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JANUARY 2025
Sourcing & Logistics
MATT MACKENZIE
8 > Preparing the Supply Chain for Disaster
32 > Clinical and Supply Chain Collaboration: An International Perspective
KAREN CONWAY
Infection Prevention
12 > Infection Prevention’s Role in Curbing Drug Diversion
JANETTE WIDER
Sterile Processing
16 > Back to Basics in the SPD
KARA NADEAU
24 > Making the Right Choice for Sterile Processing Consumable Stock Outages
MICHELE MCKINLEY
28 > Leading SPDs with Empathy, Gratitude
DAVID TAYLOR
30 > Wet Loads
ADAM OKADA
Departments
4 > New Year, (Some) New Topics
6 > What’s on the Web, Advertiser Index
New Year, (Some) New Topics
BY JANETTE WIDER, EDITOR-IN-CHIEF
As I mentioned in my last editorial of 2024, Healthcare Purchasing News (HPN) has decided to move away from the traditional grid format for editorial calendars that many of you are accustomed to seeing. The reason for that, because there’s always a method to our madness at HPN, is to ensure that we are consistently covering topical stories.
And speaking of topical stories, one such example is this edition’s cover story. The year 2024 saw numerous disasters, man made and natural. Associate Editor Matt MacKenzie comments on the year’s cyberattacks, including Change Healthcare in late February of 2024.
And further, MacKenzie covers hurricanes Helene and Milton in this very important story. As many of our readers are now aware of, the effects of Helene included Baxter’s North Cove facility in North Carolina being taken offline due to severe damage to the site, leading to disruptions in the supply chain for IV solutions.
Being based in Florida, Helene and Milton hit close to home, and HPN diligently covered the updates from Baxter as they became available. MacKenzie’s story starts on page 8.
Looking ahead, 2025 poses to be a very interesting year for the healthcare industry. At the time this edition was published, President-elect Trump has proposed tariffs on
foreign imports and made various nominations, including Mehmet Oz, M.D., to be the next Administrator of the Centers for Medicare & Medicaid Services (CMS) and Robert F. Kennedy Jr. to be the next Secretary of Health and Human Services (HHS).
These major happenings —cyberattacks, hurricanes, and a new President set to take office in 2025 — are a major reason why HPN chose to remain more flexible this year when it comes to editorial content in print.
I’d also like to share that Stephen M. Kovach, previous author of SP Insights, has picked a successor, Adam Okada, who has his first column of the year on page 30. Okada starts the year off strong with a double Q&A on wet loads and what Kovach is like in real life! (You don’t want to miss this piece.)
And don’t worry, HPN will cover its usual topics throughout the year as well, including inventory automation, offsite reprocessing, and, of course, celebrating a Sterile Processing Department of the Year as well as a Supply Chain Department of the Year. Keep your eyes out for announcements on our website for instructions on how to apply and important deadlines.
Finally, if you have comments on the proposed tariffs or a timely story to share, please reach out to me at jwider@hpnonline.com.
January 2025, Vol. 49, No. 1
VP & Market Leader
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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 60065-3257. SUBSCRIPTIONS: Publisher reserves the right to reject non-qualified subscriptions. Subscription prices: U.S. $160.00 per year; Canada/ Mexico $193.75 per year; All other countries $276.25 per year. All subscriptions are payable in U.S. funds. Send subscription inquiries to Healthcare Purchasing News, PO Box 3257, Northbrook, IL 60065-3257. Customer service can be reached toll-free at 877-382-9187 or at HPN@omeda.com for magazine subscription assistance or questions. Printed in the USA. Copyright 2025 Endeavor Business Media, LLC. All rights reserved. No part of this publication June be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopies, recordings, or any information storage or retrieval system without permission from the publisher. Endeavor Business Media, LLC does not assume and hereby disclaims any liability to any person or company for any loss or damage caused by errors or omissions in the material herein, regardless of whether such errors result from negligence, accident, or any other cause whatsoever. The views and opinions in the articles herein are not to be taken as official expressions of the publishers, unless so stated. The publishers do not warrant either expressly or by implication, the factual accuracy of the articles herein, nor do they so warrant any views or opinions by the authors of said articles.
Is Your Scale NTEP Approved?
We’ve all used scales that are NTEP certified when buying bananas at the store, since it’s critical for the weight to be accurate between the buyer and seller of the bananas. And yet a pediatric scale weighing our baby or a physician scale weighing us before surgery for assigning dosages isn’t held to the same criteria as a bunch of fruit or vegetables.
DETECTO has received NTEP (National Type Evaluation Program) approval administered by the National Conference on Weights & Measures for most of our major medical scales. How does this help you as the consumer? This verifies from a regulated governing body that our scales are manufactured to the highest accuracy and quality possible for medical scales used to treat patients.
What’s on the Web
WHO Report Shows Global Progress on HAIs Not Moving Fast Enough
A new global report on infection prevention and control (IPC) from the World Health Organization (WHO) shows “there has been slow progress in addressing critical gaps to prevent healthcare-associated infections (HAIs).” Many HAIs can be prevented with “improved IPC practices and basic water, sanitation and hygiene (WASH) services, which are also a highly cost-effective ‘best buy’ to reduce antimicrobial resistance (AMR) in healthcare settings. The report launched at an Italian G7 side event.
Read on: hpnonline.com/55246635
FDA Guidance on Ethylene Oxide Sterilization Facility Changes for Class III Devices
The FDA issued guidance entitled, “Transitional Enforcement Policy for Ethylene Oxide Sterilization Facility Changes for Class III Devices.” The guidance aims to provide a transitional enforcement discretion policy for manufacturers of certain Class III devices to respond to anticipated changes in ethylene oxide (EtO) sterilization activities. The guidance helps to prevent or mitigate the potential risk of medical device supply chain disruptions during the transition to comply with new requirements. Read on: hpnonline.com/55246601
Offsite Reprocessing with Ash Crowe
Ash Crowe, director, healthcare, St. Onge Company, joins Editor-in-Chief Janette Wider on this episode to talk about offsite reprocessing. Ash gives listeners an overview of offsite reprocessing in the U.S., discusses the numerous benefits, touches on the landscape preand post-COVID, as well as gives insight into implementating offsite reprocessing at your organization. Healthcare Hodgepodge is available on your favorite podcasting app and releases an episode each Wednesday. Subscribe today so you never miss an episode! Listen at: hpnonline.com/55247031
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
Time saving advantages of a new electronic bowie and dick test system
d dick test system
By: Craig Wallace, Medical Device Sterilization and Disinfection Industry Consultant,
Bowie-Dick (BD) testing of pre-vacuum sterilizers is an important part of sterilization quality control programs for hospital steam sterilizers, to make sure the air removal system is working properly. The generally accepted testing frequency is once per day per sterilizer.1,2
A new BD test system, 3M™ Attest™ eBowie-Dick Test System, uses a small test card with electronic sensors instead of a traditional BD test pack with a chemical indicator sheet.
After the cycle, the eBD test card is placed in a reader that translates the electronic results into a Pass or Fail response as a green or red light. The accompanying reader software automates the record keeping process by capturing test results, eBD test card lot numbers and links them with the sterilizer number and cycle records. The software can also be connected to the hospital’s instrument tracking system to automatically integrate eBD test results into the department’s instrument tracking records.
3M™ Attest™ Connect PC Application
3M Attest eBowie-Dick Test Card 10135
3M™ Attest™ eBowie-Dick Auto-reader 1190
3M™ Attest™ eBowie-Dick Test Card Holder 10135CH
“Information may be recorded in a paper or electronic log or filed as individual documentation records. Electronic records of sterilization process monitoring results, including specific load item identification, are recommended.”1
– AAMI ST79
Five U.S. hospitals participated in this Bowie and Dick Record Keeping Time study. Timing measurements were conducted five separate times at each hospital over a maximum of two calendar weeks.
Assessment of the seemingly moderate record keeping time savings of 1.3 minutes/sterilizer/day should consider the amplifying effect of multiple sterilizers in the facilities’ sterile processing department. A four-sterilizer department will see an additional 26 minutes of technician time become available each five-day work week, with 36 minutes/week for a seven-day operation. The potential impact becomes even more substantial when assessing the impact across an entire Integrated Delivery Network (IDN). Average time savings for a 10-hospital system could potentially free-up over four hours of technician time per week.
hired to write this article for Solventum.
PREPARING THE SUPPLY CHAIN FOR
With cyberattacks and natural disasters on the rise, HPN spoke with Katie Korte, VP of assurance and continuity at Vizient, about what steps to take to prevent worst-case scenarios.
BY MATT MACKENZIE, ASSOCIATE EDITOR
DISASTER
Due to the sensitivity and critical importance of their work, healthcare facilities are especially vulnerable to disasters of both the manmade and natural varieties.
According to the Office of the Director of National Intelligence, the number of ransomware attack claims worldwide rose 74 percent in 2023 compared with 2022. Specifically, ransomware attacks against the healthcare sector “nearly doubled” over that span, “reaching a total of 389 claimed victims in 2023 compared with 214 in 2022.” In the U.S. specifically, attacks against the healthcare sector were in fact “up by 128 percent.” Cyberattacks lead to any number of issues, including delays in medical procedures, disrupted patient care due to multiweek outages, and “strained acute care provisioning and capacity.”
A major cyberattack on Change Healthcare in late February of 2024 brought these issues into full relief. According to the House Energy & Commerce Committee, Change Healthcare, a subsidiary of UnitedHealth “acts as a clearing house for 15 billion medical claims each year—accounting for nearly 40 percent of all claims.” The cyberattack knocked them completely offline, creating a “backlog of unpaid claims” and resulting in “serious cashflow problems” at doctors’ offices and hospitals. Alarmingly, the Energy & Commerce Committee in the House of Representatives found that UnitedHealth “wasn’t using multifactor authentication…to secure one of their most critical systems,” leading to an estimated one-third of Americans having their “sensitive health information leaked to the dark web.” Andrew Witty, the CEO of UnitedHealth, told the Committee that he paid $22 million in Bitcoin as ransom to the criminals, but the company still cannot guarantee that more information won’t be leaked.
On top of manmade disasters, climate change is increasing the volatility and frequency of major hurricanes in the southeast United States, evinced by hurricanes Helene and Milton. These two storms caused massive disruptions in healthcare in the fall of 2024. One of the most pressing knock-on effects of Hurricane Helene was Baxter’s North Cove facility in North Carolina being taken offline due to severe damage to the site. This led to acute disruptions in the supply chain for IV solutions. The threats to healthcare facilities due to natural disasters are multifarious, and different parts of the country are becoming increasingly susceptible to different types of these disasters that require different mitigation strategies.
Healthcare Purchasing News was able to speak with Katie Korte, vice president of assurance and continuity at Vizient, about preventative measures that are being taken to bolster the strength of the supply chain in the wake of natural
disasters like hurricanes Helene and Milton and the looming specter of cybercrime.
What types of disasters (natural or otherwise) strain supply chain most?
The vulnerability of the supply chain was magnified through the pandemic as both consumers and hospitals struggled to access basic goods. These vulnerabilities consistently led to disruptions in the market due to a variety of triggers including natural disasters such as hurricanes, earthquakes, and floods, as well as cyberattacks, geopolitical tensions, labor shortages, and inflation. Each disruption strains the supply chain differently, ranging from reduced manufacturing operations and delayed delivery of products to compromised digital systems needed for real-time supply chain management and coordination.
Katie Korte
What preventive steps can be taken in advance of a hurricane or other disaster?
Proactive preparation can distinguish a health system during times of disaster. Key strategies for building resilience to supply disruptions include identifying critical items through proactive cross-referencing, diversifying supplier networks, mapping critical supply chains, and strategically pre-positioning inventory. In events like hurricanes, these measures help health systems minimize disruptions and maintain operations. In addition, healthcare organizations can further strengthen their resiliency strategy by incorporating demand planning with a robust sourcing strategy. This can drive the production of vital, life-saving products by increasing pooled or dedicated inventory. By strategizing essential medications and critical care supplies, health systems can navigate disruptions without compromising patient care.
How do hurricanes (like Helene and Milton) affect supply chain?
Hurricanes have the potential to impact every aspect of the supply chain, causing widespread disruptions. Healthcare organizations, suppliers, and distributors may experience flooding, loss of power, road closures, and interrupted transportation. These disruptions are further exacerbated by labor shortages, operational challenges, and potential damage to products stored in affected facilities. The situation becomes even more critical due to the heightened demand for essential supplies like medications, medical equipment, and fuel for backup generators. For example, Hurricane Helene caused severe destruction in the communities it affected, including catastrophic damage to a major IV fluid manufacturing plant. This event halted production, resulting
in a nationwide IV fluid shortage that impacted healthcare organizations for several months.
What technological advancements have there been to strengthen supply chain against the impact of natural disasters?
Technological advancements have significantly enhanced the resilience of supply chains during natural disasters. Healthcare organizations now have access to various tools that utilize predictive analytics and artificial intelligence to anticipate potential disruptions. For instance, some platforms process real-time data related to weather patterns, geopolitical events, supplier reliability, and financial risks. By providing greater supply chain visibility, these technologies support risk management through supplier site mapping, automated disruption monitoring, and tailored mitigation strategies, empowering healthcare organizations to make informed, proactive decisions.
How do man-made events, like cyberattacks, affect supply chain?
Man-made disruptions can have a profound impact on the supply chain, sometimes proving even more severe than natural events. In 2024, a significant cyberattack targeted a major healthcare payment processor, leading to substantial delays in electronic payments and claims processing. Although this might not seem directly linked to the supply chain, it caused delays in patients receiving essential medications. While recent reports show a decrease in cyberattacks on large health systems, the total number of cyber incidents is rising, likely due to organizations adopting stronger protective measures. Despite these advancements, the persistent threat of cyberattacks highlights the critical need for comprehensive cybersecurity strategies within supply chains and healthcare systems.
What lessons have been learned in the wake of hurricanes like Helene and Milton?
The impacts of hurricanes Helene and Milton have highlighted the vital role of proactive supply chain resilience in healthcare. Key takeaways emphasize the importance of strategic partnerships, diversified sourcing, and improved transparency via real-time data monitoring to maintain continuity of care during disruptions. Providers can boost supply chain resilience and support uninterrupted patient care by identifying their critical care supplies and essential medications. Once identified, they can strategize with manufacturers and suppliers through their contracts for increased inventory to help ensure availability during times of disruption. HPN
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Infection Prevention’s Role in Curbing Drug Diversion
James Davis of ECRI shares insights on the current state of drug diversion in the U.S. as well as the impact infection preventionists can make in their facilities.
BY JANETTE WIDER, EDITOR-IN-CHIEF
In November of 2024, The Rogue Valley Times reported that “Civil cases filed against Asante Rogue Regional Medical Center continue to build over allegations that a former hospital nurse caused injury and death to a number of patients by diverting prescription fentanyl and replacing it with non-sterile tap water.
“The latest lawsuit, which specifically names former hospital nurse Dani Marie Schofield as a former employee but does not list her as a defendant, was filed Thursday, Nov. 14, in Jackson County Circuit Court by attorney Tom Petersen of Medford law firm Black, Chapman, Petersen, Stevens.
“The suit seeks $22.4 million from Asante and lists Rebecca Rogers and the estates of Marty Bolin and Ronald Sizemore as plaintiffs. It alleges that Schofield was under the hospital’s employ when she caused ‘severe blood infections and painful conditions and/ or death as alleged’ by diverting powerful drugs.”
A recent blog post from ECRI stated, “Longtime infection prevention leaders likely remember the story of David Kwiatkowski—a healthcare worker whose drug diversion activities put thousands of patients at risk of hepatitis C infection. Kwiatkowski, who worked as a traveling radiology technician, had a ‘system’ for diverting drugs from his employers. ‘He would steal vials of painkillers, inject the drugs, and then cover his tracks in various ways including methods that lead to his blood tainting vials of medication of which was delivered into patients.’”
Further, “For years, Kwiatkowski evaded detection as he moved among different hospitals in different states. Even when he was caught and terminated from one facility, liability concerns kept administrators from taking further action. As a result, at least 45 patients contracted hepatitis C. One person died.
“Today, hospitals and their patients are safe from Kwiatkowski as he serves a maximum sentence of 39 years. Yet drug diversion remains an issue everywhere—and the Kwiatkowski example illustrates the need for infection prevention teams to pay close attention to this phenomenon.”
Stories like this may sound like the plot of Nurse Jackie, but drug diversion should not be taken lightly by hospital staff. Healthcare Purchasing News had the opportunity to speak with James Davis, the author of the ECRI blog post, about how infection prevention plays a role in reducing drug diversion.
Davis has over 25 years of nursing and infection prevention experience, spanning long-term care, adult critical care, clinical decision support, education, nurse management, and infection prevention. Currently, he serves as Manager of Infection Prevention Control at ECRI, managing local, national, and international response and multidisciplinary teams, delivering actionable plans to mitigate or eliminate threats related to infectious pathogens.
Davis also served at Abington Memorial Hospital (now Jefferson Abington); The Pennsylvania Patient Safety Authority; and consulted with Lippincott Williams & Wilkins, Wolters Kluwer.
Davis has an active RN license in the state of Pennsylvania. He is board-certified in infection control and epidemiology (CIC) and holds certifications in adult critical care nursing (CCRN-K). He is a member of the Association for Professionals in Infection Control and Prevention (APIC), is an APIC Fellow (FAPIC), has served as President of the Philadelphia/Delaware Valley Chapter, and is a past Chair of APIC’s National Research Committee.
Davis has provided educational programs on infection control topics for risk management groups and patient safety organizations, for hospitals, long-term care facilities, and ambulatory surgery systems. He designed the second version of the Pennsylvania Patient Safety Authority’s long-term care healthcare-acquired infection reporting system and analytics programs. He also developed tools and resources for healthcare facilities to translate and implement research into clinical practice as part of work for the Advisory, a peer-reviewed journal of the PA Patient Safety Authority. Davis has authored multiple infection prevention and control articles and is published in several international peer reviewed journals.
Can you give us some background on drug diversion? How prevalent is drug diversion among healthcare workers? Drug diversion is defined by HHS as “the illegal distribution or abuse of prescription drugs or their use for purposes not intended by the prescriber. Prescription drug diversion
James Davis
may occur at any time as prescription drugs are distributed from the manufacturer to wholesale distributors, to pharmacies, or to the patient. Members of the medical profession may also be involved in diverting prescription drugs for recreational purposes, relief of addictions, monetary gain, self-medication for pain or sleep, or to alleviate withdrawal symptoms.”
HHS also says that the most common types of drug diversion are selling prescription drugs, doctor shopping, illegal internet pharmacies, drug theft, prescription pad theft and forgery, and illicit prescribing. Further, HHS says that the drug classes with the highest potential for drug diversion and abuse (according to the National Institute on Drug Abuse (NIDA) and the U.S. Drug Enforcement Administration (DEA)) are anabolic steroids, central
Relevant studies on the prevalence of drug diversion:
• Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration. 2019 National Survey on Drug Use and Health (NSDUH) releases: detailed tables. Published 2020. Accessed March 8, 2021. https://www.samhsa.gov/data/release/2019national-survey-drug-use-and-health-nsduh-releases
• Bell DM, McDonough JP, Ellison JS, et al. Controlled drug misuse by certified registered nurse anesthetists. AANA J. 1999;67:133-140. [PubMed]
• Inciardi JA, Surratt HL, Kurtz SP, et al. The diversion of prescription drugs by health care workers in Cincinnati, Ohio. Subst Use Misuse. 2006;41:255-264. [DOI] [PubMed]
• McCabe SE, Teter CJ, Boyd CJ. Medical use, illicit use, and diversion of abusable prescription drugs. J Am Coll Health, 2006;54:269-278. [DOI] [PMC free article] [PubMed]
• Centers for Disease Control and Prevention, National Center for Health Statistics. Mortality. In: National Vital Statistics System. Accessed March 8, 2020. https:// wonder.cdc.gov
• Institute of Medicine and National Research Council. Under the Influence? Drugs and the American Workforce. National Academies Press; 1994:49-100.
• Substance Abuse and Mental Health Services Administration. Key substance uses and mental health indicators in the United States: results from the 2019 National Survey on Drug Use and Health. Published 2020. Accessed March 8, 2021. https://www.samhsa.gov/ data/sites/default/files/cbhsq-reports/NSDUHFFR2017/ NSDUHFFR2017.htm
nervous system depressants, hallucinogens, opioids and stimulants.
As for prevalence among healthcare workers, according to an article entitled “Impaired healthcare professional” by Marie R. Baldisseri, one in 10 healthcare workers misuse drugs or alcohol during their careers.
*Editor’s Note: Please see the accompanying sidebar for relevant studies on the prevalence of drug diversion provided to HPN from Davis.
What tactics or methods do drug diverters use?
There are numerous ways that drug diversion can take place. Healthcare staff can pocket medications intended for patients or take the waste medication home. Waste medication is extra medication left over after a delivered dose. These are just a few of the many ways it can take place in a healthcare setting and go undetected. At ECRI and our affiliate organization ISMP (a global leader in medication safety), we focus on educating organizations to reduce the risk of diversion by implementing strategies to make it hard to divert, make it more visible should a diversion occur, and should it happen, mitigate harm to self and others.
What are the consequences of an individual doing this?
Drug diversion in healthcare settings is a serious issue with far-reaching consequences. It not only jeopardizes patient and workforce safety, but it also undermines trust in the healthcare system.
Sometimes drug diversion can deprive patients of the medications they need. They could receive incomplete doses, or no medicine at all. For healthcare providers, drug diversion can lead to compromised care and increased liability. Healthcare providers or staff under the influence of drugs can deliver unsafe care.
There are also infection prevention implications, especially if a drug diverter is taking the medications themselves. Impaired providers and patients can become infected with HIV, hepatitis, and other diseases specifically associated with IV drug abusers. Providers could spread other types of infection due to viruses or bacteria, creating clusters and outbreaks of infections.
Beyond the human toll this problem can take, a healthcare organization will have a reputation crisis as well as financial penalties if a diverter has gone a long time without being caught.
Addressing drug diversion is critical to ensuring the integrity of care, the safety of patients and staff, and the well-being of the communities we serve.
Can you share a few more thoughts with us on how infection prevention plays a role?
Infection preventionists should be part of a multi-disciplinary team, committee, or taskforce for the prevention of drug diversion. It’s important for facilities and infection prevention personnel to be on the lookout for epidemiologically related clusters of infections and links to diversion behaviors. Bring any concerns or findings to the task force for further investigation. In addition, strengthen outpatient surveillance activities, as many infections may be patient in their onset and not manifest while patients are admitted. Controls should be created by the committee or taskforce that cross many departments including but not limited to pharmacy, nursing, medicine, surgery, anesthesia, risk management, and clinical human factors engineers.
Are there any technologies that assist with stopping drug diversion?
There is useful data collected by medication-related storage and dispensing technologies that organizations should
monitor on a regular basis. Auditing reports for automated dispensing cabinets and smart IV pumps have demonstrated useful in identifying suspected diversion. There are software programs that can be used with other electronic healthcare data to help organizations screen for potential diversion. Advances in hardware of medication-related devices have helped to make tampering more evident. Machine learning may also prove useful at strengthening targeted surveillance of infection data, especially in outpatient and other non-hospital environments.
Any tips for our readers about how to talk to your infection prevention team about this topic?
If the infection prevention team is not currently included in drug diversion prevention activities and working groups, ensure they are given seats at the table. Their experience in epidemiology and other disciplines is very valuable. Explain the benefits of identifying clusters and outbreaks and the importance of staying vigilant about drug diversion, especially if epidemiologic data shows there could be a link. HPN
Back to Basics in the SPD
HPN highlights sterile processing department (SPD) practices that are foundational to effectiveness and safety.
BY KARA NADEAU, SENIOR CONTRIBUTING EDITOR
When I asked the sterile processing (SP) community on LinkedIn what topics they would like HPN to cover in 2025, there was significant interest in “back to basics” in the SP department (SPD). Several SP professionals reached out to me directly to share their insights on this subject, including challenges faced and tips for reinforcing basic practices among SPD team members.
With the tremendous response to my requested comments on this topic from SP professionals, I have done my best to summarize some of the most relevant “back to basics” lessons cited in my interviews for this article. Additionally, I have included advice from SP professionals on how to reinforce basic best practices among team members.
Why is getting back to the basics so challenging in the SPD?
When asked why standard practices in the SPD may be overlooked, Nancy Fellows, MSN, MPA, RN, CNOR, senior clinical education consultant, ASP, cited the following factors:
“Staffing shortages have plagued healthcare since the COVID-19 pandemic. Fewer staff members means less productivity. Additionally, the complexity of the SPD employee’s roles and responsibilities has increased due to the intricacy of today’s surgical instruments as well as interpreting manufacturers’ instructions for use (IFU).”
Fellows also cited poor quality training as a factor for noncompliance. She noted how “training is often provided from one employee to another without the behavioral understanding of the task, resulting in skipped critical steps being replaced by reasonable habits on how things should be done.”1
Fellows summed up the overall importance of addressing what could be considered minor compliance issues:
“Small breaches in standard practice may not have an overall significant impact, such as eating in the department, brushing under water and not over it, placing chemical indicators in the wrong places, and sticking things like count sheets in the folds of wrapped trays; however, a strong, skilled, competent SPD staff performing essential invasive
surgical device reprocessing is critical to quality patient care and safe patient outcomes.”
Basic best practices throughout the SPD
Some of the most common basic best practice breaches cited by SP professionals for this article were those that can occur anywhere in the department.
With more than 50,000 members and certification holders worldwide, the Healthcare Sterile Processing Association (HSPA) routinely fields questions from its members and other SP professionals on standard practices in the SPD, according to HSPA Vice President of Strategic Initiatives, Damien Berg, BA, BS, CRCST, AAMIF.
When asked to provide his insights for this article, Berg stressed the importance of addressing the basics of infection prevention and employee safety before launching into more specific basic requirements for the core SPD areas.
Microbiology understanding “All who perform any SP-related duties should have received education (ideally, with at least annual and as-needed refresher courses) about microbiology basics and how to control microbial contamination,” said Berg. “Unfortunately, some facilities fail to provide a level of meaningful education in that regard,
which can jeopardize employees’ own safety and lead to cross-contamination of environmental and equipment surfaces and other devices.”
IFU and standards
Berg noted how facilities must understand that safe, effective processing hinges on the availability (and employees’ understanding of) the latest IFUs for all equipment, instruments, chemicals, and supplies.
“Many facilities fail to update their standards and guidelines libraries as revisions are made, and it’s not uncommon for IFU to be difficult for employees to access and understand,” he commented. “IFU and standards/ guidelines should be well organized and maintained and placed in a dedicated location that is readily accessible to all technicians. If IFU are missing, vague, or confusing, it is vital that the manufacturer be contacted directly for clarification and, if necessary, additional training.”
Proper, consistent use (and discarding) of PPE
“This is among the most vital safety and infection prevention requirements that must always be followed,” said Berg. “In countless social media posts from SP technicians - and even during some in-person SPD visits over the years - we have seen inappropriate use of PPE or instances where it is not providing adequate coverage.”
“It’s not uncommon to see hair uncontained by head and beard coverings, masks slipping below the nose, and face shields failing to provide proper coverage and protection from splashes and aerosolization in the decontamination area,” Berg continued.
Consuming food and beverages
In both my interview with her and in her recent webinar, Nightmare of SPD Street, Healthmark Clinical Education Specialist Malinda Elammari, CST, CSPM, CSPDT, CFER, CSIS, CRCST,
CIS, CHL, CER, CLSSGB, cited the problem of SP professionals eating in the department. She stated:
“We have found everything from candy wrappers in decontam to threecourse meals, including food and drinks, in departments. Beyond eating and drinking, SP professionals must remember not to put anything on their lips or in their mouths in the SPD. This includes oral medications, such as Tylenol, and the application of lip balm or lip gloss/lip stick.”
Berg commented on the common “misstep” of hiding snacks and beverages in the department, stating:
“Some individuals have shared online photos depicting how they managed to sneak and hide food and opened cans of soda into various work areas of the department, unbeknownst to their managers. These are very dangerous, risky, and unprofessional practices, and employees must understand why it’s vital to follow standards and policies and alert their departmental leaders if they witness it in action.”
Wearing
street apparel, jewelry, and other fashion items
When posting a request for SP topics to cover in 2025, Carol Malone, AAB, CSPDT, CRCST, CIS, CHL, CER, director of marketing, Clinical Education & Implementation for Turbett Surgical, was one of the first SP professionals to respond, emphasizing the importance of basic practices in the SPD.
Malone explained how there are certain essential skills every SP technician should have regardless of their shift. These include the ability to properly
execute and document all machine testing. She also outlined general guidelines for SP professionals: they should wear only hospital-laundered scrubs in the department, avoid fake nails, refrain from wearing open-backed shoes, and not wear street clothes under their scrubs or in the department.
Berg pointed out how long, polished, or artificial nails “pose an infection risk because they can harbor bacteria or chip or fall off into instrument trays.” He noted how “nails should be clean, natural, unlacquered, and wellmaintained, with a length that does not extend beyond the fingertips.”
“Additionally, personal bags and backpacks, electronics such as cell phones or other mobile devices, and other outside items should not be brought from home and into any SPD work areas because these, too, harbor microorganisms that can contribute to cross-contamination,” Berg added.
Berg also highlighted the pervasiveness of jewelry in the SPD, which goes against written standards like ANSI/ AAMI ST79. He stated: “Some technicians - and even those in leadership positions - continue to wear jewelry, such as earrings, necklaces, rings, facial piercings, and watches (including Apple-type watches). It’s imperative that managers teach by example and remain vigilant about these missteps among their employees.”
Basic best practices in each area of the SPD
Many of the back to basics insights provided by SP professionals for this article focused on practices specific to an area of the department and, in some cases, areas outside of the department.
Point-of-use (POU) basics
To drive best practices, Fellows stressed the importance of the SPD and operating room (OR) teams developing a “symbiotic relationship.” She stated:
“Because the OR may not understand the responsibilities of the SPD,
Damien Berg
Nancy Fellows
they may not appreciate the challenges faced by those employees. While it may take some coordination between the two departments, SPD staff should have an opportunity to observe a surgical procedure to see how instruments are used. This will provide the knowledge and importance of tray assembly, inspection of surgical devices for accurate functionality, and patient safety.”
John Kimsey, VP, Processing Optimization and Customer Success, STERIS, acknowledged how “Back to basics wouldn’t be complete without reaffirming the impact the OR back table instrument handling and pointof-use compliance has on sterile processing performance. The better the OR can return the correct instruments to the correct tray, remove gross bioburden, and apply point-of-use processing gel to keep the instruments from drying, the better SPD will be able to clean and complete trays.”
Speaking specifically to the importance of point-of-use (POU) treatment compliance, Berg stated:
“Removing the debris and keeping instruments moist (either with a solution developed for this purpose or at least covering instruments with a water-moistened towel) helps prevent debris from drying and hardening on the devices and making it difficult to remove in the SPD’s decontamination area. It’s important to note that saline should never be used for this purpose because it can corrode and otherwise damage instruments.”
“Another critical factor for effective decontamination is ensuring that instruments are transported to the SPD for proper cleaning as quickly as possible (ideally within an hour of the end of the procedure),” Berg added. “The longer it takes, the more likely biofilm can form and create cleaning challenges that can then affect sterilization outcomes.”
Kimsey cited two other back to basics best practices related to communication
and collaboration between OR and SP teams:
• Maintaining accurate preference cards to ensure the surgeon receives what they need, while minimizing waste of picked and unused items or missing items from the case requiring OR and SPD to scramble at the last minute.
• Measuring how well SPD meets their customer’s requirements, which he says often relies on the customer, or OR staff, to timely report all quality issues so SPD can track and follow up appropriately.
“Far too often, we hear the OR complain that the SPD under reports quality issues, yet the OR fails to notify the SPD when there is a quality issue,” Kimsey commented. “Back to basics includes a cooperation from our customers to report and notify us of SPD quality and service issues in a timely fashion.”
Decontamination and cleaning basics
“Perhaps the best back to basics reminder for decontamination is to follow the instrument IFUs,” said Kimsey. “SPDs will need to leverage technology at the sink to provide technicians with the cleaning instructions they need to follow in real time instead of relying on memory.”
Many back to basics best practices in decontamination revolved around the sink, including soak time, as Kimsey explained:
“SPDs invest in the best enzymatic and detergent chemistries to breakdown bioburden and dislodge it from the instruments, but chemistries only work
if we allow the instruments to soak at the correct temperature and dosage. We need to ensure staff understand the chemistry’s IFU as well as the instrument’s IFU and allow the appropriate soak time before starting the manual brushing and cleaning process.”
Chemical considerations
Proper management, handling, and preparation of cleaning and disinfection chemicals is a back to basics best practice on top of the list for Berg. He offered the following insights and recommendations:
• Cleaning and disinfection chemicals must be prepared properly, in strict compliance with the manufacturer’s IFU.
• Expiration dates must always be checked.
• Chemical/solution concentrations should never be adjusted outside of the manufacturers’ recommendations (improper dilution or too much product). Just as too little chemical can negatively affect process outcomes, too much can damage devices and leave residues that make removal difficult.
• The correct temperature of each solution must always be followed, along with water quality and pH requirements.
• Chemicals require the correct contact (coverage) and exposure time. This is an area that must always be stressed to all SP employees because if a chemical solution is not allowed adequate “wet contact,” it will be rendered ineffective.
• If a disinfectant or other chemical solution evaporates or otherwise dries before the manufacturer’s stated contact exposure time in the IFU, the solution must be reapplied, and the exposure time must begin again.
Brushing
Improper brushing of instruments in the decontamination sink was a
John Kimsey
Carol Malone
common back to basics failure cited among those providing commentary for this article.
“Brushing underwater and not brushing over the water is definitely one of the basics,” said Elammari. “When you brush over water, you’re spreading contaminants through the air. You’re aerosolizing them, which can put you at risk of possibly contaminating yourself and maybe breathing them in but also cross contaminating other surfaces and possibly putting patients at risk.”
“It’s also critical to utilize the appropriate type and size of brush for manual cleaning to ensure effective removal of bioburden,” said Kimsey. “Basic options such as bristle diameter, material, overall length, and handle style all play an important role to proper cleaning. New brush styles in endoscopy include a combination nylon brush on the leading end and a series of squeegees on the trailing end to remove debris.”
Washer/disinfectors
Proper loading, use, and testing of washer/disinfectors, as well as regular monitoring of water quality, were cited as other best practices where compliance failures occur.
“One thing we see all the time is SP teams leaving finger mats at the bottom of trays and sending them through the washer in this manner,” said Elammari. “Finger mats can go through the washer, but they must be taken out of the tray.”
“Failure to separate trays with multiple layers before placing them into the washer is another common issue,” she added. “Another problem I see is improper positioning of items, such as placing items in a way where they block the spray arms from spinning and placing the lid for a tray underneath the tray in the washer, blocking the water and detergents.”
Speaking on the importance of correct positioning of hinged instruments for effective automated washing, Kimsey stated, “Positioning
the instruments in an open position with working tips facing up towards the washer spray arms allows for direct washing spray contact and cleaning of the box lock hinges.”
Jonathan A. Wilder, Ph.D., managing director, Quality Processing Resource Group, suggested SP teams ask the following questions to determine if they are in alignment with back to basic best practices in disinfection and cleaning:
• Are you making sure the washer/disinfectors are doing what they should be doing by noting if the spray arms are moving as they should?
• Are cleaning indicators run daily in more than one location in the washer rack and are they coming out spotless?
• Are you testing each washer rack that is used, especially the lumen racks?
• Are you even using the lumen racks?
• Do you make sure that detergent is being dosed to the washer/disinfectors by marking the soap bottles with a Sharpie on a daily basis?
• Are you checking daily that the spray arms do not have any debris sticking out of the holes in them and that the screen in the floor of the washer chamber has no obstructions?
• Does the water suddenly have a color or smell to it?
• Can you smell blood/decaying bioburden in the washer/disinfector?
• Are you processing each layer of the trays separately to ensure that they get cleaned and the washer sprays are not obstructed? If not separated, they won’t be cleaned.
• Are you removing filters from container lids?
• Are you placing container lids and containers in the washer separately and not stacked? If stacked, they won’t be cleaned.
“If a washer/disinfector is kept running at its best, it saves you time and labor and makes the load safe to handle on the clean side,” said Wilder. “If it is not, you have to process the instruments again.”
Equipment and supplies
SP professionals underscored the importance of adequate engineering controls, equipment, and supplies in decontamination that support SP teams in adhering to best practices. Commenting on this topic, Berg cited the following:
• PPE that is properly fit tested for each technician to ensure correct coverage and protection from splashes, spills, and aerosolization.
• Decontamination sinks that can raise or lower to accommodate employees of different heights, which can greatly reduce splash and aerosolization.
• Ready access to the proper supplies and training on how to use them safely and correctly (e.g., brushes should be long enough to clean the length of lumens and of correct diameter to ensure adequate contact of the lumen interior).
• Lighting should also be prioritized in all areas of the SPD to allow technicians to closely inspect devices for cleanliness and damage.
Vendor trays
Noting how “vendor trays frequently have the highest percentage of quality and bioburden incidents in the OR due to improper basic inspection and cleaning in decontamination,” Kimsey offered these best practice recommendations:
• Picking up and manually inspecting each item in the vendor tray during the cleaning process.
• Adhering to vendor IFUs that often call for washing the instruments in a wash basket and not in the vendor tray where the instruments have specific location holders.
• Washing the tray in a sonic washer, which is usually listed in the IFU as a requirement. “Unfortunately, many SPDs do not have the adequate sonic capacity required for the volume of vendor trays requiring justifiable capital investment
to meet the clinical requirements,” said Kimsey.
• Separating multiple tray levels onto the washer manifold for effective automated cleaning.
Preparation, packing, and assembly basics
“Assembly back to basics includes three points: prioritize, follow the count sheet, and inspect,” said Kimsey. “First, assembly technicians should be working on trays that are needed or prioritized. If you have a backlog of trays, this could be critical to ensure you meet the OR’s needs and timely case cart completion. If you don’t have a backlog, good for you, and you can then assemble by first in, first out.”
Count sheets
Kimsey emphasized the importance of SP team members following count sheets instead of their memory. “As hard as it is to check off each instrument in the tracking system or paper count sheet as you place it into the tray, it is the best way to avoid a mistake and stick to the basics,” he explained.
Berg commented on how technicians must be provided count sheets that are clearly written, standardized, and available to all SP employees across all shifts. While the pack content information can be collected and stored manually or in a computer system, according to Berg, he noted how either approach should include these basic yet essential details for the assembly technician:
• Complete, accurate name of the tray.
• Detailed list of tray contents, including quantities, sizes, and catalog or reference numbers.
• Critical steps for preparation and inspection, such as how they should be assembled and disassembled according to their IFU.
• Detailed instructions for proper placement of items in the tray.
• Type and size of packaging to be used.
• Type and placement of internal and external process indicators.
• The destination or storage location for the tray.
Chemical indicators
Multiple SP professionals cited correct chemical indicator (CI) placement depending upon the sterile barrier being used as a back to basics best practice that must be followed.
“Remembering how our customer, the OR, opens and inspects instrument trays for sterility reminds us to place a chemical integrating indicator in visible sight upon opening the tray,” said Kimsey. “This may mean you place indicators in the bottom corners as the most challenging position but another indicator on the top for immediate visual confirmation by the OR staff.”
According to Elammari, it is not just where chemical indicators are placed but the manner of placement and quantity of indicators. She stated, “When you are wrapping a tray or placing instruments in a container do you know how many indicators to place and where? Are you putting the indicators in bags and not taping indicators inside a tray?” CIs should be placed in the most resistant area of the sterile barrier system being used.”
“Another back to basic is the ability to properly read printouts, she added. “So, understanding the numbers, what they mean and how to read that the cycle parameters were met via the numbers during each phase.”
Inspection and testing
Thoroughly inspecting instruments and devices for cleanliness, dryness and functionality before they are placed in trays is another back to basics best practice area SP professionals called out as critical but not always performed.
“Back to the basics means standardizing how your technicians are expected to inspect instruments and could include visual inspection, magnification, borescope inspection, cleanliness
verification tests, and testing for functionality,” Kimsey commented. “As we ‘rush’ to complete our work or find ourselves understaffed, inspection and testing is one of the first areas to cut corners on and skip. Let’s stick to the basics and ensure our patients and surgeons have clean, sterilized and functioning instruments!”
“One specific problem I have come across is failure to test scissors every time they come through assembly,” said Elammari. “Oftentimes when we go into facilities, they don’t even have scissor testing material at their stations, or they have only one size testing material and not the two different thicknesses needed to test different size scissors.”
“And it’s not just failure to test basic instrumentation, but laparoscopic instruments as well,” she added. “So many times SP teams will tell me that they test every lap tray but upon observation they are not testing critical components of these devices to ensure they are working properly, such as insulated shafts and handles, as well as monopolar and bipolar cords.”
For departments with newer staff or vendor tray quality issues, Kimsey said a great back to basics practice is to have an experienced and higher-level technician perform quality assurance checks on high-risk trays and trays assembled by newer, less experienced employees.
“Back to basics in assembly also means an organized supply of single back-up instruments,” Kimsey added. “Let’s stop piling up instruments like junkyards and instead create organized, labeled, and routinely cleaned and managed back-up instrument inventories that represent the most used and missing instruments.”
Containers
In Berg’s experience, some technicians who carefully inspect each instrument “make the mistake of not giving the same attention to the containers and all their components.”
“This can have a direct and negative impact on sterilization outcomes,” he explained. “Rigid containers, for example, must be cleaned according to the IFU, interior backets must be removed and cleaned, and dividers and pins may need to be removed if they interfere with cleaning. The containers should also be carefully inspected to identify damage or wear that could affect the sterilization process or sterility maintenance.”
Berg provided these examples of important container inspection points:
• The filter retention plate should be intact and not bent, allowing it to be seated properly over the filter and secured in place.
• The container and lid (including the edges) should be inspected for dents, chips, and other damage, and the retention post must be secure, with no movement present.
• Handles should also be checked to ensure proper movement and function, and latches and springs should function properly to ensure a proper seal.
Packaging
According to Elammari, proper sealing of peel pouches is another area to revisit when it comes to back to basics in the SPD. She stated:
“Whether you’re using a heat sealer or self-seal, are you doing the process correctly? When you seal it with the heat seal, is it a flat, even seal? Do you have any creases or wrinkles? Or if you’re using a self-seal, are you using the right technique?”
With regards to sterilization wrap, Berg emphasized how it is critical that technicians only use tape created specifically to withstand sterilization and never use safety pins, staples, paper clips and other items for packaging closure. “Punctures, creases or other damaged caused by their use can allow contaminants to penetrate the packaging,” said Berg. “Using too much tape that was
approved for sterilization can also prevent an effective process.”
Elammari stressed how technicians should not use steam tape, filters, blue wrap, and peel pouches outside of their attended purpose (e.g., using blue wrap as liners for workstations, shelves or tables).
“I’ve seen departments where technicians use steam tape to hang up peel pouches and use peel pouches to separate extra instruments in drawers,” she noted. “Nothing used for sterility should be used in any other manner. Tape on instruments is another big issue and a big focus for The Joint Commission (TJC).”
Sterilization basics
Kimsey referenced IFU compliance when it comes to sterilization back to basics, stating:
“Back to basics for sterilization should always include following the instrument sterilization cycle IFU requirements,” Kimsey added. “While many SPDs utilize instrument tracking systems for electronic sterilization records, it’s best practice to enter the instrument sterilization IFU cycle parameters into the tracking system and utilize built-in hard stops and warnings to ensure the correct cycle is selected.”
Equipment
Berg offered this list of some of the “biggest mistakes” caused by improperly cleaned instruments or residues that impede the sterilization process:
• Packages packed too densely or positioned incorrectly, preventing effective steam or sterilant contact.
• Overcrowding loads in the sterilizer chamber.
• Clogged drain strainers.
• Mechanical or utility malfunctions.
“Technicians should be shown the correct way to position and pack sets for proper sterilization, and they should notify a qualified service professional any time defects or suspected
mechanical or utility issues occur,” Berg commented.
Auditing
“Back to basics for sterilization reminds me that we used to audit our sterilization records, paper or electronic, every day to ensure we caught any mistakes and were compliant,” said Kimsey. “Keeping the daily audit routine is a best practice to ensure our instruments are sterilized, documentation correct, and mistakes caught as quickly as possible.”
Sterile storage basics
“Even the best cleaning and sterilization processes and outcomes can result in contamination and damage if packages aren’t handled, stored, and transported properly,” said Berg. “Technicians must understand that sterile storage begins the moment the sterilizer door opens at the end of cycle.”
Environment
SP professionals agree that maintaining the integrity of a sterile storage area is the first step in maintaining the sterility of the instruments, devices and supplies stored in that space.
“Sterile storage is more than the room where sterile instruments are stored, it’s the room that maintains the sterility of the instruments,” Kimsey explained. “That’s a small but important differentiating definition. To maintain sterility, we must go back to the basics of limited traffic flow, frequent air exchanges, ensure first in first out usage, protection of wrapped trays from tears, minimize stacking of wrapped items, shelf liners, dust avoidance, minimize handling, and routine cleaning.”
“No one should enter dedicated sterile storage areas without proper PPE, and these areas should not allow for pass-through traffic,” Berg commented. “The storage areas require clean, dust– and contaminant-free
surfaces, proper air filtration, and adherence to ventilation and temperature and humidity recommendations per ANSI/ASHREA/ASHE I70 Ventilation of Health Care Facilities. Whenever possible, closed shelving should be used to allow for proper cleaning and protect sterile packages from contaminants.”
Closing thoughts
The SP professionals interviewed for this article provided back to basics for other areas of the SP department and additional advice for enhancing compliance, but there simply wasn’t enough space to cover everything in this one article (perhaps there is a Back to Basics in the SPD chapter two in the future?).
Here are a few closing thoughts from the contributors:
Damien Berg, BA, BS, CRCST, AAMIF, VP of Strategic Initiatives, HSPA
It is no secret that many (perhaps most) SP professionals have experienced pressure to more rapidly reprocess instruments and devices, but as Berg asserted, “technicians must never rush or skip processes due to user expectations for rapid turnaround.”
“While it’s true that efficiency is required, that should never come at the sacrifice of safe, thorough, and consistent processes,” said Berg. “If unreasonable requests or demands are placed on the SP team, managers or other SP leaders should address those concerns with the user areas and explain why rushing steps is not an acceptable option (and provide standards for support).”
“Every patient deserves the same level of quality care, and adjustments must be made to the procedure schedule or instrument inventory if thorough, effective processing cannot be performed to accommodate procedural volume,” he added.
Malinda Elammari, CST, CSPM, CSPDT, CFER, CSIS, CRCST, CIS, CHL, CER, CLSSGB, clinical education specialist, Healthmark “The only way I have found to keep staff members accountable is to set expectations from the beginning and reinforce them through audits and follow through. While most technicians are taught according to HSPA either in school or during their training, if the basics don’t get reinforced in the work field, they will wind up losing those concepts and converting to the department ways and shortcuts.”
“I think from a leadership perspective, one of our biggest downfalls in SPD is that we teach but we don’t provide written expectations and reference points for staff in the way of standard operating procedures (SOP). My advice is to start by creating a comprehensive onboarding process according to industry standards and guidelines. Next, reinforce that with SOPs around each step where the procedures really define what the technician is supposed to be doing.”
“Lastly, have the technician sign off on the SOP acknowledging they understand it and audit that the process is being followed. You now have a way to standardize education and the ability to hold staff members accountable.”
Nancy Fellows, MSN, MPA, RN, CNOR, senior clinical education consultant, ASP “As Wendall Willkie said, ‘Education is the mother of leadership.’ Sterile processing leaders must not only inspire and motivate their employees to reinforce basic practices among their staff, but also gain trust and respect while overseeing critical safety requirements.”
“SPD leaders must be subject matter experts and remain well informed on the latest work processes in accordance with the Association for the Advancement of
Medical Instrumentation (AAMI), the Association of PeriOperative Registered Nurses (AORN), and the Healthcare Sterile Processing Association (HSPA). They must be able to identify employee mistakes readily, address them, and through education implement processes to eliminate mistakes in the future.”
John Kimsey, VP, Processing Optimization and Customer Success, STERIS
“To ensure staff retention and engagement and to improve and sustain departmental performance, we can’t forget the basics of employee engagement. Maintain open and frequent communication, set clear expectations, follow-up and offer assistance, listen, make personal connections, create fun activities, be fair and hold all equally accountable, show them you care about them and about the department’s performance.
“A great back to basics employee engagement is recognition. Too often we find ourselves so focused on the daily business we forget to recognize the multiple important efforts our staff make every day. Recognize frequently and often while learning how each person prefers to be recognized.”
Carol Malone, AAB, CSPDT, CRCST, CIS, CHL, CER, director marketing, Clinical Education & Implementation for Turbett Surgical
“My thoughts on reinforcing best practices revolve around three key elements: a clean, organized department, consistency in tasks, and unbiased accountability for all staff members. Consistency and accountability can be effectively monitored and tracked through regular audits.” HPN
Reference:
1. Here are Some Overlooked Training Practices for Sterile Processing. Charlie Lewis, September 13, 2023, https:// www.singleuseendoscopy.com/here-are-some-overlookedtraining-practices-for-sterile-processing-technicians
Making the Right Choice for Sterile Processing Consumable Stock Outages
BY MICHELE MCKINLEY, SENIOR CLINICAL EDUCATION SPECIALIST,STERIS CORPORATION
Historically, hospital inventory systems carried a large volume of consumable supplies which offered a sense of security that vital items would always be available for patient care. Large inventories came at the cost of outdated item disposals, obsolete product disposals, and tied up funds that could have been allocated elsewhere. The introduction of Just-inTime inventory management (JIT) across all industries in the late 1970s and early 1980s reduced inventories to minimum levels, freeing cash and reducing the impact from outdated and obsoleted supplies. The change
Learning Objectives
1. Identify causes of product outages and when substitutions would be needed.
2. Establish a plan for rapid evaluation and change approval of substitution products.
3. Considerations when implementing a rapid deployment of a substitution product.
Contributed by:
gave rise to new challenges, such as establishing inventory levels that could anticipate normal fluctuations and responding to recalls which soon became manageable with good inventory management. Today, global supply chains face increased disruptions from disasters, pandemics, and world events which have led to significant stock outages and facilities scrambling to find substitutions. Healthcare facilities must recognize and plan a systematic approach to managing supply chain disruptions that lead to out of stock situations so that patient care can safely continue.
The Impact of Supply Chain Disruptions
Supply chains are complex global entities that start with raw materials. Manufacturers source raw materials from several suppliers often located in multiple countries. Manufacturing sites convert the raw materials into products. Simple products, like chemical indicators, may have a single manufacturing site. Complex products, like incubators, enlist several manufacturers to make components with the incubator’s assembly relegated to a different manufacturing site.
The next step in the chain is the distributor. Distributors inventory multiple consumable products from different manufacturers. They offer healthcare facilities a straightforward way to buy multiple products from a variety of manufacturers in
a single business transaction. This simplifies buying and shipping of healthcare supplies.
Disruption in the flow of materials through this chain can lead to outof-stock situations for the healthcare facility. Not only can a disruption impact the vendor’s ability to provide product, but multiple vendors sourcing the same raw material or component from the same supplier can be impacted at the same time.
Vendors have experienced out-ofstock situations from raw material shortages; machinery repairs; transportation issues; poor planning; natural disasters that affect transportation or manufacturing sites; and unforeseen spikes in demand. In most cases, the stock outage is short lived but, as the pandemic demonstrated, some are not.
Recall is the second way healthcare facilities can experience outof-stock situations. Recalls occur when a manufacturer removes or corrects a product at the healthcare facility to protect the public health. Most recalls are voluntary manufacturer actions but when the manufacturer fails to act, the FDA may issue a mandatory recall order to the manufacturer. Recalls can be initiated from design defects, manufacturing defects, material failures, and labeling defects such as misprinted or illegible expiration dating.
Product outages have a profound impact on healthcare facilities. Facilities may postpone voluntary
procedures to preserve product inventory for urgent care. When supplies run out for extended periods of time, life preserving procedures may be cancelled. Facilities should have a means to evaluate and implement alternative solutions so that life preserving procedures are never cancelled.
What is the Plan?
It only takes one out-of-stock event to create chaos, cause delays, cancel surgeries, and potentially place patients at risk. Instead of being reactionary, developing a preventive plan that outlines roles, actions, and resources reduces the stress and chaos from product outages.
When outages are anticipated to be short term, it may be possible to source the same product from a different distributor or dealer. Facilities may also be able to obtain supplies from sister facilities or healthcare neighbors. However, when the shortage affects multiple vendors or is anticipated to be long, these options may not be available.
Ideally, all critical consumables would be second sourced. Second sourcing does not mean having two order quantities to choose from. Second sourcing is the identification and approval of a second vendor that supplies a similar product used for the same purpose. Consider creating a second source resource file that includes the ordering information, emergency reorder numbers, and quantities so there is minimal down time. When second sources are not available, facilities must quickly identify, qualify, and obtain substitutes.
The first step in preparation for a rapid response to stock outages is to identify a multi-disciplinary team that includes everyone that has a role in the process affected by potential stock outages. This may include but is not limited to C-suite
representatives, material’s management, sterile processing leadership, surgical leadership, Biomed / Facilities, and infection control & risk management. Vendor representatives may also be needed. Each member has a defined responsibility to identify, assess, and implement a substitute product.
Unlike a change approval or new product evaluation board, this team must move quickly with less consideration on the budgetary impact and more consideration on securing a short-term substitution or process that will allow sterile processing to continue to provide services without jeopardizing patient safety.
Material management and sterile processing work together to identify potential substitute products. The substitute is reviewed against the current out-of-stock product, the specific application in the facility, and department interactions with the product.
Infection control and risk management should assess the risks to staff and patients from using the substitute product and ensure that appropriate measures to reduce new risks from the substitute are taken.
The findings, along with a financial impact assessment, are presented to the multi-disciplinary team for approval and development of an implementation plan. The implementation plan should include:
• How the product will be ordered
• Policies and procedures that may need to be temporarily changed to accommodate the substitute product
• Training and competencies of affected staff
• Implementation of any newly identified safety controls
Rapid identification, obtainment, and deployment of a substitute product is not without its challenges. At minimum, facilities should consider three basic challenges.
Making the Right Choice for Sterile Processing Consumable Stock Outages
January 2025
This lesson was developed by STERIS. Lessons are administered by Endeavor Business Media.
Earn CEUs
After 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 preapproved 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 November 18, 2027.
For more information, direct any questions to Healthcare Purchasing News editor@hpnonline.com.
Contracts and Purchasing Systems
Material managers work to control costs by establishing long term contracts, joining group purchasing organizations (GPO), and limiting the ability of facilities to buy products that are not on contract. These become barriers when a rapid substitution is needed. Materials management should include clauses within contracts that allow non-penalized purchases of non-contracted products in the event of a long-term product outage.
Stock outages may affect a portion of a larger healthcare group. There can be challenges adding the emergency substitute product to the healthcare system’s centralized purchasing system. A plan should be in place to quickly add emergency reorder numbers, stock keep units (SKUs), or new vendors for the affected facilities.
Product Evaluation Committee approvals could slow down rapid adoption of a replacement product especially when product trials are a requirement of the product review committee. Ensure that approvals and review expectations of emergency replacement products are identified within policies and procedures. Material management may be the first to know about impending stock outages and recalls but may not have the knowledge to judge the severity.
Ensure that a communication strategy is in place which includes escalation guidance in time of recall and stock outages.
Product Instructions for Use
No two products’ instructions for use (IFU) are the same. An important consideration is reviewing the substitute product’s IFU. Identify differences between the out-ofstock product and the proposed substitute. Identify substitute product constraints and contraindications. Consider things like reactions between chemicals, compatibility with devices, water incompatibility, test result interpretation differences, etc.
Review the IFU of the equipment, medical devices, and accessories that the substitute product will be used on or with. When conflicts between the substitute product’s IFU and other products’ IFU exists, vendors should be contacted to help reconcile these differences. If the vendor approves the use of the product despite the differences within IFU, request the approval in writing on company letterhead. This should be included in the risk assessment for the emergency use of the substitute product. Review facility processes, policies, and procedures that are specific to current product and may not be compliant with the replacement product IFU. Facilities should have a plan for
incorporating temporary changes to policies and procedures. Also consider the incorporation of educational tools such as wall charts and interpretation guides when necessary.
Off Label Use
The search for replacements may also require verification of intended use by reviewing the product’s market clearances. If the clearance is in line with the facility’s intended use, no further action is required. If, however, it is not in line with the facility’s intended use, the use becomes an “off label” use.
Off label use is only considered acceptable when a healthcare professional at their clinical discretion determines that using a device in a way not explicitly approved by the regulatory agency is the best course of action for a patient’s specific condition especially when there are no other suitable treatment options available. It is crucial to always consider the potential risk and benefits involved by performing a risk assessment to support the decision of off label use, the benefit must outweigh the risk.
What is the decommission process?
Returning to the normal state should be as methodical as it was to rapidly deploy a substitute product. Consider:
Figure 1: Example of multi-disciplinary review team responsibilities
• Disposition of substitute product inventory
• Deactivating reorder numbers/SKU
• Reimplementing former policies and procedures
• Training needs and removal of product use tools
Conclusion
Supply chain disruptions are improving as manufacturers turn towards second sourcing and regional sourcing and use advanced planning and scheduling software. Inventories,
initially raised to counter the disruptions from the COVID pandemic, are beginning to drop. Now is the time for healthcare facilities to identify the emergency substitution team and shore up the emergency substitution policies and procedures before the next great supply chain disruption happens. HPN
Reference:
1. Alicke, K. and Foster, T. (14, October 2024) Supply Chains: Still vulnerable. McKinsey & Company. https://www.mckinsey. com/capabilities/operations/our-insights/supply-chain-risksurvey#/
Michele McKinley, LVN, CRCST, CIS, CHL, AGTS, ASQ CMQ/OE, ASQ CQA is a Senior Clinical Education Specialist for STERIS Corporation. She has been in the healthcare field for 42 years, as an operating room technician, materials management coordinator for the operating room, materials manager, and site manager for outsourced sterile processing. Michele has also worked as a consultant in the areas of sterile processing, operating room and endoscopy cleaning, and sterilization processes. She holds licenses and certifications as an LVN, CRCST, CIS, CHL, AGTS, ASQ CMQ/OE, ASQ CQA, and is a member of HSPA, AORN, SGNA, APIC and ASQ.
Making the Right Choice for Sterile Processing Consumable Stock Outages -
Practice Quiz
1. Which is not part of a supply chain?
A. Transportation
B. Material supplier
C. Manufacturer
D. Distributor
2. How can two different vendors be affected by a material shortage?
A. Source different suppliers
B. Source the same supplier
C. Sell to the same customer
D. Sell to the same distributor
3. What FDA action can cause stock outages?
A. Clearance
B. Recall
C. Rebranding
D. Sale
4. All recalls are mandated by FDA.
A. True
B. False
5. What is the best prevention for long term stock outages?
A. Large volumes of inventory
B. Second sourcing critical items
C. Vendor penalties for stock outages
D. In-house manufacture
6. What is infection prevention’s role on the rapid response team?
A. Find substitutions
B. Price negotiation
C. Training
D. Risk evaluation
7. What should be included in the implementation plan?
A. Ordering instructions
B. Product training
C. Temporary changes to policies and procedures
D. All of the above
8. This should be in purchasing agreements to protect against stock outages.
A. Non penalized off contract purchasing
B. Second source items
C. Noncontracted purchase prevention
D. Recalled items list
9. Which instruction for use should be reviewed against the substitute product’s IFU?
A. None
B. Out of Stock product IFU
C. Medical Device IFU.
D. Both B and C
10. What should be done when the old product is back?
A. Removal of substitute product
B. Deactivating reorder numbers in purchasing systems
C. Returning to former policies and procedures
D. All of the above
Leading SPDs with Empathy, Gratitude
BY DAVID TAYLOR, PRINCIPAL, RESOLUTE ADVISORY GROUP LLC
Sterile processing (SP) leaders face immense pressure managing production demands, teams, and high-stakes decisions to ensure safe, high-quality services are provided. Still, in the rush of daily demands, leaders must remember the importance of creating an empathetic culture and showing gratitude for their hard-working employees.
Leading with empathy and gratitude not only improves team dynamics, but it can also create a ripple effect of positive outcomes. Research suggests that leaders who demonstrate empathy and express gratitude regularly see a significant boost in employee morale, engagement, and retention rates.1 This is crucial in an industry where turnover can deeply affect operational efficiency and patient outcomes. Creating an empathetic culture begins with empathetic SP leaders. When they model desired behaviors, those behaviors permeate the department. Employees deserve to feel seen and heard and know that their leaders support their needs. Leaders who convey empathy in their interactions with others and demonstrate that they value an individual’s well-being as much as their ability to perform their duties will more likely benefit from a satisfied, quality-focused team.
Prioritizing empathy begins with hiring and onboarding processes. It should be reflected in recruitment practices and carried into job descriptions, highlighting potential new hires as human beings, not just employees expected to fulfill a role. Benefits packages can reflect the facility’s commitment to their employees, and leaders should carry that into how they recognize, value, and reward employees in the department. Staff members should also be encouraged to demonstrate empathy among their peers, which promotes collaboration and team cohesion and creates a workplace where all are shown respect, encouragement, and compassion.
Showing gratitude can also help leaders stay grounded in challenging times because it serves as a reminder of the hard work and dedication being provided. A recent study revealed that employees who feel appreciated are 2.7 times more likely to be highly engaged at work. In healthcare,
where burnout is high, this engagement is a key factor in reducing turnover.2
Creating a culture of empathy and gratitude
To help SP professionals feel more valued, recognized, and appreciated in the workplace, leaders should consider:
• Seeking employees’ input and soliciting their ideas and feedback.
• Celebrating individual and team successes (this needn’t involve grand gestures; a written thank-you note and verbal congratulations during team meetings can be effective).
• Sharing positive feedback whenever an opportunity presents itself; providing public thanks will encourage others in the department to model similar behavior among their peers.
• Asking employees how they can be supported to facilitate professional growth.
• Being available to help when employees are struggling personally or professionally.
• Holding periodic recognition ceremonies where employees nominate colleagues for awards (consider providing customized trophies or other personalized items).
• Rewarding the team with group events that can strengthen bonds (e.g., End-of-year holiday party, shift breakfasts or lunches).
Conclusion
Successful leaders create a supportive work environment where gratitude and empathy are expressed routinely. As a result, employees tend to be more engaged, satisfied, and optimistic about the work they do each day. Empathetic, appreciative leaders also benefit from improved team dynamics, reduced staff burnout, and improved retention. HPN
References:
1. https://www.ccl.org/articles/leading-effectively-articles/empathy-in-the-workplace-a-toolfor-effective-leadership/
2. https://www.quantumworkplace.com/future-of-work/importance-of-employee-recognition
Wet Loads
BY ADAM OKADA, CLINICAL EDUCATION SPECIALIST, HEALTHMARK, A GETINGE COMPANY
Q“Our facility has been dealing with wet loads for the past six months or so, and we keep increasing our dry time to eliminate it. We now are doing 90 minutes of dry time. Is this normal?”
AIn short, no.
I have dealt with this same issue at an old facility of mine, where we also responded by increasing our dry times. It certainly stands to reason, but, in truth, it rarely eliminates wet loads.
Put on your Sherlock Holmes “deerstalker” cap because you’ll need to do some investigative work to determine the root cause of your wet loads.
Are you taking pictures of the sterilization rack and contents and documenting the wet load configuration? Load configuration can be one of the causes of wet loads if rigid containers are placed over wrapped items/linen packs or if containers/trays are placed too closely together.
• Items should be evenly spaced about a finger width apart (≈1 to 1.5 in or ≈2.54 to 3.81 cm).
• Rigid containers and heavier trays should be on the bottom rack, while lighter wraps and peel pouches should be on the top.
• The recommendation is to take a picture of the sterilization rack and examine the configuration to see if anything jumps out visually.
Next, you will want to follow up with some documentation of the load.
Cycle: What cycle was used? When I was a baby tech still learning my trade, I accidentally started loads on a Gravity cycle instead of Pre-Vac.
Overpacked tray : Are you noticing a specific tray that is continually present on these wet loads? It could be an overpacked tray with dense metal mass or potentially some heavy sets weighing over 25 lb.
Contents of tray : What were the contents of the load(s)? All sterilizers have a weight limit for cycles, so it could be possible that you’re overloading the sterilizer itself.
All these questions can be investigated with proper wet load documentation.
But the most likely potential root cause of your wet loads would be that you probably have an issue with steam quality.
Steam: Steam should be 97–98% dry saturated steam and 2–3% water. At my aforementioned facility where I was dealing with wet loads, testing revealed that we had 92–93% saturated steam and 7–8% water. This was the cause of our wet loads and was solved with some new steam traps installed on the steam intake line.
Autoclave drain: Blocked or clogged autoclave drains would conceivably slow down the vacuum process in prevacuum sterilizers. Make sure your chamber drain is checked and cleaned as recommended by the manufacturer.
Wet items: Check if items are getting loaded into the sterilizer wet. Too much water in the chamber before sterilization can throw off the optimum wet/dry steam ratio (97–98% dry to 2–3% wet), so make sure you are drying items before packaging them for the autoclave.
If the initial documentation and pictures don’t immediately identify a particular culprit, my first step for identification of the root cause would be to have a reputable company perform a steam quality check on your autoclaves to determine the wet/dry steam ratio and then move on to other potential causes.
QWhat is it like to work with Stephen Kovach?
AIn a word, “Exhausting.”
I am kidding, of course. . .. Stephen Kovach is my idol, mentor, and hero, and I am beyond lucky to call him a good friend. He has a passion and enthusiasm for sterile processing which is unmatched in our industry. His face would appear on just about every industry professional’s “Mount Rushmore” of educators, who have made a positive impact in our history.
A few months ago, Stephen and I had breakfast at McDonald’s. His friends and colleagues will agree with me that this is considered fine dining by Kovach-ian standards. It was at this breakfast that Stephen informed me of his intention to retire, and he asked me if I would be willing to take over this article from him (for all those wondering who Adam Okada is and why he is writing Stephen Kovach’s Sterile Processing article).
I was, at first, excited. What a great opportunity! I love writing and sterile processing, so it seemed to be a perfect intersection of my favorite things.
Then reality set in.
There is an incredible history behind this article and an incredible legacy and precedent that has been
set. It started with the legendary (and fellow “Mount Rushmore” face) Ray Taurasi. I remember one of Ray’s responses to a question in one of these HPN articles was something that I had been using in my day-to-day sterile processing life for almost 20 years.
After 19 years, the article passed on to Stephen, who has been writing these since 2020. Stephen has a lifetime of experience, and his brain is an encyclopedia of sterile processing knowledge. He is often my first text if there is a question that has me stumped, and he always seems to have the answer. If not the answer per se, he will provide enough information for me to arrive at the correct answer on my own, which is so much more valuable!
It is difficult to comprehend how many professionals have read Stephen’s words of wisdom over the years and improved upon their practices.
While there is plenty of pressure, I promise that I will do everything I can to live up to the astronomically high bar that’s been set by Stephen and Ray. I will research every article to try and provide the best possible answers to your questions. Keep those questions coming to HPN !
A personal message to Stephen: You are the reason I am here. Watching you present on washer disinfectors 7 years ago gave me a direction and purpose to my career that I didn’t previously have. Your infectious enthusiasm for best practice has inspired so many in our industry. Through them, you have helped positively impact their patients. I can’t accurately put into words how much you mean to me and this business, but you have certainly made an indelible impression. Put simply, thank you for everything you’ve done for me, and everything you’ve done for all of us.
Enjoy your retirement, my friend. Let’s grab a “Big Mac” soon! HPN
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.
Clinical and Supply Chain Collaboration: An International Perspective
BY KAREN CONWAY, CEO, VALUEWORKS
Late last year, I once again attended the winter conference of the Health Care Supplies Association (HCSA), the procurement association for the National Health Service (NHS) in the United Kingdom (U.K.) and a sister organization of AHRMM, the professional supply chain association for the American Hospital Association. I first attended the HCSA conference in 2016 when I was chair-elect of AHRMM, and after attending a total of seven such events, I am intrigued by two overarching themes:
• The similarity in the challenges faced by our respective healthcare systems, despite the differences in how they are financed and governed.
• How supply chain professionals in both countries are increasingly supporting the overarching healthcare needs of our respective nations.
Both the United States (U.S.) and the U.K. find themselves spending more money caring for persons with chronic disease. In the U.S., nearly 90 percent of our total health expenditures go toward chronic disease, and that will only increase with the aging of the population and earlier onset of chronic disease in children, especially those of low socioeconomic status. The U.K. also spends a majority of its money in healthcare on chronic disease, roughly 75 percent.
The chief commercial officer of the U.K. Department of Health and Social
Care, Stuart Nelson, noted the primary drivers of chronic conditions, including health inequities and climate change, and how the prevalence of chronic disease lowers worker productivity, and in turn tax revenues available for health services. That’s why the U.K. government is prioritizing prevention and more care being delivered in the community vs. the hospital setting. With similar causes and impacts of chronic disease in the U.S., the private health sector is also starting to shift priorities. An interesting experiment to watch will be how well our respective countries do, given healthcare delivery in the U.K. is primarily government run, while mostly a private affair in the U.S. Regardless of who funds and runs healthcare, the supply chain can play an important role. To do so, supply chain will need to enhance its ability to collaborate with an even greater number of partners, a key theme at the HCSA conference. Since that first conference in 2016, I’ve watched how HCSA has promoted not only greater collaboration with vendors but also with clinical leaders.
Andrew New, the chief executive of NHS Supply Chain, noted the collaborative relationship between the commercial and clinical leads at the government agency. Michelle Johnson and Richard Evans, the clinical and commercial executive directors, respectively, each spoke ardently about how collaboration can achieve savings, through both improved
supply chain and clinical efficiencies. As an example, Deborah Clatworthy, deputy chief nurse at a north central London hospital, spoke about how she collaborated with supply chain to improve the preparation of catheter trays. Not only were they able to reduce the amount of time nurses had to spend gathering the different products required on the tray, but they also reduced catheter-associated infections by 80 percent, a win for the hospital and especially for patients.
Examples like this illustrate the value of collaboration, but I agree with conference speakers who believe there is much more that can be done, especially as it relates to the human and economic costs of chronic disease. Here is where I see opportunities for supply chain and clinical leaders from our respective nations to share best practices around reducing health inequities and the negative environmental consequences of healthcare operations. U.S. healthcare can learn a lot from the NHS’s journey to achieve net zero greenhouse gas emissions, which is also a government directive. On the other hand, I believe U.S. supply chain professionals are leading the way in supporting health equity through supplier diversity and other initiatives to spur community wealth building in disadvantaged neighborhoods, where chronic disease is the highest. In the coming months, I plan to share more of these stories for our collective learning and advancement. HPN
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