8 > Innovations in PPE: Advancements and What’s Next
MATT MACKENZIE
34 > Not Scanning UDI: What Are You Missing?
KAREN CONWAY
Infection Prevention
12 > Infection Prevention in the Spotlight
JANETTE WIDER
Sterile Processing
18 > Sterile Processing Compliance and Standards Update
KARA NADEAU
22 > Sterilization Quality Control: Your Path to Protecting Your Patients
CRAIG WALLACE
28 > How to Get a Job in Sterile Processing
ADAM OKADA
30 > Lint-Free or Non-Linting?
ADAM OKADA Departments
6 > On Conferences
7 > What’s on the Web, Advertiser Index
On Conferences
BY JANETTE WIDER
Over my career as a journalist, I’ve attended dozens of conferences. And sometimes, to be honest, I’m just not feeling it on the day of my flight. I’m not sure if it’s hauling myself and my luggage to the airport, the fact that I’ll miss my bed at home, that I don’t want to leave my dog, or maybe a combination of all three (let’s be serious, it’s most likely the dog) but there have been times when I’ve literally caught myself groaning as I head to the airport.
For this year’s HSPA conference in Louisville, Ky., I was really struggling. I had been traveling just two weeks before for the AORN conference in Boston and had the flu between events. Plus, my flight wasn’t until the late afternoon, so I had way too much time to get caught up in my own head about the days to come.
As the responsible Editor-in-Chief of this brand, I made it to the airport and had a glass of wine and checked emails and reviewed my schedule. I knew I’d be presenting the Sterile
Processing Department (SPD) of the Year award at the show, so I decided to buck up.
The flight to Louisville was smooth—a win. The short cab ride to our hotel came with a reminder about the upcoming Kentucky Derby and a view of the Ohio River, another win. We stayed at the Galt House, a historic hotel right on the river. My room even had a river view, a refreshing change from the usual parking lot—yet another win.
The real turning point of the trip came at the show. The educational sessions were excellent, and I finally met many passionate SP professionals, some of whom I’d only connected with virtually. Kentucky may be rubbing off on me, but y’all truly value Healthcare Purchasing News Our booth was nonstop with folks sharing ideas or just stopping to say hello. The highlight: presenting the SPD of the Year Award to UF Health Shands. My mood had completely turned around.
Before I wrap up—this issue, packed with infection prevention content, will be with us at APIC in Phoenix. I may have a few pre-flight “ugh” moments, but I’m excited to connect with many of you there. The same goes for upcoming stops like AHRMM and a couple of Healthcare Innovation’s (our sister publication) HIT Summits. If you see me, say hello and share your ideas. Not traveling? You know where to find me. Finally, Kentucky, I’m sorry I didn’t want to visit.
June 2025, Vol. 49, No. 5
VP & Market Leader
Healthcare and Dental
Chris Driscoll cdriscoll@endeavorb2b.com | 978-880-8345
Editor-in-Chief
Janette Wider jwider@hpnonline.com
Associate Editor
Matt MacKenzie mmackenzie@endeavorb2b.com
Senior Contributing Editor Kara Nadeau knadeau@hpnonline.com
Advertising Sales
East & West Coast
Kristen Hoffman khoffman@endeavorb2b.com | 603-891-9122
Midwest & Central
Brian Rosebrook brosebrook@endeavorb2b.com | 918-728-5321
Advertising & Art Production
Production Manager | Ed Bartlett
Art Director | Kelli Mylchreest
Advertising Services
Karen Runion | krunion@endeavorb2b.com
Audience Development
Laura Moulton | lmoulton@endeavorb2b.com
Endeavor Business Media, LLC
CEO Chris Ferrell
COO Patrick Rains
CRO Paul Andrews
CDO Jacquie Niemiec
CALO Tracy Kane
CMO Amanda Landsaw
EVP Medical & Healthcare Technology Kylie Hirko
EVP Endeavor Business Intelligence Paul Mattioli
Healthcare Purchasing News USPS Permit 362710, ISSN 1098-3716 print, ISSN 2771-6716 online is published 11 times annually - Jan, Feb, Mar, Apr, Jun, Jul, Aug, Sep, Oct, Nov/Dec, Nov/Dec IBG, by Endeavor Business Media, LLC. 201 N Main St 5th Floor, Fort Atkinson, WI 53538. Periodicals postage paid at Fort Atkinson, WI, and additional mailing offices. POSTMASTER: Send address changes to Healthcare Purchasing News, PO Box 3257, Northbrook, IL 600653257. SUBSCRIPTIONS: Publisher reserves the right to reject non-qualified subscriptions. Subscription prices: U.S. $160.00 per year; Canada/Mexico $193.75 per year; All other countries $276.25 per year. All subscriptions are payable in U.S. funds. Send subscription inquiries to Healthcare Purchasing News, PO Box 3257, Northbrook, IL 60065-3257. Customer service can be reached toll-free at 877-382-9187 or at HPN@omeda.com for magazine subscription assistance or questions.
Printed in the USA. Copyright 2025 Endeavor Business Media, LLC. All rights reserved. No part of this publication should be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopies, recordings, or any information storage or retrieval system without permission from the publisher. Endeavor Business Media, LLC does not assume and hereby disclaims any liability to any person or company for any loss or damage caused by errors or omissions in the material herein, regardless of whether such errors result from negligence, accident, or any other cause whatsoever. The views and opinions in the articles herein are not to be taken as official expressions of the publishers, unless so stated. The publishers do not warrant either expressly or by implication, the factual accuracy of the articles herein, nor do they so warrant any views or opinions by the authors of said articles.
View from the Galt House
Innovations in PPE: Advancements and What’s Next
BY MATT MACKENZIE
Personal protective equipment (PPE) is obviously a necessity for healthcare workers in all healthcare settings. However, despite its omnipresence, there are still a number of lingering questions surrounding how to ensure that workers and patients are protected as best as possible while remaining environmentally sustainable. On top of those concerns, it still feels like there are improvements to be made surrounding how to manufacture PPE that protects all people in ways comfortable enough not to impede the work they do.
Recently, a study was published in JAMA exploring links between PPE and COVID-19 incidence. The WHO provided certain guidance at the beginning of the COVID-19
pandemic that suggested healthcare workers wear gowns, face shields, gloves, and medical masks. However, in September of 2022, the Singapore Ministry of Health “revised PPE guidance for HCP [healthcare personnel] attending to suspected or confirmed patients with COVID19, recommending the use of N95 respirators alone. This eliminated routine use of gowns, face shields, or eye protection, and gloves for routine COVID-19 care.” These decisions were made due to the Omicron variant’s association with milder illness, population hybrid-immunity via vaccination and/or natural infection, and “local studies” that found “no significant PPE contamination by the virus.”
Isis Lamphier
The researchers analyzed staff health databases at a health center in Singapore for a 12-month period before the PPE de-escalation and a 12-month period after. Ultimately, the researchers concluded that the de-escalation “was not associated with an increase in monthly COVID-19 infections among hospital staff, with the trends aligning with population infection rates.” In addition to safety trends remining at desired levels, a total of 440,532 gowns were saved over a 12-month span, which led to an enormous reduction in carbon emissions and plastic waste. The authors of the study were led to conclude that “removing protective gowns and eye shields from routine COVID-19 care did not significantly alter transmission risks to HCP.” With further research, PPE protocols for infectious diseases can likely be adjusted to “consider the biological basis of disease transmission route(s), transmissibility, and availability of countermeasures.”1 There is enormous potential to improve both environmental sustainability and costs without skimping on safety.
All that being said, there remains a need for new and innovative PPE that gets the job done better. It’s an admittedly difficult balance to strike between environmental sustainability, efficiency, comfort, and, perhaps most importantly, safety. Innovations are constantly being made across the industry, and new conversations are always being had about where to go next to balance all these factors as best as possible.
HPN received input from several members of Cardinal Health regarding advancements in PPE, including commentary on a few specific products they have been rolling out. We also spoke with Isis Lamphier, MPH, MHA, CIC, manager of infection prevention at Moffitt Cancer Center, regarding the underdiscussed need for PPE specifically designed for women.
Innovations in PPE
Certain items like gloves and masks are very prevalent in certain healthcare settings, but there remain questions about how to manufacture and develop them with an eye toward comfort for everyone while continuing to hit the right marks safety-wise.
There are a couple of products Cardinal Health has been working on in this vein, and HPN was able to see them inperson at AORN25. The first is the Hydrogel Anti-Fog Surgical Mask. This mask appears at first to look just like the classic blue surgical mask seen in every operating room, but it contains a hydrogel strip that peels off to create a strong adhesive seal against the bridge of the wearer’s nose. It also reduces fogging for people who wear glasses.
Hydrogel Anti-Fog Surgical Mask
We spoke to Brittany Julian, director of communications, Global Medical Products and Distribution at Cardinal, and Jennifer Nichols, BSN, BA, RN, clinical manager, OR, business and clinical optimization. They specifically called out the fact that this product was being asked for by healthcare workers, especially those who participate in lengthy, complex surgeries. The adhesion hydrogel in these masks is the same that is found in Cardinal’s neonatal electrodes. The mask “forms a moisture barrier across the bridge of the nose, helping reduce skin irritation and adhesive residue upon removal.” The hydrogel also “has an absorbative capacity to better manage sweat and exhaled moisture.”2
Marc Michaud, MD, an orthopedic surgeon in New Hampshire who has used the new hydrogel mask, stated, “When I do five or six surgeries a day, which I often do, my skin tends to get pretty torn up from other surgical masks. My glasses would get fogged up during surgeries, so I’d have to get a new mask, which means that I have to scrub in again before I return to the surgery. I’ve found that it’s hard to get a good fit with surgical masks, especially because I wear glasses. I don’t have that problem with [these masks].”
Kathy Tremblay, director of research and development at Cardinal, spoke on common concerns on the mask front. She said, “Clinicians often wear facial protection for long durations which can limit functionality and lead to mask movement, poor adhesion, moisture flow, residue and skin irritation. For lengthy, complex surgeries, clinicians want and need a mask that offers enhanced comfort, a snug fit and reduced moisture build-up or fogging.
“Surgeons require a clear field of view during patient procedures, which drove our development of a design that allows healthcare professionals to maintain comfortability and a clearer view during operative care.”
Cardinal has also developed a surgical glove that contains a material called Neu-Thera on the inside. Neu-Thera is a “moisturizing coating” placed on the inside of the
“Our
customers have expressed a major desire to have more sustainable options in highuse disposables like PPE, and specifically exam gloves, because these products are used in such great volume every day across the care continuum.”
gloves, which are referred to as “Protexis PI Blue” gloves. The coating moisturizes the skin of the wearer without compromising on safety, tactility, or durability. In addition, the gloves have a distinct blue color that “aids in alerting wearers to perforations in the outer glove.” The gloves are also made with synthetic polyisoprene as opposed to natural rubber latex, which obviously aids people with latex allergies or sensitivities.3
Annie Copeland, global marketing director for Cardinal’s PPE portfolio, spoke about another glove of theirs, the FLEXAL Nitrile Biodegradable Exam Glove, that has just been launched in the U.S. She said, “Our customers have expressed a major desire to have more sustainable options in high-use disposables like PPE, and specifically exam gloves, because these products are used in such great volume every day across the care continuum. The Covid-19 pandemic heightened awareness of the volume of PPE waste ending up landfills, which made biodegradable options more appealing to healthcare providers and suppliers.
“During the manufacturing process for these gloves, an organic additive is introduced to the product, a crucial step that differentiates a biodegradable glove from a standard nitrile glove. The organic additive and subsequent biodegradable process allows the glove to break down nearly 40% through the first year and nearly 75% through the second year in a landfill, while traditional gloves can take decades to biodegrade. The product also meets the same standards as traditional nitrile gloves, offering the same storage conditions and a three-year shelf life.
“In addition to the biodegradable nature of the product, the corrugate and dispenser cartons for the gloves are recyclable and certified by the Forest Stewardship Council, the leader in sustainable forestry. Each carton of gloves is packed in alternating layers to dispense a single glove at a time, which helps reduce the number of wasted gloves compared to traditional packing methods.”
Speaking on PPE in general, Larissa Torkelson, RN, MSN, senior global medical
—ANNIE COPELAND
advisor for Cardinal Health PPE, said, “Healthcare professionals work tirelessly to provide exceptional care to patients, and they do not pause to consider if their PPE will adequately protect them when moving quickly to immediately treat a patient. Clinicians expect to have effective PPE, and we appreciate the confidence they have in us to design and provide reliable solutions. It’s our responsibility to continue evolving and innovating a portfolio customers can trust.”
Women’s PPE
Isis Lamphier commented on the need for women’s PPE and increased awareness for PPE fitting different body types in general.
Lamphier said that women’s PPE “entails all specialized clothing and equipment to protect a woman’s body from harm, injury, and infection.” However, most PPE tends to be unisex. Lamphier explained that this is because PPE was “tested primarily on men in the 1990s. When it was designed, males were also predominately making up the workforce which is no longer the case.”
She also stated that PPE not fitting correctly can lead to harm: “Healthcare workers can have injuries or be exposed to blood and bodily fluid if PPE is not secure. Depending on the healthcare worker’s role, they may be wearing PPE for hours, so it is important it fits correctly.” The risk of injury impacts both productivity and, most importantly, safety. She says that the problem is not being addressed appropriately by and large. “PPE is primarily unisex. It is easier to only have small, medium, large, extra large, etc. in our society because these items are mass-produced and used by millions every day,” she stated. “This makes PPE available at a lower cost too.”
Generally, she identifies a need to have more PPE specifically designed for a woman’s body, “especially masks.” She also said it would be “more appropriate if the organization has more size options and availability for employees” in general for other types of PPE. HPN
REFERENCES:
1.Sutjipto S, Aung AH, Soon MML, et al. Plastic waste and COVID-19 incidence among hospital staff after deescalation in PPE use. JAMA Netw Open. https://jamanetwork.com/journals/ jamanetworkopen/fullarticle/2832735
2.Cardinal Health. “Protecting healthcare providers and patients across care settings.” https://newsroom.cardinalhealth.com/Protecting-healthcare-providers-and-patients-acrosscare-settings
Further, Kley added, “The COVID-19 pandemic resulted in an influx of new IPs. We need to double-down on efforts to provide education for these novice IPs.”
Benjamin D. Galvan, MPH, MLS (ASCP), CIC, CPH, is a board-certified Director of Infection Prevention with HCA Florida Brandon Hospital, a part of HCA Florida Healthcare’s West Florida Division. Galvan told HPN, “Infection preventionists have really been focused the last few years on getting ‘back-to-basics’ especially after the COVID-19 pandemic caused a mass exodus of experienced healthcare workers. As the healthcare workforce has begun to re-stabilize, at top of mind is moving on from a ‘back-to-basics’ mindset to developing our current caregivers into seasoned clinicians that can critically weave in basic infection prevention practices into all patient care.”
Resources in today’s climate
Peter Graves, BSN, RN, CNOR, Infection Prevention Consultants, and Maureen Spencer, M. Ed., BSN, RN, CIC, FAPIC, Infection Prevention Consultants, were interviewed together, live on site in Boston at AORN2025.
When asked where to best find resources in today’s political and ever-changing environment, Graves said, “My bias, of course, comes from being a perioperative nurse, so I always go back to what I call the “source of truth,” which, for me, is AORN’s guidelines. AORN has over 15 different guidelines focused on infection prevention—not just in the OR, but also for sterile processing, pre-op, and post-op areas. If you’re looking for evidence-based recommendations and best practices, AORN is where to go.”
Spencer largely agreed. She said, “I recommend that IPs join AORN so they can access the e-guidelines. Even if they’re not nurses—and might not feel they can join—I believe there’s a membership category for non-nurses. At the very least, ask your OR director, who is likely to have access, to get you the infection control-related guidelines. They’re evidence-based, so you’ll get the latest research and supporting articles.”
Further, she added, “I subscribe to journals like JAMA, New England Journal of Medicine, Surgical Infections, APIC, AJIC, and more—they send me updates daily. When I find something that’s really important for IPs, I share it on LinkedIn since they’re often too busy to stay on top of it all. As consultants, we have the flexibility to help in that way.”
“You can also go to the CDC’s website for updates,” Spencer noted. “We don’t rely on WHO as much—mostly CDC, American College of Surgeons, and sometimes other associations depending on the topic. For instance, I’m currently researching disinfection recommendations for percutaneous ultrasound probes. For that, I’m reviewing guidance from various specialty groups like SGNA for endoscopy. And with AI tools like ChatGPT, you can
just ask about an issue and get references instantly. That’s huge.”
Clorox’s Kley added two cents as well. Her go-to resources are:
• CDC’s evidence-based guidelines.
• Guidance and best practices from professional organizations such as:
• Association for Professionals in Infection Control & Epidemiology (APIC)
• Society for Healthcare Epidemiology of America (SHEA)
• Association for Perioperative Registered Nurses (AORN)
• Association for the Healthcare Environment (AHE)
She added, “I encourage IPs to attend and network at their local APIC chapter meetings as well as the national conference held every June. In fact, I will be co-presenting with Dr. Mariana Torres from BlueDot (a company that uses artificial intelligence to conduct global infection surveillance) at this year’s APIC conference on highpriority pathogens.”
Further, “Trusted vendors who are experts in their respective fields,” Kley said. “IPs don’t have to reinvent the wheel. Many vendors provide valuable resources, including educational content and protocols at no extra cost.”
HCA’s Galvan largely agreed. He said, “What initially comes to mind is APIC, our professional organization that has a ton of resources available from the APIC text, educational webinars, conferences, and many more downloadable resources. Beyond that, we have local APIC chapters that can provide a network of other local infection preventionists and public health leaders that serve as resources as well. Of course, the CDC provides many guidelines and other resources that are essential for IPs in their day-today work. IPs may also look to other professional organizations like SHEA, IDSA, AORN, and so on thathave a multitude of guidelines or best practice documents related to particular areas of practice.”
Post-COVID landscape for IP
When asked about the landscape for IP post-COVID, Clorox’s Kley noted, “In addition to managing staffing shortages and burnout in remaining staff, there is a need for the newer IPs who came onboard during the pandemic to get back to basics. While our attention was on COVID, infection prevention and control (IPC) practices may have drifted, resulting in regulatory compliance issues and HAI increases.”
Galvan commented on the role of infection prevention in hospitals. He said, “I believe the biggest change, at least in my career, has been a greater acceptance and collaboration with infection prevention. I think the COVID pandemic highlighted the critical importance of infection preventionists as clinical collaborators that bring an
evidence-based, common-sense perspective to all types of complex situations in healthcare.”
OR and IP Collaboration
Graves said, “Many IPs don’t come from a clinical background. It’s critical that they partner with OR clinicians to understand how to integrate guidelines into actual practice.”
Spencer, agreeing, continued, “Data drives your program. Take, for example, the NHSN study on antimicrobial resistance a few years ago. It analyzed HAIs over a span of years, and for the first time, SSIs became the most common, accounting for 40%—up from the low 30s previously. It’s easier to manage CLABSIs, CAUTIs, and VAPs because they’re often in the ICU and protocols can be applied consistently. But SSIs require a full team approach. IPs can’t do it alone. The OR director can’t do it alone.”
“It involves the entire continuum: pre-op holding, intraop, post-op in PACU, the nursing unit, and even home care,” she added. “That’s a challenge, especially for IPs who don’t have a strong relationship with the OR. When we lecture to OR directors, we suggest they give IPs—especially those from public health backgrounds—the same orientation they give to new OR nurses.”
Spencer also explained that AORN has videos of procedures, toolkits, checklists, and PowerPoint presentations, and that if IPs are AORN members, they have access to all of this important material to help them.
Graves jumped back in and added, “From our recent lectures and events, what’s clear is that there’s a real hunger for knowledge. You have to leave the office, put on scrubs, and go into the OR. Observe. Work with your team. That’s how we model best practices and collaborate to reduce infections. Whether you’re in a critical access hospital or a large teaching facility, collaboration between IPs and surgical staff is key. Reducing SSIs—making them a ‘never event,’ as Maureen often says—has to be the goal. Don’t accept even one infection. When one occurs, go straight to the root cause.”
“Every facility has internal resources and external ones through professional organizations. Use them—not just for patient safety, but to improve your facility overall,” Spencer chimed in.
Graves, commenting on the show, said, “At AORN this year, what really stood out was the attention on infection prevention in the OR. The average OR nurse spends 70–80% of their day focused on this. A lot of the products here may not be labeled directly as ‘infection prevention,’
but they are—surgical drapes, UV systems, hand hygiene tools, gowns. It’s a common theme.”
Technology advancements
When it comes to new technology, Clorox’s Kley has a warning: “Technology isn’t always the best solution. I prefer to start by analyzing the existing process and making necessary improvements before implementing technology as the solution. It’s also important for IPs to scrutinize the evidence. Is the potential technology proven to reduce pathogen transmission or to reduce HAIs outside of a simulated testing environment? We also must be cognizant of ‘shiny new object syndrome.’ The last thing we want is expensive technology to be left unused, sitting in a closet somewhere. Especially given that healthcare facilities are still rebounding financially from the pandemic. Operating margins, while improving, remain below pre-pandemic levels. Sometimes, simple is best. For example, ready-to-use cleaning and disinfecting products. My motto is, ‘make the right thing to do the easy thing to do.’”
Yet, she sees promise for technology, nonetheless. She said, “In terms of innovation, whole genome sequencing (WGS) - which has only come about in the past few years - holds great promise for busy IPs. WGS helps us to better understand how microorganisms move through a facility. WGS can be used to detect and investigate outbreaks, including those which previously may have gone undetected. Reflecting on my time as a frontline infection preventionist, I can only imagine how many outbreaks went unnoticed. Looking ahead, I anticipate that the use of WGS will become more prevalent at the individual facility level.
“Finally, on my watch list is artificial intelligence (AI), as it may have potential to assist IPs with various tasks including infection surveillance. It may even help to identify patients at risk for infection so that the healthcare team can proactively intervene.”
HCA’s Galvan commented on technology as well. He said, “I believe many hospitals are starting to investigate the application of artificial intelligence, which is very exciting to me. A lot of infection preventionists often get ‘stuck’ at their desks conducting necessary computer work like surveillance, data management, presentation building, and so on that could potentially be accomplished down the road with AI. I can’t wait to see what advancements are coming down the line as less time at the computer means more time interacting with our fellow caregivers and patients.”
At AORN2025, Graves noted, “AI isn’t fully integrated yet, but it’s coming. Some really interesting technologies
“Hospitals o en think their problems are unique, but most of us are dealing with the same issues. Go back to the data. Go back to the evidence.” —PETER GRAVES
are being introduced—like automated instrument tray assembly. If trays are complete, OR nurses don’t have to leave the room to grab missing tools, which helps keep the door closed and preserve air quality. That real-time data is essential. If you can’t measure it, you can’t manage it. There are also AI and UV technologies. But one area we need to focus more on is door discipline in the OR. Laminar airflow is outdated. Newer options, like temperature-controlled airflow, use physics to push contaminated air down and out. With traditional laminar flow, any disruption— lights, bodies, warm air—can cause turbulence that compromises the sterile field.”
Spencer added, “We’ve done full-day workshops on this at APIC. Not every OR will use the same tech. But if you’re rebuilding or renovating OR suites, consider newer systems like those from Avidicare in Sweden. There are also portable systems that combine UV disinfection with HEPA filtration—great for areas like PACUs, emergency rooms, or nurses’ stations. Some facilities use dry hydrogen peroxide, which is non-toxic and effective for air disinfection. AORN now recommends forming air quality management teams, just like we do for water. They also advise that any SSI investigation include an assessment of OR air quality. That’s where the field is headed.”
“And remember, you don’t need to reinvent the wheel,” Graves commented. “Hospitals often think their problems are unique, but most of us are dealing with the same issues. Go back to the data. Go back to the evidence.”
Spencer agreed, and explained, “Peter and I lecture on a bundled, foundational approach to SSI reduction. Start with a safe OR environment. We conduct surveys looking at the whole picture—pre-op, intra-op, and post-op— using AORN guidelines.
“Second, prepare patients properly: pre-op showers (with clear instructions), screening and decolonizing MRSA carriers, addressing risk factors like smoking and weight.
“Then, in surgery: use alcohol-based skin preps. Stop using antibiotics in irrigation—they don’t work. Use antiseptics instead.
“Close wounds with antimicrobial sutures, seal incisions properly, and consider antimicrobial dressings for those allergic to adhesives.
Sterile Processing Compliance and Standards Update
BY KARA NADEAU
There are several new, updated, and emerging standards and guidance docu ments that impact sterile processing (SP) professionals, some of which were discussed during the Association for the Advancement of Medical Instrumentation (AAMI) March 2025 Spring Sterilization Standards Week and April 2025 Healthcare Sterile Processing Association (HSPA) Conference.
As quickly as governance evolves in the handling, cleaning, sterilization, and transport of surgical instruments and medical devices – inside
and outside of the sterile processing department (SPD) – it can be challenging to keep up with the changes.
HPN provides an overview of some of the most impactful standards and guidance shifts, featuring expert commentary from individuals involved in shaping these documents. We also call out a common but controversial topic – how to address standards deviations.
Updates from AAMI
AAMI VP of Sterilization, Amanda Benedict, MA, SES-CSP, SES Fellow and HSPA VP of Strategic Initiatives
Damien Berg, BA, BS, CRCST, AAMIF, offered the following standards and guidance updates.
ANSI/AAMI ST58:2024
Published in April 2024, ANSI/AAMI ST58:2024, Chemical sterilization and high-level disinfection in health care facilities “provides guidelines for the selection and use of liquid chemical sterilants (LCS)/high-level disinfectants (HLD) and gaseous chemical sterilizers that have been cleared for marketing by the U.S. Food and Drug Administration (FDA) for use in hospitals and other health care facilities.”1
“ST58:2024 is a complete revision and reorganization of the previous edition of the standard, which was published in 2013,” Benedict explained. “It presents processes for different chemical sterilization and HLD modalities — essentially anything other than steam sterilization. This includes ethylene oxide (EtO) sterilization, which was previously a standalone document (AAMI/ ANSI ST41).”
“While fewer facilities are now using EtO sterilization, ANSI/AAMI ST58:2024 will serve as an all-inone resource for HLD and sterilization modalities outside of steam sterilization,” said Berg. “Based on the criticality and clinical use of the device (Spaulding classification), those responsible for HLD or sterilization can use the document to find the appropriate modality.”
AAMI TIR99:2024
Also published last year, AAMI TIR99:2024, Processing of dilators, transesophageal and ultrasound probes in health care facilities “provides guidance for the proper processing of dilators and ultrasound probes in health care facilities to assist in making them safe and effective for use in patient care.” It includes “information on selection and use of cleaning,
The new document, which combines information from the three documents that previously formed the ISO 17665 series, includes an annex that is focused on healthcare facility applications.
Under development:
• ISO 25224, Sterilization of health care products — Sampling and culturing for reusable thermolabile flexible endoscopes.
• ISO/AWI TS 20327, Packaging for terminally sterilized devices — Receiving, handling, transporting, distributing and storing of packaged sterile medical devices under the control of health care facilities.
Commenting on ISO 25224, Benedict stated: “This is one that I’m really excited about. Different countries around the world have different ways of doing sampling and culturing. The intent of this document is to help provide more information and guidance on effective ways to do sampling and culturing for these types of flexible endoscopes.”
The hot topic of transportation
There has been a great deal of work across the board on new standards related to the transportation of sterile items. Berg noted how in addition to ISO/AWI TS 20327, which is under development, both AAMI and the Association of periOperative Registered Nurses (AORN) recently published their own guidance on the topic.
topic, it is very limited. This document provides guidance on transport from hospital to hospital and from hospitals to clinics and other nonacute facilities, whether it is a small ‘doc in a box,’ wound care clinic, or other care delivery location.”
According to Berg, AAMI TIR109:2025 considered global guidance and standards, which will also inform the development of ISO/AWI TS 20327. “Instead of reinventing the wheel, we are looking at other countries that have been doing this for years,” he stated. Berg added how HSPA plans to align its guidance with both the AAMI and ISO guidance documents.
UV
disinfection of medical devices
Under development is brand new guidance on UV disinfection of medical devices in the SPD, AAMI TIR118, which was proposed by Berg who is leading one of the task force groups on the topic.
Damien Berg
“UV disinfection in healthcare facilities has been around for a long time but it’s not typically used in the SPD or for medical devices,” noted Berg. “It has been used primarily in cancer clinics or immunocompromised areas for disinfection of items such as clinicians’ cell phones, tablets, or stethoscopes that could harbor dangerous microbes.”
professionals on UV disinfection, including material compatibility and safety factors,” he explained. “Essentially what we are saying is, ‘if you’re going to use UV disinfection, these are all the factors you need to take into consideration.’ It’s really a first step in educating the U.S. market on expanding UV disinfection beyond environmental services (EVS) and into the SPD.”
The overarching importance of quality management
While standards documents like ANSI/AAMI ST79 tend to steal the spotlight in SPD, Hannah Schroeder, BSHA, CRCST, CHL, CIS, CER, Clinical Education Specialist, Pure Processing, explained to HPN how she is doing a “deep dive” into ANSI/ AAMI ST90:2017; Processing of health care products - Quality management systems for processing in health care facilities. She stated:
“We hear a lot about ST79 and ST91 and see them referenced pretty much daily. We know we need to achieve those standards but how do we get there? That’s the kind of question ST90 answers for us. While it doesn’t necessarily tell us every aspect of quality assurance that’s needed, it’s absolutely a guide and a skeleton framework of exactly what you need to build a strong quality assurance program in your healthcare facility. Now that we have standards around water quality in ST108, ST90 can serve as a compass.”
One of the newest guidance documents, AAMI TIR109:2025, External transport of reusable medical devices for processing, was published in March 2025. Berg commented on the importance of this guidance, stating:
“The need arose from the fact that U.S. healthcare organizations are frequently transporting sterile items from one facility to another, and while ST79 has some information on this
“It wasn’t until the COVID-19 pandemic that UV disinfection boxes were introduced to the SPD for personal protective equipment (PPE) disinfection in response to shortages of these items at the time,” Berg continued. “Since then, SPDs around the world have been using UV disinfection for medical devices, but the U.S. has been a bit behind on this type of usage.”
“The goal of the document under development is to educate SP
ST90 specifies minimum requirements for quality management systems (QMS) to effectively, efficiently, and consistently process (transport, clean, decontaminate, disinfect, inspect, package, sterilize, and store) medical devices to prevent adverse patient events and nonmanufacturerrelated device failures.4
According to Schroeder, ST90 is helpful to SPD professionals in understanding the quality assurance
Sterilization Quality Control: Your Path to Protecting Your Patients
BY CRAIG WALLACE
Protecting the patient is the objective of all infection prevention programs. Safe and effective processing of medical devices that have been used in surgery and patient care is a critical element of every healthcare infection prevention program. The sterilization processes used in healthcare are designed to kill all microorganisms on the medical devices, rendering them sterile. The problem, of course, is that you can’t see sterility. You can’t just look at the instruments after processing and decide if they are sterile and safe for use on a patient. You need a quality testing system designed to provide you with the information you
Learning Objectives
1.Discuss the key elements of sterilization quality control.
2. Review the information provided by sterilization monitoring tests.
3. Examine the current best practice recommendations for sterilization monitoring.
Sponsored by:
need to decide if the instruments are safe for patient use.
Introduction to quality control
Quality control in manufacturing is a process that relies on a test or combination of tests to ensure that a product meets its required performance or quality standard. Sterilization quality control is a set of procedures and tests intended to ensure that the sterilized devices have been properly processed and are then safe for patient use. The quality control plan should address all stages of the process, from the time soiled instruments are received for cleaning and decontamination until they are sterilized and ready for patient use. The quality tests used through the process may include visual or functional inspections, or specific tests on the device or process to demonstrate that the latest step in the process was completed correctly. For this article we will focus on quality control testing during the last step in the process: the complex and critical sterilization step. Sterilization quality control processes will generally be based on frequent testing of the sterilizer with different types of monitoring devices that are designed to provide information on different aspects of each sterilization process. These monitoring products are typically placed in different locations within the loaded sterilizer (load control) or inside the packs (pack control) to provide a complete view of
the process. The information provided by these monitors is reviewed and the final decision about the quality of the cycle (and hence safety of the instruments) is made based on the results of all the tests. This fundamental QC approach is applied to both of the primary sterilization processes used in healthcare today – steam sterilization and vaporized hydrogen peroxide sterilization (VH2O2).
Sterilization quality control testing
Variations in a sterilization process could significantly impact the effectiveness of that process. Each type of sterilization process has critical process variables, or process variables that must be within their validated range or they can have a negative impact on the effectiveness of the process. For steam sterilization the critical process variables are exposure time, temperature, and the presence of saturated steam. For VH2O2 sterilization, the critical process variables are exposure time, temperature, and the concentration of hydrogen peroxide. Sterilization quality control testing uses tests that are sensitive to these critical process variables. The best practice is to monitor the process with different types of tests and include the results of each of the tests in the final load release decision. The three types of tests typically used in sterilization quality control are physical tests, chemical indicator tests, and biological indicator tests.
demonstrate that the item has been exposed to the process by a change in indicator color.
Bowie-Dick tests provide important information on the function of the vacuum system on steam sterilizers that use dynamic air removal processes. These tests are done in an empty chamber to assess the worstcase conditions (maximum amount of air to be removed). Bowie-Dick tests are specific to steam sterilizers.
Chemical indicator types 3, 4, 5, and 6 are designed to be placed inside each package or container to provide information on the sterilization conditions at the location of the surgical instruments themselves. Internal or pack indicators provide a cost-effective way to obtain information on the status of each package and are particularly useful in finding errors in packaging or sterilizer loading. The amount of information provided by the indicator will depend on the type of indicator selected.
Finally, for steam loads that don’t contain an implant (more on this below), Type 5 or Type 6 chemical indicators can be placed inside a process challenge device (PCD) and used as part of a load release decision.
Biological indicators
Biological indicators (BIs) are defined as a “test system containing viable microorganisms providing a defined resistance to a specified sterilization process.”1 BIs contain a large number of bacterial spores that are highly resistant to the sterilization process. After exposure to the process, the BI is incubated to determine if the spores produce any biological activity, which would indicate a sterilization process failure. Technological advancements have reduced BI readout times (incubation time required to determine that the BI is negative) from days to minutes or seconds.
BIs are generally contained inside PCDs, which are placed in the chamber
External (process) Cl On the outside of every package On the outside of every package
Internal (pack) ClInside every packageInside every package
PCD (load challenge)
PCD with BI and Type 5 Cl: In every load.
with the instrument load and are designed to challenge the sterilization process and directly demonstrate that the sterilization process was effective in killing microorganisms. BI will be able to detect problems with steam quality or VH2O2 concentration that are not detected by the other indicators, as poor sterilant quality will reduce the cycle lethality and result in a positive BI.
Process challenge devices
Process challenge devices (PCD) are defined as an “item providing a defined resistance to a cleaning, disinfection, or sterilization process and used to assess performance of the process.”2 PCD contain a barrier system and a biological or chemical indicator (or both) that provide information about the quality of the sterilization process. The PCD barrier system restricts the access of the sterilization process to the indicator during routine processing. It is intended to mimic the effect of placement of the indicator inside one of the sterilization load’s packages or medical devices, where the load and packaging would also restrict access
Optional use: PCD with Bi, BI/Type 5 Cl, BI Type 6 Cl
of the sterilization process to the indicator. The PCD is easily retrieved from the sterilizer after the cycle is completed, and the indicator can be removed and evaluated without compromising any of the load contents.
Quality control testing plans
The key U.S. recommended practice standards for VH2O2 and steam sterilization are AAMI ST583 and AAMI ST79,4 respectively. These standards recommend using all three monitors (physical, chemical, biological) and combining the information they provide to decide if the instruments and packages were processed correctly and are safe for patient use. Table 2 reviews the recommended testing plan for load release for VH2O2 sterilization:
Table 3 reviews the recommended testing plan for load release for steam sterilization:
Current quality testing recommendations for VH2O2 and steam sterilization are quite similar. Both standards recommend a quality control plan that uses a combination of physical, chemical, and biological
Tips to Elevate Staff Education and Engagement
BY DEBRA SAMS
Learning new information, processes, and skills can be daunting for employees, and educators behind the lessons can find the experience challenging as well. Increasing the odds of success from both sides lies in providing education that is engaging, inspiring, unique in its approach, and fun.
Although many Sterile Processing (SP) educators and managers tap creative learning approaches during certain times of the year, such as Sterile Processing Week each October, they could benefit their teams far more by applying some of that creativity yearlong. To deliver more engaging educational inservices or formal training sessions, I encourage educators to pick a topic or theme that clearly sets expectations with employees about what they will learn. Last year, we had a “Summer of Soft Skills” at my facility, where we focused on soft skills development, the power of a positive attitude, and encouraged all employees to be their best. We had experienced industry speakers teach about various related topics that inspired our employees and encouraged them to keep sharpening their knowledge and skill sets, personally and professionally.
I believe that SP educators and leaders should always pay close attention to their hardworking teams to ensure their staff members are recognized for going above and beyond with their contributions and receive the support needed during challenging
times or where additional targeted training would help them develop confidence and proficiency with a new process. Educators should think about how they can acknowledge the SP team across all shifts and provide educational opportunities that promote teamwork and encourage fullscale participation. Interactive games tailored to the SP work environment and specific areas or processes, for example, can be quite effective. In my facility, we use an online learning platform (called Kahoot!) that has helped make learning more engaging and memorable. It not only lets educators generate multiple-choice quizzes related to our discipline, but educational games can be accessed through a web browser or app and played in groups or individually. The games can be played in conference rooms or break areas, allowing employees to learn and team build in a relaxed setting outside hectic work areas.
Crossword puzzles can also be beneficial, helping employees learn and recall instrument or equipment names, specialty surgery types, and current standards and guidelines, for example. Each of these games can assist with memory recall and concentration while also introducing or reinforcing new concepts that can be discussed in greater detail during more traditional educational sessions. Educators can also help run in-department contests where employees demonstrate how to wrap the most challenging items. It is an
entertaining yet educational way to assess neatness, accuracy, consistency, and efficiency with a practice they perform regularly within the department. Personally, I have discovered that friendly competition can boost employee confidence and technical acumen, especially when
The importance of quality, engaging education can never be overestimated.
the contest ensures every employee is given the same challenge and adequate space to perform the task.
Perhaps the best way to teach and inspire employees is to remain committed to new ways of knowledgebuilding and educational support. No single teaching approach will work best for all employees, so trying new methods (and adjusting as needed) will help ensure all staff members feel inspired and eager to engage in the training. Given the extensive amount of information that SP technicians must know and apply to be effective in their roles each day—and how rapidly that knowledge must evolve to keep up with advancements in technology, specialties, standards, and more—the importance of quality, engaging education can never be overestimated. The more memorable and engaging the training is, the more likely the information will be retained and applied effectively. HPN
ƔƏ" ! " ( !+ !"
! (&
!+&! +
;moubm u ;uv7u -ѴѴ o u _;-|Ŋv;mvb|b ;-m7v|;-l v|;ubѴb -0Ѵ;7; b1;v-||_; v-l;|bl;ŋbm-0o |ƒƏ lbm |;v
-||;ub;v
-l;u-v
ubѴѴv
Ѵ; b0Ѵ;vbm]Ѵ; 1_-mm;Ѵv1or;v
ou1;rv
b]_|1ou7v
u|_or;7b1v;|v !;|u-1|ouv
!b]b7v1or;v
!o0o|b1-ulv
!om]; uv "1bvvouv
$uo1-uv
)ROORZ\RXUGHYLFH,)8V
b1h;u| um-uo m7-m7v|-m7-u7b ;7
7u bm]1u;-|;v0;||;u ouh=Ѵo -u];1-r-1b| v rrou|vor|bl-Ѵbm ;m|ou
l-m-];l;m|
u bm]-ѴѴv u]b1-Ѵ7; b1;v0;=ou; v|;ubѴb -|boml;;|vş! v|-m7-u7v
How to Get a Job in Sterile Processing
BY ADAM OKADA
Q: “I was looking online for information on how to become a sterile processing technician, and I came across your articles in Healthcare Purchasing News (HPN). How do I get a job in sterile processing?”
A: A quick Google search of “sterile processing” terminology reveals that “how to get a job in sterile processing” is one of the most searched phrases relating to our industry. This is for a few reasons. Entry level jobs in the healthcare industry are difficult to come by, and sterile processing (SP) is one of the better paying and most rewarding jobs on that short list. It’s also a very complicated and difficult job to perform and I could certainly argue the point that sterile processing is no longer an entry-level position, but I will step down from my soapbox to answer the actual question that was posed.
My goal with this article will be to give you an idea of the realities of a career in SP without terrifying you so much that you won’t want to explore it as an option. A very fine line to walk here. Getting started or getting a job in SP can be a daunting task because employers have very different standards for employment. First, let’s answer a few basic questions on the profession.
What is sterile processing?
Put simply, sterile processing professionals (SPP) are responsible for processing medical devices for use on patients. This incorporates such
tasks as a) cleaning, b) testing, c) inspecting, d) packaging, and e) disinfecting and/or sterilization of reusable medical devices. These devices can include simpler surgical instruments (e.g., retractors, clamps, forceps, scissors, and needle drivers)
reprocessing devices?” is vastly more valuable information.
Sterile processing is a fast-paced field, so don’t expect an easy gig with a lot of sitting around. Sterile processing departments (SPD) are often in constant motion and priorities change
One-Way Workflow
and increase in complexity up to modern sophisticated devices (e.g., flexible endoscopes and robotic instrumentation).
Now, I don’t intend to scare anyone away from a career in SP, but modern-day sterile processing requires competence in several areas of science and study such as a) anatomy, b) microbiology, c) medical terminology, and d) infection prevention. Teaching the skills needed for reprocessing devices is only part of the story, as SPPs also need to have a vast understanding of the “why” behind each of the tasks they’re performing. For example, “What is one-way workflow?” (Fig. 1) is a great question to know the answer to; however, “Why is one-way workflow important when
minute-to-minute. The job requires a large amount of knowledge, patience, and attention to detail. If this sounds like you, read on!
Who should look for a career in sterile processing?
My first piece of advice here is that you should not go into a career in SP thinking you’ll have an easy road ahead. Sterile processing is physically demanding, requiring the ability to lift 25 lb trays constantly, loading sterilizer racks that can weigh over 200 lb, and then pushing 500 lb carts all over the facility to put trays away during the sterile storage process. You will be physically exhausted at the end of your shift, and especially at the end of the work week.
There are thousands of different surgical instruments and devices in the SPD (each with instructions for use from their respective manufacturers) for the SPP to process.
These instructions can include information on a) point-of-use treatment, b) manual cleaning, c) ultrasonic steps, d) automated washer instructions, e) disinfection, and so on. Each device also needs to be inspected, which can include a) visual inspection, b) quality testing, c) cleaning verification testing, et cetera. Suffice to say, sterile processing is a mentally taxing job that requires tremendous vigilance.
And if the physical and mental parts of the job weren’t enough, we are also in an emotionally challenging profession because sterile processing is a critical part of patient care. If there is a mistake or problem with patient care that impacts that patient’s health, there is a definite emotional toll that it takes on you. The job is important, so the errors and delays attributed to SPD can feel intense. I’ve seen many SPPs leave the department in tears over patient care situations–the stakes do feel higher than in your average working situation.
It’s this combination of physical, mental, and emotional challenges that make sterile processing such a unique profession . . . and it’s not for everyone. The best piece of advice I could give on whether you should explore a career in SP is that you need to be prepared for the physical, mental, and emotional toll that it will take on you, but, if you’re up for the challenge, it’s one of the most rewarding jobs out there. Also, you shouldn’t be squeamish at the sight of blood.
How to get a job in sterile processing
Have I scared you away yet? If you haven’t run away anxious, overwhelmed, and screaming, let’s
Healthcare Sterile Processing Association (HSPA)
Registered Central Service Technician (CRCST)
Certification Board for Sterile Processing and Distribution (CBSPD) Certified Sterile Processing and Distribution Technician (CSPDT)
start looking for our first job in the profession.
My first piece of advice is to get yourself certified in sterile processing. There are two certification bodies (Fig. 2) recognized by hospitals in the United States.
These certifications are one of the most important prerequisites that SPD employers look for. Some employers will reject your application immediately if you do not have one of them. (Note: There are some requirements
give you a huge advantage in the examination process.
• Instructors can tell you a) what sections of the book hold more weight, b) how questions may be worded (pro tip: not always straightforward), c) what definitions are most important, and more.
• A preparation course (e.g., Fig. 3) gives you focus, and good courses really reinforce the “why” behind everything that you will need to know.
that must be met for each certification body. Go to their website to learn more.)
The most recent study I looked at showed that almost half of test takers fail the basic CRCST (HSPA)2 or CSPDT (CBSPD)3 exam on their first try. Most of these first timers failed because they made the mistake of trying to study on their own. This is where certification preparation courses come in handy.
Certification preparation courses are a great way to introduce yourself to the concepts of SP and help prepare you for your certification exam.
• Taking a preparation course with certified and experienced SPPs can
Once certified (or well on your way to becoming certified), you’ll need to start applying for jobs in the field. Some nuggets of advice for that process.
• Review your resume – As a former hiring manager myself, you’d be surprised at how many resumes had typos or errors in them. If you can’t spell your name consistently throughout a resume, it gives me pause as to whether you have the attention to detail needed for a job in sterile processing.
• Call or email the department leadership – I used to advise job seekers to actually go in-person to hand in their resume and application;
Figure 2: Basic SPD Certifications from HSPA and CBSPD.2,3
Figure 3: CRCST Certification Preparation Course – Healthmark Academy (academy.hmark.com).4
however, since COVID, the restrictions around hospitals have changed dramatically and this is likely no longer an option. You can still take the initiative to make an introduction to the department leader in other ways. I used to call the hospital main line, ask for the sterile processing manager, and then get transferred directly to the person responsible for hiring. Tell them your name and ask them to look for your application. Trust me, this works!
• Make connections in the industry – There are a number of ways to make connections in the industry in the digital age. There is likely a local HSPA chapter in your area. Reach out to them and learn how to get involved. Most local chapters are made up of hiring managers, so they’re a great place to start for those who are new to the industry. Also, join LinkedIn and start making connections there. You can start by looking up yours truly!
• Utilize a cover letter – It’s a simple letter (about 3 paragraphs in length), and it will detail your pursuit of a career in SP at the particular facility you’re applying to. So many resumes are bland, generic, and make it seem like the applicant is looking for any job in any field. A cover letter makes it clear to the hiring manager that you have an intended focus on a career in sterile processing and want to work at their facility. This is an easy and free way to make your application stand out from the crowd!
If you’ve read this far and you’re not scared of a challenge, then you’re exactly the type of detail-oriented and diligent worker ideally suited to a career in the fast-paced and everchanging field of sterile processing! I wish you the best of luck on your sterile processing journey! HPN
Article conclusion and references can be found at hpnonline.com
Lint-Free or Non-Linting?
BY ADAM OKADA
Q: “I have an IFU that requires a lint-free cloth, but I am having a hard time finding a cloth that is sold as lintfree. Why can’t I find one?”
A: I receive this question via email a few times every year, and I never feel like I have enough space to fully explain the situation in an email response. So, let’s see if we can untangle our way through a potentially hairy situation and try to weave a narrative, tying in some scientific studies, and rolling in some clarification on lint terminology. ( Author sincerely
apologizes for these terrible attempts at lint humor.)
First, let’s talk about lint itself. Merriam-Webster1 defines it as: •“a soft fleecy material made from linen usually by scraping.”
•“fuzz consisting especially of fine ravelings and short fibers of yarn and fabric.”
In the healthcare space and, specifically, in sterile processing, our lint is typically made of fine fibers that separate from items like wraps, towels, and other textiles. Like their partner in grime (dust), lint is usually very lightweight, and it can be
Figure 1: “Inside a lumened device.”COURTESY CHERON ROJO, HEALTHMARK, A GETINGE COMPANY.2
and some microscopic fibers from that towel make their way onto your clean device and into your tray. You may be tempted to believe sterilization will kill any harmful microorganisms, so there’s no harm in some lint in your tray; right? Wrong! Even if the lint has been sterilized inside a sterile barrier, if it’s allowed to escape via instrument or airflow into a patient’s incision, it can have devastating impact.
In our above example, if our sterilized lint enters a patient’s bloodstream, the body will treat it as a foreign body, and it triggers the vascular defense system. Clotting begins to “wall off” the foreign invader and forms a sort of “net” inside the blood vessel to hold it and keep it from traveling farther into the bloodstream. This clotting continues to grow and trap more blood cells or foreign material, which then forces blood flow and pressure to increase from behind to get around it. If the force is significant enough, it can tear the clot from the vessel and into the bloodstream. This clot becomes what is called a foreign body embolus.
Blockages of blood vessels, or embolisms, can occur, and organs behind the embolism can become oxygen deprived, damaged, and even necrotic (infarction).4
There’s also a risk of what is called immune distraction (where the foreign body/lint enters the patient),
not after being removed from the packaging or having been handled. Have you ever had a bathroom or kitchen towel or maybe even a favorite shirt that over time started tearing or “pilling”? The more handling of a linen (the more friction applied to the fibers), the more likely it will result in lint. All fibers, given enough wear and tear, or enough usage, will start to separate from the bunch. This phenomenon is what we call lint. Rub two sides of a lint-free cloth together and watch as the “lint-free” cloth magically produces lint! This phenomenon is why the language in ANSI/AAMI ST79:2017 (Section 7.4.1) states, “Cloths used in decontamination should be clean and non-linting and should be changed frequently.”3 Non-linting is simply more accurate terminology to describe the cloth. It can’t really be lint-free because it’s made of fibers that can lint; however, when it arrives, it’s not actively linting because it’s arriving in a nonlinting form. Thus, the term “nonlinting” was born.
If you have an IFU asking for a “lint-free” towel (Fig. 3), it’s likely
and while the immune system is distracted fighting off the larger foreign body (that the lint presents), other damaging pathogens are allowed to survive, find protected pockets inside the body, and thrive.
So, Adam, what does all that have to do with the terminology of “lint-free” or “non-linting”?
Well, for one, the term “lint-free” doesn’t really apply to any woven or non-woven linen or textile. At least
it was written prior to 2017 when that terminology was more prevalent and included in older editions of the standards.
ISO® (ISO 9073-10)7 (Fig. 4) and European standards have done extensive testing on textiles to determine particle counts of lint and other particles generated from a dry state. They created a “coefficient of linting,” which is the “log of the particle count applied to all or to a part
Figure 2: “Lint fiber with bacteria.” – Wava Truscott, 2014.5
Figure 3: Example from pre-2017 general instrument Mfr.’s IFU – V. Mueller®, 2012.6
of the measurement channels.”7 In plain English, that means a count of how many foreign body particles are shed from non-woven materials and a baseline for what should be considered non-linting or “low-linting” (which is the preferred terminology in Europe).
Reusable towels are the biggest culprits of lint creation in the sterile processing environment and should be avoided, if possible. Some suggested solutions to our ever-accumulating lint problem:
•Non-linting liner alternatives can be used inside trays and on your workstations.
•Shelf liners can be used on your autoclave racks and carts to avoid using linty towels as wicking materials.
•Personnel in the sterile processing department should be wiping their workstations at the beginning and end of their shifts to prevent the accumulation of dust and lint.
•Routine and recurrent cleaning of the environment for places where dust and lint collect. So, there you have it. There really isn’t such a thing as a lint-free cloth, but if you encounter
this terminology, you’re really looking for a cloth that is not actively linting, or, in other words, non-linting. Does your head hurt as much as mine does? I think I need to put a cold, non-linting compress on it. HPN
REFERENCES (APA STYLE 7TH EDITION):
1.Merriam-Webster. (n.d.) Lint. In Merriam-Webster.com dictionary. Retrieved March 10, 2025, from https://www. merriam-webster.com/dictionary/lint
2.Rojo, C. (n.d.). Inside a lumened device [Photograph]. Healthmark, A Getinge company.
3.AAMI (2017). ANSI/AAMI ST79: 2017 Comprehensive guide to steam sterilization and sterility assurance in health care facilities . Arlington, VA: Association for the Advancement of Medical Instrumentation.
4.Truscott, W. (2023). Lint Fiber-Associated Medical Complications Following Invasive Procedures. Biomedical instrumentation & technology, 57(s1), 5–10. https://doi. org/10.2345/0899-8205-57.s1.5
5.Truscott, W. (2014). The Clinical Issue: Foreign Debris In Post-Surgical Complications [Photograph: Lint fiber with bacteria on p 2], Knowledge Network Kimberly-Clark Healthcare Education, Issue 8, 1–8.
6.V. Mueller Division. (2012). V. Mueller® Products and Services General Surgical Instrument Cleaning and Sterilization Guide. CareFusion Corporation.
7.ISO®. (2003, May; Confirmed 2019). ISO 9073-10:2003 Textiles — Test methods for nonwovens — Part 10: Lint and other particles generation in the dry state. (1st ed.). International Organization for Standardization.
Figure 4: Front Cover of the ISO 9073-10 Standard.7
Bone Punches
Consistent. Comfortable. Clean. Convenient.
Engineered to meet the demands of spinal and cranial neurosurgery, SQ.line KERRISON Bone Punches deliver dependability and comfort.
