Cleaning our homes and offices is simple and straightforward. You pick up a cloth, clean off the dust, and maybe disinfect with a spray if it’s been a while. If something more is required, a wet cloth typically does the job. But the story is quite different in hospitals. A scalpel or an incision tool used in surgery isn’t just cleaned off with water and disinfectant. For that, hospitals use sterile processing machines.
To put this in context, a 2014 paper outlined that there are approximately 50 million surgeries annually in the US alone. This number remained between 40 and 50 million in an updated 2020 paper as well. That means there are approximately 50 million chances of infection for patients per year in the US, a risk that is mitigated using sterilization.
Sterilization & Mitigating Disease Transmission
Sterilization is the process of cleaning any device or piece of equipment from bacteria and other microorganisms that cannot typically be removed through regular cleaning methods. For hospitals, sterilization is a basic, necessary part of the process. It’s not just the surgical equipment, but patient-patient, patient-practitioner, practitioner-patient, and many other forms of transmission exist that must be accounted for on some level.
A doctor, for example, checks in on various patient rooms and moves from one to the other over time. Doing so, they follow basic healthcare procedures and might take a patient’s temperature if the nurse already hasn’t, but they don’t necessarily decontaminate before moving to the next room.
Generally, this isn’t an issue–and asking even a doctor to decontaminate between each room is an unrealistic prospect. Still, it goes on to show how disease can spread easily between doctors, patients, equipment, and other transmission vectors.
Hospitals & Healthcare – An Infection Hotbed
Hospitals are a hotbed for disease transmission, with some of the highest rates of infectivity being common in such locations. Patients come and go, and if sick people are coming in, they spread diseases to others. Someone with a cold or flu could be visiting a doctor, but infections can still spread even if they take all the precautions, such as wearing a mask and covering any sneezes and coughs with a tissue over their mouth.
However, the transmission of disease to patients is even more severe through hospital equipment. One hospital bed could see use with hundreds of patients over a single year, and while hospital policies for cleaning up and sterilizing a hospital bed do exist, complete sterilization is not always viable due to the severity of patient conditions. In surgical operations, hospital equipment typically undergoes sterilization, but that doesn’t mean every single piece of equipment is sterilized.
An important note is that hospitals are an inflection point despite all the precautions taken to prevent disease transmission. This doesn’t question sterilization’s efficacy as much as it alludes to hospital treatment and patient precautionary systems requiring considerable improvement. Outbreaks aren’t common, but they have happened due to a lack of proper compliance with sterilization procedures, whether it is individual hospital policy or based on scientific methods.
Sterile Processing Equipment
The types of medical equipment manufactured in the early to mid-20th century were generally made of materials that could withstand the heat it takes for traditional sterilization methods. However, the materials used to make current medical equipment cannot withstand high temperatures and typically require different, low-temperature sterilization.
A scalpel used for surgical incisions or any surgical equipment used for invasive operations has plenty of bacteria and other microorganisms on its surface, and sterilization removes those surface-level organic substances. However, most sterile equipment passes through enough cleaning cycles that even inadequately sterilized equipment may not be too likely to transmit disease, though taking precautions is still critical for hospital personnel.
Typically, hospitals use more than one type of sterile processing machines and equipment as different pieces of equipment differ in their requirements. Common types include steam, flash, low-temperature, and gas sterilization techniques. These different types of sterile processing techniques are offered by different pieces of equipment, such as:
- Decontamination Sinks
- Ultrasonic Cleaners
- Washer Disinfectors
- Cart Washers
- Drying Cabinets
- Steam Sterilizers
- Vaporized Hydrogen Peroxide Sterilizers
- Liquid Chemical Sterilant Processing Systems
- Prep and Pack Tables
- Surgical Case Carts
Each piece of equipment has varied uses and sterilization methods, but they are critical to healthcare delivery in hospitals and other healthcare settings.
Autoclaves, or steam sterilizers, are some of the most common types of sterile processing equipment. They are called autoclaves to be distinguished for use in a healthcare setting, as steam sterilizers are common across industrial, manufacturing, pharmaceutical, and even research sectors.
Autoclave machines come in various shapes and sizes according to what’s needed. A small clinic may have an autoclave sitting on a desk or a countertop with the rest of their equipment. There are also larger variants that can sterilize large swaths of equipment and linens all at once, which are necessary for large-scale operations.
Not all processes are automated, and one of them is manual decontamination using specially designed sinks. They follow a set process where each step is conducted in a different sink. For example, cleaning, drying, and sanitization all have their individual work areas with specialized equipment.
Decontamination sinks are typically large, you can also find single-sink tables that are used to clean and sanitize equipment in smaller clinics. Sometimes, they will be attached to countertops, and sometimes, they will have their own portable tables on wheels as well.
Surgical carts aren’t used for sterilization but are an important piece of equipment for such processes. These carts can be fitted into certain machines for easier decontamination of a large number of surgical equipment. They are also immensely helpful in transporting sterilized equipment to other areas of hospitals without causing any exposure to harmful bacteria.
Water Treatment and Sterilization
Sterilization doesn’t just happen to equipment but also to organic matter such as water. Medical processes such as dialysis are offered in both homes and hospitals, meaning certain equipment might need to clean water more so than regular filtration methods. Here, hydro water treatment or reverse osmosis methods are often used for hemodialysis treatment.
A hospital bed will have its sheets and linens cleaned fairly regularly (and with each patient), but the bed frame and the mattress are done so less often. Here, sterilization often requires the use of liquid chemicals. For example, at home, you might use bleach to clean and sanitize areas, and similar chemicals approved by various authorities and institutions are often used to sterilize hospital equipment.
Is Sterilization 100% Effective?
In short, the clear answer is no. There isn’t just one or a few types of microorganisms on any given piece of equipment. Moreover, we don’t know the volume or number of such organisms present.
In fact, the more organisms present, the more disinfection is required, but that also means every crack and crevice needs to be reached. Most sterile processing equipment solves this issue through steam sterilization, but that doesn’t always account for the resistance of microorganisms to sterilization.
Not every piece of equipment goes through the full sterilization process, either. Depending on the type of equipment, it can be either cleaned regularly, disinfected, or sterilized. The level of sterilization is determined through the use case of the equipment.
External Factors Affecting Sterilization
Even if similar equipment and procedures are used, external factors can change the overall result and require consideration. Humidity affects the activation of sterilization chemicals. Even if sterile equipment is stored, humidity in storage conditions can affect the sterility of the equipment. Other factors, such as water and temperature, also affect the overall disinfection and sterilization.
Sterilization processes are not 100% effective, but as long as the procedures are followed and external mitigating factors are dealt with, it helps keep infectivity in control and fulfill proper decontamination procedures.
Negligence, Ethics, and Equipment Reuse
Sterilization is an ethical necessity for any doctor delivering care to patients. Ensuring the equipment is effective and from reputable manufacturers and distributors is just one part of the process. Neglecting even this aspect can lead to ethical and medical concerns for patients, compromising. not just the sterility of the hospital equipment but also exposing patients and others to harmful bacteria, diseases, and other microbes.
Negligence in the process can occur in hospitals, too, from neglecting to change the hospital bed linens when changing patients to effectively scrubbing the equipment that only needs occasional cleaning.
There is no such thing as ‘too safe’ in a hospital where life hangs in the balance every minute. For example, single-use medical items and equipment are not made to be reused in any scenario, regardless of whether they have passed ten different sterilization cycles. However, the reuse of single-use equipment is more common than we think, and the implications of that can be concerning, whether concerning ethics or patient outcomes.
A similar concern exists for water treatment as well. Hemodialysis machines require regular replacement of the filters, cleaning, and strict guidelines on the level of contamination considered acceptable for treatment.
Current systems of sterile processing equipment are effective, but a system that isn’t followed as often cannot be, and despite all the innovation in this sector, we need better compliance measures to ensure proper efficacy.