne

Pathogens Final Rule – a shout out to my fellow Gen-Xers).

Looking back on the past 25-30 years, there is abundant evidence that protocols, practices, and technology have signiﬁcantly improved sharps injury awareness and prevention. When I was assigned this story for HPN, my ﬁrst thought was, “Aren’t sharps injuries a thing of the past?”

Digging into The National Library of Medicine’s online PubMed database, searching LinkedIn for recent posts on the topic, and speaking with sharps injury experts, I quickly discovered that my initial impression was wrong.

There is conﬂicting evidence on the current prevalence of sharps injuries in healthcare settings, with many sources showing such injuries are underreported by physicians, nurses, and other clinicians both employed and in training.

Then there is the false sense of security when a healthcare worker suﬀers a sharps injury during care to

a patient who has tested negative for common bloodborne pathogens (e.g., HIV, HBV, HCV), even though their blood could harbor other potentially dangerous pathogens for which they were not tested.

Ironically, as we come up on the anniversaries of the OSHA Bloodborne Pathogens Final Rule and Needlestick Safety and Prevention Act, the International Safety Center (ISC), home of Exposure Prevention Information Network (EPINet) data, announced that it is closing its doors on December 31, 2025.

In this article, sharps safety experts comment on the current state of injury risk and reporting among healthcare workers, particularly surgical team members, and share insights on why the healthcare ﬁeld must remain vigilant in its injury prevention and incident reporting eﬀorts.

The latest data on reported sharps injuries

The ISC convened its Board of Directors to review the 2024 annual EPINet data, “compiled from U.S. healthcare facilities on injuries from needlesticks, contaminated sharps, and mucocutaneous occupational exposures to bloodborne and infectious disease (e.g., HIV, HCV, influenza, COVID-19).” Since the mid-1990s, ISC has been collecting surveillance data and reporting on it annually.

They reported their ﬁndings in a July 10, 2025, ISC press release, noting how EPINet data illustrates:1

“A clear uptick in numbers of injuries across all categories over the last 5 years – especially for hypodermic syringes (mostly nurses) and suture needles (mostly physicians).”

The number of EPINet network facilities contributing their data in 2024 is the same number as in past years, according to the press release.

Key ﬁndings from a comparison of the 2024 to 2023 reporting data include:

• A 10% increase in needlesticks and sharps injuries reported (1,945 in 2024, up from 1,687 in 2023); and

• A 15% increase in splash and splatter incidents (797 in 2024, up from 678 in 2023).

As the EPINet data shows, perioperative team members are among those clinicians for whom sharps injuries are on the rise. During an interview with HPN, Emily Jones, PhD, RN, CNOR, EBP-C, senior perioperative practice specialist, Association of periOperative Registered Nurses (AORN), commented on sharps injuries in the operating room (OR), stating:

“Sharps safety is critically important for every member of the surgical team, as the risk of injury aﬀects everyone. Despite ongoing efforts, data shows that sharps injuries continue to occur in the operating room. In fact, one study found that nearly half of all reported sharps injuries took place in the perioperative setting.”

The tip of the iceberg

Because sharps injuries often go unreported, the EPINet data is only the tip of the iceberg when assessing real-world risk to healthcare workers and the actual number of injuries sustained each year in the U.S.

This was evidenced by landmark study led by current U.S. Food and Drug Administration (FDA)

Commissioner Martin A. Makary, M.D., M.P.H. and published in the New England Journal of Medicine (NEJM ).2 Entitled “Needlestick injuries among surgeons in training,” the

study surveyed surgeons in training at 17 medical centers about previous needlestick injuries.

The survey had a 95% response rate, with 699 participants questioned about whether their most recent needlestick injury was reported to an employee health service or involved a “high-risk” patient (e.g., one with a history of infection with HIV, hepatitis B or hepatitis C, or injection-drug use).

The survey revealed:

• 83% of residents experienced at least one needlestick injury during training.

• The mean number of needlestick injuries increased with each postgraduate year (PGY):

• PGY-1: 1.5 injuries

• PGY-2: 3.7 injuries

• PGY-3: 4.1 injuries

• PGY-4: 5.3 injuries

• PGY-5: 7.7 injuries

• By their final year, 99% of residents had experienced a needlestick injury; 53% of those injuries involved a high-risk patient.

• 51% of the most recent injuries incurred (297 of 578) were not reported to an employee health service, and 16% of those involving high-risk patients (15 of 91) were not reported.

Primary reasons for underreporting

Among the surgeons in training surveyed by Dr. Makary and his team of researchers, 42% cited “lack of time” as their reason for not reporting their injury, with this being the most common reason cited (126 of 297 respondents).

While Dr. Makary’s research was published 18 years ago, the ﬁndings still hold true nearly two decades later. In his interview with HPN, Scott Roberts, MD, medical director, Infection Prevention for Yale New Haven Health and assistant professor, Infectious Diseases for Yale School of

Scott Roberts

Emily Jones

Medicine, shared both anecdotal stories and research findings demonstrating how sharps injuries remain an underreported and underestimated risk in healthcare.

“I’ve had surgical residents tell me they had a needlestick injury on a Saturday night when they’re the only resident on call and the health system doesn’t have occupational health services available after hours on weekends,” said Dr. Roberts. “While the emergency department (ED) has needlestick injury protocols, the residents don’t want to wait in the ED for hours to get post exposure prophylaxis.”

A recent study, “National Survey of Sharps Injuries Incidence Amongst Healthcare Workers in the United States,” published in the April 2023 edition of the International Journal of General Medicine, found the top three reasons for not reporting sharps injuries are:3

• Healthcare workers perceiving low infection risk based on patient medical history;

• Fear of peer perception; and

• Belief of lack of reporting utility or that reporting is inconsequential.

It is this first reason that Dr. Roberts highlighted in his co-authored case report, “Blood exposure to Babesia microti through sharps injury,” which was published in the October 2024 edition of Infection Control & Hospital Epidemiology. It described how a physician sustained a sharps injury from a scalpel contaminated with blood by a patient later conﬁrmed to have Babesia microti (B. microti) infection.

B. microti is a parasitic blood-borne piroplasm commonly transmitted to humans by deer tick bites, but it can also be spread by exposure to infected blood products through transfusion or organ transplantation. Babesiosis, an infectious disease caused by B. microti, ranges in severity from “asymptomatic infection in about a ﬁfth of adults

to severe disease requiring hospital admission.”

While still rare, babesiosis has been described as “an unseen epidemic, with rates increasing in the U.S. by 9% per year from 2015 to 2022.”4,5 As Dr. Roberts and his colleague wrote in their case report, “A sharps exposure to B. microti has never been reported,

bloodborne transmission potential of babesiosis be taught to healthcare workers in endemic regions, which today include the Northeastern and Northern Midwestern regions of the U.S.”6

Dr. Roberts also highlighted the importance of raising awareness for activities that increase health-

“While the emergency department (ED) has needlestick injury protocols, the residents don’t want to wait in the ED for hours to get post exposure prophylaxis.”

and no guidance exists for managing exposed healthcare workers.”

“In general, healthcare workers do not have an accurate knowledge base of what deﬁnes a bloodborne pathogen,” Dr. Roberts explained. “They order patient testing for Hep B, Hep C, and HIV, and when all that comes back negative, they think, ‘OK, we are good to go.’ They don’t explore other diseases transmitted through bloodborne means that could put them at risk if a sharps injury occurs.”

Recommendations for maintaining awareness and reducing risk

A good ﬁrst step in combatting complacency around sharps injury risks among healthcare workers is promoting awareness – both dangerous pathogens that can be transmitted through contact with a patient’s blood and factors that increase or decrease the risk for injury.

“My team is working to educate the healthcare workforce that there are many other things that can be transmitted, such as Syphilis, Cytomegalovirus (CMV), and B. microti,” he continued. “We need to broaden patient evaluation and testing to reduce healthcare workers’ risk for exposure and harm.”

In the case report, Dr. Roberts and his colleague recommend the

care workers’ risk for injury, along with positive behaviors that can help enhance safety.

“There’s been some recent epidemiological data indicating suturing on closure is a high-risk activity compared with non-suturing-based activities,” he stated. “Additionally, research has shown that a stable team can improve safety. If a surgical team doesn’t change team members every day but rather has the same team in place for six months, safety incidents decrease.”7,8

According to Dr. Jones, organizations can strengthen their commitment to sharps safety by renewing eﬀorts to develop and maintain a comprehensive sharps safety program that involves every team member.

“Experts emphasize that institutions have a responsibility to actively foster a culture of sharps safety,” she stated. “Leadership plays a key role by promoting a non-punitive environment, which helps create psychological safety and encourages more accurate and consistent reporting of sharps injuries. With consistent reporting of sharps injuries, we can follow the trends in injuries and identify ways we can continue to improve.”

Dr. Jones pointed to the AORN Guideline for Sharps Safety as a valuable resource, which features evidence-based recommendations,

such as applying a bundled approach when structuring a sharps safety program.9

“One quality improvement initiative described in the literature demonstrated a decrease in sharps injuries after implementing a comprehensive bundle,” said Dr. Jones. “This included consistent use of a neutral zone, clear verbal communication when passing sharps, adoption of devices with engineered sharps injury prevention features, and routine double gloving.”

To effectively implement the updated AORN Guideline for Sharps Safety, Dr. Jones recommends the following best practices:

Review your current program: Begin by reviewing your organization’s existing sharps safety program to identify current practices, gaps, and areas for improvement.

Establish an interdisciplinary leadership team: Form a team with the authority and responsibility to develop and lead implementation eﬀorts. This team should include:

Perioperative leaders and perioperative RNs

Surgeons and surgical technologists

Anesthesia professionals and perianesthesia RNs

Occupational health professionals, quality professionals, and risk managers

Additional representation may come from executive leadership, infection prevention, materials management, and nurse informatics

Develop a comprehensive sharps safety program that includes:

An exposure control plan

A process to evaluate and select devices that help reduce the risk of sharps injury

Implementation of safe sharps handling practices

Consistent use of personal protective equipment (PPE)

A user-friendly sharps injury reporting system

A robust quality improvement process

Role-speciﬁc education on sharps injury prevention

The future of sharps injury reporting

Since its introduction in 1992, EPINet has served as the only multi-state data source for occupational needlesticks, contaminated sharps injuries, and high-risk mucocutaneous exposure incidents.10

On July 10, 2025, the Association of Occupational and Environmental Clinics (AOEC) announced that ISC, the

home of EPINet, is closing at the end of this year and EPINet data is being transitioned to AOEC’s domain (www.aoec.org/epinet).11

The announcement read, “EPINet data remains publicly available. Everyone is encouraged to delve deeper into EPINet ﬁndings to actively contribute to AOEC and its initiatives and join as a member of AOEC. Continued collaboration, adoption of evidence-based strategies, and improved surveillance will be essential for upholding safety standards and protecting workers in the healthcare sector.”

Commenting on the transition, Dr. Jones stated:

“With the ISC closure and EPINet data transition over to the Association of Occupational and Environmental Clinics, AORN continues to support perioperative teams with evidence-based recommendations for creating a comprehensive organizational sharps safety program to cultivate a culture of safety that promotes sharps injury prevention, supports consistent PPE use, and encourages sharps injury reporting.” HPN

REFERENCES:

1. International Safety Center Posts Long-Awaited 2024 EPINet Data, Announces its Closing, and Transition to AOEC, July 10, 2025, https://www.einpresswire.com/article/830251092/ international-safety-center-posts-long-awaited-2024-epinet-data-announces-its-closing-andtransition-to-aoec

2. Makary MA, Al-Attar A, Holzmueller CG, Sexton JB, Syin D, Gilson MM, Sulkowski MS, Pronovost PJ. Needlestick injuries among surgeons in training. N Engl J Med. 2007 Jun 28;356(26):2693-9. doi: 10.1056/NEJMoa070378. PMID: 17596603.

3. Yun J, Umemoto K, Wang W, Vyas D. National Survey of Sharps Injuries Incidence Amongst Healthcare Workers in the United States. Int J Gen Med. 2023 Apr 5;16:1193-1204. doi: 10.2147/ IJGM.S404418. PMID: 37041800; PMCID: PMC10083018.

4. Noor Fatima, MD; Steven Lippmann, MD WMJ. 2025;124(1):3-4, https://wmjonline.org/124no1/ fatima/

5. Paddy Ssentongo, Natasha Venugopal, Yue Zhang, Vernon M Chinchilli, Djibril M Ba, Beyond Human Babesiosis: Prevalence and Association of Babesia Coinfection with Mortality in the United States, 2015–2022: A Retrospective Cohort Study, Open Forum Infectious Diseases, Volume 11, Issue 10, October 2024, ofae504, https://doi.org/10.1093/ofid/ofae504

6. Paddy Ssentongo, Natasha Venugopal, Yue Zhang, Vernon M Chinchilli, Djibril M Ba, Beyond Human Babesiosis: Prevalence and Association of Babesia Coinfection with Mortality in the United States, 2015–2022: A Retrospective Cohort Study, Open Forum Infectious Diseases, Volume 11, Issue 10, October 2024, ofae504, https://doi.org/10.1093/ofid/ofae504

7. Wound closure higher risk: Snavely JE, et al. Infect Control Hosp Epidemiol. 2019, 40, 1253-1257.

8. Team stability lower risk: Myers DJ, et al. Infect Control Hosp Epidemiol. 2016; 37:512-518.

9. Sharps Safety, AORN, https://aornguidelines.org/guidelines/content?sectionid=1737243 14&view=book

10. International Safety Center Posts Long-Awaited 2024 EPINet Data, Announces its Closing, and Transition to AOEC, July 10, 2025, https://www.einpresswire.com/article/830251092/ international-safety-center-posts-long-awaited-2024-epinet-data-announces-its-closing-andtransition-to-aoec

11. International Safety Center Posts Long-Awaited 2024 EPINet Data, Announces its Closing, and Transition to AOEC, July 10, 2025, https://www.einpresswire.com/article/830251092/ international-safety-center-posts-long-awaited-2024-epinet-data-announces-its-closing-andtransition-to-aoec

Preparing for Respiratory Illness Season

With fall and winter right around the corner, hospitals and health systems can take steps to make sure they are doing all they can.

BY MATT MACKENZIE

With respiratory illness case rates sure to increase this coming fall and winter, it’s important to take a look at lessons learned from last year in order to reduce severe outcomes for patients and unnecessary strain on health systems.

Numerous studies demonstrate the dangerous eﬀects of respiratory

illnesses in patients. One study, published in the Journal of the American Geriatrics Society in July of this year, sought to quantify the increased risk of cardiovascular events in older patients hospitalized with RSV compared to other common causes of hospitalization in that age cohort, like flu, UTI, or fracture. Researchers took a look at about 2,500 patients

hospitalized with RSV from 2011 to 2020 and found that 18.5% of them subsequently had a cardiovascular event, compared to 17.7% from ﬂu, 12.1% from UTI, and 8.4% from a fracture. Matched analyses then showed an association between RSV hospitalization and greater risk of subsequent heart failure events relative to all other patient groups.

Practically every outcome analyzed in patients hospitalized in the study was found to be more prevalent in patients with RSV compared to other conditions. In addition to cardiovascular events, higher rates of 30-day mortality and ICU admission were observed, as well as longer lengths of stay for RSV patients compared to other patient groups. The odds for intensive care were higher for RSV patients “regardless of whether pre-existing cardiovascular conditions were present.” The authors of the study characterized the risk of ICU transfer as “substantial” in RSV patients compared to those with UTI or fracture.1

Frightening revelations about the impacts of respiratory illness after acute infection don’t end there. Another study, published in Nature, found that “infection with [COVID19] is linked with a nearly twofold increase in cancer-related death.” Researchers set out to test whether or not dormant cancer cells could be reawakened by a respiratory illness; they seeded breast tumors in mice and then infected them with either COVID or ﬂu and found that the dormant cancer cells “kicked into high gear, proliferated, and formed metastatic lesions” in the animals within days of infection. Evidently, the culprit was an immune molecule called

interleukin-6, as the removal of that molecule slowed the multiplication of the cancer cells down drastically.2

The study helps to explain a marked increase in metastatic lung disease among breast cancer survivors following infection with COVID. The dormant cancer cells may be catalyzed by an infection with a respiratory illness, which only further goes to show the importance of eﬀective, aﬀordable, and widely available interventions against diseases like COVID.

While the safety of patients is obviously of paramount importance, hospitals and health systems find themselves under strain during respiratory illness season as well, and that strain can lead to negative impacts on patient care. In January of 2024, the CDC posted an update on hospital capacity as respiratory illnesses began their seasonal annual increase,

which acts as an eﬀective microcosm for how these diseases progress every year and impact hospital systems. The agency warned specifically that “low vaccination uptake… could lead to more disease and potentially more severe disease, straining healthcare capacity.” They mentioned that strain on healthcare systems has been associated with delays in treatment and elective procedures, increased medical errors and lower quality of care, longer patient stays, increased rates of healthcare-associated infections, and poorer outcomes.3

Rodney Rohde

HPN spoke with Dr. Rodney Rohde, PhD, MS, SM(ASCP)CM, SVCM, MBCM, FACSc, Regents’ Professor at Texas State University System, about lessons learned from last

year’s respiratory illness season and what hospitals and health systems can implement and think about this year to try to assuage this issue before it begins to worsen, as it does each year.

What are some lessons learned from last year’s respiratory illness season?

Last year’s respiratory illness season reinforced the importance of early surveillance, rapid diagnostics, and clear communication. We saw how co-circulating viruses—COVID19, inﬂuenza, and RSV—can strain healthcare systems. It highlighted the need for higher vaccination rates, public trust in science, and the critical role of medical laboratory professionals in outbreak response.

What do you expect to see this fall and winter?

This fall and winter, I expect another complex respiratory season with overlapping waves of COVID-19, inﬂuenza, and RSV. We may also see emerging variants or viral shifts. Continued vigilance, updated vaccinations, and strong public health mes-

Stay up to date on vaccinations for COVID-19, ﬂu, and RSV if eligible.

saging will be essential—as will the behind-the-scenes work of medical laboratories guiding early detection and response. While inﬂuenza, RSV, and COVID-19 are the primary concerns for severe illness, other respiratory viruses circulate during the season as well, including adenovirus, rhinovirus/enterovirus (common cold), pertussis, and parainﬂuenza. Human metapneumovirus (HMPV) is also on the radar and is expected to follow a similar late season peak as observed in the previous year.

What should clinicians and health systems keep in mind as the season draws nearer?

Clinicians and health systems should prepare for simultaneous surges of respiratory viruses by ensuring vaccine access, staffing support, and diagnostic capacity. Early testing, public education, and collaboration with laboratories will be key. Proactive planning—not reactive response—will make the diﬀerence in managing this season eﬀectively.

What can hospitals do before respiratory illness season gets underway to minimize adverse outcomes?

Hospitals can get ahead by ensuring vaccine availability, reinforcing infection prevention protocols, checking on supply chains, and optimizing lab testing workflows. Cross-training staﬀ, reviewing surge capacity plans, and engaging in public outreach can also reduce strain. Early action is critical to minimize

hospitalizations and protect vulnerable populations.

What advice would you give people to follow this fall and winter to stay healthy and avoid becoming severely ill?

Stay up to date on vaccinations for COVID-19, ﬂu, and RSV if eligible. Practice good hand hygiene, stay home when sick, and wear a mask in high-risk settings. Test early if you have symptoms, especially if you’re at higher risk. Prevention and early action are your best defenses.

Are there any new technologies you’re aware of that are helping infection prevention teams prevent severe outcomes?

Yes—syndromic multiplex PCR panels, real-time wastewater surveillance, and AI-driven predictive analytics are transforming how we detect and track respiratory viruses. These tools help infection prevention teams respond faster, allocate resources more eﬃciently, and intervene earlier to prevent severe outcomes, especially in high-risk settings like hospitals and long-term care. In my professional opinion, now

more than ever it’s important to utilize diagnostic management teams [DMT] composed of clinicians, medical laboratory professionals (including Doctor of Clinical Laboratory Science, DCLS), pharm, infection prevention, EVS, nursing, and others involved in tracking infections. Personally, I would also recommend IT who could help create a dashboard or other handy tools to track real-time respiratory (or other) infections.

How can clinicians keep other patients safe from contracting a respiratory infection?

protocols, and promoting vaccination. Ensuring proper ventilation, cohorting patients when needed, and using rapid diagnostics also help limit spread within healthcare settings.

Anything else you’d like to share with our readers?

stronger recruitment and retention strategies. Together, through prevention, preparedness, and compassion, we can protect our communities and save lives. More than ever, it’s critical that everyone in healthcare work diligently to share accurate science communication and help ﬁght misinformation, disinformation, and outright falsehoods surrounding vaccines, infection prevention and control, and clinical research. HPN Practice

Clinicians can protect others by promptly identifying and isolating symptomatic patients, following strict hand hygiene and PPE

Respiratory illness season is no longer predictable—it’s dynamic and evolving. We must stay vigilant, trust the science, and support the professionals working behind the scenes in labs and public health. The U.S. is in a healthcare workforce crisis and we must support building new academic programs, scholarships, and

Taming the Beast: Best Practices for Managing HLD Inside and Outside the SPD

From fragmented oversight to centralized control, SPD and clinical leaders share strategies for improving the safety, eﬃciency, and consistency of high-level disinfection (HLD) across healthcare facilities.

BY KARA NADEAU

High-level disinfection (HLD) of medical devices, including endoscopes, outside of the sterile processing department (SPD) is often a blind spot in healthcare facilities. With reprocessing occurring in decentralized

pockets—from imaging to gastroenterology (GI) to ambulatory clinics—oversight is limited, risks are heightened, and accountability can be murky.

“High-level disinfection outside of SPD has always been a challenge.

It’s like the Wild West, every man for himself,” said Amy DeGraw, BSHA, CRCST, CHL, clinical educator for the Healthcare Sterile Processing Association (HSPA). “It’s time-consuming, complex, and often invisible until something goes wrong.”

Whether an organization chooses to keep HLD decentralized or bring it into the SPD, both models require strong collaboration, education, documentation, and leadership support.

In this ﬁrst of a two-part series, HPN oﬀers a high-level overview of HLD inside and outside of the SPD. DeGraw and John D. Shadle, BA, CRCST, GTS, operations supervisor, Temple University Health System in Philadelphia, served as our subject matter experts (SME) for this article.

The next article, slated for the October 2025 issue of HPN, will present a more detailed roadmap for centralizing HLD to the SPD.

About our experts

DeGraw has experience in both sterile processing education and infection prevention. She previously served as an infection preventionist (IP) and sterile processing education coordinator at Froedtert Hospital and held leadership and instructional roles at Mercyhealth and Blackhawk Technical College.

Shadle has 25 years of experience managing HLD inside and outside the SPD. He serves as secretary and past president of the Keystone Alliance of Sterile Processing Professionals (KASPP), supporting education and advancement in the ﬁeld. Prior to joining Temple University Health System this year, Shadle held SPD leadership roles at UPMC, Wellspan Health, and Aureus Medical Group.

Considerations, challenges, and opportunities for centralizing HLD to the SPD

Drawing from their experiences, DeGraw and Shadle offered their insights and advice on managing HLD both when it is performed across various clinical departments and when sterile processing teams have successfully centralized it within their departments.

Be aware of the risks

“There are a number of risks that come into play when HLD is performed outside the SPD,” said Shadle. “The biggest issue I’ve seen—not just in hospitals but in other sites—is a lack of consistent and proper education and competency. Staﬀ are often trained on how to perform HLD safely, but not on the ‘why’ behind it, which can lead to problems when things don’t go as planned. One also needs to acknowledge that when a

specialist in another role performs HLD, their primary focus remains their main responsibilities—not high-level disinfection.”

“Of course, any competent individual can complete a task without error, but the lower the frequency of performing the task, the greater chance of error,” Shadle added. “Conversely, when the frequency is increased, efficiency and proﬁciency naturally follow. You know I’ve changed a few tires in my life, but I’ve got nothing on the pit crew at the Indy 500.”

Uncover the invisible DeGraw noted how many SPD teams lack visibility to where HLD is being performed in their hospitals and health systems.

“When I started as an SPD technician, I was completely unaware of what was happening outside my department,” said DeGraw. “It wasn’t until I entered leadership and was tasked with identifying all the departments outside of SPD that were performing HLD that I came to understand we weren’t the only ones performing this level of disinfection.”

“I think that’s the case with many SPD teams,” she continued. “They’re just very unaware of what is happening outside their department in terms of HLD and instrument reprocessing in general. I’ve asked SPD teams if they knew a department was disinfecting scopes, and they’d say, ‘We had no idea.’”

Because SPD professionals are usually not involved in conversations about reprocessing outside their department, it makes organizationwide HLD oversight very challenging. “If you don’t know what’s happening, you can’t help with the process,” said DeGraw.

Rather than trying to assess and address all places where HLD is performed outside of the SPD – both onsite in a hospital and throughout oﬀsite ambulatory sites – DeGraw suggests starting within the hospital’s four walls.

Build a village, not a silo

To identify areas where HLD is performed outside of the SPD, DeGraw recommends tapping into a healthcare organization’s supply chain and biomedical teams, stating, “Build a relationship with them because they can tip you oﬀ to what is happening across your healthcare organization, serving as your early-warning system.”

“I turned to my supply chain/purchasing department and asked them to help me identify departments outside of the SPD that were placing orders for HLD equipment and supplies,” DeGraw explained. “Then I could approach those requisitioning departments and have conversations about their protocols and practices.”

“Because the biomedical team is responsible for servicing HLD equipment, they are another great partner in this eﬀort,” DeGraw continued. “For example, they can notify you when a department installs an automatic endoscope reprocessor (AER), which SPD might not know about.”

Approach stakeholders with curiosity and compassion

DeGraw acknowledges that many clinical departments have trust issues with their SPD that drive them to retain control over HLD. She stresses the need for SPD to focus on relationship building before attempting any HLD transitions.

“I’m guilty of this as well: Going in there like a bull in a china shop and

John D. Shadle

Amy DeGraw

saying, ‘You’re doing HLD wrong. SPD is taking it over,’ basically being inconsiderate of their eﬀorts and not acknowledging their feelings,” said DeGraw. “Moving HLD to SPD is not meant to be punitive. So, you really have to focus on that relationship building to have them understand that you’re there to help, to alleviate them of the reprocessing burden so they can focus more time on their patients.”

She suggests SPD professionals ﬁrst approach clinical departments with curiosity-led conversations.

“Like, ‘Hey, this is who I am. Can I shadow you? Can you walk me through your HLD process? What challenges do you face? How can I help you?’ Show them that you care about their processes and that you’re there to help, not make it harder for them,” she explained.

Perform risk analysis to guide your approach

As DeGraw explained, risk assessments can reveal whether a department should retain HLD or transition it. Again, multidisciplinary collaboration is key to success. SPD doesn’t have to go it alone. She stated:

“Infection prevention (IP) is your best collaborator in performing risk assessments because if there are gaps in HLD processes, it aﬀects them as well. As an IP, I wrote risk assessments related to HLD and reprocessing all the time. So, work with your IP resources and make it a team eﬀort.”

Because clinical departments might push back on the SPD taking over HLD, a risk assessment is an invaluable tool to help SPD and IP teams make their case for change.

“In my experience, it’s common for clinical stakeholders to think, ‘SPD is going to lose or damage my instruments or equipment.’ That makes them very reluctant to hand HLD over. So, the risk assessment should convey, ‘Here’s our healthcare organization’s policy and procedures for HLD. Can you meet these in your own department? If yes, then that’s great. If you need help, what steps do you need to take to meet them? And if you can’t meet them, then SPD should be taking that over.’”

As SPD manager at UPMC, Shadle led the eﬀort to centralize HLD for the gastroenterology (GI) and pulmonary departments, leveraging ANSI/AAMI ST91 as evidence that change was needed. He described his work with pulmonary department leadership:

“After ST91 was released, we had frequent meetings with the team to explain the importance and reasons why

it’s better for the responsibilities to change. The manager of pulmonary, Emily McCann, was particularly invested in these meetings and even had celebratory luncheons for the team to show her team’s gratitude for taking on the new tasks.

Consider the impact of centralization on SPD and clinical stakeholders

While hospital and SPD leadership might feel HLD centralization is the best move, it is best to take a step back and assess whether SPD has the resources to do it successfully:

“I’ve been in healthcare organizations where HLD centralization was SPD led, and others where it was leadership telling the SPD team that they needed to take it over,” said DeGraw. “Given the strain on SPD resources today, it makes sense that many SPD teams would be reluctant to take on the extra work. So, in the case where hospital leadership is spearheading the eﬀort to centralize HLD, SPD leadership should insist on running the numbers before any change happens.”

According to DeGraw, key factors for consideration include:

• Does the clinic have enough devices/instruments to maintain patient care continuity based on the anticipated SPD reprocessing turnover time?

• How many more items will come into the SPD for reprocessing?

• When will the additional HLD reprocessing take place, who will that impact – ﬁrst, second, third shift?

• How many more full-time employees will be required to do the extra reprocessing work?

• Does the SPD have enough reprocessing equipment to accommodate the extra volume?

• How will the instruments/devices be transported to/from the SPD?

• Do the departments have the necessary resources to properly pretreat items and prepare them for transport?

“And given the reluctance of some clinical departments to entrust HLD reprocessing to the SPD, particularly related to fears that the SPD might lose instruments/devices, you need to have a system in place to track instruments and ensure they are accounted for throughout the whole process,” said DeGraw.

Shadle spoke to his experience overcoming challenges with transport when centralizing HLD to the SPD at UPMC, stating:

“One challenge with pulmonary was physically transferring the scopes to the processing room, which was on the other side of the hospital. We also had concerns about the scopes being processed in a timely manner, so the team was educated on proper ‘delayed reprocessing’ processes and procedures written.”

“While it was a very time-consuming and arduous task, in the end it paid oﬀ,” Shadle continued.

“For their efforts, during Sterile Processing Week in the fall of 2023, the department was awarded HealthMark’s ‘Heart of the Hospital’ nationwide award.”

Leave HLD where it is, when it makes sense

DeGraw and Shadle point out how every hospital and clinical department is diﬀerent; therefore, there may be cases where it isn’t practical to bring all HLD into the SPD.

“There are some departments where it makes sense to keep HLD there,” said DeGraw. “Like ultrasound where they are reprocessing probes with Trophon. It’s a quick and eﬀective process that’s repeated so many times per day the clinical staﬀ generally has it down.”

“At UPMC, we examined taking on the responsibilities of reprocessing the transesophageal echocardiogram (TEE) at the site, but it proved impractical in many ways,” said Shadle. “After coming to this conclusion, we worked with quality and regulatory and decided that my leadership team should perform audits for competency and compliance.”

Lead HLD education and training When HLD remains decentralized, SPD team responsibilities go beyond reprocessing items to educating and training clinical team members on proper HLD policies and protocols. Shadle commented on his approach at UPMC:

“We implemented several strategies and systems for training and competency. First off, we conducted numerous in-services where every staff member received regular vendorled education on the flexible scopes, reprocessors, and support equipment to ensure they knew how to use the equipment and every scope processed was patient safe.”

“Also, my first and second shift supervisors were the only team members responsible for completing competencies after they received specialized 1:1 training with vendors on all scope types,” he continued.

“Additionally, we created an ‘SPD HLD Team’s page’ which included everything from competency documents, relevant IFUs and weekly cleaning documents, etc.,” Shadle added. “This proves quite handy during a survey to retrieve requested

information for auditors. I referred to it as our ‘SPD Swiss army knife.’”

DeGraw recommends designating and training departmental “super users” who own the HLD processes in their areas.

“At the two facilities where I oversaw HLD, we designated ‘super users’ in each department performing HLD outside of the SPD. These individuals were trained by SPD, received a higher level of competency validation, and were responsible for training and oversight within their departments.”

Share oversight of decentralized HLD While educating and training clinical department staﬀ members and designating super users for HLD takes some of the burden off SPD while helping enhance reprocessing eﬀectiveness and safety, it is not a “set it and forget it” initiative.

“In large hospital systems, managing HLD outside the SPD is a fulltime job,” DeGraw said. “Having super users in place is helpful, but I still had to check on them multiple times a year. Each quarter, I’d visit these sites, verify their processes, review records, and ensure everything was done correctly. It was a time-consuming task that became a job in itself.”

“I’ve found that SPD oversight of HLD outside the department is really a mixed bag,” she added. “While SPD may own the policies and procedures, they often have very little control over how other departments carry them out.”

Again, oversight can’t fall on the shoulders of the SPD team alone. DeGraw encourages the engagement of both IP and quality teams to assist with enforcing policies and procedures, stating:

“Because IP and quality often do their own rounding on the departments, they can help with HLD oversight. I would ask them, ‘When you

go into this department during your rounding, can you check these things for me?’ Having that additional oversight helps eliminate gaps in HLD processes. You also need support from leadership, especially when you identify gaps in compliance that must be addressed.”

Shadle commented on HLD at his current employer Temple University Health System, where clinical departments continue to reprocess outside of the SPD:

“Being at Temple is a big change. I first would like to say that I’m excited to be part of the SP leadership team with LaTrice Tate and Melissa Vargas. We have one awesome HLD coordinator, Michelle DiSalvo, who works between multiple sites acting as an educator and facilitator, performing competencies and acting as a point person for all things HLD. I can’t say enough wonderful things about her and how many times I wished I had someone in that capacity in previous roles.”

When asked how he and his team manage quality assurance for HLD processes performed outside of the main SPD, Shadle’s response was “surveillance!” He described several strategic approaches they have employed:

• Engage internal and external auditors: Partner with the system educator and a primary vendor to conduct complementary mock-surveys and provide process improvement recommendations.

• Digitize all possible documentation: Convert any trackable process into an electronic record, including those supported by device interfaces and tracking systems.

• Eliminate reliance on paper logs: Ensure that hand-written records— such as pre-cleaning start times, cleaning delays, and manual documentation—are entered into the electronic tracking system or securely retained by other means.

• Implement routine auditing and checks: Regularly audit cycle processes; daily shift reports should include checks on critical areas, such as weekly endoscope reprocessing, manual HLD, and water ﬁlter expiration.

• Establish documentation as a habit: Foster a culture where thorough documentation becomes second nature to staﬀ, supporting consistency and compliance over time.

“Looking ahead, I’d like to see all of the flexible endoscopes entered into our tracking system, if anything just for comfort and ease of process

“In large hospital systems, managing HLD outside the SPD is a full-time job”

retrieval,” said Shadle. “Scope reprocessing can occur in diﬀerent departments, floors, even buildings; it’s so much easier to be able to retrieve the cycle info without interfering with the working technicians from another space.”

Wrap up and next up

Managing high-level disinfection outside of the SPD is undeniably complex, but as this article highlights, it’s far from insurmountable.

Whether decentralization remains the reality or centralization is the goal, success depends on multidisciplinary collaboration, data-driven decision-making, and a commitment to education, accountability, and continuous oversight.

By uncovering hidden risks, building cross-functional relationships, and leveraging proven best practices, healthcare leaders can tame the “beast” of HLD and safeguard patient care.

Look for part two of this series in HPN’s October issue, where we’ll share a detailed roadmap for bringing HLD under centralized SPD control. HPN

What Is an Indicator?

BY NELSON WINTER, VANESSA FRANK

How do you know it’s sterile?” is a question commonly asked in Central Sterile Processing. Thankfully, our technicians have multiple methods and tools at their disposal to prove the completion of the sterilization cycle. The answers that these tools give CSP professionals are called “Sterility Assurance Levels” or SALs. When first entering a Central Sterile Processing Department (CSPD), you might find it difficult to comprehend the technical aspects pertaining to how SALs equal sterility for the end users. AMMI ST79:2017 2022 quotes SAL as the “Probability of a single viable microorganism occurring on an item after sterilization. SAL is normally expressed as 10n. A SAL of 106 means that there is less than or equal to one chance in a million that a single viable microorganism is present on a sterilized item” (AMMI, 2022). This is how the CSPD shows that the instruments are processed adequately and are safe for patient use, and this is where indicators come into play.

There are two common types of indicators used in CSP, and they each have sub-qualities important to the sterilization process. There are chemical indicators, which are placed with the items being sterilized to show the end users that the instruments have been exposed to the sterilization process. Then there are biological indicators, which are used by CSP to conﬁrm that the sterilization machines have performed their cycles perfectly.

Chemical Indicators

Chemical indicators (CIs) confirm that sterilization practices have been performed by changing colors in various ways depending on how they’re made. These range from type 1-6. ANSI/AAMI is the American National Standards Institute, and AAMI is the Association for Advancement of Medical Instrumentation. Together, they standardize practices through a census of experts ranging from regulatory agency representatives and manufacturers to end users and subject matter experts. These bodies meet to discuss best practices backed by scientiﬁc data and create standards such as ST58 and ST79, as well as technical information reports such as TIR109. Based on ANSI/AAMI standards, chemical indicators are divided in the following manner.

Type 1: Process indicator. A process indicator shows the package has been exposed to a sterilization process. This could be locks with indicator dots, external indicator tags, or sterilization tape. Once sterilized, the indicator portion will change colors to show that the item has run through the process, but not necessarily that it

has reached a 10-log-6 level of organism reduction.

Type 2: Specific test indicator. A speciﬁc test indicator shows the results of one particular sterilization modality. This includes the Bowie Dick, also known as the Dynamic Air Removal Test (DART test). The DART test is specially made to prove that enough air is removed in the pre-vacuum stage of sterilization so that the steam pulse can penetrate the ﬁlters or wraps as well as enter lumened items inside the tray. DART tests should be run each day when the sterilizer is in use.

Type 3: Single critical process variable indicator. These react to a single parameter, such as temperature. Single variable indicators react at a speciﬁc stated value, but that is the end of their limitation, and so they are rarely used in our industry.

Type 4: Multicritical process variable indicators. These are similar to type 3 but react to two or more variables at stated values. This could include time and temperature. These are not typically used in CSP because they do not react to all critical parameters.

Type 5: Integrated indicators. Also known as integrators, these react to all critical parameters of the sterilization process, which are exposure time, temperature, and pressure. They are placed within the package to be verified in the sterile field. Type 5 indicators meet or exceed the 11138 series of biological indicators. The 11138 series of biological indicators are standardized tests with speciﬁc microorganisms that are known for their resistance to sterilization. These indicators are used to ensure that sterilization methods are eﬀective in healthcare, pharmaceutical, and laboratory settings and validated by the International Standards Organization (ISO). These interrogators are placed inside the sterile packaging to show that the sterilant has penetrated the tray and the instruments have been exposed to all of the correct sterilization parameters. These will change color when the minimum parameter requirements have been met.

Type 6: Emulating indicators. These indicators react to all critical parameters of sterilization, but only for a speciﬁc sterilization process. These indicators will not change if exposed to improper sterilization parameters.

Of the CIs, types 1, 2, and 5 are the most used of these types of indicators.

Biological Indicators

Biological indicators (BIs) are live spores enclosed in a protective device designed for contained incubation. These spores, such as Geobacillus Stearothermophilus or Bacillus Atrophaeus, are resistant to speciﬁc modalities of sterilant, so proving that they can be eradicated helps CSPD technicians attest that the instruments are safe for use.

A BI and a type 5 chemical indicator, packaged in a Process Challenge Device (PCD), are only required to be run at speciﬁc moments in the instrument workﬂow cycle. These times are during sterilizer testing after major

repairs, with implantable surgical items, or at a minimum of weekly; it is preferred by AAMI to be run daily. Many healthcare facilities choose to run a BI and indicator on every sterilization load. When a BI fails the incubation test, all of the instruments run in that cycle must be recalled to CSP and reprocessed.

If only one PCD is run per week, then there are potentially hundreds or thousands of instruments that must be recalled or have already been used on a patient. Testing for every cycle means only one sterilizer load would need to be recalled for reprocessing. A BI is considered to “pass” when, after being incubated for the indi-

“Biological indicators (BIs) are live spores enclosed in a protective device designed for contained incubation.”

cated amount of time, the spore is “negative,” meaning that it has eﬀectively been killed by the sterilization cycle. If a BI fails, it will read as “positive,” meaning positive for microbial growth. To ensure that the BI lot number isn’t faulty, the biological indicator should have a control run every 24 hours or with every lot change. A control is a BI that has not been processed in a sterilizer. This means that it should read as “positive” or a failure, and that the lot has viable spores prior to the sterilization process.

Along with the BIs, physical indicators or mechanical indicators are typically only seen by CSPD technicians unless otherwise requested by other departments or individuals. These physical indicators include sterilizer printouts, charts, digital sterilization records, and parameter screens. These records show a plethora of information such as load counts, sterilizer information, exposure times, temperatures, and pressures within

the chamber. Technicians should be ﬂuent in their ability to read these records to visually verify that the sterilizer sensors’ recorded information matches known parameters for the selected cycle.

Lastly, there are administrative or process indicators. These include load stickers, sterilization logs, package labeling, and testing logs. These are indicators created by CSP to track all of the sterilization information for every instrument that is run through the sterilizers. This includes information on the technician who assembled the instruments, what sterilizer and load number the instruments were processed in, and more information. When all of these are used together, a competent technician can show that the sterilizer is operating correctly, who assembled the set, how it was processed, that the process sterilized the set to the correct parameters, and the set has not been tampered with post-sterilization. Indicators are small but vital tools in the sterilization cycle. If an instrument set is missing internal indicators (those Type 5s!), then the end user is supposed to reject the set. There is no physical evidence that the instrument went through the entire sterilization cycle. Indicators are required to prove process completion.

Next time you’re asked, “Did you remember the indicators?” you can reply with “Which ones do you want me to show you?” You have the knowledge to properly ensure that your fellow technicians, leadership, and end users know that your instruments have been sterilized and are ready for patient use. HPN

Vanessa Frank Nelson Winter

Automatic Equipment and Productivity in a Sterile Processing Department

BY WILLIAM LEIVA

Learning Objective #1: Understand the basic elements of productivity in a sterile processing department.

Attendees of the Healthcare Sterile Processing Association (HSPA) Annual Conference and Expo may have noticed that many presentations and booths focused on productivity. Productivity is often measured in terms of eﬃcacy, eﬃciency, process time, reduced manual labor, reduced

Learning Objectives

1. Understand the basic elements of productivity in a sterile processing department.

2. Describe technologies and considerations when adopting automatic equipment to increase sterile processing department productivity.

3. Discuss the balance between automatic equipment and human resources to achieve desired sterile processing department productivity levels.

Contributed by:

consumable usage, increased reuse, and more.1 Improvement strategies explore how technology may help address the needs for increased productivity and how to eﬀectively quantify the improvements. Innovations such as robotic tables that wrap sterilization trays or carts that automatically load onto washer-disinfectors (WD) are commonly displayed at conferences and expos.

First, it is important to understand what the main drivers of productivity are in the sterile processing department (SPD). Signiﬁcant research has been conducted about productivity, and results indicate that productivity is primarily driven by equipment and technologies, followed by staﬀ training

and allocation, then SPD workﬂow, and inventory management, including loaners. 1-5 Let’s explore this further.

The first element, equipment and technologies, is often considered the golden path to improve SPD productivity. However, financial and infrastructure challenges may fail to deliver expected outcomes. The second element, staff, training, and the allocation of resources, involves a complex set of decisions and multiple internal and external variables. On the hospital side, this requires approval for resources, selection, onboarding, and ongoing training that in light of the high turnover rates continue to challenge healthcare systems. The third element is SPD workflows, which can

VariableConsiderationImpact

Frequency

Detergent

Frequencies between 35 and 42 kHz are common. Verify with the instrument manufacturer to determine the most suitable frequency.

Enzymatic detergents are often preferred due to their ability to break down multiple debris types

Higher frequencies are considered gentler on medical devices, given the smaller size of the cavitation bubbles.

In general, ophthalmologic devices should not be cleaned using enzymatic detergents.

Higher pH levels may have detrimental effects on instruments. Always verify the pH of the detergent and ensure the devices are approved for that speciﬁc ph.

Time Newer systems may have multiple cycle times. Identify the most suitable cycle time for your devices.

Irrigation

A non-irrigated system requires manual irrigation. Lumened devices must be irrigated with the detergent from the bath prior to starting the cycle.

Irrigated systems may require speciﬁc adaptors.

Consult your medical device manufacturer to ensure adequate irrigation.

Table 1: Considerations and Impacts of the Use of Ultrasonic Cleaning Systems.

always be improved. However, this is similar to equipment and technology due to the investment required and implementation timelines. Inventory management may also be addressed with investment in more instrument sets. Owning more highly speciﬁc sets may reduce the dependency on loaners for hospital surgical procedures.

With these elements in mind, looking into new technologies and equipment seems a natural pathway. While not necessarily new, systems such as ultrasonic cleaning baths, and washer-disinfectors (WD) or autowashers, and low-temperature sterilization technologies, highlight time as the key metric to fuel their implementation. In general, these technologies reduce some processing steps and time, which may increase SPD productivity. However, like in any manufacturing process, the primary output of the SPD - the sterile product - is a function of the multiple inputs. Given the complexity of the reprocessing journey, the inputs are diverse and include SPD workflow and staff of an individual process, tools required for that process such as water gun adaptors or brushes, detergents and time required for them to work effectively, and specific cleaning steps of systems such as ultrasonic washers.

Learning Objective #2:

Describe examples of how automatic equipment may increase SPD productivity. There are three primary technologies that help streamline load release and increase SPD throughput. This article will focus on ultrasonic cleaning systems (UCS), WD, and steam sterilizers. UCS use cavitation, tiny bubbles of water and detergent generated by sound waves at very high frequencies, often over 35,000 times per second. These bubbles deliver mechanical action over surfaces that access areas or design features that are hard to reach or simply inaccessible

by manual means. Specifically, for lumened devices such as laparoscopic and some endoscopic devices, some UCS have active irrigation that enables connecting the bath with the instruments. This increases the ability of the cleaning bath to soften or remove debris. While UCS cycle times are different for different manufacturers, it is important to consider a few factors during their implementation such as device compatibility, specific limitations including pH, time, frequency, or specific requirements, or incompatibility with enzymatic cleaners, as is the case for ophthalmologic instruments (Table 1).

UCS processes may take up to 40 minutes, but the primary benefit to SPDs is that the staff is free to conduct other activities within the department during that time. When adopting this technology or expanding its use, it is important to document specific cycle parameters and UCS compatibility with the instrumentation and devices intended to be cleaned. Also, it is important to use adequate monitoring tools to ensure UCS cavitation is at the desired level.

The second technology, WDs, is a highly sophisticated system that cleans instrumentation in load carriers or wash-carts. WD cycles use pressurized water and specific cleaning steps such as pre-rinsing, cleaning, rinsing, disinfecting, and drying, to clean instrumentation with spray force action. Important factors include the timing of each step, the load carrier or rack that instruments are loaded into, and the detergent(s) used to achieve each cleaning step. Given the effective combination of water pressure, temperature, detergent concentration, and time, they are a highly effective technology to deliver a highly standardized level of cleanliness, in multiple devices, instruments, and configurations.

To deliver the adequate level of cleanliness, speciﬁc load carriers or

Lesson:

Automatic Equipment and Productivity in a Sterile Processing Department

September

2025

This lesson was developed by STERIS. Lessons are administered by Endeavor Business Media.

Earn CEUs

A er careful study of the lesson, complete the examination online at educationhub.hpnonline.com. You must have a passing score of 80% or higher to receive a certiﬁcate of completion.

Certification

The Certification Board for Sterile Processing and Distribution has pre-approved this in-service unit for one (1) contact hour for a period of five (5) years from the date of original publication. Successful completion of the lesson and post-test must be documented by facility management and those records maintained by the individual until recertification is required. DO NOT SEND LESSON OR TEST TO CBSPD. www.cbspd.net.

Healthcare Sterile Processing Association, myhspa.org, has pre-approved this in-service for 1.0 Continuing Education Credits for a period of three years, until July 30, 2027.

For more information, direct any questions to Healthcare Purchasing News editor@hpnonline.com.

Quiz Answers: 1. D, 2. C, 3. D, 4. D, 5. C, 6. D, 7. C, 8. C, 9. A, 10. D

wash carts are used. These are designed to accommodate specific product families, including general surgery, orthopedic cases, anesthesia devices, minimally invasive surgical instruments, or robotic instruments. WDs are not only used to clean devices that will undergo terminal sterilization but are also used with specific load carriers to decontaminate non-critical reusable devices. While these systems are generally compatible with most instruments, it is always important to verify the recommendations from the instrument manufacturer making sure that specific cycle parameters are followed. This ensures that cycles, load configuration, load carriers, and detergents are compatible with the instruments to be cleaned. WDs may utilize utility water and critical water, especially during the final rinse.6 The process time of WDs will vary widely based on the cycle parameters, load carriers, and specific cleanliness requirements for the devices. Similar to UCS, WDs require no supervision after loading. This frees staff from manual cleaning activities and streamlines the cleaning processes. Lastly, steam sterilization relies heavily on highly standardized cycles.7 Although the cycles are fully automated, specific cycle parameters and duration significantly affect the time required to complete a cycle and the ability of each cycle to deliver dry loads. In the United States, cycle parameters closely align with FDA recommendations regarding exposure or sterilization time at a given temperature, and drying time, for which the FDA offers minimum values. Given the significant variations in load configurations such as devices and instruments, their materials (i.e. metal alloys or plastic), and sterile barriers (i.e. peel pouch, wraps, or rigid containers), the drying times are often much longer than those proposed in the FDA recommendations. Sterilization requirements, including exposure and drying time, vary widely between medical device manufacturers. To prevent significant cycle variations, SPD professionals often create product families, with similar devices, and sterile barriers exposed to similar conditions, including their drying time. While this helps to optimize the cycle and the sterilizer throughput, it does not fully solve the challenges around improving productivity.

Understanding the factors that drive drying may prove valuable when assessing productivity and identifying improvement opportunities. Drying is driven by the conditions present in the sterilizer during the drying phase, including the temperature and pressure inside the sterilizer. During the drying phase, the pressure inside the sterilizer is reduced, ideally very quickly, to levels around 1 to 2 PSI (68 to 138 mBar).8 Rapidly reducing the pressure enables quick vaporization of condensate on the loads, which is drawn out of the sterilizer chamber thanks to the ongoing negative pressure or vacuum. This process relies on an adequately functioning pre-vacuum system, which is aﬀected

by the water temperature supplied to the pump6; temperatures above 60°F have a direct impact on pumping speed.

Learning Objective #3: Discuss the balance between automatic equipment and human resources to achieve desired sterile processing department productivity levels. While productivity can be improved by adopting automated equipment designed to increase the efficiency and efficacy of the process, the adoption of new technologies or the expansion of existing ones, will not deliver increased productivity alone. Any assessment of new technologies should include a holistic approach that considers several factors, including current staff training and ongoing development opportunities, the SPD workflow, the specific nuances of the hospital’s workload, and the ability of the SPD infrastructure to utilize each technology for the best possible outcome.

Relying solely on technology to increase productivity may prove fruitless, as many production bottlenecks may remain if overall workflows are not carefully planned, improved, and assessed over time. Specifically, during the cleaning steps, the processes often required by complex devices, such as multiple rinsing, brushing, and soaking, can add significant time to overall production and must be considered when estimating the SPD productivity goal. Another important element is the input of contaminated instruments, which can vary due to differences in surgical cases at each hospital. These variations are impacted by many elements that the SPD cannot control, such as availability of the surgical team and patients, operating room readiness, and in some cases, specific implants.

In general, exploring how cycles can be standardized across instruments and devices into product families can help utilize the ultrasonic cleaning systems to the highest possible levels on every cycle. This approach leads to improved system utilization and use of energy, water, and detergents. The same principle applies to WD systems, where some devices may need to wait for the next available WD that has a compatible cycle and load carrier. By standardizing instruments and devices into product families, the use of cleaning systems can help increase the throughput of each cleaning system.

For steam sterilization, the product family approach may enhance sterilizer utilization rates and streamline cycles by specifying drying times according to each product family. Additionally, collaboration with other departments may enable SPDs to have the right water temperature to increase the eﬀectiveness of the drying phase of steam sterilizers, while understanding the speciﬁc cycle parameters, such as pressure and time, to deliver the desired vacuum level can also contribute to reducing the overall cycle time.

Conclusion

Productivity is, and will remain, a concern in health care facilities. SPDs are not exempt from productivity concerns. Cross-collaboration with internal departments, medical devices, and equipment partners can help SPDs address the challenges around productivity by addressing the adoption or expansion of automated systems to deliver faster reprocessing turnaround times. HPN

REFERENCES:

1.Swenson D, Conklin E. How to measure productivity in sterile processing. Biomed Instrum Technol. 2016;50(1):36-43. doi:10.2345/0899-8205-50.1.36.

2.Huynh E, Klouche S, Martinet C, Le Mercier F, Bauer T, Lecoeur A. Can the number of surgery delays and postponements due to unavailable instrumentation be reduced? Evaluating the benefits of enhanced collaboration between the sterilization and orthopedic surgery units. Orthop Traumatol Surg Res. 2019;105(3):563-568. doi:10.1016/j.otsr.2019.01.012.

3.Alfred M, Catchpole K, Huffer E, Fredendall L, Taaffe KM. Work systems analysis of sterile processing: assembly. BMJ Qual Saf. 2021;30(4):271-282. doi:10.1136/bmjqs-2019-010740. Epub 2020 Oct 19. PMID: 33077512; PMCID: PMC7979531.

4.Alfred M, Catchpole K, Huffer E, Taafe K, Fredendall L. A work systems analysis of sterile processing: sterilization and case cart preparation. Adv Health Care Manag. 2019;18. doi:10.1108/ S1474-823120190000018008. PMID: 32077655.

5.Segarra GC, Catchpole K, Rayo MF, Hegde S, Jefferies C, Woodward J, Taaffe K. Revealing complex interdependencies in surgical instrument reprocessing using SEIPS 101 tools. Appl Ergon. 2024;119:104307. doi:10.1016/j.apergo.2024.104307. Epub 2024 May 11. PMID: 38735234; PMCID: PMC11194015.

6.ANSI/AAMI ST108:2023. Water for the processing of medical devices.

7.FDA Guidance: Reprocessing medical devices in health care settings: validation methods and labeling.

8.ISO 17665:2024. Sterilization of health care products — Moist heat — Requirements for the development, validation, and routine control of a sterilization process for medical devices.

William Leiva MBA - MPH is currently a Subject Matter Expert on Medical Devices Sterilization and Reprocessing and is currently the Senior Program Manager for Sterile Reprocessing with Medtronic. He holds undergraduate degrees in physics and engineering and master’s degrees in business administration and public health, where he focused his research on infection prevention strategies involving medical device reprocessing. He is currently a candidate for a Ph.D. in Cybernetics and Econometrics, researching around the economic impact of the burden of premature mortality. He has published peer review articles on the application of 3D printing technologies for medical devices and for austere environments.

Automatic Equipment and Productivity in a Sterile Processing Department - Practice Quiz

1.Research around SPD Productivity shows that it is driven by:

A.Equipment and technologies.

B.Staff training and allocation.

C.SPD workflow.

D.All of the above.

2.Technology and equipment:

A.Are the only elements needed to increase productivity.

B.Are considered the golden path to productivity.

C.May not be sufficient if other challenges are not addressed.

D.Are linked to infrastructure and capital investment.

3.SPD Staff:

A.Is an element relevant in productivity.

B.Is affected by turnover.

C.Is not affected by training.

D.A and B.

4.Examples of SPD Process inputs are:

A.Staff

B.Workflow

C.Tools

D.All of the above

5.Ultrasonic Cleaning systems are effective in:

A.Ophthalmologic surgeries instruments.

B.Flexible endoscopes.

C.Complex devices with hard-to-reach areas.

D.High level disinfection.

6.While implementing Ultrasonic Cleaning Systems, some key variables are:

A.Irrigation

B.Material compatibility

C.Frequency

D.A and C

7.Washer Disinfectors are effective at cleaning all type of reusable medical devices:

A.Yes

B.No

C.Only devices compatible with the system (load carrier, cycle, detergent)

D.Only compatible devices

8.The final rinse on washerdisinfectors is done with:

A.Tap water

B.Cold water

C.Critical water (AAMI St 108)

D.Soft water

9.FDA Recommendations for steam sterilization cycles include:

A.Minimum drying time.

B.Maximum exposure time.

C.Pressure and steam quality.

D.Temperature during drying phase.

10.The “Product families” approach can help streamlining:

A.Steam sterilization

B.Washer-disinfector cycles

C.Ultrasonic Cleaning Systems

D.All of the above

Great SP Leaders Turn Mistakes Into Valuable Lessons

BY DAVID TAYLOR

Sterile Processing (SP) leader is not just a title; it’s a mindset and a daily commitment. Whether overseeing workﬂow across the department, supporting the team, or leading process improvement initiatives, leadership is about presence, awareness, and the courage to grow and teach. And one thing is certain: even the best SP leaders make mistakes.

In the SPD, where precision and accountability are essential to patient safety, admitting mistakes can feel like failure. However, the diﬀerence between a competent manager and an exceptional leader is how they respond to setbacks and challenges. The best SP leaders see these as learning tools, not opportunities for blame or denial. If a tray goes missing or a biological indicator is misread, for example, leaders should leap into action to investigate, educate, and make necessary improvements. Every challenge is an opportunity to reinforce best practices and accountability and promote a culture of safety, transparency, and continuous improvement.

Power of connection and vision

Often, SP leaders make the mistake of managing from behind a desk, disconnected from the realities of decontamination area, prep and pack, and sterile storage areas. This “Wizard of Oz” leadership style—issuing directives without visibility—doesn’t work in a dynamic, person-centered

environment like the SPD. Staying accessible and engaged means rounding in every area, supporting technicians during complex set assembly, observing sterilizer load cycles, and jumping in during staﬀ shortages. Visibility builds trust, boosts morale, and facilitates real-time problem-solving.

“Building bench strength” is another essential aspect of effective SP leadership. This is not about assigning tasks, but rather mentoring team leads, trainers, and senior technicians to empower decision-making and promote accountability. In highreliability organizations, leadership is distributed. Delegating and mentoring future leaders encourages responsibility, improves communication, and prepares departmental team members for growth. Leaders can’t cultivate such an environment if locked in an oﬃce, largely disconnected from the workﬂow and the team’s daily reality.

Eﬀective SP leaders have a clear, well-communicated vision for their department and team. That might include requiring certiﬁcation for all technicians and helping support them through the process, implementing a new tracking system, or reducing set errors by an established percentage. Vision isn’t just about setting goals; it’s about explaining the “why” behind every task and process. Why do we need higher compliance? Why invest in continuing education? Why change workflows? When SP professionals understand the purpose behind a

process or initiative, they’re far more likely to embrace it—and that starts with the leader.

Vision also requires adaptability. Whether responding to surgical volume changes, onboarding robotic trays, or implementing new instructions for use (IFU), standards, or departmental processes, the most adept leaders will know how to pivot quickly and explain why change, however diﬃcult it may be, is necessary and beneﬁcial. They recognize that calculated risks are essential for growth and model the learning that comes from each change.

Dodging the burnout trap of denial

SPDs are intense work environments. From managing case cart backlogs to facing harried demands from surgical teams, it’s easy for morale to slip if leaders aren’t paying attention. One of the most dangerous leadership pitfalls is denial, ignoring signs of employee burnout, severe stress, boredom, or frustration. A strong SP leader notices when a technician is disengaging or feeling overburdened with on-the-job pressures. They address those situations proactively by communicating openly with team members, demonstrating empathy, reassigning tasks, or offering cross-training, among other approaches. Leadership denial breeds dissatisfaction, but early action builds resilience and loyalty.

Great SP leaders also prioritize self-care. This can include stepping away momentarily to gain composure and respond appropriately during stressful situations, using vacation time, setting boundaries, and committing to professional development. Whether attending the HSPA Annual Conference, participating in webinars or networking with peers, learning from others energizes and informs leaders. HPN

Article conclusion can be found at hpnonline. com/55306697

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Visual Communication

BY ADAM OKADA

Q: “Are we required to have hangtime or expiration labels on our ﬂexible scopes? What about labeling for dirty transport?”

A: To answer your specific question about hangtime, here is a section from ANSI/AAMI ST91:20211 – 11.2.3 – Identiﬁcation of endoscopes during storage.1a

“Protocols should be developed to help ensure that users can readily identify an endoscope that has been processed and is ready for patient use.”

Further, it states, “Before it is placed in the storage cabinet, a label or tag should be attached to the processed endoscope that includes:

• The processing date;

• The name(s) of the person(s) who performed the processing, optionally as speciﬁed by facility policy; and

• The expiration date, based on facility’s established risk assessment, if applicable.”1a

The facility must establish a policy for hangtime based on a risk assessment of their inventory, or, if they are following or referencing SGNA standards in their policies or procedures, SGNA recommends no longer than a 7-day hangtime.2

And for dirty transport, also from ANSI/AAMI ST91:2021 –7.3.2 – Procedure:1b

“Each endoscope should be isolated and transported with its components in a closed container or closed transport cart to the next stage of processing, as it is considered contaminated. The transport cart or container must be labeled with a ﬂuorescent orange, orange-red, or red label containing a biohazard legend and must meet OSHA requirements (29 CER 1910.1030)3 for transporting hazardous items. The closed container or closed transport cart must be non-porous, leak-proof on its side and bottom, puncture-resistant, and large enough to accommodate a single endoscope without the need to over-coil the insertion or light guide tubes. When endoscopes are transported on cart tops, a bag with an aﬃxed biohazard label and designed for containment and transportation of soiled endoscopes may be used.”1b

Later in that section, “Hand-oﬀ communication from the transporter to the processing location should include:

• Conﬁrmation that the endoscope was transported correctly, and all accessory parts are present;

• The date and time of completion of use of that device;

• The time of point of use treatment; and

• Patient identiﬁer.”

The rationale for why all this information is required for soiled transport is because the time between pointof-use and decontamination is vitally important. If there is a delay of more than 60 minutes between point-of-use treatment (POUT) and manual decontamination steps, it can trigger “delayed reprocessing” steps found in most ﬂexible scope IFUs. These delayed reprocessing steps can be time-consuming, with extended soak times and additional steps adding to the cleaning process. Surveyors are scrutinizing communication steps between point-of-use and reprocessing steps (and there is plenty of must have information), so make sure your facility has a good, easy-to-explain process of how that communication is taking place.

This leads me to another major point that should be mentioned: Visual communication is key.

Visual communication is the use of visual elements like images, designs, and graphics to convey messages and information. (canva.com)4 Think about that biohazard symbol ☣. The ﬂuorescent orange, orange-red, or red label containing the biohazard symbol (Fig. 1) gives the handler information about the contents without any verbal communication.

A good visual communication labeling system conveys vital information easily with low probability of misinterpretation/miscommunication. For hang-time labeling, I’ve seen some departments make

Figure 2: 7-Day Indicator Hangtime Label. (Picture source: hmark.com).6

Figure 1: Clean/Dirty Reversible Signs. (Picture source: hmark.com).5

Figure 3: Instrument Repair Tag (red). (Picture source: hmark.com).8

The processing date alone written on the label could lead someone to misunderstand the label and assume it is already expired. I once visited a facility that wrote both the processing date and the expiration (use-by) date on the label, causing confusion with the endoscopy staﬀ.

This is where utilizing visual communication labels (e.g., Fig. 2) on the market can give a visual indication of whether a scope has passed its hangtime (per facility policy).

There are too many examples of the importance of visual communication in the healthcare environment to list them all, but here are some other notable examples:

• Areas that are labeled “Do not enter,” such as the decontamination area.

Another aspect to consider is how scopes are labeled as damaged or in need of repair. Trust me when I say that for an endoscopist, there aren’t many more frustrating experiences than starting to use an endoscope only to realize that the endoscope is damaged. In addition to hangtime and used endoscope labeling, ANSI/ AAMI ST91:2021 – 7.8 – Inspection and cleaning veriﬁcation1c also speaks to the need to label scopes in need of repair:

Figure 4: Symbol for “Single-Use Devices” (SUDs) or “Do not reuse.” (ISO 7000-1051).9

“Defective endoscopes, accessories, and equipment should be removed from service and repaired or replaced (AORN, 2018e [39])7 A label should be aﬃxed to the device to identify defective equipment for repair.” (Fig. 3).

The repair process and communication between the point-of-use and reprocessing staﬀ is another area of frequent communication breakdown. Communication must be clear when it comes to a defective scope—even if there is no verbal communication between the departments.

• The ISO symbol (the number 2 encompassed in a circle with a diagonal line slashing from the top left to bottom right [Fig. 4]) means “do not reuse,” typically seen on single-use surgical instrumentation.

Visual communication is an everyday part of the healthcare environment, and clear, easy-to-understand communication (e.g., Fig. 5) is a vital component for eﬀective reprocessing. HPN

References are available online at hpnonline.com/55306340

Adam Okada has 18+ years of experience in Sterile Processing and is passionate about helping improve the quality of patient care by giving SPD professionals and their partners greater access to education and information. He has worked in just about every position in the Sterile Processing Department, including Case Cart Builder, SPD Tech I, II, and III, Lead Tech, Tracking System Analyst, Supervisor of both SPD and HLD, Manager, and now as an Educator. Adam is the owner of Sterile Education, the world’s ﬁrst mobile application dedicated to sterile processing education, and a former Clinical Manager at Beyond Clean. He has published articles for HSPA’s Process magazine, is a co-chair on AAMI WG45 as well as co-project manager for the KiiP “Last 100 Yards” group, and is the former President for the Central California Chapter of HSPA. Adam is currently a Clinical Education Specialist at Healthmark, A Getinge company, where he works on Healthmark webinars, hybrid events, and educational videos, as well as the “Ask the Educator” Podcast with Kevin Anderson.

Figure 5: Custom Vinyl Labels. (Picture source – hmark.com).10

Linking Sustainability Investments to Organizational Priorities

BY KAREN CONWAY

The past two editions of Value.Delivered have addressed ongoing initiatives to reduce the negative environmental impacts of healthcare operations and more recent efforts to mitigate the cost implications of tariffs. One might think that tariffs, which are expected to increase supply costs by 15 percent, combined with the pending rise in uninsured patients as the result of recent federal legislation, would decrease interest in sustainability initiatives. But the fact is many programs that are good for the environment, and in turn human health, can also ease financial constraints. For example, healthcare systems across the country have documented millions of dollars by switching to less carbon intensive anesthesia gasses, increasing the purchase of reprocessed medical devices, reducing food and plastic waste, and moving to alternative energy sources.

Demonstrating the return on investment (ROI) of environmental initiatives is increasingly important, according to healthcare leaders attending the ﬁrst ever American Hospital Association (AHA) Sustainability Summit in July. Still, even a positive ROI is not always enough to get approval, with speakers emphasizing the need to demonstrate additional beneﬁts, such as patient satisfaction or employee engagement.

A key takeaway from the Summit was the need for an enterprise-wide view of the costs and benefits of sustainability initiatives, which can be supported by simulation tools and the involvement of a team of crossfunctional leaders.

At the Summit, participants were introduced to the Carbon Emissions Learning Lab (CELL) , one of several simulation tools offered by the Geneva Sustainability Centre to help health systems reduce the negative impact of climate change on human health and the risks to operations as a result of climate-related natural disasters, such as wildfires and flooding.

In the CELL simulation, teams of multi-functional healthcare system leaders consider a range of actions they could take over the course of multiple years to reduce their organization’s overall carbon emissions while supporting safe, eﬀective, and resilient operations. Beyond deciding

how much they want to invest in employee sustainability training each year, the participants can only choose a total of three initiatives per year from four categories: leadership and governance, clinical practice, operations, and supply chain. As a result, they need to consider which projects are more foundational and should be implemented ﬁrst or which are necessary to mitigate downstream risks. As participants submit their decisions for a given year, the program provides them with results, not only on carbon emissions reduction but also on how their decisions impacted budgets, employee engagement, organizational reputation, and operational continuity.

Many of the Summit presenters also described the value of creating cross-functional sustainability teams to support broader thinking when making decisions. They speciﬁcally referenced leadership involvement from clinical areas, supply chain, facilities, food and nutrition, and environmental services (infection prevention) among others. The beneﬁts include:

• By viewing sustainability initiatives from diﬀerent vantage points, organizations can identify multiple beneﬁts that otherwise might be missed if only evaluated through a single functional lens.

• A systems approach can also identify where costs will be incurred and where the beneﬁts, including cost savings, will be realized.

• By securing the support of the leaders of various functional areas, it is easier to gain the involvement and ideas of front-line workers who often see opportunities for improvement before anyone else.

• When front line employees make suggestions and/or successfully implement projects, they can be commended for their involvement, securing important recognition for critical yet often unheralded employees.

Like healthcare delivery, making decisions about what actions best support sustainability is a complicated topic, with multiple aspects to consider. What works best for one hospital will vary. The key is taking a system level perspective and garnering the broad expertise needed to recognize all the implications of various sustainability initiatives. HPN

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