Healthcare Purchasing News - June/July 2026

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The Care Chain ... 12 Outbreak Readiness ... 18 Toward Accountability ... 20 C L I N I C A L I N T E L L I G E N C E F O R T H E H E A LT H C A R E E C O S YS T E M

JUNE-JULY 2026

Hartford HealthCare

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JUNE-JULY 2026

8

Sourcing & Logistics

Sterile Processing

8 Supply Chain Department of the Year: Hartford HealthCare

26 How AI-Powered Inspection is Transforming Sterile Processing at MarinHealth

DANIEL BEAIRD

12 The HPN Conversation: From Supply Chain to Care Chain

RALPH BASILE

28 Reducing Holes in Sterile Wrap

DANIEL BEAIRD

ADAM OKADA

16 From Siloed Spreadsheets to Strategic Visibility

30 Creutzfeldt-Jacob Disease and Other Prion Diseases

DANIEL BEAIRD

DR. BRIAN KIRK

Infection Prevention

Departments

18 Preparing for the Next Outbreak

6 Care Chain Leadership

MATT MACKENZIE

7 > What’s on the Web, Advertiser Index

Sterile Processing 20 From Guidance to Accountability KARA NADEAU

24 Celebrating HPN’s SPD of the Year at HSPA DANIEL BEAIRD

12 ON THE COVER: From top (L-R): Bunmi Mfuko, System Director of Expense Management | Noubar Kevorkian, MD, Surgical Intensivist, Surgery Critical Care Redesign | Matthew Miller, MD, Director, Clinical Care Redesign | Jeff Stigliano, Director, Clinical Value Analysis | Colin Huguenel, MD, FACEP, Medical Director, Clinical Care Redesign | Donald Woods, Director, Strategic Sourcing & Contracting | Ryan Donahue, Sr. System Director, Procure to Pay | Milrose Mercado, Senior Vice President, Supply Chain & Support Services| Ajay Kumar, MD, EVP and Chief Clinical Officer | Dan Pak, Vice President, Procure to Pay | Center: Sharon Fried, Vice President of Supply Chain Operations

4 | June-July 2026 | Healthcare Purchasing News

EDITOR’S NOTE

June-July 2026, Vol. 50, No. 4

Care Chain Leadership

Group Content Director Healthcare Melinda Taschetta-Millane mtaschetta-millane@endeavorb2b.com Editor-in-Chief Daniel Beaird dbeaird@endeavorb2b.com Associate Editor Matt MacKenzie mmackenzie@endeavorb2b.com

BY DANIEL BEAIRD

Senior Contributing Editor Kara Nadeau knadeau@hpnonline.com

F

or years, healthcare supply chain was largely viewed as a support function focused on purchasing, contracts, logistics, and inventory management.

While those responsibilities remain critical, the role of supply chain inside hospitals and health systems has evolved dramatically. Today, supply chain leaders are increasingly influencing clinical operations, financial sustainability, physician engagement, resiliency planning, and patient care itself.

Th a t e volu t io n i s r e f l e c te d throughout this issue and in the organizations HPN has recognized with its Supply Chain Department o f t h e Ye a r h o n o r s o v e r t h e last two years.

Ha r t ford Hea lt hCa re, HPN’s 2026 Supply Chain Depar tment of the Year, represents a powerful example of how health systems are rethinking the role of supply chain across the enterprise. Rather than operating in isolation, Har tford HealthCare has integrated supply chain into clinical collaboration, analytics, governance, operational strategy, and financial stewardship in ways designed to directly support the organization’s mission around access, affordability, excellence, and health equity.

Those same themes were central to a recent HPN discussion with Omar Devlin at Stanford Health

Care, HPN’s 2025 Supply Chain Department of the Year. During the conversation, Devlin described how healthcare organizations are increasingly shif ting from traditional “supply chain” thinking toward the “care chain,” a more connected operational framework where supply chain decisions are directly lin ked to physicia n workf lows, patient outcomes, operational resiliency, and financial performance.

The need for greater visibility and operational intelligence is extending beyond acute ca re environments as well. As discussed in this issue, ambulatory surgery centers and physician practices are increasingly facing many of the same pressures hospitals have experienced for years, including reimbursement cuts, supply disruption risks, fragmented purchasing processes, rising costs, and growing operational complexity.

What connects all these conversations is the growing realization that supply chain is no longer simply about moving products through healthcare environments efficiently.

It is increasingly about supporting smarter clinical decisions, strengthening resiliency, improving financial stewardship, and helping organizations operate more cohesively across the continuum of care.

In many ways, healthcare supply chain is part of care delivery itself.

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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;

What’s on the Web

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

WHO Stresses Low Risk of Epidemic from Hantavirus Outbreak WHO’s director of epidemic and pandemic preparedness and prevention said that “this is an outbreak on a ship and we do not anticipate a large epidemic.” Extreme close contact is needed in the “rare cases where person-to-person transmission has been recorded.” Five of the eight suspected cases have been “laboratory-confirmed with hantavirus.”

Read on: hpnonline.com/55376440

Global Glove Manufacturing Faces Raw Material Shortages and Price Hikes Malaysia, which accounts for nearly half of global glove manufacturing capacity, is at the center of the issue. Leading producers have indicated they may implement additional price increases or reduce output if raw material inflation continues.

Read on: hpnonline.com/55373065

CDC Cancels Publication of Scientific Report on COVID Vaccine Efficacy The report cleared the agency’s scientific review process but was delayed by acting CDC director Jay Bha acharya over “con-

cerns about the methodology,” despite that methodology having “long been used by the CDC to evaluate vaccine effectiveness for respiratory viruses.” It was “used in a study on the flu vaccine published last month in MMWR.” Read on: hpnonline.com/55373087

McKesson Sells 13% Stake in Medical-Surgical Business to Apollo Funds for $1.25B MMS provides medical products, equipment, and supply chain services to physician offices, ambulatory surgery centers, and other non-acute care se ings. McKesson said it will retain majority ownership and continue to control the business following the close of the deal.

Read on: hpnonline.com/55372040

ECRI Announces New Spend and Recall Management Solutions Company The company will aim to combine the “largest independent source of healthcare supply and capital datasets with deep expertise and advanced analytics to help organizations in over 70 countries understand market trends and be er manage their supply chains.”

Read on: hpnonline.com/55373424

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

Index of Advertisers

This index is provided as a service. The publisher does not assume liability for errors or omissions.

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Medtrica ................................25

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Clorox Company .................... 5

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Ruhof Corporation..............C2

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Healthmark Industries ...... C4

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Uline ........................................ 13

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hpnonline.com | June-July 2026 | 7

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Editorial Advisory Board

SOURCING & LOGISTICS

2026 Supply Chain Department of the Year: Hartford HealthCare

BY DANIEL BEAIRD

A

• More than 50% price reductions in key commodt many healthcare organizations, supply chain ity categories. still operates largely behind the scenes, respon• 99.1% OR procedural inventory accuracy. sible for sourcing products, negotiating con• 99.9% consolidated service center inventory accuracy. tracts, and ensuring clinicians have what they • More than $556 million directed to local suppliers. need when they need it. Hartford HealthCare sees the role • More than 161,000 concierge inquiries managed, with very differently.

85% resolved in less than 24 hours.

For Hartford HealthCare, supply chain is not simply an But Hartford leaders emphasize that the story is not operational support function. It is a strategic enterprise about numbers alone. capability tied directly to financial stewardship, clinical performance, patient access, operational resilience, and “This is not episodic improvement; it is enterprise ownlong-term system transformation. ership, embedded in how the system operates every day,” That philosophy, combined with measurable enterprisesaid Milrose Mercado, senior vice president, supply chain wide impact, helped earn Hartford HealthCare recogniand support services, and chief procurement officer at tion as HPN’s 2026 Supply Chain Hartford HealthCare.

Department of the Year.

Hartford HealthCare’s The organization’s submission From supply function Supply Chain to strategic engine stood out not only because of the scale Enterprise Scope of its accomplishments, but because One of the clearest themes emerging Procure to Pay of how comprehensively supply chain from Hartford HealthCare’s transfor• Strategic Sourcing has been integrated into the health mation is the evolution of supply chain • Purchasing system’s broader strategy. Hartford from transactional service provider to • Accounts Payable frames supply chain as foundational enterprise strategic partner.

• Concierge Services / Call Center to its mission of becoming “the most Many healthcare organizations consumer-centric health system in continue to separate supply chain Supply Chain Operations the nation.” from clinical and executive decision• Distribution / Receiving It is a model that goes well beyond making. Hartford intentionally dis• Consolidated Service Center traditional purchasing. mantled those silos.

• Courier Hartford HealthCare’s supply chain By integrating clinical partnership, • Print Services organization spans clinical integraadvanced analytics, governance, and Clinical Supply Chain tion, analytics, operations, expense financial stewardship into a uniSupport Services management, suppor t ser vices, fied operating model, Hartford built • Food & Nutrition Services transportation, capital planning, a supply chain organization capable • Patient Transport governance, and leadership developof influencing decisions far beyond • Linen & Laundry ment. The scope includes more than procurement.

• Environmental Services 30 teams and more than 4,500 supThat transformation required • Patient Ride Share ply chain-related initiatives and serboth operational redesign and culSystem Capital vices across the enterprise. tural change.

Fleet Management The results are significant: The organization embedded supply Expense Management • $91.4 million in cost reducchain expertise directly into clinical tions in FY2025. workflows and executive leadership

8 | June-July 2026 | Healthcare Purchasing News

structures. Rather than functioning downstream from physicians and operational leaders, supply chain became part of the decision-making process itself.

The shift is especially evident through Hartford’s Clinical Care Redesign (CCR) initiative, which aligns clinicians, physicians, finance leaders, and supply chain teams around operational standardization, utilization management, and evidence-based purchasing decisions.

According to Hartford, CCR now represents more than 60% of the system’s total cost reductions and is jointly led by executive clinical and supply chain leadership.

That structure is intentional.

Rather than positioning supply chain initiatives solely as cost-saving exercises, Hartford frames them as clinical and operational improvement efforts tied to patient outcomes, affordability, and care consistency.

Defining a consumer-centric supply chain For Hartford HealthCare, “consumer-centric supply chain” is not simply a strategic phrase. Leaders say it directly shapes how care is delivered, experienced, and supported across the enterprise.

For patients, that means affordability, reliability, and a more seamless care experience. Hartford leaders point to the organization’s cost reductions and price reductions in key commodity categories as examples of how supply chain strategy can directly support lower costs of care.

Patients also experience fewer disruptions because of strong operational coordination, dependable access to supplies, and integrated support services such as transportation, meals, and concierge support.

For clinicians, the focus is on reducing friction and strengthening confidence in the system. Leaders say clinicians benefit from coordinated operations, strong inventory accuracy, and tools that help inform decision-making without disrupting workflows.

For operational leaders, the supply chain organization functions as a strategic engine providing oversight, analytics, and enterprise-wide visibility into performance and decision-making.

Ultimately, this is how Hartford HealthCare fulfills its promise to be the most consumer-centric health system in the nation by making care more accessible, affordable, and consistently excellent, Hartford leaders explained.

Building analytics that clinicians trust Perhaps the most distinctive aspect of Hartford HealthCare’s transformation is its internally developed Procedural Insights platform.

SOURCING & LOGISTICS

In an era where health systems increasingly invest in large-scale analytics infrastructures and enterprise business intelligence platforms, Hartford took a different approach.

The organization built its own physician-facing procedural analytics platform using native Epic OR supply data, standard Python workflows, and portable HTML architecture.

But Hartford leaders emphasize that the innovation is not the technology itself.

“The innovation isn’t flashy technology,” said Dan Pak, a Hartford HealthCare leader involved in the platform’s development. “It’s disciplined design a nd operational insight.”

The platform was designed specifically to foster trust and actionable clinical dialogue rather than impose mandates.

“Clinical variation work fails the moment it feels like a mandate,” Mercado explained. “The moment a dashboard tells a physician they’re an outlier and need to stop doing something, the conversation ends and the data gets dismissed.”

Instead, the platform surfaces variation data, peer medians, and procedural comparisons while allowing physicians to interpret the information within the context of their own patient populations and practice patterns.

“That distinction matters because the goal isn’t compliance, it’s alignment,” Mercado said. “When physicians own the interpretation, the standardization decisions that come out of it stick.”

The decision to build the platform internally was driven largely by flexibility, speed, and practicality.

Hartford leaders said internally developed architecture allowed the organization to define its own procedural taxonomy, customize variation logic for individual service lines, and rapidly deploy updates without

relying on outside vendors or development cycles.

“We are also not paying for more tools,” Mercado noted. “HTML output gives us infinite flexibility in how we visualize data, with no licensing fees, no web storage costs, and no servers to deploy or maintain.”

The organization also prioritized speed and usability.

“Shipping a dashboard is measured in hours instead of weeks, and updates happen in minutes — not the next development cycle,” Mercado explained.

The results were immediate.

The first cardiovascular deployment identified approximately $9.7 million in move-to-median opportunity, with some high-volume procedures showing supply cost variation ratios exceeding 10-to-1.

More importantly, Hartford demonstrated that meaningful innovation does not always require large-scale technology investments.

Sometimes it requires operational focus, workflow understanding, and organizational trust.

Governance that extends beyond savings While many organizations highlight cost reductions in supply chain transformation stories, Hartford HealthCare places equal emphasis on governance and sustainability.

That focus may be particularly relevant for healthcare executives navigating ongoing financial pressures, margin compression, and operational uncertainty.

Hartford’s Expense Management 2.0 strategy elevates expense management from a tactical initiative to what the organization describes as a “core enterprise capability.”

The system’s governance structure includes: • Enterprise-wide initiative tracking.

• B u d g e t-i n t e g r a t e d s a v i n g s validation.

10 | June-July 2026 | Healthcare Purchasing News

Hartford HealthCare by the Numbers Contracts Negotiated: 4,500+ Teams: 30 Initiatives: 373 Cost Reduction: $91.4 million Spend with Local Suppliers: $556.1 million Patient Meals Served: 1.8 million Patient Transports: 660,000+ Cost Reduction in Key Commodity Categories: 50%+ Inquiries Managed Through Concierge Service: 161,000+ OR Procedural Inventory Accuracy: 99.1% CSC Inventory Accuracy: 99.9% Product Expiration Clinical Inventory: 0.5%

• Monthly operational and finance alignment reviews.

• E V P- l e v e l a c c o u n t a b i l i t y structures.

• Post-implementation reviews conducted six to 12 months after deployment.

The goal is not simply identifying opportunities, but ensuring accountability and sustainability over time.

“All expenditures $250,000 and above are validated against defined criteria,” Mercado noted.

This level of operational rigor is increasingly important as health systems face heightened pressure to demonstrate measurable return on investment for both operational and technology initiatives.

Hartford’s leaders appear acutely aware of that challenge.

The organization’s governance model is designed to ensure that approved initiatives continue delivering expected outcomes well after implementation. Savings are not treated as one-time wins; they are operationalized into ongoing financial stewardship processes.

That discipline may be one of Hartford’s strongest differentiators.

Many organizations can generate isolated savings projects. Sustaining enterprise-wide accountability across multiple regions, institutes, service lines, and executive teams is far more difficult.

A culture built on ownership and accountability Hartford leaders describe the organization’s supply chain culture as one grounded in enterprise ownership, accountability, measurable outcomes, and disciplined execution.

“This is an outcomes-focused culture, where success is not measured by activity but by impact,” Mercado said. “Teams are accountable for delivering tangible results that advance affordability, clinical excellence, and system performance.”

That accountability extends well beyond traditional supply chain boundaries.

According to Hartford leaders, the organization operates not as a support function, but as a strategic enterprise capability responsible for value creation across financial, operational, and clinical domains.

The organization also emphasizes consistency and operational discipline through standardized governance structures and a unified operating model.

Innovation, leaders say, is pursued pragmatically.

“Tools like the Procedural Insights platform demonstrate how the team builds simple, high-impact solutions rooted in operational reality,” Mercado said.

Local sourcing and community impact A nother compelling aspect of Hartford HealthCare’s strategy is the organization’s focus on community impact and local supplier engagement.

In FY2025, Hartford directed more than $553 million toward local suppliers, reinforcing both sourcing resiliency and regional economic development.

Hartford leaders say local partnerships improve resiliency by reducing dependence on distant or fragile supply networks while strengthening communication, flexibility, and response capabilities during disruptions.

complexity of moder n healthcare systems.

The program provides: • End-to-end operational and clinical exposure.

• Executive mentorship.

• Enterprise strategy involvement.

• R e a l-w o r l d d e c i s i o n -m a king experience.

• Capstone projects presented directly to executive leadership.

Hartford leaders say local partnerships improve resiliency by reducing dependence on distant or fragile supply networks while strengthening communication, flexibility, and response capabilities during disruptions.

“These partnerships also drive meaningful economic and social benefits,” Mercado said. “By investing heavily in local businesses, Hartford HealthCare acts as an anchor institution, supporting job creation, business growth, and economic stability.”

The organization also views local sourcing as part of its broader commitment to health equity and community wellbeing.

“By investing locally, Hartford HealthCare strengthens operational performance while contributing to healthier, more resilient communities,” Mercado said.

Developing the next generation of leaders Hartford HealthCare’s Supply Chain Leadership Program (SCLP) adds another important dimension to the story: sustainability.

Rather than focusing exclusively on current performance metrics, Hartford is actively investing in future leadership development.

The organization created SCLP because leaders believed traditional development programs were not adequately preparing supply chain professionals for the increasing

That investment reflects a growing reality across healthcare that future supply chain leaders will require broader skill sets than traditional procurement expertise alone.

Hartford appears to be building intentionally for that future.

A model reflecting healthcare’s next phase Ultimately, Hartford HealthCare’s Supply Chain Department of the Year recognition reflects more than operational excellence.

It reflects the changing role of healthcare supply chain itself.

The most advanced organizations are no longer viewing supply chain primarily through the lens of purchasing efficiency. They are integrating supply chain into enterprise transformation efforts tied to clinical quality, financial sustainability, patient experience, workforce development, and operational resilience.

Hartford captures that evolution clearly.

“This is supply chain reimagined, not as theory and not as aspiration, but as a proven engine of access, affordability, excellence, and health equity,” Mercado concluded. HPN

hpnonline.com | June-July 2026 | 11

MOOR STUDIO|DIGITALVISION VECTORS|GETTY IMAGES

SOURCING & LOGISTICS

THE HPN CONVERSATION:

From Supply Chain to Care Chain How Stanford Health Care is connecting supply chain, clinical care, and data integration.

BY DANIEL BEAIRD

H

ealthcare supply chain leaders are increasingly being asked to think beyond purchasing, logistics, a nd inventory management. As financial pressures, disruption risks, and clinical complexity continue to rise, many health systems are rethinking

how supply chain connects to patient care, physician decision-making, and operational performance across the organization.

That evolving mindset was at the center of a recent Healthcare Purchasing News webinar, “From Supply Chain to Care Chain: Driving

12 | June-July 2026 | Healthcare Purchasing News

Clinical Integration and Operational Excellence,” sponsored by Amazon Business. During the discussion, Omar Devlin, Executive Director of Supply Chain Technology and Analytics at Stanford Health Care, shared how healthcare organizations are working to build more resilient, data-driven, and clinically integrated supply chain operations.

For Devlin, the concept of “care chain” reflects a broader shift happening across healthcare. Supply chain is no longer viewed solely as a support function focused on product movement and cost containment. Instead, it is becoming an increasingly strategic function tied directly to patient outcomes, physician collaboration, operational visibility, and financial sustainability.

The conversation explored several major themes shaping healthcare supply chain today, including pandemic-driven resiliency planning,

what makes healthcare disruption modeling, physupply chain fundamensician engagement, data tally different from many integration challenges, other industries. and the growing imporOutside hea lt hca re, tance of connecting ERP, supply chains are often EMR, and revenue cycle focused primarily on profsystems into a more uniOmar Devlin fied operational frameitability, customer demand, work. Stanford’s efforts and ensuring products are to improve item master data qualavailable at the right place and price.

In healthcare, our responsibility is ity, reduce non-standard purchasing, much broader because every operaand expand procedural analytics also tional decision ultimately touches offered a practical look at how health patient care. systems are beginning to bridge longFor us, “care chain” means ensurstanding silos between supply chain ing clinicians have the right prodand clinical care. ucts, at the right place, at the right When you hear the phrase time, while also managing disruption “supply chain to care chain,” risk, substitutions, shortages, and operational complexity behind the what does that mean inside scenes so those issues never impact Stanford Health Care today? patient outcomes.

Devlin: At the center of everything Healthcare is also incredibly we do in healthcare is the patient complex operationally. We manage experience and patient care. That’s

approximately 100,000 SKUs across the network, and at any point we’re navigating supply disruptions, substitutions, changing physician preferences, and patient variation. The challenge is maintaining optionality while still driving efficiency and resiliency throughout the organization.

How has the pandemic changed the relationship between supply chain and patient care?

Devlin: The pandemic was a major catalyst for the industry. It exposed how vulnerable healthcare supply chains could become during prolonged disruption events.

Before COVID, many organizations relied heavily on inventory levels and traditional sourcing models without fully appreciating how quickly global disruptions could affect care delivery. During the pandemic, healthcare organizations learned the importance

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SOURCING & LOGISTICS

of having contingency planning already in place — alternate sourcing strategies, pre-approved substitutions, and better visibility into supply risk.

We’ve also experienced additional disruption events since then, whether it’s IV fluid disruption, cyber incidents affecting suppliers, or geopolitical and weather-related events. What’s improved significantly is healthcare’s ability to pivot more quickly during disruptions.

Today, organizations are much more focused on resiliency planning and operational optionality. Technology is also helping make those transitions easier by improving reporting, substitution management, and visibility into alternate sourcing strategies.

Looking ahead, I think the next evolution is predictive disruption modeling — essentially using simulation capabilities and digital twin concepts to understand how different disruption scenarios could impact operations before they occur.

What has Stanford done to improve that level of integration?

Devlin: One of our major initiatives has focused on improving item master data quality and strengthening integration across systems following our ERP implementation.

We manage around 100,000 items, and each item contains approximately 135 different attributes. That creates a tremendous amount of operational complexity.

What we found was that data wasn’t always flowing cleanly between systems and revenue cycle platforms.

There were duplicate fields, inconsistent coding, missing attributes, and manual workarounds happening across departments.

Through significant cross-functional collaboration, we focused heavily on data health, data governance, and integration accuracy. We reduced large numbers of problematic data elements, improved charge capture workflows, and strengthened traceability throughout the organization.

Were there measurable operational gains from those efforts?

Devlin: Yes, several.

One major improvement involved reducing what we call “special” item orders — essentially products ordered outside standard item master workflows.

At one point, approximately 43% of our orders were classified as specials. That creates visibility challenges, traceability issues, and inefficiencies throughout the system.

We’ve now reduced that number to roughly 8%, which significantly improves standardization, tracking, reporting, and downstream operational workflows.

We also improved revenue cycle efficiency because cleaner data now flows more effectively between systems.

14 | June-July 2026 | Healthcare Purchasing News

Previously, revenue cycle teams often had to manually code products or correct information. By improving item master accuracy and integrations, we dramatically reduced manual intervention requirements.

Is clinical integration becoming the next major frontier for healthcare supply chain?

Devlin: Absolutely. One of the biggest opportunities — and challenges — in healthcare today is connecting fragmented systems and fragmented data.

Healthcare organizations often have ERP systems, EMRs, revenue cycle systems, analytics platforms, and other applications that were designed independently to solve specific operational problems. The issue is they don’t always communicate effectively with one another.

That fragmentation makes it difficult to create a true end-to-end operational view. Ideally, we should be able to understand the entire chain — from product purchasing and inventory management all the way through clinical utilization, patient outcomes, and reimbursement.

Compared to other industries, healthcare still has significant opportunity to improve holistic operational visibility across those systems.

What are some of the biggest barriers healthcare organizations still face around integration?

Devlin: One major challenge is cultural.

Healthcare organizations still tend to operate in silos.

Clinical teams focus appropriately on patient care. Supply chain teams focus on inventory and logistics. Revenue cycle teams focus on reimbursement and coding.

Each group is optimizing for different priorities, but they don’t always have visibility into how decisions impact other parts of the organization.

The fragmentation of healthcare IT systems reinforces those silos because it’s difficult for teams to see the downstream operational consequences of inaccurate data, inconsistent workflows, or disconnected processes.

Another challenge is healthcare’s complexity itself.

Unlike many industries, healthcare cannot simply standardize everything around cost. Patient variation matters. Clinical judgment matters. Physician preference matters. That creates a much more nuanced operational environment.

How is Stanford engaging physicians in sourcing and standardization discussions?

Devlin: One example is our procedural analytics program, which I’m very excited about.

The platform allows us to analyze supply utilization patterns across procedures, physicians, and service lines.

It highlights variation in product selection, procedural costs, and utilization patterns in a way that supports more informed clinical conversations.

For example, if one surgeon consistently uses a $2,000 product while others performing the same procedure use a $1,000 alternative, the platform helps surface that information transparently.

The goal is not to dictate physician behavior. It’s to create visibility and support collaborative conversations around value, outcomes, and standardization opportunities.

What’s been especially valuable is giving clinicians better comparative information while still respecting clinical judgment and patient-specific decision-making.

How do you balance standardization with physician preference and patient-specific care?

Devlin: That’s one of the toughest challenges in healthcare operations.

In other industries, standardization decisions are often primarily cost driven. Healthcare is different because patient outcomes always come first.

There are legitimate situations where different products may be clinically appropriate for different patients.

The challenge becomes understanding what variation is necessary versus what may represent unwarranted variation.

We’ve spent a lot of time analyzing procedural variation, preference cards, and supply utilization patterns to better understand those differences.

The key is not eliminating physician choice. It’s creating better transparency and data-informed conversations so organizations can distinguish between clinically necessary variation and opportunities for improvement.

Looking ahead, where do you see healthcare supply chain evolving next?

Devlin: I think healthcare supply chain will continue becoming more integrated with clinical and operational decision-making.

We’ll see greater use of predictive analytics, disruption modeling, procedural analytics, and connected data environments that help organizations make faster, more informed decisions.

The future is about building a more resilient, transparent, and clinically integrated care chain — one capable of supporting both operational efficiency and better patient outcomes simultaneously. HPN

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SOURCING & LOGISTICS

From Siloed Spreadsheets to Strategic Visibility How Trivalence is helping ASCs modernize spend management.

BY DANIEL BEAIRD

A

s ambulatory surgery centers (ASCs) and physician practices face mounting reimbursement pressure, rising supply costs, and increasing operational complexity, many organizations are discovering that their biggest challenge is not simply controlling spend, but seeing it clearly in the first place.

That was the reality facing Century Vision Global, an ophthalmology and ambulatory surgery organization operating 13 locations and two surgery centers, before implementing Trivalence’s centralized procure-to-pay (P2P) platform.

According to Lonna Carter, CEO and General Counsel for Century Vision Global, the organization inherited a highly manual purchasing and invoice management process spread across multiple sites.

“We started doing Excel spreadsheets and saving everything on a consolidated shared drive,” Carter said. “It was a very manual analysis to figure out our spend. We had different people ordering things; it was an antiquated system that we inherited.”

That challenge is increasingly common across non-acute healthcare environments.

Will Byington, CEO of Trivalence, notes many ambulatory providers still rely on fragmented purchasing processes, spreadsheets, emails, vendor portals, and manual workflows that create blind spots around procurement, inventory, and accounts payable.

The growing operational pressure on ASCs ASCs are under increasing pressure to operate more like sophisticated health systems while maintaining the lean staffing and fast-paced workflows that define outpatient care. As more procedures continue shifting from inpatient hospitals to outpatient environments, supply chain and spend management are becoming critical operational and financial differentiators.

Byington says that outpatient services now account for nearly half of total hospital system revenue, while ambulatory care spending in the U.S. exceeds $1 trillion annually. Yet many ASCs still lack centralized supply

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chain oversight and continue managing purchasing through disconnected tools and manual processes.

The pressures facing ASCs today extend well beyond supply ordering.

Reimbursement cuts, payer scrutiny, geopolitical disruptions, labor costs, and ongoing supply chain instability Lonna Carter are forcing organizations to rethink operational efficiency.

“The operational pressure has been outstanding,” Carter said. “Medicare cuts, insurance payers reducing reimbursements, and increasing denial rates are all contributing.”

At the same time, supply disWill Byington ruptions continue to ripple through healthcare.

“We were advised by one vendor that we have supplies stuck in a container ship in the Strait of Hormuz,” she said.

“There’s always going to be a supply chain issue.”

For many ASCs, these operational pressures expose longstanding weaknesses in decentralized purchasing and inventory management. Multi-site ambulatory organizations often operate with: • Different staff members ordering from different vendors.

• No centralized item master.

• Limited standardization of products.

• Inconsistent invoice workflows.

• Minimal inventory visibility.

• Off-contract purchasing activity.

The result can be higher supply costs, excess inventory, stockouts, delayed reimbursements, and limited visibility into true supply utilization across locations.

Moving beyond “the way we’ve always done it” For Carter, one of the biggest shifts was moving the organization away from siloed workflows toward centralized visibility.

“A lot of folks are just doing it the way that they’ve always done it,” she said. “You don’t see the bigger picture. You’re siloed.”

That lack of visibility often limits organizations’ ability to compare purchasing behaviors, identify utilization trends, or negotiate better pricing across locations.

“When we start being able to compare locations and other processes, that’s when we start having those ‘aha’ moments about operational improvements. We have meaningful data to potentially renegotiate contracts and get better pricing,” Carter explained.

Byington emphasizes this same concept of “clarity plus control,” arguing that most health systems and ambulatory networks have significant unmanaged non-labor spend due to fragmented processes and inconsistent data.

The company says its platform is designed to unify procurement, inventory visibility, AP automation, and payments into a single system that improves operational clarity and financial control.

Building a more data-driven ASC environment Carter said one of the biggest advantages has been gaining faster access to actionable operational data.

“Now we have the data to say this location overutilizes,” she said. “And compare that to another location using less product easily. This leads to process improvements, cost savings, opportunities for us to reflect on possible compliance issues and improve our compliance improvements.”

The organization also sees opportunities to improve vendor negotiations and purchasing strategies using broader visibility into spend patterns and utilization trends.

“We have better insight into how to improve our negotiations,” Carter said, “and, just get that data faster because it is less manual now.”

Byington estimates organizations can reduce non-labor supply spend by up to 10%, cut purchasing errors by 70%, and reduce inventory waste through centralized visibility and automation.

The platform also reflects a broader shift happening across outpatient healthcare: moving from reactive purchasing toward proactive operational intelligence.

Increasingly, ASCs are looking for systems that not only automate workflows, but also generate actionable insights around utilization, physician preference variation, supplier performance, and contract compliance.

One of the biggest pain points for many organizations is the disconnect between procurement and accounts payable.

Why spend management has become strategic for ASCs Spend management is no longer viewed as simply a finance or purchasing function. Increasingly, ASC leaders are treating it as an enterprise-wide operational strategy.

One of the biggest pain points for many organizations is the disconnect between procurement and accounts payable. In many ASC environments: • POs are inconsistently created.

• Invoices arrive through multiple channels.

• Invoice reconciliation is manual.

• GL coding varies across locations.

• Finance teams spend excessive time matching purchases and invoices.

This creates additional administrative burden while limiting real-time financial visibility.

Trivalence positions its platform around closing those operational gaps through automated purchasing workflows, PO-to-invoice matching, inventory tracking, payment automation, and real-time analytics.

Inventory management is another growing challenge.

Smaller ambulatory sites frequently operate with lean staffing models and limited supply chain infrastructure, making it difficult to track inventory levels, expiration dates, or usage trends consistently across locations.

Trivalence says its platform helps organizations improve visibility into stock levels, expiration tracking, and inventory utilization to reduce waste and improve purchasing accuracy.

AI, benchmarking, and predictive visibility Like many healthcare technology vendors, Trivalence is also exploring AI-enabled capabilities. Byington describes future applications ranging from supplier performance analytics and predictive automation to spend forecasting and intelligent workflow optimization.

Carter believes the future of non-acute supply chain management will increasingly revolve around peer benchmarking and predictive analytics or AI. “Within three to five years, a platform like this will have access to even more information from our peers,” she said. “They’ll be able to de-identify it and say, ‘Your team is spending $100,000 on XYZ over six months. Your peers are spending $80,000. There might be an opportunity here for you.’”

For ASC leaders navigating tightening margins and growing operational complexity, that kind of visibility may become increasingly valuable.

“The more data, the better,” Carter said. “That’s going to give us more information so we can make more informed decisions faster.” HPN

hpnonline.com | June-July 2026 | 17

INFECTION PREVENTION

Preparing for the Next Outbreak As hantavirus sparks concern, strong alignment between infection prevention and supply chain teams is critical to outbreak preparedness and resiliency.

BY MATT MACKENZIE

A

s of this writing, concerns about hantavirus have run rampant across social media as new details emerged surrounding an outbreak tied to an MV Hondius cruise ship in May. Hopefully, this will simply mark a brief period of heightened public anxiety over a virus that never becomes a widespread threat. According to the World Health Organization, that is the most likely scenario, as the agency continues to emphasize that the risk to the public is currently very low. Hantavirus is not considered highly transmissible between people in most forms, and many infectious disease outbreaks are ultimately contained through surveillance, vaccination efforts, isolation protocols, and coordinated public health responses.

Still, the fervor surrounding the outbreak reflects that the public was

scarred by the COVID-19 pandemic and is concerned by the possibility of another large-scale infectious disease event. Public health experts generally view future pandemics as a matter of when, not if. The next outbreak may not mirror COVID-19 in scale or severity, but the capability of straining health systems, supply chains, and public health infrastructure is considered highly likely over the long term. Health systems and hospitals must be ready to tackle whatever new viral threats may arise in future.

HPN spoke with infection preventionist and APIC member Haley Hoffman, BSN, RN, CIC, about the importance of collaboration between infection prevention and supply chain teams within health systems to close procurement gaps and maintain operational continuity during future outbreaks. For healthcare leaders, it’s no

18 | June-July 2026 | Healthcare Purchasing News

longer a question of whether another outbreak will occur, but whether hospitals are better prepared to respond without repeating the shortages, procurement disruptions, and operational strains of COVID-19.

That preparation requires alignment across the enterprise, including PPE and critical supply resiliency, supplier diversification, inventory visibility, workforce preparedness, predictive analytics, and close collaboration across healthcare teams.

From APIC’s perspective, how should supply chain leaders be thinking about emerging pathogen threats today?

Hoffman: Supply chain in regards to emerging pathogens should be concerned with sourcing. As experienced during the pandemic, having supplies from one area in the world or

amongst each other. This was more for larger equipment like ventilators, but we also worked in assistance with N95 sterilization for re-use. This sharing can still occur now through a grant for our region.

Where should organizations draw the line between preparedness and overstocking?

Hoffman: Depending on organizational needs it would be helpful to be just above par. Otherwise you are dealing with a storage problem and expiration dates.

UNDEFINED UNDEFINED/ISTOCK/GETTY IMAGES PLUS/GETTY IMAGES

Environmental disinfection is evolving quickly. What should supply chain leaders be paying attention to?

state is not ideal. As well as innovative designs-non-fogging eye protection with glare reduction that are full coverage and comfortable.

If a new pandemic emerged tomorrow, where are health systems still most vulnerable?

Hoffman: The same as above applies: not having one area be the distribution center is important. Additionally, not one company having the market share of a good is important. Recalls can also drastically affect hospital systems, adding further to an ongoing crisis.

What changes did you see in PPE procurement strategies coming out of the pandemic, and are they still true today?

Hoffman: Our region worked together and could stockpile and distribute

Hoffman: Full coverage with low contact times, as well as measures to keep wipes moist for the whole contact time. A wipe that dries out or is not wet enough to cover surface area is not ideal. It’s nice to have color changes, but if it dries out, it is a waste.

Supply chain leaders are under intense financial pressure. How should they measure the ROI of infection prevention investments?

Hoffman: Lives saved. While this is not an actual amount, it is a life. Supplying life-saving PPE pays for itself and may even produce brand loyalty.

How is the relationship between infection prevention and supply chain evolving inside health systems?

Hoffman: We work together, or at least I do at my organization. Infection prevention looks at the science and adaptability, not the price. I will review the coverage of organisms for a cleaning wipe along with contact time and durability. Most important is a clear IFU that does not require new cleaning products or more work for the user. I will advise a more expensive item if it’s more coverage and easier to use.

Infection risks are expanding beyond the hospital. How should supply chain strategies adapt across the continuum of care?

Hoffman: Availability of pricing and products outside of a hospital is crucial.

A lot of independent companies tell their RNs/LPNs to purchase at a retail drugstore for some items, like gauze. They will of course be reimbursed but the quality is not the same.

Where do you see AI having the most immediate impact in infection prevention, and what does that mean for supply chain?

Hoffman: That is hard to say but I would say early interventions. If programs are built that flag a patient faster, then interventions can be undertaken faster.

Ideally if a patient is flagged as a contact and precautions are required, then supplies would immediately be delivered or restocked to that unit. How nice would it be to not have think of questions like “we used 8 gowns but have 3 left. I will wait to order until we are out.” If AI could calculate each entry to the room and combine that with gown use, there would be no ordering.

What’s the biggest misconception supply chain leaders still have about infection prevention?

Hoffman: We don’t make choices independently or blindly. We ask our healthcare workers for thoughts. We research and review evidence-based guidance.

If an accrediting body doesn’t like it, then neither will we. HPN

hpnonline.com | June-July 2026 | 19

STERILE PROCESSING

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From Guidance to Accountability Navigating the latest sterile processing standards - and the reality of deviations.

BY KARA NADEAU

I

n June 2025, HPN examined a wave of evolving standards shaping sterile processing departments (SPD), highlighting the growing complexity of compliance and the increasing expectations placed on departments. Less than a year later, the conversation has shifted.

Today, the issue is no longer awareness – it’s execution.

“Over the past years, sterile processing and endoscope reprocessing have seen some of the most significant standards updates,” said Christy Newland, senior director, clinical solutions and delivery, STERIS. “These changes aren’t just technical - they reshape survey expectations, patient safety, and operational risk. As someone who works closely with teams across hospitals and

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ambulatory surgery centers (ASC), I see both the progress and the pain points these shifts create.”

Those “pain points” are becoming increasingly visible as updated standards move from guidance documents to operational requirements.

They are scrutinized not only in daily workflows, but also during accreditation surveys.

At the center of this evolution are several key standards and guidance documents redefining how SPD professionals approach water quality, sterilization practices, endoscope reprocessing, and documentation.

At the same time, a long-standing but often uncomfortable topic is gaining more attention: How to manage unavoidable deviations from those standards.

Water quality moves to the forefront

ST108 requires organizations to define ownership, monitor perforAmong the most impactful developments is ANSI/AAMI ST108:2023 Water for Processing Medical Devices, which elevates water quality from a background conmance, trend results, and take action sideration to a defined, measurable component of sterile processing performance. when parameters fall outside defined “If you have worked in sterile processing long enough, you already know limits, fundamentally shifting water this - water has always mattered,” said Shawn Flynn, business unit director, quality from a passive condition to an SPD, for Skytron. “We just have not always treated it like our responsibility. actively managed process.

ANSI/AAMI ST108 changes that.”

For many sterile processing professionals, ST108 raises a familiar question: Is this truly new, or simply newly enforced?

“The answer is both,” Flynn added. “The science has always been there. What is new is the clarity, accountability, and expectation that water quality is actively managed, not passively assumed.”

Historically, water quality was often referenced in broader standards such as ANSI/AAMI ST79 Comprehensive guide to — DANIELLE M. WEST, PH.D. steam sterilization and sterility assurance in health care facilities, with ownership typically falling to facilities departments and limited visibility within the SPD. Expanding expectations ANSI/AAMI ST108 removes that ambiguity, defining across core standards water quality as a critical input into cleaning, disinfection, While ST108 has captured significant and sterilization processes. attention, it is not the only standard Danielle M. West, Ph.D., lead scientist, diagnostic solutions on the minds of SPD professionals. service, STERIS, and a member of the AAMI WG95, Water Quality for Processing of Medical Devices – contributing to both ANSI/AAMI ST79: Raising the bar—and ST108:2023 and the forthcoming AAMI TIR119, Guidance on Healthcare under active revision Implementation and Use of ANSI/AAMI ST108:2023 - noted that impleANSI/AAMI ST79 continues to serve mentation remains a key challenge for many organizations. as the foundational guidance document for steam sterilization and “As healthcare facilities work toward implementing ANSI/AAMI ST108:2023, many questions arise regarding the practical aspects of execution,” she said. sterility assurance in healthcare facil“Once published, AAMI TIR119 will serve as an implementation guide, offerities, but it is also actively evolving.

“Amendments and ongoing reviing risk-informed, practical guidance – including tools for gap analysis, action planning, and evaluating system modifications – to support application of the sion work emphasize daily air-removal standard within existing facility environments.” testing, quarantining implant loads until biological indicator (BI) results Importantly, the relationship between the two documents is complementary. are negative, and trending docu“In essence, ST108 defines the requirements and TIR119 provides guidance mentation errors,” said on implementation,” West added.

Newland. “Surveyors now From an operational standpoint, the implications are significant. expect magnified inspecWater is not a neutral element in reprocessing - it directly influt ion a nd mec ha n ica l ences outcomes.

“Water is the medium for cleaning chemistry, the final contact cleaning checks as routine point before sterilization, and a direct contributor to instrument - not optional.”

At the same time, a and equipment outcomes,” said Flynn. “When water quality drifts, broader revision effort we see it immediately - inconsistent cleaning results, staining and Christy Newland is underway to improve residue, corrosion, wet loads, failed indicators.” clar ity, usability, and The impact extends beyond instruments to the equipment itself. a l ig n ment w it h rea l“Poor water quality accelerates scale buildup, corrodes components, world workflows. and increases stress on washers, ultrasonics, steam sterilizers, and “A central goal of the associated plumbing,” Flynn continued. revision effort is to make Despite this, misconceptions remain.

ST79 more streamlined “One misconception I hear frequently is that ST108 is simply and easier to use in realabout installing a reverse osmosis system. It is not. Infrastructure matters, but governance matters more,” he added.

Mary Ann Drosnock world healthcare settings,”

“In essence, ST108 defines the requirements and TIR119 provides guidance on implementation,”

hpnonline.com | June-July 2026 | 21

STERILE PROCESSING

said Mary Ann Drosnock, DHSc, CIC, CFER, RM (NRCM), FAPIC, AAMIF, co-chair of AAMI working group 40, which oversees ST79.

The working group is focused on reorganizing the standard to better reflect the actual flow of instrument processing - from point-of-use (POU) treatment through cleaning,

“A central goal of the revision effort is to make ST79 more streamlined and easier to use in real-world healthcare settings” — MARY ANN DROSNOCK

sterilization, and storage - while integrating prior amendment content directly into the main body of the document to reduce redundancy and improve clarity.

“We really decided to break the document down more closely to have the actual flow of a medical device as it’s going through the processing cycle,” Drosnock explained.

The revision process is also being structured to move more efficiently, with task groups assigned to specific sections and a goal of producing an initial draft for broader review later this year.

For sterile processing professionals, this presents an opportunity to engage. Drosnock emphasized that participation in the standards development process - whether through working groups, public review, or professional feedback - helps ensure that ST79 remains practical, evidenceinformed, and responsive to the realities of healthcare delivery.

“Now is the time to get involved in the working group, because you can have an impact on what the document says in the end,” she said.

ST91: Endoscope reprocessing under intensified scrutiny Endoscope reprocessing remains a high-risk, high-visibility area, and the 2021 revision of ANSI/AAMI ST91 continues to drive change.

“The 2021 revision tightened requirements for leak testing, cleaning verification, and storage,” said Newland. “Chain-of-custody and quality assurance (QA) audits are now non-negotiable for patient safety.”

These requirements have translated into increasingly detailed audits, with surveyors expecting documentation for every step of the process.

Beyond AAMI: ISO and additional guidance In addition to AAMI sta nda rds, broader frameworks are influencing expectations within SPDs. “Validation discipline (DQ/OQ/PQ) and process control expectations are influencing IFUs and surveyor questions, even when ISO isn’t directly cited,” said Newland regarding ISO 17665:2024

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Sterilization of health care products — Moist heat — Requirements for the development, validation and routine control of a sterilization process for medical devices, and related frameworks.

Guidance documents such as AAMI TIR17:2024 Compatibility of materials subject to sterilization are also expanding considerations around material compatibility and device longevity, reinforcing the need for evidence-based decision-making.

“What ma ers most is having a clear, documented approach and the ability to explain how decisions are made” — SHAWN FLYNN Education, certification, and advocacy: Supporting the profession As standards evolve, so too must the education and professional development of sterile processing personnel.

“Education and standards for the sterile processing profession are constantly evolving and improving,” said Damien Berg, vice president of strategic initiatives, Healthcare Sterile Processing Association (HSPA).

“There have been many updates to the standards and education over the years.

“Still, one thing remains constant: we must continually review what is being done, what is required, and how we can ensure that standards and education are up to date with the manufacturer’s requirements and regulations.”

“Aligning HSPA’s educational resources with the most current standards and regulations and having HSPA team members participating in the standards development process are essential to the process,” Berg added.

longer a reactive exercise Certification efforts are - it is a core component also gaining momentum. of compliance.

“HSPA maintains a unified voice to advocate for the profession and to creFrom deviation ate legislative and reguto discipline latory changes that help As scrutiny increases, Shawn Flynn ensure every patient has so does the need for an educated, certified sterst r uc tu red, proac tive ile processing technician approaches to managing responsible for reprocessdeviations. ing their instruments,” “Surveyors are increassaid Josephine Colacci, ing their scrutiny and Esq., d i rector of govstandards are becomernment affairs, HSPA. ing stricter,” Newland “HSPA’s dedicated and commented. “Facilities Damien Berg focused advocacy efforts that combine strict comhave resulted in state statpliance with organized utes in New York, Connecticut, approaches to managing deviations will safeguard both patient safety Delaware, Pennsylvania, Tennessee, and their accreditation. The focus and Minnesota. Before HSPA started is not on flawless performance, but its legislative efforts, only New Jersey rather on open communication, required certification.” assessing risks, and ensuring consistent action.”

The reality no one can This shift - from perfection to ignore: Standards deviations transparency - ref lects broader Despite increasing expectations, trends in healthcare quality and one reality remains unchanged: Not risk management. every facility can meet every standard requirement perfectly, all the time.

“Here’s the truth: deviations hapBuilding reliable systems pen,” said Newland. “Facility design for patient safety constraints, IFU conflicts, supply Ultimately, the evolving standards disruptions, staffing shortages landscape reflects a larger principle: they’re real. The difference between Patient safety depends on reliable, a finding and a defensible plan lies interconnected systems. in structure.”

“Patient safety is not achieved This reflects an important shift in in a single step. It is built through how compliance is evaluated. Rather dep e ndable syste m s wor k i ng together,” said Flynn. than expecting perfection, surveyors From water quality and sterilizaare increasingly focused on how orgation practices to documentation and nizations assess risk and document decision-making. deviation management, each compo“What matters most is having a nent plays a role in ensuring consisclear, documented approach and the tent, safe outcomes. ability to explain how decisions are For sterile processing professionmade,” said Flynn. “Surveyors are als, the challenge and the opportunot looking for perfection. They are nity is clear. Standards will continue looking for awareness, oversight, and to evolve, and expectations will conaccountability.” tinue to rise. Success will depend not For sterile processing professiononly on understanding those stanals, deviation management is no dards, but on integrating them into

resilient, well-documented processes that can withstand both operational pressures and regulatory scrutiny.

In that sense, the shift from guidance to accountability is not just a regulatory change - it is a defining moment for the profession.

“Facility design constraints, IFU conflicts, supply disruptions, staffing shortages - they’re real.

The difference between a finding and a defensible plan lies in structure.”

— CHRISTY NEWLAND

Ambulatory surgery centers: same standards, fewer buffers While these standards apply across healthcare settings, ambulatory surgery centers (ASC) often face unique challenges in meeting them.

“This standard is especially important for ambulatory surgery centers,” said Shawn Flynn, business unit director, SPD, for Skytron, referring to ANSI/AAMI ST108:2023 Water for Processing Medical Devices. “ASCs often operate with leaner sterile processing infrastructure, limited on-site facilities support, and a historical assumption that water quality is ‘good enough.’”

At the same time, procedural complexity in ASCs continues to increase, placing greater demands on reprocessing workflows.

“That combination creates risk,” Flynn continued. “Without intentional water quality management, ASCs are more likely to experience variability in cleaning outcomes, premature equipment wear, and unexpected downtime that directly impacts case flow.” HPN

hpnonline.com | June-July 2026 | 23

SPECIAL REPORTS

HPN’s 2026 Sterile Processing Department of the Year at HSPA: Nemours Children’s Hospital, Delaware The hospital’s leadership emphasizes investing in people, technology, and strategic integration of SPD with perioperative services.

BY DANIEL BEAIRD

I

n April, I had the opportunity to speak with the leadership team at Nemours Children’s Hospital, Delawa re, ou r 2026 Ster i le Processing Department of the Year, and celebrate them at HSPA’s Annual Conference in Baltimore. It was one of the most energizing conversations I’ve had since joining Healthcare Purchasing News.

What stood out immediately was that this was about far more than trays, instruments, and workflows.

It was about culture, leadership, and what can happen when a health system fully recognizes sterile processing as mission-critical.

At Nemours, SPD has a true seat at the table. Leaders are involved in strategy, capital planning, facility design, workforce development, and daily collaboration with the OR, infection prevention, and executive leadership. That level of integration has helped produce results many organizations are still striving for: zero vacancies, zero travelers, advanced certification rates, and a highly engaged team.

What impressed me most was the pride. The Nemours leaders spoke passionately about developing people, celebrating certifications, investing in technology, and eliminating the outdated idea that sterile processing is a hidden support function. They

understand SPD for what it is and that’s an essential link in the patient safety chain.

Their story should resonate far beyond Delaware. As healthcare organizations work to improve perioperative performance, reduce turnover, and strengthen resilience, Nemours offers a blueprint: elevate sterile processing, invest in the people doing the work, and align the department with enterprise goals.

The future of SPD becomes brighter when leaders treat it like the strategic asset it already is. Nemours is proving exactly that.

Here are just a few of my favorite quotes from the interview with the Nemours team…

“Here at Nemours, we do not view SPD as a support function or

24 | June-July 2026 | Healthcare Purchasing News

something to consider after the fact.

SPD definitely has a seat at the table.”

— Dr. Edna Gilliam, Assistant Vice President, Perioperative Services & SPD, Nemours Children’s Hospital, Delaware “They’re no longer just the department that’s cleaning the dishes… this is a true critical area in our organization.”

— Dr. Gilliam “SPD is not in the basement. It is on the third floor, and the OR is on the second floor.”

— Kwame Gyabaah, Manager, Sterile Processing, Nemours Children’s Hospital, Delaware “We invest in our people. We think that it’s very important to invest in our people.”

—Dr. Gilliam HPN

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SPECIAL REPORTS

INSIDE THE SCOPE:

How AI-Powered Inspection Is Transforming Sterile Processing at MarinHealth

F

or years, sterile processing professionals have followed detailed endoscope reprocessing instructions while relying largely on process adherence and experience to determine whether a scope was truly clean. At MarinHealth Medical Center in Greenbrae, Calif., that changed when the organization implemented AI-assisted endoscope inspection technology capable of visualizing internal channel damage and debris in real time. According to SPD leaders at MarinHealth, the technology has strengthened compliance efforts, improved technician confidence, reduced costly repairs, and introduced a new level of visibility into one of healthcare’s most critical and high-risk reprocessing workflows.

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Paul Melter, SPD Supervisor at MarinHealth, and K.C. Van Voorhis, Director of Implementation at BH2 Innovations, recently sat down with Ralph Basile, a retired standards corporate executive at Healthmark, A Getinge Company, and a contributor to Healthcare Purchasing News.

BH2 Innovations is the creator of WatchDog AI. Basile: Give us a snapshot of MarinHealth

and its SPD operation.

Melter: MarinHealth is a 327-bed independent hospital serving the North Bay area of suburban San Francisco.

Our SPD team runs 24/7 with 25 team members. Each month we process about 100,000 in-house instruments,

500 loaner trays, and prepare roughly 220 scopes to support more than 11,000 annual procedures, including over 2,600 endoscopy cases.

Before SPD owned the process, how were endoscopes managed?

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Melter: Endoscopy handled their own cleaning. Over time, compliance issues and inconsistencies appeared. That pushed a re-evaluation and the transition of scope processing into SPD, where we could strengthen standardization.

What did scope cleaning look like before AI tools entered the picture?

Melter: We followed manufacturer instructions, but it was essentially blind cleaning—you completed steps and assumed the outcome. We added ATP testing for reassurance, but we still couldn’t see inside the channels, especially for difficult-to-clean scopes.

How did inspection scopes and WatchDog AI change the game?

Melter: We started with an inspection scope that was hard to set up. After switching to the Healthmark FIS-007 paired with WatchDog AI, the difference was immediate—we began seeing scratches, debris, and fraying we would’ve missed.

Change management is always a hurdle. How did your team adapt?

Melter: Initially, techs resisted adding a step. With hands-on training and the ability to see issues in real time, confidence grew quickly. The visuals created trust in the process and in their own work.

What happened on the compliance front?

Melter: Our team proactively reported a potential issue to Olympus and the Joint Commission. When surveyors visited, they found our process above best practice—leadership received a report noting we were operating above and beyond expectations.

What operational and financial outcomes have you observed?

Melter: We’ve reduced rewash and consumable use (fewer ATP/protein tests and brush replacements), and repairs are caught earlier. After an initial surge—because we finally

saw problems—repair costs trended down. Catching a scratch early can be a ~$2,000 repair; a puncture can exceed $10,000.

K.C. Van Voorhis: The inspection step proved time-neutral. You add verification, but you remove uncertainty and rework—it balances out.

Walk us through a typical inspection in your workflow.

Melter: After high-level disinfection and before hanging to dry, we place the scope in a clean transport tray. Using a high-level disinfect inspection scope, we examine the instrument channel from proximal and distal ends, wipe the scope with alcohol, and move on to the next.

If you had to summarize your biggest lessons learned, what would they be?

Melter: Change is hard but necessary. Inspection scopes paired with AI dramatically improve cleanliness and scope health, and seeing anomalies in real time gives the team peace of mind.

K.C. Van Voorhis: More observable data leads to better decisions. AI amplifies the strengths of SPD technicians.

What would you tell a hospital considering AI-assisted inspections?

Melter: Don’t wait. Being able to see inside a channel changes everything—you won’t want to go back.

K.C. Van Voorhis: We’re just getting started. As tools mature, SPD becomes safer, smarter, and more standardized. HPN

hpnonline.com | June-July 2026 | 27

STERILE PROCESSING INSIGHTS

Reducing Holes in Sterile Wrap

BY ADAM OKADA

Q A

“O u r faci l ity is hav i ng issues with a lot of holes and tears in trays. Do you have suggestions for us?”

As someone who talks too much, I always have suggestions about everything.

Relationship problems? Kids acting out? Is a hot dog a sandwich or not? I have thoughts. I may not have the correct answers for most of these problems, though a hot dog is a sandwich by definition, but I can assist with some suggestions for your issues with holes and tears in the wrap. (Fig. 1).

You’re not alone. Just about every facility that I worked for struggled with the same issue. One facility was particularly bad. We even had meetings with the C-suite to discuss disgruntled doctors who had filed complaints about excessive trays being rejected due to holes in the wrap.

1. Start with education.

(My two cents’ worth: don’t jump to conclusions and assume there’s an issue with your wrap.)

All sterilizer wraps undergo qualification testing by the manufacturer so

Figure 1. Hole/ Tear in Wrap.

that they are designed to withstand a fair amount of wear and tear. During testing, wraps are handled roughly and, in some cases, drop-tested from a few inches of height to withstand impact. In the sterile processing space, most products made of cheaper stuff, if not all, are likely cheaper for a reason.

Cheaper wrap is likely to be thinner or comprised of cheaper materials.

So, if you’re trying to save pennies on the Dollar by going with a cheaper wrap, or if you were like me and stuck with a terrible system-wide contract with a less-than-reputable vendor, the quality of your wrap could be the issue, but I wouldn’t automatically assume that.

It is more likely there’s a process issue with how staff are loading/unloading the sterilizer rack or loading/unloading from sterile storage. We did a full training and competency review at shift huddles, showing staff how to lift the trays and place them gently on the rack for loading, then lifting and pulling them off the shelf without dragging them across the metal.

We a lso i mplemented a check prior to sending any tray to the operating room (OR) via the du mbwa iter.

Each tray that was sent up had to be scanned to its designated location,

28 | June-July 2026 | Healthcare Purchasing News

Figure 2. Silicone Corner Hugs.

Healthmark, A Getinge company.4

and a reminder button would appear in our tracking system to prompt staff to inspect the corners and underneath the tray for any holes. This was moderately effective and took the pressure off the sterile processing staff, but we were still having issues with holes in wrap.

2. Education also needs to be given to the OR staff.

We learned this lesson by bringing in a third-party vendor to do a focused assessment of our storage and transportation protocols. Their observations determined our issues were actually with the OR staff, who were pulling wrapped trays off case carts or off sterile storage shelves to bring them to the patient rooms.

They observed dragging and dropping, and in one case an OR scrub tech ran into the corner of a rack while carrying an instrument set, causing a tear in the corner big surprise and even a case delay.

With the problem gap identified, we addressed the issue with education, started using more robust corner protection (more on that later), and reduced our issue with holes in trays to almost zero!

Figure 3. Dual Underguard Dry Mats. Healthmark.5

Q: “We are having wet pack issues now that we started using corner protectors. Are the corner protectors causing wet packs?

A:It’s entirely possible that both of these questions came from my former staff because we had the exact same issue after we started using heavier corner protectors. We addressed our facility’s holes-in-trays issue, in part, with heavy-duty corner protection but then saw an increase in wet packs.

In short, no; corner protectors should not be causing wet packs or wet loads. Similar to how manufacturers test packaging for durability, they are also testing corner protectors to ensure they do not impede proper sterilization and are not causing issues with wetness.

I’ve written about wet packs/loads in previous HPN articles (x-ref editions January 20252 and December 20253), but wet loads are most likely due to an issue with wet-todry steam ratios. Steam should be 97−98% dry, saturated steam and 2−3% water. In our case, we saw an increase in wet loads after using corner protectors. (Fig. 2). Rather than assuming the corner protectors were to blame (they weren’t), we brought in a company to assess our water and boiler quality.

Their assessments determined that our steam was 92−93% dry, saturated steam and 7−8% water.

This is extremely “wet” steam! Once we started using the corner protection, it surprisingly helped

Figure 5. Tearguard Shelf Liner. Healthmark.7

us to identify an underlying issue with the quality of our steam.

Thank you, corner protectors!

Q: “Are there products that can help with holes in our wrapped trays?”

A:In addition to the aforementioned “savior of wet steam,” the corner protector (Fig. 2), I am a big fan of under tray liners (Fig. 3). Liners help to wick moisture from our wrapped trays by soaking up the moisture during steam sterilization, which makes it easier to dry them (usually a paper product) than it will be to dry the inside or underside of a plastic or metal tray.

These liners help create another barrier under the tray, making it less likely that holes or tears will appear, especially with trays that have sharp edges. Every little bit helps, and bonus, these liners can help with wet packs!

In addition to under tray liners, you can also try shelf liners (Fig. 4) for your autoclave rack. Most holes and Figure 4.

Underguard tears come from dragfor Autoclave ging a wrapped tray Shelves. across a metal shelf, Healthmark.6

so autoclave rack liners can really assist with preventing issues when placing trays on or removing them from the rack.

And last, but not least!

3. Try shelf liners (Fig. 5) for your sterile storage areas.

The metal racks in our sterile storage areas can be of varying quality, and I’ve seen more than a few in my day that had sharp edges, burrs, or imperfections in the metal that could easily tear through the fibrous sterile wrap.

All these solutions are relatively inexpensive and can really help reduce the number of holes in wrapped trays! HPN `References are available online at hpnonline.com/55375924.

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.

hpnonline.com | June-July 2026 | 29

CONTINUING EDUCATION

Creutzfeldt-Jacob Disease and Other Prion Diseases: A challenge for the decontamination department.

DR. BRIAN KIRK

C

reutzfeldt-Jacob Disease (CJD) is one of several transmissible spongiform encephalopathies (TSEs), which are characterized by the accumulation of abnormal forms of the prion protein.1 Clinically, CJD presents as a progressive deterioration of brain function arising from the buildup of misfolded proteins within the brain, which impair normal function, ultimately causing tissue damage. Histological

examination indicates the formation of microscopic vacuoles within brain tissue, making it appear sponge-like, hence the use of the term “spongiform”. All known prion diseases are invariably fatal.

There are a number of mammalian TSEs that have been known for centuries, the most common being scrapie, which affects sheep. Other mammalian TSEs include chronic wasting disease (CWD) in elk and deer. More

widely known is bovine spongiform encephalopathy (BSE), also known as mad cow disease, which occurs in cattle. Several human forms of TSEs exist, the most well-known being CJD. Another is kuru, identified in tribal communities in Papua New Guinea whose funerary traditions included cannibalism. Other human forms include Gerstmann-SträusslerScheinker syndrome and fatal familial insomnia.1, 2

Learning Objectives 1. Describe routes of prion transmission relevant to sterile service departments.

3. Identify sterile processing practices used to manage potential prion exposure.

4. Recognize limitations of sterilization technologies and how monitoring systems affect prion risk management in sterile processing.

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30 | June-July 2026 | Healthcare Purchasing News

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2. Explain the limitations of conventional reprocessing on prions.

The aim of this lesson is to introduce sterile services technicians to key concepts related to prion transmission risk and its implications for sterile processing.

LEARNING OBJECTIVE 1:

Describe routes of prion transmission relevant to sterile service departments.

Unlike diseases caused by bacteria or viruses, which involve replication of an organism, prion diseases progress through the propagation and accumulation of misfolded prion proteins.

These misfolded proteins act like a template that induces normally folded proteins to adopt the same abnormal conformation, initiating a self-propagating chain reaction. The misfolded proteins accumulate because the body’s normal functions are unable to eliminate them. The method of diagnosis relies on the development of symptoms and supporting brain scans; a definitive diagnosis is made after the disease has progressed.

Prior to 1980, prion diseases received limited attention due to their infrequent incidence, occurring at a rate of approximately one to three cases per million globally.1 However, in the 1980s, the incidence of BSE rose dramatically in the United Kingdom (U.K.) and was subsequently found to be due to a change in cattle feed processing that allowed prions to enter the food. This would have been considered a serious but manageable veterinary incident until human cases of CJD appeared in the U.K. population. These cases occurred in young individuals and proved fatal within months. Investigation indicated a causal relationship between the ingestion of BSE-contaminated cattle meat and the development of the disease, resulting in the identification of a new variant of CJD (vCJD).

This discovery became a major health crisis, resulting in the implementation of stringent control

measures and the instigation of research to understand the cause, routes of transmission, and consequences on human health. Although the highest level of concern occurred more than four decades ago, studies have shown that there could be a residual population of vCJD carriers, making ongoing preventative measures important.

CJD and other TSEs can occur in several ways, including the following:1, 2 • Sporadically, with few cases available to study causal relationships.

• Genetically, due to inherited mutations in the prion protein gene.

• Through oral ingestion of contaminated food, such as meat derived from TSE-infected animals. This is thought to be the pathway of the vCJD outbreak in the U.K. • Iatrogenically as a result of • Medical procedures involving exposure or transplantation of materials or tissues containing prions.

Historically, reported sources have included transplantation of dura mater and use of human-derived therapeutic agents such as human growth hormone extracted from pituitary glands.1,2,3 • Improperly decontaminated reusable surgical instruments previously used on a patient with a TSE. A primary example of this involved intracranial electroencephalography electrodes contaminated with prion protein from previous use on a patient with CJD. The electrodes were subsequently used on a second patient, resulting in transmission of disease. Other laboratory studies have supported this mode of transmission.1,3 The infectious dose of a TSE agent is thought to be very low.

Experimental studies indicate that small amounts of disease-associated prion protein may be sufficient to initiate disease, depending on the route of exposure, such as oral

Lesson: Creutzfeldt-Jacob Disease and Other Prion Diseases June-July 2026 This lesson was developed by Solventum. Lessons are administered by Endeavor Business Media.

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

Certification The Certification Board for Sterile Processing and Distribution has 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 May 17, 2027.

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

Quiz Answers: 1. A, 2. C, 3. B, 4. C, 5. C, 6. B, 7. C, 8. C, 9. B, 10. B, 11. A, 12. C, 13. C, 14. A, 15. C

hpnonline.com | June-July 2026 | 31

CONTINUING EDUCATION

or direct exposure to brain tissue.

The risk of transmission is tissuedependent, with brain, spinal cord, and eye tissues classified as having higher levels of prion infectivity in patients with CJD.3

Learning Objective 2:

Explain the limitations of conventional reprocessing on prions.

National guidance must be consulted to develop operational policies and protocols for prion risk management. The World Health Organisation (WHO) issued guidance on managing risks associated with TSEs, including considerations for contaminated reusable medical devices.3 Individual countries have implemented this guidance directly or adapted it based on national expert advice and opinion, regulatory frameworks, local circumstances, and assessed risks.4,5 Prion proteins are chemically stable and therefore resistant to many of the conventional processes used for disinfection and sterilization of medical devices. A number of methods have been described to remove prion contamination from surfaces or reduce infectivity.6 Many of these methods have been developed within laboratory settings and are not practical for use in a sterile service department (SSD).

The WHO recognizes that prions are unusually resistant to the cleaning, disinfection, and sterilization processes routinely used in SSDs. As a result, standard reprocessing cycles cannot be relied upon if medical devices become contaminated. WHO guidance references enhanced decontamination strategies that have demonstrated greater effectiveness under research and controlled conditions. These approaches include extended exposure times at elevated steam-sterilization temperatures, use of strong chemical agents such as sodium hydroxide or high concentrations of sodium hypochlorite,

and thorough cleaning. However, the WHO acknowledges that many of these methods raise practical challenges for SSDs, including concerns related to staff safety, handling of hazardous and corrosive chemicals, equipment compatibility, and potential damage to surgical instruments.

Use of such chemicals in an SSD can create operational problems and safety concerns.6 Because no monitoring tool can measure prion risk reduction, SSDs must rely on process assurance rather than biological confirmation.3, 4, 11 Routine monitoring of every cleaning, disinfection, and sterilization load, using appropriate mechanical data as well as chemical and biological indicators, helps demonstrate that process parameters have been met, supports appropriate load-release decisions, and helps ensure documentation, traceability, and compliance.

Learning Objective 3:

Identify sterile processing practices used to manage potential prion exposure.

One approach to managing prion transmission risk involves singleuse instruments and the quarantine and disposal of reusable instrument sets used on high-risk tissues or on patients known to have a high risk of carrying a TSE disease. This approach presents the lowest risk of transmission from one patient to another but is expensive since surgical instrument sets are quarantined whilst awaiting confirmation of disease and then destroyed by incineration if disease is confirmed. Single-use instruments are invaluable when following this approach. This approach relies on clear identification of patient risk, based on a reliable clinical diagnosis of a TSE or assessment of known risk factors, such as family history; previous therapeutic interventions; and recognized non-medical exposure routes, including ingestion of

32 | June-July 2026 | Healthcare Purchasing News

contaminated food products or injection drug use.3, 5 The surgical centre undertaking the procedure must have an established TSE protocol in place for isolation and cross-contamination prevention measures. Once the medical procedure has been completed, instrument sets and associated consumables must be isolated using contaminated waste procedures and then quarantined for subsequent destruction using registered disposal agencies. Good communication and planning between clinical teams and the SSD helps ensure that correct procedures are followed.

Using a track and trace system helps maintain instrument accountability, supports safe handling after use, and prevents migration of instruments between sets.

National guidance must be consulted to develop operational policies and protocols for prion risk management.

Given the nature of the causative agent of TSEs, one approach to reducing the risk of cross-contamination is to remove residual bio-contamination.

Manual cleaning processes cannot be validated or reproducibly applied every time they are performed. Therefore, the use of a cleaning procedure that uses an automated instrument washer disinfector (AWD) with a validated process is a preferred option. Such processes typically use alkaline detergents with high efficiency for protein removal. The development, validation, and routine control of cleaning processes is described in ISO 15883.7 Despite the expectation that AWDs provide highly effective cleaning, published studies have shown that residual protein can remain on the surfaces of medical devices following AWD processing.8, 9, 10 This suggests

that residual protein monitoring protocols are an important component of cleaning process assurance.

Recommendations for acceptable levels of residual protein following cleaning can be found in standards and local guidance documents.5, 7 Proteins that have dried onto instrument surfaces are significantly more difficult to remove than fresh deposits.3,11 Therefore, consideration should be given to methods that prevent tissue debris and fluids from drying during transport from the point of use to the decontamination department. Several commercially available products assist in this objective by maintaining instruments moist prior to cleaning.

Learning Objective 4:

Recognize limitations of sterilization technologies and how monitoring systems affect prion risk management in sterile processing.

Steam sterilization processes have been shown to provide limited reduction of prion infectivity under certain conditions, and enhanced steam cycles are referenced in some international guidance as part of broader risk-management frameworks.3, 6 Where such measures are considered, they are implemented based on national policy and expert guidance, not routine sterile processing practice. However, caution should be exercised to avoid a false sense of security.

Evidence shows that steam sterilization may reduce prion infectivity, but high residual protein remaining on instrument surfaces after cleaning significantly compromises the effectiveness of any sterilization process.

The adage “if it isn’t clean, it cannot be sterilized” is highly pertinent in this context.

Some low-temperature sterilization processes have been tested for prion reduction capability. Processes

that use alkylating agents, such as ethylene oxide, or low-temperature steam with formaldehyde, have been shown to be ineffective. In contrast, processes that employ oxidizing agents, such as hydrogen peroxide vapour, have demonstrated some reduction in prion infectivity under controlled experimental conditions.12 Manufacturers’ claims regarding prion inactivation should be critically examined, and the data supporting such claims should be carefully evaluated.

Monitoring of sterilization processes is addressed in multiple standards and guidance documents. In the context of prion risk management, routine monitoring systems employed for standard exposure periods may not be applicable when alternative or enhanced cycles are referenced in guidance. Chemical and biological indicators do not detect or confirm prion inactivation; however, they play an important role in verifying that validated process parameters, such as time, temperature, and sterilant exposure, have been achieved as intended. 3, 4, 5 For CRCST professionals, appropriate selection, use, and interpretation of indicators support process verification, documentation, traceability, and quality assurance by confirming consistent system performance and identifying deviations from established parameters in accordance with facility policy and national guidance.

Conclusions CJD and other TSEs are invariably fatal and, despite being rare, pose a unique challenge to SSDs due to the resistance of prions to conventional decontamination methods. After the vCJD outbreak in the U.K., many countries reviewed their national guidance and issued recommendations to support healthcare facilities and SSDs in managing TSErelated risks.

Destruction of contaminated items by incineration provides maximum risk reduction where prion contamination is suspected or confirmed.

Validated cleaning processes offer a practical approach to reducing, but not eliminating, risk. The prevention of residual tissue contamination drying before being decontaminated ensures the cleaning process is more effective.

It is vital that the SSD has a policy for dealing with potential TSE contamination and regularly reviews it in light of updated national guidance and emerging published evidence. Although it cannot confirm reduction of prion infectivity, routine monitoring, using mechanical data, chemical indicators, and biological indicators, supports process verification, documentation, traceability, and compliance. HPN REFERENCES AND FURTHER READING: 1. Baker HF, Ridley RM. Prion Diseases. Methods in Molecular Medicine series. Totowa, NJ: Humana Press; 1996.

2. Giles K, Woerman AL, Prusiner SB. Prions. In: McDonnell G, Hansen JM, editors. Block’s Disinfection, Sterilization and Preservation. 6th ed. London: Wolters Kluwer; 2021. Chapter 68.

3. World Health Organization. WHO Infection Control Guidelines for Transmissible Spongiform Encephalopathies. Report of a WHO Consultation; Geneva, Switzerland; 23–26 March 1999. WHO/CDS/CSR/APH/2000.3. Available at: http://www. who.int/emc 4. Association for the Advancement of Medical Instrumentation. ANSI/AAMI ST79: Steam Sterilization and Sterility Assurance in Health Care Facilities, Annex C. Arlington, VA: AAMI; current edition.

5. Advisory Committee on Dangerous Pathogens. Transmissible Spongiform Encephalopathy (TSE) Guidance, Annex C: Decontamination. London, UK: Department of Health and Social Care.

6. McDonnell G, Comoy E. Decontamination of prions. In: Walker J, editor. Decontamination in Hospitals and Healthcare.

2nd ed. London: Woodhead Publishing; 2020. Chapter 18.

7. International Organization for Standardization. ISO 15883: Washer-Disinfectors. Geneva, Switzerland: ISO. 8. Baxter RL, Baxter HC, Campbell GA, et al. Quantitative analysis of residual protein contamination on reprocessed surgical instruments. Journal of Hospital Infection.

2006;63(4):439–444.

9. Murdoch H, Taylor D, Dickinson J, et al. Surface decontamination of surgical instruments: an ongoing dilemma. Journal of Hospital Infection. 2006;63(4):432–438.

10. Lipscombe J, Pinchin H, Collin R, et al. Rapid method for sensitive detection of protein contamination on surgical instruments. Journal of Hospital Infection. 2006;62(2):141–148.

11. Centers for Disease Control and Prevention. Infection Control for Creutzfeldt-Jakob Disease (Classic CJD). Available at: https://www.cdc.gov/creutzfeldt-jakob/hcp/infectioncontrol/index.html 12. Fichet G, Antloga K, Comoy E, et al. Prion inactivation using a new gaseous hydrogen peroxide sterilization process.

Journal of Hospital Infection. 2007;67(3):278–286.

hpnonline.com | June-July 2026 | 33

CONTINUING EDUCATION

Creutzfeldt-Jacob Disease and Other Prion Diseases - Practice Quiz 1. CJD is the abbreviation for which prion disease?

A. Creutzfeldt-Jacob Disease B. Craner-Johannes Disease C. Coldman-Jugerand Disease 2. CJD is predominantly a disease of which organ?

A. The kidneys B. The lungs C. The brain 3. CJD is one of a group of diseases called: A. Transportable Sporadic Encephalitis B. Transmissible Spongiform Encephalopathies C. Transient Soporific Endocrinology 4. CJD is caused by A. Bacteria B. Viruses C. Misfolded proteins 5. CJD can be treated by: A. Antibiotics B. Antiviral drugs C. There is no treatment 6. What makes prions challenging for sterile service departments?

A. They multiply rapidly on instrument surfaces B. They are resistant to routine cleaning and sterilization methods C. They can be identified by visual inspection 7. Instruments should be: A. Allowed to dry before transportation to the decontamination department B. Washed under a tap before being transported to the decontamination department C. Kept moist and transported as quickly as possible after use to the decontamination department 8. The presence of residual prion protein on instrument surfaces can be detected by A. Looking at the instrument.

B. Checking the weight of an instrument after cleaning C. Using a highly sensitive protein detection system 9. According to international guidance, which statement best reflects current understanding of prion decontamination?

A. Standard sterilization cycles reliably eliminate prions B. No single method guarantees complete removal of prion infectivity C. Chemical disinfection alone is sufficient to manage prion risk

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EDUCATION HUB

All CEU quizzes must be taken online at: educationhub.hpnonline.com.

The cost to take the quiz is $10.

34 | June-July 2026 | Healthcare Purchasing News

10. Why is timely communication between clinical areas and the sterile service department important when prion risk is suspected?

A. To allow SSDs to make a diagnosis B. To ensure potential exposure risks are identified and instruments are managed according to facility policy C. To replace indicators and documentation requirements 11. Which practice presents the lowest risk of patient-to-patient transmission when prion exposure is known or suspected?

A. Use of single-use instruments with quarantine and disposal of reusable sets B. Reprocessing reusable instrument sets using standard cycles C. Extended cleaning of reusable instruments followed by routine sterilization 12. According to the section, how are standards and guidance on prion risk management typically used by healthcare systems?

A. Implemented identically worldwide without modification B. Replaced entirely by facility-specific procedures C. Used as a foundation and adapted based on national guidance and assessed risk 13. Why can’t conventional cleaning, disinfection, and sterilization processes be relied upon to fully manage prion contamination?

A. Because prions are primarily transmitted through airborne exposure B. Because prions multiply during routine sterilization cycles C. Because prions are resistant to many conventional reprocessing methods 14. Which situation represents a documented example of iatrogenic transmission of a prion disease relevant to sterile processing?

A. Reuse of inadequately decontaminated intracranial EEG electrodes previously used on a CJD patient B. Consumption of beef from cattle affected by bovine spongiform encephalopathy C. Inherited mutation of the prion protein gene.

15. Which tissue type is considered highest risk for prion infectivity?

A. Muscle tissue B. Gastrointestinal tissue C. Brain and spinal cord tissue

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