By Allison Mascarenhas,
Vizient Senior Category Manager
Healthcare facilities are the third-largest water consumers of all buildings in the United States, according to the Environmental Protection Agency's Energy Star Data. Considering that level of consumption, water conservation should be a key concern for health systems — and so too should the quality of the water used, especially within hospital sterile processing departments.
Sterilization plays a critical role in preventing healthcare-associated infections (HAIs) and safeguarding patient wellbeing in hospitals. Proper sterilization of medical instruments is essential to eliminate microorganisms like bacteria, viruses and fungi. If the water used in the sterilization process is contaminated, it can compromise the entire wash cycle, which jeopardizes patient health, decreases decontamination effectiveness, and shortens the life of medical instrumentation and devices.
The quality of the water used to sterilize equipment is central to the procedure's effectiveness. After all, water is the foundation in all stages of medical device reprocessing, from soaking to manual or automated cleaning and sterilization. That's why it's so important for healthcare facilities to consider the impact of water quality parameters on sterilization efficacy and patient safety, particularly in three main areas.
Purity levels: Water hardness is a common impurity that can negatively impact the decontamination process. Water hardness is comprised of dissolved calcium and magnesium and can lead to insoluble complexes when water deposits. Dissolved salts may deposit on devices or within washer disinfectors when water is heated or evaporated. Accumulation of mineral deposits and scaling on the surfaces of sterilization equipment can decrease the effectiveness of most detergents/disinfectants and the performance of washers/disinfectors or steam generation systems; reduce the lifespan of equipment; and increase the frequency for maintenance and/or replacement.
pH and conductivity: Water pH and conductivity levels play critical roles in the corrosiveness and conductivity of water. High conductivity levels suggest the presence of dissolved solids, such as salts, minerals and organic compounds that can tarnish or damage sterilization equipment. Corrosion of equipment not only affects its structural integrity but also creates pits, cracks and rough surfaces where microorganisms can live, leading to inadequate sterilization and increased infection risks.
Endotoxin levels: Endotoxins come from the cell walls of certain bacteria, which can be potent inflammatory agents that compromise patient health if present within water used for sterilization. Even at low concentrations, endotoxins can inhibit the activity of sterilizing agents, such as steam or chemical disinfectant, leading to inadequate disinfection. This can result in persistent microbial contamination on medical instruments, leading to higher risk of HAIs among patients.
Clearly, hospitals must consider various parameters around water quality to ensure sterilization process efficacy and patient safety and health. But where to begin? Consider implementing the following comprehensive water quality management strategies.
- Regular water quality testing: Conduct routine testing of water quality based on the above parameters. By routinely performing these tests, hospitals can ensure that regulatory requirements are met, and sterilization equipment is operating optimally against manufacturers' recommendations and specifications. In addition, facilities should adopt a systematic approach to monitor and document water quality data, including test results, corrective actions and maintenance records.
- Water treatment technologies: Consider installing water quality treatment technologies such as reverse osmosis, deionization, ultraviolet disinfection, and filtration systems to remove impurities and contaminants from water sources. By investing in such technologies, facilities can be assured of optimal sterilization equipment performance and effectiveness in reducing waterborne pathogens and endotoxins.
- Equipment maintenance and calibration: In addition to routine water quality tests, it's also important to conduct routine maintenance and calibration of sterilization equipment to ensure optimal performance and accuracy of wash cycles. Equipment that is malfunctioning or reporting inaccurate data should be addressed immediately as water quality could impact its performance.
- Education and collaboration: Provide education and staff training within sterile processing and biomedical engineering departments. Staff members should be aware about the importance of water quality within the sterilization processes to identify potential risks associated with poor water quality. The sterile processing department team should collaborate with water quality experts to obtain further education around environmental regulations and guidelines governing water quality within healthcare facilities.
By encouraging the adoption of these strategies, you can ensure you meet your No. 1 mission of patient safety.
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About the author
Allison Mascarenhas is a senior category manager on Vizient’s capital, imaging and asset management team. She has more than eight years of experience in medical supply chain operations, health insurance and managed care administration. Her educational background includes a Bachelor of Science in biological sciences from Louisiana State University, a Master of Public Health with a concentration in health policy and systems management from Louisiana State University Health Sciences Center, and a Master of Business Administration from the University of New Orleans.