Healthcare Purchasing News - July 2025

CLEAN

CO N F I D E N T

INTRODUCING

The Next Generation Of Contamination Monitoring Technology by

For the cleaning verification of surgical instruments, endoscopes, and surfaces, Clean Read Handheld by Empire Bio Diagnostics is a cloudbased cleaning monitoring system used to help hospitals and other healthcare organizations achieve optimal standardized cleaning levels.

Sourcing & Logistics

8 > Rising Costs, Shrinking Margins: Healthcare Faces Tariff Fallout

JANETTE WIDER

30 > Certified Sustainability: How Hospitals Can Set and Meet Anesthetic Gas Waste Benchmarks

CHRIS STAUFFER

34 > The Sustainability of Sustainability

KAREN CONWAY

EVS and Facility Services

12 > Environmental Services Update: Healthcare-Associated Infections, Antimicrobial Resistance, and New Tech

MATT MACKENZIE

Sterile Processing

16 > The Realities of Offsite Reprocessing

KARA NADEAU

22 > Critical Connections: Improving SP and OR Synergy

CODY MCELROY

26 > Brushes on the Clean Side

ADAM OKADA

Tariff Talk

BY JANETTE WIDER

This month’s editorial is more serious than my usual tongue-in-cheek style— though don’t worry, my sarcasm hasn’t gone on vacation, just scaled back to business casual. I tackled the topic of tariffs in healthcare and what that means for the people keeping hospitals stocked and functional. You can read the full piece on page 8. It’s not exactly a beach read, but it might validate your stress levels.

Healthcare supply chain professionals know better than most how delicate—and let’s be honest, occasionally absurd— the global medical supply ecosystem is. Every day, behind the scenes, you’re sourcing gloves, syringes, diagnostic kits, and enough pharmaceutical components to keep things running… all while juggling backorders, vendor ghosting, and demand curves that behave more like roller coasters. And then—just to keep things spicy—we add tariffs. These tariffs, originally imposed as part of broader trade disputes, were perhaps meant to flex economic muscle. But in healthcare? They’re just deadweight. They don’t improve quality, they don’t incentivize innovation—they just hike up prices and inject uncertainty into already fragile procurement pipelines.

Tariffs have become the surprise twist no one asked for in your weekly sourcing strategy meeting. They force impossible decisions: absorb rising costs (and hope finance doesn’t notice), pass them on (and hope patients can afford it), or cut corners (and hope that’s not the headline next month).

Some still cling to the idea that tariffs will jumpstart domestic manufacturing. But let’s be real: building a U.S.-based medical supply chain isn’t a quick DIY project— it’s a multi-year, multi-billion-dollar marathon that requires regulatory approvals, skilled labor, and some magical thinking. Until then, we’re left patching together global supply routes with hope and a spreadsheet.

What the industry really needs is targeted investment, smarter supplier diversification, and policies that reflect actual operational realities, not broad, outdated trade tactics. Tariffs create friction in places where we need agility, responsiveness, and yes, a little grace.

We learned during the COVID-19 pandemic that constrained supply chains can be the difference between preparedness and chaos. Removing tariffs on critical medical imports won’t solve everything—but it would be a solid step toward sanity.

It’s time to give healthcare supply chains the policy support they deserve. Because this work is vital— and it shouldn’t be a casualty of economic posturing.

July 2025, Vol. 49, No. 5

VP & Market Leader

Healthcare and Dental

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Editor-in-Chief

Janette Wider jwider@hpnonline.com

Associate Editor Matt MacKenzie mmackenzie@endeavorb2b.com

Senior Contributing Editor Kara Nadeau knadeau@hpnonline.com

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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.

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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

AHA

Urges Senate Committee on Finance to Address Critical Supply Chain Vulnerabilities

AHA Urges Senate Commi ee on Finance to Address Critical Supply Chain Vulnerabilities

On May 14, the American Hospital Association (AHA) made a statement for the United States Senate Commi ee on Finance on “Trade in Critical Supply Chains.” Key highlights of the statement include: Severe supply chain vulnerabilities, substantial dependence on imports, and rising costs and financial strain. The AHA urges maintaining and expanding tariff exceptions for critical medical products to avoid access disruptions.

Read on: hpnonline.com/55290923

AACN Launches Nursing Workforce Solutions Program

The American Association of Clinical-Care Nurses (AACN) launched the Clinical Scene Investigator (CSI) Academy’s Nursing Workforce Solutions program.

The program aims to empower “direct care nurses with the tools and leadership skills to promote a healthy work environment, strengthen nurse retention, and improve nurse satisfaction.” It will feature “AACN’s Healthy Work Environment standards and AACN Clinical Scene Investigator (CSI) Academy, a proven hospital-based direct-care nurse leadership, innovation and experiential implementation science-based program.

Read on: hpnonline.com/55295103

Data and Analytics with Jeff Wertz

Jeff Wertz, President of Surgio Health, joins our Editor-in-Chief Jane e Wider an episode of Healthcare Hodgepodge to talk data and analytics.

Wertz and Wider discuss data and analytics in healthcare, specifically as it relates to sterile processing. Are hospitals really using all this data? How can hospitals effectively leverage data? Why is healthcare so behind the curve when it comes to data and analytics? Listen to this episode to find out the answers to these questions and more.

Listen at: hpnonline.com/55292793

Rising Costs, Shrinking Margins: Healthcare Faces Tariff Fallout

Experts warn that new trade policies could delay patient treatments and inflate costs across an already fragile healthcare landscape.

BY JANETTE WIDER

Editor’s Note: This piece was written in late May.

Healthcare has long stood at the forefront of political, economic, and social discourse in the United States. According to Statistica, in 2022, U.S. national health expenditure as a share of its gross domestic product (GDP) reached 17.3%, a decrease from the previous year. The U.S. has the highest health spending based on GDP share among developed countries. Both public and private health spending in the U.S. is much higher than other developed countries.

Healthcare not only reflects domestic priorities but is also intricately tied to global trade dynamics. In recent years, the healthcare landscape has been significantly influenced by a complex and often volatile international trade environment, particularly in the context of tariffs. While tariffs are typically discussed in relation to steel, electronics, or agriculture, they have increasingly become a critical factor in the healthcare supply chain, affecting everything from the cost of medical equipment to the availability of pharmaceutical ingredients.

The current U.S. tariff strategy, shaped by ongoing geopolitical tensions, especially with China, as well as efforts to bolster domestic

manufacturing, has had wide-ranging implications for healthcare providers, patients, and manufacturers. The imposition of tariffs on imported goods—including critical components like personal protective equipment (PPE), diagnostic devices, and raw materials for pharmaceuticals—has created a ripple effect that impacts both costs and access to care. The COVID-19 pandemic starkly highlighted the vulnerabilities of global supply chains, prompting the federal government to reassess its dependency on foreign-made healthcare goods. In response, new policies aimed at reshoring production and diversifying sources of imports have emerged, but these measures come with their own economic trade-offs.

According to Wisconsin Economic Development, “Overall, Mexico exports more medical equipment than it imports, with exports totaling $6.4 billion in 2021 and expected to reach $6.9 billion in 2022, compared

to imports of $5.9 billion in 2021 and an estimated $5.4 billion in 2022, according to the U.S. Commerce Department’s International Trade Administration (ITA). U.S. suppliers represent about one-third of the imports.”

Furthermore, tariff policies have added pressure to an already burdened healthcare system that continues to grapple with rising costs, staffing shortages, and unequal access to services. Hospitals and healthcare providers are being forced to navigate this complex terrain, balancing budget constraints with the need to maintain high standards of care. For patients, these macroeconomic decisions translate into higher outof-pocket expenses and delayed treatments, especially in lower-income communities.

This evolving intersection of healthcare and trade policy raises urgent questions about national priorities: Should cost efficiency or domestic self-sufficiency take precedence? Can the U.S. sustain a healthcare system that is both affordable and secure amid fluctuating global trade dynamics? And what role should tariffs play in ensuring that the U.S. healthcare infrastructure is resilient, equitable, and forward-looking?

As policymakers continue to weigh these decisions, the outcome will significantly shape the future of American healthcare—economically, politically, and ethically.

Healthcare Purchasing News had the opportunity to speak with three supply chain leaders about the current state of tariffs and healthcare in the U.S. Here’s what they had to say.

Tom Redding, executive VP, Healthcare Practice Leader, St. Onge, when asked to give an overview on tariffs, noted that “Products and equipment manufactured outside the United States may face rising costs due to tariffs. A key consideration is who will bear these added expenses.

Since most health systems already have existing contracts, manufacturers may be forced to absorb the increased costs, at least initially. Over time, this could lead manufacturers to reduce the availability of certain products and/or scale back investments in developing new equipment. Such dynamics are likely to strain relationships between manufacturers and health systems, especially given that health systems typically operate on razor-thin margins, while manufacturers may have more financial flexibility.”

Further, he added, “As previously noted, if manufacturers are responsible for covering increased costs, their ability and willingness to invest in the development of new products and technologies could be significantly curtailed.

“Some more sophisticated health systems may have anticipated the tariffs and stockpiled supplies in advance. While this strategy could provide short-term insulation, it may also contribute to broader product shortages in the market.

“Tariffs may prompt manufacturers to delay shipments while they wait to see if trade conditions improve. This uncertainty could lead health systems to increase local stockpiling or seek alternate suppliers rather than relying solely on traditional distribution channels.”

Redding also noted, “Turning to alternative local suppliers may introduce new challenges, including higher costs and potential quality concerns. In some cases, lower-quality products may enter the supply chain, potentially impacting patient care outcomes.

“Health systems may postpone purchasing new equipment due to budget constraints and pricing uncertainty. These delays can have downstream effects on care delivery and limit access to advanced technologies in the future.”

Michael Schiller, FAHRMM, CMRP, executive director, AHRMM, American Hospital Association, largely agreed. He said, “Each day in America’s hospitals and health systems, patients receive safe and effective care from provider teams using a wide array of pharmaceuticals and medical devices. Many of the pharmaceuticals used are sourced from overseas. Additionally, the U.S. sources many raw ingredients internationally for pharmaceuticals. These raw ingredients are commonly known as active pharmaceutical ingredients (APIs) and are the most important components of any pharmaceutical manufacturer’s supply chain. According to a 2023 Department of Health and Human Services estimate, over 90% of generic sterile injectable drugs, including many chemotherapy treatments and antibiotics, depend on APIs from either India or China.”

He continued, “Medical supply chains for other medical devices are highly complex and require hospitals to draw on domestic and international sources. An infusion pump manufactured in the U.S. can contain parts from 20 or more countries, and an MRI system can contain parts sourced from 15 different countries. For many patients, even a temporary disruption in their access to these needed medications could put them at significant risk of harm, including death. For example, carefully planned chemotherapy treatments and antibiotic schedules are essential to giving patients the best chance of overcoming their diseases.”

Steve Liou, founder & CEO, Clarium Health, said “Healthcare faces a perfect storm with these tariffs because we’re simultaneously experiencing cost pressures, supply chain vulnerabilities, and an inability to quickly pass through costs. Unlike retail or manufacturing, healthcare can’t easily adjust pricing in response to tariff increases due to fixed reimbursement rates and ethical obligations to patients.“

He commented, “Our analysis shows hospitals could face 4.5-8% immediate cost increases, potentially rising to 18-30% with the full tariff package implementation in July—that’s unsustainable when operating margins are already thin. Critical life-saving supplies like injection needles and test kits face astronomical tariffs up to 279%, creating both financial strain and potential accessibility issues.”

Challenges

As for the biggest challenges facing supply chain leaders in healthcare right now, Redding said, “One of the primary challenges is the uncertainty surrounding when tariffs might change, who will ultimately bear the associated costs, and the general lack of transparency regarding where products are manufactured. Unless a health system has a

strong relationship with its suppliers or participates in an industry-wide supply chain transparency initiative, this information is often unavailable.

“Health systems may delay investments in new technologies due to uncertainty about the true cost of those investments. This includes concerns about the future availability of spare parts, as some suppliers are postponing their own purchasing decisions while awaiting clarity on tariff policies.”

He added, “Tariff pressures may drive smaller or lessresilient suppliers out of the market, leading to increased consolidation. While this may improve supply chain efficiency for some, it can also reduce competition, limit options, and increase dependency on fewer suppliers, potentially raising costs further.

“To hedge against uncertainty, health systems might increase their inventory levels. While this approach can protect against short-term shortages, it also ties up cash and physical space, resources which are already constrained in most health systems.

“The situation underscores the importance of proactive and strategic supply chain management, including better supplier vetting, geographic diversification of suppliers, and enhanced analytics to forecast tariff-related impacts. Health systems may need to invest in more robust supply chain intelligence capabilities.”

Schiller added two cents. He said, “Protecting patients’ access to the safe, high-quality 24/7 care provided by hospitals and health systems is important. A recent survey found that 82% of healthcare experts expect tariff-related expenses to raise hospital costs by at least 15% over the next six months. These increased costs come at a time when hospital expenses are already outpacing inflation and significantly outpacing Medicare reimbursement, which continues to lag behind inflation. Though expense growth has started to slow this year, it remains elevated, particularly in areas driven by labor and supply chain pressures.”

Solutions

As for solutions, Schiller said, “AHA urges reintroduction of the Mapping America’s Pharmaceutical Supply (MAPS) Act and the Pharmaceutical Supply Chain Risk Assessment Act. Supply chain vulnerabilities often only become apparent when the chain has been broken, as has been the case for a number of recent shortages, including blood culture media bottles and IV fluid. Proactively mapping and assessing the pharmaceutical supply chain, as well as supply chains for other medical devices and equipment, is an important step to improving resiliency in U.S. supply chains and protecting patients’ access to care.”

And Redding noted, “Health systems should continue to identify strategies for building and buffering inventory

across departments to mitigate the risks associated with price increases and potential product shortages.”

“It is essential for health systems to gain greater visibility into where their supplies and equipment are manufactured,” he added. “This knowledge is key to assessing potential cost impacts and identifying vulnerabilities in the supply chain. Additionally, health systems should evaluate the availability of spare parts from suppliers to better understand potential operational disruptions.”

Further, “Supply chain leaders must conduct a comprehensive assessment of inventory levels across all support departments—such as supply chain, facilities, and IT—to evaluate risks related to both cost increases and product availability. This proactive approach will help mitigate potential disruptions and support more informed decision-making.”

Schiller emphasized that “Understanding Country of Origin is critical to assessing the potential impact tariffs will have on current product pricing, as well as help to identify opportunities to shift sourcing to countries with lower tariffs. Calculate cost impact by reviewing contractual terms, leverage GPO relationships, resources, and negotiating power, and engage in strategic conversations with distributor and key trading partners.”

Schiller also said that “AHA has urged the administration to maintain tariff exceptions for pharmaceuticals and pharmaceutical products and to adopt them for medical devices and other critical supplies to minimize inadvertent disruptions to patient care. It is especially critical to have these exceptions for products already in shortage, and for which production in countries subject to increased tariffs supplies a significant part of the U.S. market for that product. Mitigating supply chain challenges requires diversifying where raw materials are sourced and where products are manufactured. Imposing tariffs that limit the U.S.’s ability to acquire constituent parts or finished medical and pharmaceutical products from abroad will hinder supply chain resiliency.”

And for St. Onge, Redding said, the organization is Actively collaborating with their suppliers to assess available inventory levels and gain visibility into product manufacturing locations. This information is critical for identifying and mitigating potential supply chain risks.”

Liou of Clarium said, “Clarium has built a proprietary database that links authorized manufacturing locations to products at the SKU level through our Location Registry, mapping FDA-registered facilities to specific items. Unlike general supply chain analytics, Clarium’s system integrates FDA registration data, advanced web-scraping algorithms, AI-driven validation, and geo-tracking to confirm actual manufacturing locations—not just company headquarters.”

He added, “Clarium is offering hospitals and health systems a free tariff impact analysis to help quantify their specific exposure and identify immediate cost-saving opportunities. This isn’t just a marketing tool—it’s our contribution to maintaining healthcare resiliency and stability during this challenging transition. This isn’t just about cost-cutting—it’s about preserving healthcare accessibility and quality during economic uncertainty.

“Clarium’s data suggests hospitals combining strategic sourcing with targeted standardization can offset approximately half of this pressure before it impacts patient care. This situation highlights why sophisticated data analytics are no longer optional in healthcare supply chain—they’re essential for navigating complex global challenges. The organizations that will thrive are those viewing this challenge as an opportunity to build more resilient, transparent supply chains that can weather future disruptions, whatever form they take.”

What’s next

When asked what leaders should focus on next, Redding commented, “The primary areas of focus should include enhancing inventory visibility across support departments, reviewing contracts to identify potential exposure to price increases, and assessing supplier-related risks concerning product availability.”

Schiller added, “Given the dynamic situation, it is imperative for supply chain leaders to monitor global trade and policy developments closely. In addition to product costs, a slowdown in the global economy is impacting the logistics sector. Determine risk exposure and the necessary steps required to mitigate the level of risk. Assess indirect spend across the health system and consolidate where possible to generate savings.

Finally, Schiller concluded by saying that “Maintaining and improving pharmaceutical and medical device supply chains is essential to preserving patient access to care, reducing healthcare costs, and protecting America’s interests. While AHA recognizes the many challenges associated with the medical supply chain, we are committed to identifying workable solutions that protect America’s interests and shore up the supply chain while avoiding access disruption and increased costs.” HPN

Steve Liou

Tom Redding

Michael Schiller

Environmental Services Update

Healthcare-Associated Infections, Antimicrobial Resistance, and New Tech

BY MATT MACKENZIE

In 2024, ISSA announced that the Healthcare Surfaces Institute, or HSI, was being merged into the association.

HSI was formed in 2015. The institute went on to make progress on issues including “identifying the many aspects of surface issues and how they support the spread of deadly pathogens via surfaces leading to unaddressed patient and healthcare worker safety risks.” Including in the institute is “an advisory committee of world-renowned experts in the fields of healthcare, infection prevention, facilities management, environmental services, manufacturing and engineering, regulatory agencies, microbiology, occupational health, and academia…HSI’s work includes scientific research, development of guidelines and standards, and outreach and educational programs to support the use of surfaces that support effective and efficient cleaning and disinfection of healthcare facilities.”

ISSA also said at the time of the merger that the addition of HSI provided “strength and subject matter expertise in the healthcare sector to bolster education and training and develop new programs to support the industry, especially in the fight against the rampant spread of healthcare-associated infections (HAIs) via surfaces…Cleaning and facility solutions professionals are invited to join HSI at a rate of $290 per year and gain access to select ISSA benefits.”

The HSI division works closely with the ISSA management team to “develop and implement new training and certification programs, education events, and other engagement opportunities for the cleaning, facility solutions, and healthcare markets under ISSA’s global platform.”1

In April of this year, HSI held its first in-person summit since 2019. Healthcare Purchasing News spoke with Rodney Rohde PhD, MS, SM(ASCP)CM, SVCM, MBCM, FACSc, Regents’ Professor at Texas State University System, who provided some insight into what was discussed at the summit; and Sarah Wilkerson, MN, RN, CIC, CNOR(E), FAPIC, System Executive Director Infectious Disease Management and Prevention at Providence Health & Services, about higher-level concerns affecting environmental services (EVS) in general.

What were some of the top focuses of the live summit in April?

Rohde: The Healthcare Surfaces Summit 2025, held on April 7–8 at ISSA’s global headquarters in Rosemont, Illinois, brought together professionals from healthcare, infection prevention, design, and manufacturing to address the critical role of surfaces in preventing healthcare-associated infections (HAIs). The summit emphasized actionable

strategies and collaborative efforts to enhance patient safety through improved surface hygiene. Key focus areas included:

1. Surface Hygiene and HAI Prevention

The summit underscored the importance of surface hygiene in preventing HAIs. Participants engaged in discussions and breakout sessions aimed at developing strategies to mitigate the spread of deadly microbes through contaminated surfaces. These sessions facilitated the formation of task forces dedicated to ongoing research and the development of practical tools for healthcare settings.

2. Collaborative and ActionOriented Approach

Unlike traditional conferences, the summit adopted an interactive format featuring lightning talks, group discussions, and task force breakout sessions. This approach fostered collaboration among attendees, leading to the establishment of clear goals and new partnerships focused on improving surface hygiene and patient safety.

3. Keynote on the Ongoing HAI Epidemic

Jeanine Thomas, founder of the MRSA Survivors Network, delivered a compelling keynote titled “The Forgotten Ongoing Epidemic: Healthcare-Associated Infections (HAIs).” Drawing from her personal experience as an HAI survivor, she highlighted the persistent challenges posed by HAIs and the need for continued vigilance and innovation in infection prevention.

4. Formation of Ongoing Task Forces

A significant outcome of the summit was the establishment of task forces committed to year-round efforts in improving surface safety. These groups aim to develop research projects, tools, and resources that address the complexities of surface cleanability and disinfection in healthcare environments.

5. Emphasis on Surface Material Standards

The summit highlighted the need for standardized guidelines in surface material selection, testing, and maintenance. By focusing on the entire lifecycle of surfaces—from design and manufacturing to installation and upkeep—the summit aimed to reduce the risk of HAIs associated with contaminated surfaces.

Overall, the Healthcare Surfaces Summit 2025 served as a catalyst for actionable change, emphasizing the critical role of surface hygiene in patient safety and fostering ongoing collaboration among stakeholders to combat HAIs.

What are some advancements currently being made in HAI prevention?

Rohde: Advancements in the prevention of healthcare-associated infections (HAIs) are increasingly driven by innovations in technology, infection control protocols, and data analytics. As of 2025, here are some key developments:

1. Artificial Intelligence and Predictive Analytics

AI-powered surveillance tools analyze electronic health records (EHRs), lab results, and patient vitals in real-time to identify infection risks early. Predictive modeling helps hospitals identify patients at high risk for HAIs like catheterassociated urinary tract infections (CAUTIs) or central line-associated bloodstream infections (CLABSIs) and intervene proactively.

2. Antimicrobial Stewardship Programs (ASPs)

Enhanced use of AI-driven decision support tools to guide appropriate antibiotic prescribing is growing. Rapid diagnostic tests using molecular techniques enable targeted treatment, reducing unnecessary broad-spectrum antibiotic use and combating resistance.

3. UV-C and Hydrogen Peroxide Disinfection

Automated disinfection robots using UV-C light or hydrogen peroxide vapor are being used more widely to disinfect patient rooms and operating theaters, reducing pathogens like C. difficile and MRSA. Smart sensors ensure proper coverage and dosage during disinfection cycles.

4. Antimicrobial and Self-Disinfecting Surfaces

New materials embedded with copper, silver, or zinc oxide nanoparticles are being used on high-touch surfaces (e.g., bed rails, doorknobs) to continuously kill pathogens. Photocatalytic coatings that activate under visible light to degrade microbes are gaining traction in clinical settings.

5. Hand Hygiene Monitoring Technologies

Use of RFID and Bluetooth systems to track staff hand hygiene compliance in real-time is becoming more common. AI-enabled video analytics can detect hand hygiene adherence without intrusive supervision.

6. Smart Catheters and Sensors

Catheters with embedded sensors monitor pH, temperature, and biofilm formation to provide early warning of infection. Closed-system catheter drainage systems reduce the risk of bacterial entry.

Rodney Rohde

Sarah Wilkerson

7. Vaccination and Immunotherapy

New vaccines are under development or in use for nosocomial pathogens like Klebsiella pneumoniae, Pseudomonas aeruginosa, and C. difficile. Monoclonal antibodies are being tested as prophylactics for patients at high risk of specific HAIs.

8. Real-time Location Systems (RTLS)

This is used for contact tracing and monitoring equipment movement to identify contamination pathways. Staff can be alerted if a potentially contaminated device is reused without sterilization.

9. Enhanced Training and Simulation

Virtual reality (VR) and augmented reality (AR) are being used to simulate infection control scenarios and train healthcare workers in best practices for preventing HAIs.

10. Genomic Surveillance

Whole-genome sequencing of pathogens allows hospitals to track outbreaks more precisely and identify sources of transmission (e.g., a contaminated sink or instrument).

How has the incorporation of HSI into ISSA aided its research and work?

Rohde: The integration of the HSI into ISSA in July 2024 has significantly enhanced HSI’s capacity to advance research and initiatives aimed at preventing HAIs through improved surface hygiene. This strategic merger has yielded several key benefits:

1. Expanded Educational and Certification Programs

By joining forces with ISSA, HSI has broadened its educational outreach, offering webinars, training sessions, and certification programs focused on surface hygiene and infection

prevention. These programs provide healthcare professionals with the knowledge and tools necessary to implement effective surface cleaning and disinfection protocols.

2. Enhanced Research and Development Opportunities

The merger has facilitated collaborative research efforts, enabling HSI to work closely with industry experts, manufacturers, and healthcare

Monoclonal antibodies are being tested as prophylactics for patients at high risk of specific HAIs.

professionals to develop and validate surface materials and cleaning methods. This collaboration aims to establish standardized guidelines and best practices for surface selection and maintenance in healthcare settings.

3. Increased Global Reach and Influence

As a division of ISSA, HSI benefits from ISSA’s extensive global network, allowing for greater dissemination of research findings and best practices. This expanded reach supports the adoption of improved surface hygiene standards worldwide, contributing to the reduction of HAIs on a global scale.

HSI’s Executive Director, Linda Lybert, has assumed a full-time role within ISSA, bringing her extensive experience in infection control and surface hygiene to the organization. Her leadership ensures that HSI’s mission remains focused on developing sustainable solutions to prevent the transmission of pathogens via surfaces.

Overall, the incorporation of HSI into ISSA has strengthened efforts to combat HAIs by promoting research,

education, and the implementation of effective surface hygiene practices across the healthcare industry.

What should healthcare leaders be focusing on when it comes to EVS right now?

Wilkerson : They should be ensuring that they have strong training programs that include competency validation, and they should also be following CDC’s best practice guidelines for environmental cleaning healthcare facilities.

What would be the consequences of EVS staff disappearing all together?

Wilkerson: Increased HAIs! Without them none of the other HAI prevention efforts would be worthwhile.

What specific challenges need to be addressed within EVS right now?

Wilkerson: Improving manufacturers’ development and instructions for use of equipment (IFU) and surfaces used in the healthcare setting is a big challenge. Often the IFU only lists one cleaning/disinfection solution that can be used by brand, which makes it challenging if the healthcare facility does not have access to this solution and confusing for the care team if they need to use multiple different products. We have IFUs for products used in healthcare settings that require the use of solutions that are not appropriate for the healthcare setting like mild detergents or Pine-Sol that may clean but do not disinfect. Then we have surfaces/ equipment that cannot be cleaned/ disinfected appropriately due to their complex design like some endoscopes or porous surfaces like grout in bathrooms. HPN

REFERENCES:

1. “Healthcare Surfaces Institute (HSI) Merges With ISSA.” Maintenance Sales News. https://maintenancesalesnews.com/ healthcare-surfaces-institute-hsi-merges-with-issa/

The Realities of Offsite Reprocessing

BY KARA NADEAU

When HPN asked sterile processing (SP) professionals what topics they wanted covered in 2025, one request stood out: A deeper look into offsite reprocessing—not just the concept, but the real-world complexities of making it happen.

This article features insights from a diverse group of stakeholders directly involved in offsite reprocessing, including an instrument manufacturer, a sterile processing department (SPD) equipment and supply provider, a Canadian sterilization service provider, a U.S.-based single-use device reprocessor, and both a U.S. health system and Canadian hospital that have successfully transitioned to offsite models.

They commented on common offsite reprocessing misconceptions and pitfalls and provided advice and resources to healthcare organizations and SPD teams considering offsite reprocessing, whether a transition to a health systemowned facility or outsourcing to a third-party company.

Common misconceptions

Given the complexities and challenges of sterile processing, it is no surprise that healthcare organizations and SPD team members have differing ideas as to the pros and cons of offsite reprocessing. Our team of expert contributors shared these common misconceptions.

It’s easy

Jennifer Greisen, Principal of Strategic Solutions, Surgical Asset Management for Aesculap, Inc., leads national initiatives focused on sterile processing department (SPD) centralization and enterprise-wide transformation within complex health systems. Greisen highlighted a common misconception in moving offsite: the belief “that it’s as simple as relocating sterile processing.” She went on to say:

“In reality, success depends on meticulous planning, especially around logistics. Offsite reprocessing becomes a business in itself, focused on fill rates, production schedules, and distribution timelines. Without real-time visibility and carefully defined handoff processes between the hospital and the offsite facility, even minor breakdowns

can disrupt surgical schedules, increase case delays, and create friction between departments.”

It’s less expensive

Sara Vinson, MBA, CRCST, director of Sterile Processing for UF Health Shands Hospital in Gainesville, Fla., HPN ’s 2025 SPD of the Year, led her hospital on the transformational change of centralizing instrument reprocessing to a 57,000 square foot offsite reprocessing center (read their full story in the April 2025 issue of HPN ).

Vinson said many believe that with an offsite move a healthcare organization will “save money, need less staff, or need less overall equipment,” but in reality:

“You are likely able to reduce redundancy in equipment if you are able to decommission existing equipment, but you will likely need additional staff for new roles necessary to support changes in logistics (e.g., transporting case carts to and from the loading dock). Increases in inventory will be necessary to support longer turnaround times for reprocessing.”

It’s risky

Ajay K. Jain, MBA, is managing partner for SteriPro International, an accredited, ISO 9001 and ISO 13485 certified company providing leading practice reprocessing and sterilization services from its facility in Mississauga, Ontario, and on-site at its partner hospitals. He said the prevailing fear is:

SteriPro’s ORC Assembly Stations

“Quality will slip, and my tray won’t return on time. But in practice, a well-run offsite reprocessing center does the opposite. Instrument-level bar-code tracking timestamps every hand-off; dynamic courier loops mirror operating room (OR) start times; and live dashboards surface exceptions instantly. Our clients record a 99.98% on-time delivery while reducing cost per procedure and gaining full transparency into every instrument’s journey.”

Fear that tech jobs will be lost

Heather Macmillan, clinical manager of the Perioperative Program for Pembroke Regional Hospital in Pembroke, Ontario, Canada, commented on her experience moving offsite with SteriPro International.

She said a common misconception of offsite reprocessing is largely around loss of medical device reprocessing (MDR) technician jobs or scope of practice, stating “This was a particularly true misconception for our site when we made the move to reprocess offsite and no jobs were lost.” In Cananda, a medical device reprocessing technician (MDRT) is an equivalent to a sterile processing (SP) technician in the U.S.

It’s a hand off

Lars Thording is senior vice president of Innovative Health, an advanced, U.S. Food and Drug Administration (FDA) regulated reprocessing company focused on electrophysiology devices. While the company has traditionally focused on reprocessing single-use devices, Thording said they are increasingly asked by healthcare organizations to reprocess reusable devices.

Thording highlighted that while hospitals often think outsourced reprocessing means handing over the problem, the reality is more complex. “There is this perception that a hospital can wash its hands of the issue of compliance with standards and IFUs by outsourcing,” he said. “But that’s not enough. There must be a system of accountability in place.”

It’s an all-in-one fix

Randalyn Harreld is national clinical education manager, U.S. for SteelcoBelimed, a global leader in providing medical and surgical instrument sterilization, disinfection and cleaning products and services. She said a common misconception with moving offsite is “That it solves all your problems with reprocessing capacity and spacing issues.”

The reality according to Harreld:

“It’s not a ‘solve your problems’ solution. It takes a lot of planning and coordination to be successful. It also requires an increase in many things like staffing, supplies, and budget. For instance, if you’re handling a high volume of loaned instrument trays, especially with growing volumes,

careful coordination with vendor representatives is essential to streamline the process.”

She also pointed out the operational impact of physical distance: “When you introduce additional space between the reprocessing center and the end users, you must account for added time in the workflow to accommodate transportation and delivery windows.”

Common pitfalls

Like anything in life, it is hard to fully comprehend the challenges of moving to offsite reprocessing until going through it firsthand. Having made the move in their own hospital or supported other organizations in the transition, those interviewed for this article shared the common pitfalls they have experienced.

Lack of evidence breeds hesitancy

According to Jain, hospitals that don’t have a concrete picture of their in-house SPD expenses and key performance indicators (KPI) have trouble justifying a move offsite. He stated:

“Hospitals often underestimate the fully loaded cost— and defect rate—of in-house SPD. Once the true baseline is clear, the offsite reprocessing center value proposition of higher quality, elastic capacity, and lower unit cost becomes undeniable.”

Assuming quality operations opens the door for risk

Thording cautioned healthcare organizations against assumptions that all professional reprocessing companies are operating to the highest standards, including adherence to instrument and device manufacturers’ instructions for use (IFU).

“If you can move off-site reprocessing to a company that operates with accountability and transparency, that’s an improvement,” said Thording. “But the hospital must make sure that accountability actually exists.”

Undervaluing change management and accountability threatens quality assurance

Macmillan advised against taking too lightly the level of change required when moving to offsite reprocessing and urged healthcare organizations to keep their third-party

Jennifer Greisen

Sara Vinson

Lars Thording

reprocessing companies accountable for quality standards, stating:

“Change can be difficult for any organization, but to move to an offsite reprocessing partnership does really create a sense of fear, largely about trust in another facility. Establishing a collaborative partnership founded on trust is essential for ensuring adherence to processes and procedures.” Another key element is keeping staff engaged in conversations and being open and transparent about incoming changes. “They are key in the change management process, and they are the experts in the work, so they need to be front and center”.

“It is crucial for the organization to recognize themselves as the customer and engage in courageous conversations. Open and honest communication is critical to a successful partnership such as follow up with discrepancies, commitment to contractual obligations, tapping into education support, on-site support, having regular touch point meeting to follow-up on KPIs and quality, etc.,” she added.

Underestimating resources risks falling short Vinson warned against underestimating the volume of instrument and device inventory required for offsite reprocessing, noting how, “In some cases, a hospital might not fully understand their inventory requirements due to bad data or lack of process oversight.”

Harreld emphasized how healthcare organizations often underestimate the full budget required for offsite reprocessing, particularly when it comes to staffing and supplies. She highlighted the importance of reevaluating existing staffing models, noting the potential need for adjustments in headcount, roles, or scheduling at the new location. Human resource planning, she stressed, should go beyond technician staffing to include the structure and responsibilities of the leadership team. Key questions to consider during planning include:

“Where will the SPD manager be located? Will they have an office at the offsite location, or remain at the main hospital? Do you need additional leadership to support offsite operations?”

“Ensuring you have adequate staff and leadership structure is key to daily management,” said Vinson. “Shift leads, educators, instrument coordinators, etc. all play key roles in ensuring priorities are met and instrumentation is processed at the highest quality.”

Short-sightedness impacts long-term success

Greisen noted that “failing to anticipate future needs and overlooking complex distribution scenarios” is a common pitfall she has seen in the offsite planning process.

“This can lead to inefficiencies such as delays in instrument turnaround times, inconsistent case readiness,

Ajay K. Jain

bottlenecks in transportation logistics, and misalignment between reprocessing capacity and surgical volume,” said Greisen. “These challenges are often hard to resolve once operations are live and can significantly impact operating room (OR) performance and staff satisfaction.”

She emphasized the importance of accurately projecting surgical volume, instrument demand, and growth, stating, “Misjudging future needs can result in capacity shortfalls and require expensive, unnecessary redesigns that could have been avoided in the first place.”

Your number one piece of advice

All elements and factors that go into a successful offsite move cannot be captured in a single article, particularly because each individual health system or hospital has its own nuances and needs. At a high level, our group of experts offered their number one piece of advice to SPD teams and healthcare organizations considering a move to offsite reprocessing.

Don’t skimp on strategic planning

“Prioritize strategic planning that accounts for both current operational needs and long-term growth,” said Greisen. “Building flexibility into the design from the outset is key to scaling effectively. One common pitfall is designing a facility solely around current case volume or equipment mix without accounting for evolving service lines, technology upgrades, or shifts in surgical demand, which can lead to costly retrofits or workflow disruptions down the line.”

Vinson pointed to the criticality of data quality and access during the offsite planning process, stating: “I cannot over-emphasize the importance of data-driven decision making. Invest in robust tracking systems for inventory management as well as data analytics for predictive and live dashboards.”

“While certainly not required, having a vendor partnership to help in advising in data review and logistics is extremely helpful,” she added. “You have to have good, clean data to review process, inventory, and staffing analysis.”

Macmillan explained how strategic planning for offsite reprocessing must include financial planning. She stated:

“Choosing offsite reprocessing must align with the organization’s fiscal responsibility. Therefore, knowing the

Heather Macmillan

Randalyn Harreld

She also highlighted the value of strong leadership engagement: “Having leadership support and a champion involved from the start is critical to success.” While leadership will ultimately be part of the approval process, Harreld emphasized that representatives from all operational areas should actively participate in the planning committee to avoid surprises at go-live. This includes nurse managers, infection control, environmental services, human resources, perioperative leaders, nurse coordinators, central supply, and a surgeon champion.

offsite reprocessing proposal and additional costs, especially for future planning, is essential.”

Engage the right stakeholders

Harreld stressed the importance of involving the right stakeholders early in the planning process, along with setting an appropriate timeline. “Ensure the right people are at the table for planning meetings and that you include vendor partners who can support key areas like data collection, budgeting, staffing models, and equipment capacity,” she advised.

“Having all the right people involved in the steps is essential,” said Macmillan. “This includes front line members from the operating room (OR) and MDR. Ensure there are regular and frequent meetings in the planning phase with set timelines and action items. Have the offsite partner involved onsite as much as possible to help build trust and confidence with the perioperative teams. Planning appropriate education and transition support is essential.”

Focus on logistics

“Offsite success is 80% logistics planning and 20% stainless steel,” said Jain. “Before signing any lease or contract, map the entire peri-operative supply chain—instrument

SteriPro’s Dedicated Sterile Transport Fleet (temperature & humidity controlled)

mix, block schedules, staffing, volume peaks, transport routes, and contingency buffers.”

“While there are many considerations when establishing an offsite or centralized reprocessing center, in my experience, logistical planning is the most critical,” said Harreld. “This includes ensuring instrument traceability and carefully planning transportation methods. It’s essential to involve couriers and drivers in the planning meetings early on, as they play a key role in the success of the operation.”

Harreld also emphasized the importance of mapping delivery routes in detail: “Track each set and assess the delivery pathways. Every region presents unique challenges—flood zones, traffic congestion, highways, and school zones can all impact timely delivery.”

Commenting on offsite reprocessing center design, Greisen noted that it is “more than just the physical layout,” stating:

“It’s also about creating efficient workflows, optimizing equipment placement, and planning for flexibility. A well-designed offsite supports scalability and can minimize unnecessary bottlenecks.”

“Overall building design and workflows are vitally important for operational efficiency,” said Vinson. “Think ‘LEAN’ processes and incorporate as much standardization as possible.”

Macmillan noted how the healthcare organization needs to know the inventory and quality of instruments, recommending that there are “Dedicated MDR and OR champions to assist in the setup, training, and knowledge on the partnership processes.”

If outsourcing, ensure accountability

For SPD leaders evaluating reprocessing partners, Thording recommended asking for three things:

• Batch-level reporting on how many turns a device has gone through.

• Functionality testing protocols for every single device and results—did devices pass or fail?

• Documentation of cleaning processes used for each batch.

“These are not just operational details,” Thording explained. “They are the foundation of safe and effective device reprocessing. We test every device for functionality before it returns to the hospital. And we follow the manufacturer’s IFUs to the letter—including using the right chemicals, the right temperature, and cycle counting for every device.”

“It is vital that both parties are transparent, supportive, and accountable,” said Macmillan. She recommends:

“Ongoing communication updates, listening to concerns, and asking the right questions so that the teams can feel reassured during the process from start to finish.”

The hospital’s core SPD team should maintain a vital role

Macmillan advises health systems and hospitals considering an offsite move to ensure their core MDR/SPD teams still have a vital role within their organizations.

“Despite not having the reprocessing aspect for the MDR tech, the team maintains a significant responsibility with cleaning, inspection and handling, and overall quality assurance of trays and equipment,” said Macmillan. “Another key factor is to understand the program’s needs and the turnaround time for returning the trays. For example: Trays picked up from hospital at 4 p.m. on Monday won’t be returned until 4 p.m. on Tuesday. Having the right amount of equipment, including redundancy, to ensure that patient care is not compromised is crucial.”

Available resources

Lastly, HPN asked those interviewed to offer recommended resources healthcare organizations and SPD teams can use when considering offsite reprocessing. Here is what they provided.

Start with the standards

“Begin with AAMI ST79 and the new 2025 AAMI TIR109 on off-site processing,” said Jain. “Augment them by touring mature ORCs, hosting open forums between SPD and OR teams to surface pain points, and commissioning third-party audits for an unvarnished baseline. Progress demands embracing change—the only route to safer, more efficient care.”

Look to real-world resources

“Leverage real-world experience,” said Greisen. “Learn from those who have successfully managed an offsite and break down the issues of current offsite facilities using RCA/Fishbone methodology to unpack and correct what is not working. Just as important is bringing in professionals

A 3D model of an offsite center

who specialize in redesigning SPDs and offsite workflows. Their firsthand knowledge from supporting similar transitions at other institutions can help you anticipate challenges, avoid common missteps, and build smarter, more scalable solutions from the start.”

Lean on industry partners

“Utilizing vendor partners and industry professionals for support is a huge benefit,” said Harreld. “There are many companies that offer support in the offsite planning and preparation and can really be a guiding tool as you go through the process - from equipment planning, to

budget, to data and analytics, to quality assurance, and staffing models. I highly recommend partnering with a few and not trying to complete the entire thing on your own. We are lucky to have so many resources in this area in the industry.”

“There are several vendors in the marketplace that offer consulting services in this area,” said Vinson. “I recommend doing your due diligence to ensure they are knowledgeable and reputable. There are also vendors that offer full service in building and operating an offsite. You have to review your specific needs and customize to what will solve your unique challenges.”

Maintain success through collaboration

Commenting on her hospital’s experience partnering with an offsite reprocessing company, Macmillan stated:

“Having a dedicated lead between both sites is necessary to maintain clear lines of communication. Organizing site visits for both parties is also valuable and a way to support the transition and build trust. We should hold regular meetings to ensure consistent communication and transparency, sharing reports, including quality review recommendations or discrepancies, and to follow up on incidents that can be shared monthly with both teams.” HPN

Example of the fully designed offsite decontamination area

Critical Connections: Improving SP and OR Synergy

BY CODY MCELROY

Learning Objectives

1. Outline best practices to improve operating room and sterile processing efficiencies

2. Outline four principles for effective communication

3. Overcome challenges and build synergy

Contributed by:

In the intricate dance of hospital operations, the relationship between Sterile Processing (SP) and the Operating Room (OR) is often likened to that of a service provider and its customer. The OR places orders for surgical cases, and SP dutifully delivers the necessary instruments and supplies. The efficiency and precision of SP’s work directly impact the success of the OR’s procedures. However, this dynamic is far from one-sided. The performance and demands of the OR equally influence the effectiveness of SP. This symbiotic partnership underscores the mutual dependency, with each department playing a crucial role in the other’s success.

The OR plays a pivotal role in maintaining the efficiency of the SP team, starting with proper instrument care at the point of use. When instruments have difficult to clean soils or are damaged or misplaced, it hampers the processing team’s ability to clean and prepare devices efficiently, leading to delays. The OR can significantly support the SP team by taking a few proactive measures.

Protect Instrumentation

•Use instruments for their intended purpose. How often have fine tissue scissors cut sutures or lens become levers?

•Never use saline solutions to wipe or soak instrumentation as it is highly corrosive.

PHOTO CREDIT: STERIS

•Manage with proper care and handling.

Adopt practices that reduce processing time in SP

•Remove debris early to prevent drying and caked on soils

•Flushing debris from lumens during the procedure

•Soaking items with solutions like sterile water between uses

•Use anti-stick solutions to reduce eschar build-up on electrosurgical tips

•Organize returning instrumentation

•Sort instruments into their original containers

•Discard disposable items

•Group sharp items and align tips

•Protect delicate instrumentation during handling and placement

•Use pretreatment products

•Gels and foams prevent drying, making cleaning more efficient

•Vials that are pre-filled with a neutral pH enzymatic detergent protect tips and loosen tough to remove soils

The SSP team plays a crucial role in maintaining OR efficiency. It begins with meticulous assembly and thorough inspection of instrumentation.

A missing instrument can cause significant disruption in the OR, delaying procedure start times as staff search for replacements.

Nonfunctional instruments discovered during a procedure can harm the patient and extend the procedure time. By ensuring that all instruments are present and functional, the SP team enables the OR team to operate at optimal efficiency. The SP team can greatly enhance the OR team’s efficiency by implementing just a few key measures.

Manage inventory to prevent shortages

•Maintaining an accurate inventory of instrument sets and supplies helps prevent OR shortages

Complete and organized trays to help instrument counts in the OR

•Locate or replace missing instrumentation

•Maintain preference cards

•Keep like instrumentation together and standardize instrument placement

Ensure clean and functioning instrumentation

•Cutting tests for scissor and other sharp instrumentation

•Residual soil testing tools using borescopes and residual protein soil tests

•Identifying and removing damaged and nonfunctional instrumentation

Lesson:

Critical Connections: Improving SP and OR Synergy

July 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 May 12, 2027.

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

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

Figure 1: Vial filled with detergent loosens tough soils.

Four Principles of Communication

Communication is the key to a great partnership. It is the foundation of collaboration between SP and OR staff. Effective communication is built upon four principles: empathy, active listening, clarity, and openness.

Empathy requires understanding of the other teams’ experiences and having sensitivity to their thoughts and feelings. To accomplish this, team members must use active listening. Active listening is the practice of hearing and understanding the other party. The goal is to acknowledge how they feel and understand what they are saying.

For empathy and active listening to work, the communication must be clear and concise. It’s important to avoid generalities and demeaning speech, instead focusing on the facts of the situation.

Lastly, communication must be open. Anything and everything should be discussed through the lens of mutual respect and trust. Only then can OR and SP teams effectively communicate.

“While the collaboration between SP and OR teams can be complex, overcoming common challenges through shared goals and proactive communication can significantly enhance the relationship.”

Often the communication between OR and SP involves a stressful experience. Take for example a nonfunctioning device found during the procedure. The OR reaches out to SP for a replacement to be sent immediately. Accusations begin with SP blaming the OR team for damaging the device and the OR team stating that the SP team is not doing their job. This situation is an opportunity to improve communication.

Implementing a systematic tagging system for surgical instruments and trays can bridge the communication gap. By using tags in the OR to indicate broken items or instruments needing sharpening, SP staff can quickly address issues without unnecessary guesswork or miscommunication from oral communication. These communication tags also create a visual queue, allowing SP teams to prioritize repairs or replacements, further reducing delays in instrument preparation.

The process fosters a sense of shared responsibility between departments, as both OR and SP staff contribute

to maintaining instrument integrity. Moreover, clear communication ensures that all parties are aligned in their goal of achieving optimal surgical outcomes.

Overcoming Challenges and Building Synergy

While the collaboration between SP and OR teams can be complex, overcoming common challenges through shared goals and proactive communication can significantly enhance the relationship. Strategies include:

• Fostering a Cooperative Environment: Encouraging teamwork through cross-departmental training sessions where SP and OR staff can better understand each other’s workflows and challenges.

• Adopting Real-World Case Studies: Learning from successes and setbacks in similar surgical settings can provide actionable insights into enhancing interdepartmental synergy.

By prioritizing this collaboration, both teams can contribute to higher standards of patient care and operational efficiency.

To build and sustain an effective partnership between SP and OR staff, establishing a robust feedback loop is essential. This feedback mechanism should include regular reviews of performance, highlighting what each department is doing well and identifying areas for improvement. For instance:

• SP Feedback for OR Staff: Reporting on improperly sorted or heavily soiled instruments, highlighting successes in point-of-use practices, and suggesting targeted training if recurring issues arise.

• OR Feedback for SP Staff: Providing input on instrument sterilization quality, turnaround times, and overall readiness of surgical trays.

Acting on this feedback is equally important. Regular team meetings, training sessions, and collaborative workshops can address identified challenges and reinforce best practices. Providing metrics from both sides can assist each team with setting actionable goals. This feedback loop not only fosters mutual respect but also creates a culture of accountability and continuous learning.

Figure 2: Reporting heavily soiled instruments is an important part of SP feedback for OR staff.

Elevating Standards for Patient Care

The synergy between the SP and OR teams is critical for achieving optimal patient outcomes. By implementing point-of-use best practices, leveraging effective communication tools, and fostering a culture of feedback and continuous improvement, these departments can work together seamlessly. Critical collaboration between SP and OR staff lays the foundation for safer, more efficient patient care. HPN

REFERENCES:

1.American National Standard/Association for the Advancement of Medical Instrumentation. (2020). ANSI/AAMI ST79:2017 & 2020 Amendments A1, A2, A3, A4 (Consolidated Text) Comprehensive guide to steam sterilization and sterility assurance in health care facilities. Arlington, VA: Author.

2.Association of Perioperative Registered Nurses. (2025). Guidelines for perioperative practice. Pp. 423-426. Denver, CO: Author

3.Dr. Harry Hertz. (October/November 2015). Effective Communication Requires Caring, Explaining, Listening, and Living the Role. NIST.gov. https://www.nist.gov/baldrige/effectivecommunication-requires-caring-explaining-listening-and-living-role#:~:text=Effective%20communication%20requires%20explaining%20your,others%2C%20when%20they%20read%20it

Cody McElroy is the manager of sterile processing and high-level disinfection at University Hospitals Cleveland Medical Center, a Level One trauma center with over 500 beds. Cody has a BBA from Kent State University and an MBA from Cleveland State University. He also holds CSPDT and CSPM certifications from CBSPD. Cody also teaches the sterile processing program at Cuyahoga Community College in Cleveland, Ohio.

Critical Connections: Improving SP and OR Synergy - Practice Quiz

1.What is the primary focus of the partnership between the SP and OR?

A.Increasing hospital revenue

B.Ensuring optimal patient outcomes and operational efficiency

C.Training new surgical staff

D.Reducing hospital waste

2.Which point-of-use solution should never be used on surgical instruments due to its corrosive nature?

A.Neutral pH enzymatic detergent

B.Sterile water

C.Saline

D.Anti-stick phospholipid solution

3.What do anti-stick solutions help achieve during surgical procedures?

A.Sterilizing instruments mid-surgery

B.Reducing eschar build-up on electrosurgical instrument tips

C.Cleaning protein soils off endoscopes

D.Lubricating robotic devices

4.Which instrument organization steps help sterile processing efficiencies?

A.Sort instruments into their original containers

B.Discard disposable items

C.Group sharp items and align tips

D.All of the above

5.What can sterile processing do to help instrument counts in the OR?

A.Use borescopes

B.Identify damaged instrumentation

C.Cutting tests

D.Replace missing instrumentation

6.What is needed to have effective communication?

A.Empathy and concise language

B.Active listening and generalities

C.Openness and clarity

D.Identifying blame and reconciliation

7.How can tagging systems improve communication between SP and OR teams?

A.Fosters responsibility in both departments

B.Identifies sterile processing failures

C.Tracks disposable surgical items used

D.Eliminates the need for verbal communication entirely

8.What is an essential component of the feedback loop between SP and OR staff?

A.Limiting communication to emergencies only

B.Holding one-sided performance reviews

C.Regularly reviewing performance and identifying areas for improvement

D.Eliminating cross-departmental training

9.What is a recommended strategy for fostering a cooperative environment between SP and OR teams?

A.Creating separate workflows for each department

B.Conducting cross-departmental training sessions

C.Avoiding discussions of workflow challenges

D.Prioritizing verbal communication alone

10.What is the ultimate benefit of enhancing collaboration between SP and OR teams?

A.Faster emergency response times

B.Reduced need for surgical training sessions

C.Elevating standards for patient care

D.Increased hospital staff retention rates

Brushes on the Clean Side

BY ADAM OKADA

Q: “We recently conducted a mock survey, and the consultant told us that it was acceptable to use brushes in the prep/pack area for inspection. When I argued, they said there are no standards saying you can’t use them. Can you use brushes to inspect instruments on the clean side of sterile processing? Are there any standards that speak to this?”

A: There are many “experts” in sterile processing. I see a lot of them on social media pages—not everything found on Facebook or a Reddit thread is good quality information—but it’s surprising to hear this coming from a consultant who is supposed to be guiding your facility in the right direction. The answer is “NO,” you shouldn’t use brushes in the inspection areas, but let’s dive deeper into why.

Standards

There are standards that support not using brushes on the clean side. The big one that sterile processing departments use is ANSI/AAMI ST79:2017 Comprehensive guide to steam sterilization and sterility assurance in health care facilities (also colloquially known within the industry as the “sterile processing bible”). Blasphemy aside, let’s see what it has to say on the subject:

ANSI/AAMI ST79:2017 - 7.6.1 General considerations1

h) Brushing is a cleaning function and should only be done in the decontamination area and not in the clean (preparation and assembly) area.

That’s clear instruction from AAMI ST79:2017, and it’s not up for debate. If your facility follows AAMI standards, or especially if they are referenced in your policies, then you should follow that statement.

So why the confusion?

As with most debates in the sterile processing (SP) space, the confusion comes from a good place. We know we should make sure lumened instruments are inspected for cleanliness before being sterilized and sent to surgery, where contaminated instruments can potentially cause an infection.

In the old days (I sound like an old man SP technician now . . . when did that happen?!), brushes and/or sterile water flushes were the only tools at our disposal to “verify” (more on this word later) cleanliness. It’s likely that the consultant that came to your department also came from that era of “verification” of cleanliness by use of brushing.

This is further confused by manufacturers that sell brushes as “single-use inspection brushes,” and market them for “clean-side” inspection.

What is brushing?

This is not an existential or philosophical question. What it boils down to is the action: Brushing = Cleaning. You are brushing an instrument to see if you can remove soil from the device, and if the brush comes out either clean

ProChek-II™ from Healthmark, A Getinge company. (Reference 5)

or soiled, you can “verify” if that device is clean or contaminated. Brushing is a cleaning action, and not a proper form of inspection.

Surveyors, like those from The Joint Commission (TJC), the Accreditation Association for Ambulatory Health Care (AAAHC), or DNV (which, fun fact, stands for Det Norske Veritas or “the Norwegian Truth”) also see brushing as a cleaning action, which is why surveyors have started giving findings to hospitals when they see brushes on the clean side. You might explain to them, “Well, these are inspection brushes. We only use them on the clean side,” but a surveyor doesn’t know the difference between using brushes in different settings. They see a brush, and a brush is used for cleaning.

If you are still using brushes on the clean side, the other factor that you should consider is, “What happens

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when we find soil on an instrument after brushing?” That instrument (and the entire set it came from) should be sent back to the decontamination area.

What about cross contamination?

That brush is certainly contaminated, and possibly the workstation; maybe even the technician who was holding the brush? Brushes clean by way of friction against surfaces, so is there a possibility that the brush aerosolized contamination? All things to consider with this issue.

What should we use if we shouldn’t use brushes on the clean side?

This is really the crux of our issue today. If Brushing = Cleaning, what are some ways that we can inspect these devices? Let’s get back to that terminology from earlier.

Verify: to establish the truth, accuracy, or reality of. (Merriam-Webster Dictionary online.)2

In this case, we are establishing our claim that our particular instrument or device is clean. There are a few ways to do this in modern times. (Another phrase that makes me sound ancient!)

Visual inspection: One of my favorite all-time keynote speeches at Healthcare Sterile Processing Association (HSPA) was when the legendary Sharon Greene-Golden gave her “View from My Window” talk. She talked about how in the old days ( you know, since we’ve clearly established my old age now), “We used to clean suctions in decontamination, send them over to the clean side, say the magic words, ‘Hakuna Matata,’ and hope for the best!”3,4 But now we have microscopes and borescopes and can visualize all the things we couldn’t previously see. Want to know if your lumen is clean? Put a borescope down the lumen and see if it was cleaned properly.

Swabs: Another form of inspection that should be considered. Swabs are used in various industries for sample collection purposes. (Note: Surveyors are seeing them in the medical field.)

Cleaning verification tests: Objective methods of testing that are run to show cleanliness of a device. If swabs and visual inspection are still considered subjective methods (meaning up for interpretation), then cleaning verification testing would be an objective method (meaning unbiased and based on factual data or measurable phenomena).

Isn’t that what we’re really looking for—something measurable that can show if a device is contaminated?

There are several cleaning verification tests sold by many manufacturers in the sterile processing space. They can be:

Protein-based: testing for residual protein.

Hemoglobin-based : testing for presence of hemoglobin.

Adenosine triphosphate (ATP): testing for the primary energy carrying molecule found in all living cells.

Some cleaning verifications5,6,7 combine multiple methods of testing:

Conclusion

Brushes are cleaning instruments and should not be used for inspection purposes. To avoid cross-contamination and issues with surveyors, it is best practice to keep brushes in the decontamination area and to utilize visual inspection, inspection swabs, or cleaning verification testing methods in prep and pack areas.

Take it from an old, old man like me! HPN

REFERENCES:

1. AAMI (2017). ANSI/AAMI ST79:2017 Comprehensive guide to steam sterilization and sterility assurance in health care facilities, 7.6.1 General considerations. Arlington, VA: Association for the Advancement of Medical Instrumentation.

2. Merriam-Webster Online. (n.d.). VERIFY Definition & Meaning. Merriam-Webster Dictionary. https://www.merriam-webster.com/dictionary/verify

3. Allers, R., Minkoff, R. (Directors); Mecchi, I., Roberts, J., Woolverton, L. (Writers). (1994). The Lion King [Film]. “Hakuna Matata.” Walt Disney Animation Studios. Burbank, CA.

4. Greene-Golden, S. (Sunday, May 7th, 2023). “View From my Window” [eShow Management conference]. Healthcare Sterile Processing Association (HSPA), Gaylord Opryland Resort & Convention Center (Delta A). Nashville, TN. https://s6.goeshow.com/hspa/annual/2023/conference_programs_sessions.cfm?session_key=6FDE4DC9-DF5E-071C-A5FAB5644239C698&session_date=Sunday,%20May%2007,%202023

5. Healthmark. (Dec 2024). ProCheck-II™. Healthmark, A Getinge company. https://www.hmark. com/product/expose-contaminants-on-surfaces-with-prochek-ii

6. Healthmark. (Dec 2024). Getinge Assured SafeStep - ATP Monitor. Healthmark, A Getinge company. https://www.hmark.com/product/getinge-assured-safestep-atp-monitor/ 7. Getinge. (2019). Getinge Assured SafeStep - ATP Monitor [White paper/Sales Flyer]. Getinge AB. https://www.getinge.com/dam/hospital/documents/english/mcv00095087-safestepflyer-us-en-us.pdf

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.

Getinge Assured SafeStep - ATP Monitor. (Resources 6 & 7)

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Certified Sustainability: How Hospitals Can Set and Meet Anesthetic Gas Waste Benchmarks

Generate the data required for TJC’s Sustainable Healthcare Certification.

BY CHRIS STAUFFER

U.S. hospitals understand their impact on the environment, including their production of harmful carbon emissions.1 One area they are targeting for reduction is greenhouse gas (GHG) emissions produced by inhaled anesthetics.

With approximately 50 million patients each year in the U.S. undergoing general anesthesia, hospitals have a tremendous opportunity to reduce GHG emissions through use of low- and minimal-flow anesthesia and the recirculation of sample gas.2

To encourage hospitals in their decarbonization efforts, The Joint Commission (TJC) has established its Sustainable Healthcare Certification. It is a framework to help healthcare organizations expand or continue their decarbonization efforts and to receive public recognition of their commitment and achievements in contributing to environmental sustainability.3

A key requirement to achieve Sustainable Healthcare Certification is providing TJC data demonstrating emissions reduction. A hospital must present baseline emissions data for GHG sources during the initial review process, and 24 months of

data to demonstrate a reduction for recertification.

This article provides answers to commonly asked questions around the benefits of achieving Sustainable Healthcare Certification, why inhaled anesthesia is a target for reduction, and how hospitals can generate the data required to benchmark baseline anesthetic gas emissions and show a reduction over time.

Why get certified?

As described on TJC’s website,3 certification in sustainability can help hospitals reduce environmental impact, enhance reputation, and improve health outcomes for patients, staff and the community.

Through energy-efficient practices, hospitals can achieve operational efficiencies that result in cost reductions. They may also “qualify for tax incentives to finance climate resiliency and renewable energy infrastructure projects.”

Additionally, “sustainability practices can help mitigate environmental, societal, and financial risks, ensuring that hospitals are prepared to adapt to changing regulatory landscapes and potential disruptions.”

5 key benefits of TJC

Sustainable Healthcare Certification

• Environmental impact reduction

• Cost savings

• Improved health outcomes

• Enhanced reputation and community engagement

• Regulatory compliance and risk mitigation

Who is eligible for certification?

Voluntary Sustainable Healthcare Certification is open to any hospital or critical access hospital that meets the following requirements:3

• The organization must be in the U.S., operated by the U.S. government, or operated under a charter of the U.S. Congress

• The organization is a hospital or critical access hospital that is compliant with applicable federal laws, including applicable Medicare Conditions of Participation

• At the time of review, the organization needs to have baseline emissions data for three GHG emission sources and an action plan to reduce

• At the time of recertification, the organization needs to have 24 months of data and demonstrate a reduction of three GHG emission sources

Why target inhaled anesthetics?

Anesthetic gas use, including volatile agents and nitrous oxide, is one of the six GHG emission sources TJC considers for certification. The others are as follows:3

• Energy use (fuel combustion)

• Purchased electricity (purchased grid electricity, district steam, chilled and hot water)

• Pressurized metered-dose inhaler use

• Fleet vehicle carbon-based fuel use (from organization owned vehicles)

• Waste disposal

In high-income countries, including the U.S., inhaled anesthetic gases released directly into the atmosphere are estimated to contribute 5% of acute hospital CO2e emissions and 50% of perioperative department emissions.3 The anesthetics desflurane and nitrous oxide contribute the most emissions out of the major medical GHGs, equivalent to driving 12 million gasoline-powered cars annually in the U.S.4

While inhaled anesthetics are a significant source of harmful healthcare emissions, there are practices hospitals can implement and supporting technologies they can deploy to help reduce their impact.

In its Action guidance for addressing pollution from inhalational anaesthetics, the Association of Anaesthetists recommends hospitals “avoid inhaled anesthetics with disproportionately high climate impacts, such as desflurane and nitrous oxide,” and select “the lowest possible fresh gas flow” when using inhaled anesthetics.5

With regards to the latter, there are anesthesia machines available to hospitals today that are designed to help facilitate the use of low- and minimal-flow anesthesia and the recirculation of sample gas. The benefits of this approach may go beyond sustainability. Low- and minimal-flow anesthesia delivery techniques are

associated with lower costs and can offer clinically relevant benefits.6

How can my hospital access data on anesthetic gas usage?

As noted previously, there are two data sets TJC requires a hospital to provide for Sustainable Healthcare Certification:

• During the review process, baseline emissions data for the three GHG emission sources they are targeting to reduce

• For recertification, 24 months of data and demonstration of a reduction of three GHG emission sources Additionally, TJC requires certified organizations to convert greenhouse gas measurements to metric tons of carbon dioxide equivalents (MTCO2e). Digital transformation of hospital processes and the leveraging of data for actionable analytics has increased in recent years, with hospital executives prioritizing investments in enabling technologies.7 When it comes to analytics on anesthetic gas usage, perioperative teams and anesthesia providers might question where this data exists in their infrastructures and how they can access it.

With increased recognition for the impact of anesthetic agent usage on a hospital’s costs, patient care quality, and environmental footprint, applications have emerged that provide gas consumption analytics for networked anesthesia machines.

A hospital can meet TJC requirements for its Sustainable Healthcare Certification by leveraging gas consumption analytics to:

• Gain transparency on inhaled anesthetic gas consumption, uptake, efficiency, cost, and applied fresh gas flows

• Analyze the usage of desflurane, nitrous oxide, sevoflurane, and isoflurane

• Visualize the CO2 equivalent of each wasted anesthetic agent

• Review performance and improvements in anesthetic and gas use reduction with indicators such as efficiency (uptake vs consumption), cost per case, total cost, and fresh gas flows used

• Filter the data by selecting single operating rooms (OR) or cases, case durations, and specific time frames

• For individual reporting purposes or subsequent analysis, the collected data can be exported into a spreadsheet

As evidenced by TJC’s Sustainable Healthcare Certification initiative and the Association of Anaesthetists’ published guidance, reducing anesthetic gas waste is a core component of U.S. hospitals’ sustainability efforts, aligning with broader goals to help minimize healthcare’s environmental footprint.3,5

TJC’s certification provides a structured path for hospitals to measure, report and reduce GHG emissions, reinforcing their commitment to responsible healthcare practices. Gas consumption analytics for networked anesthesia machines can serve as a valuable tool for helping hospitals meet sustainability benchmarks and drive meaningful change.3 HPN

REFERENCES

1. Hospitals and the environment: Pressure to do better, Chief Healthcare Executive, April 22, 2024, https://www. chiefhealthcareexecutive.com/view/hospitals-and-theenvironment-pressure-to-do-better

2. Uday Jain, Dolores Njoku, Chris R. Giordano; Waste Anesthetic Gases: Focus on a Major Problem. ASA Monitor 2019; 83:26–28

3. Sustainable Healthcare Certification, TJC, https:// www.jointcommission.org/what-we-offer/certification/ certifications-by-setting/hospital-certifications/sustainablehealthcare-certification/

4. Wang J, DasSarma S. Contributions of Medical Greenhouse Gases to Climate Change and Their Possible Alternatives. Int J Environ Res Public Health. 2024 Nov 22;21(12):1548. doi: 10.3390/ijerph21121548. PMID: 39767390; PMCID: PMC11675797.

5. Devlin-Hegedus JA, McGain F, Harris RD, Sherman JD. Action guidance for addressing pollution from inhalational anaesthetics. Anaesthesia. 2022 Sep;77(9):1023-1029. doi: 10.1111/anae.15785. Epub 2022 Jun 21. PMID: 35729804; PMCID: PMC9543086.

6. Protective Ventilation in the OR, Clinical Benefits of Lowand Minimal- Flow Anesthesia, Dräger, https://www.draeger. com/Content/Documents/Content/low-flow-210x260-wp9105175-en-us-1801-1-K2.pdf

7. Deloitte 2025 U.S. health care outlook https://www2. deloitte.com/us/en/insights/industry/health-care/life-sciences-and-health-care-industry-outlooks/2025-us-health-careexecutive-outlook.html

The Sustainability of Sustainability

BY KAREN CONWAY

Recently, given changes in the federal government’s priorities, some have questioned whether hospitals and healthcare systems will continue to work to improve the environmental sustainability of their operations, which are estimated to represent more than eight percent of total U.S. greenhouse gas emissions. If attendance at this year’s CleanMed conference was any indication, the answer is a resounding “yes.” More than 800 people, on par with last year’s attendance, showed up in Atlanta for the event (even without the 40 or so representatives from the Veterans Administration who attended last year).

Those who did attend included your “usual suspects” – sustainability leaders and supply chain professionals, the latter particularly important given that a significant portion of the carbon footprint and waste generated by hospitals can be traced to the decisions made about the products procured for use in patient care and to run healthcare facilities. What was striking to me was the breadth of participants, which included more than 170 practicing clinicians, as well as researchers, manufacturers, group purchasing organizations, and a growing number of payors.

One of the attendees was Dr. John Balbus, who received the Visionary Leader Award from Healthcare without Harm (HCWH) at the conference. As leader of the White House Office of Climate Change and Health Equity during the Biden Administration, Dr. Balbus launched the Health Sector Climate Pledge, a voluntary commitment signed by more than 140 organizations, including those representing over 1200 hospitals (nearly 20 percent of US hospitals). With the closure of his office, Healthcare without Harm (HCWH) has launched a similar initiative, dubbed the Health Sector CARES (Climate Action, Resilience, and Equity Solutions) Pledge. The CARES pledge commitments are similar to the White House effort, including:

• Cutting direct greenhouse gas emissions (e.g., from fossil fuels consumed on site for energy use, medical waste incineration and transportation, etc.) and purchased energy (e.g., from utilities) in half by 2030 and achieving carbon neutrality by 2050.

• Developing a publicly available climate resilience plan to keep health facilities operating (e.g., during extreme

weather events) that takes into account the needs of vulnerable populations.

• Naming an executive-level leader for this work within six months of signing the pledge.

• Creating an inventory of Scope 3 carbon emissions (those related to procured products and services) within one year of signing the pledge.

Many of the speakers at the conference also addressed the myth that sustainable procurement is more expensive. Here are some examples of how supply chain is helping save the planet and money for their organizations.

• Nearly 70 percent of hospitals have already switched anesthesia gasses from carbon-intensive desflurane to lower emission and less expensive sevoflurane. By doing so, Yale New Haven realized an annual savings of $1.2 million; its largest hospital alone eliminated 1600 tons of carbon dioxide emissions (the equivalent of 360 gas powered cars). (Healthcare without Harm)

• U.S. hospitals and ambulatory surgery centers that used reprocessed single use devices in 2023 collectively saved more than $465 million, while keeping nearly 98 million pounds of carbon dioxide out of the atmosphere. (Association of Medical Device Reprocessors)

• University of Maryland Medical Center saved close to $750,000 in waste disposal fees over 15 years through the use of reusable gowns and drapes. (Practice Greenhealth)

• By installing nearly 1500 solar panels on buildings, the University of Nebraska Medical Center cut its energy costs in half. (Better Buildings Solutions Center) Advocating for and shepherding these kinds of programs often takes a dedicated sustainability leader, and even adding a new position can generate a quick return on investment. Several of the speakers at the conference spoke about how they convinced their leadership to create sustainability positions by promising their salaries would be easily covered by the savings they would generate. One of those leaders – Sara Wohlford from Carillion Clinic – was able to document $250,000 in just the first year, well beyond what it cost to create her new role.

How are you evaluating the financial and environmental sustainability of your supply chain decisions? HPN

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