4 Critical Questions to Answer Before Running Your Next High-Level Disinfection Cycle

Ambulatory surgery centers put their reusable, heat-sensitive, semi-critical and non-critical scopes, cameras and other endoscopic accessories through high-level disinfection procedures every day. If they have a limited scope inventory, they do it multiple times a day.

The physicians typically have no idea what type of product is used to disinfect their devices, but the staff is very aware of disinfectants and processes because they deal with them daily. Many facilities are using the same high-level disinfectant and process they have used for many years because they haven't been aware of any reason to change — or can't justify the compliance validation and documentation required for a new HLD practice.

If your facility has adopted the "if it's not broke, don't fix it" philosophy, it may be worthwhile to ask some critical questions about the HLD product you are currently using. The answers may indicate whether it would be beneficial to make a change — and whether it might be risky not to.

1. Is my HLD chemistry causing health risks? Are these risks to staff, patients or both? There are two HLD product families available in the industry: aldehyde-based products, including glutaraldehyde and opthalaldehyde chemistries, and oxidative formulations, including peracetic acid and hydrogen peroxide-based solutions. Each core chemistry and formulation has its own safety profile. The labeling, instructions for use and material safety data sheets that come with each product provide details about the product's safety when being handled and used by ASC staff. These documents cover such things as the proper personal protective equipment needed, the toxicity of the chemistry, whether there is an inhalation risk, the chemistry's allergy profile and symptoms and proper handling and use requirements, including any special rinsing requirements to assure that toxic residue or accumulated biofilm does not remain on the devices when they are used on the next patient.

It would be valuable to review this documentation for other available HLD formulations to compare the relative safety of other products with the products you are currently using. It may be possible to improve the work environment for ASC staff, help prevent the risk of contact dermatitis and other symptoms and see fewer days lost to illness. Changing formulations may also help prevent the risk of toxic residues and biofilm, which pose a risk to patients.

2. Is my chemistry costing me more money — now and over the long run?
Purchasing the chemistry itself may be only one cost of using your product. There may be additional expense involved, such as the cost of installing special venting systems to reduce inhalation risks, the cumulative cost of additional water and utilities to perform more than one rinse phase every time you run a cycle and the cost of neutralizing agents that must be added after every cycle before the HLD effluent can be discarded. There's also a cost associated with chemical reactions that stain instrument surfaces and affix protein to the instruments, which can require additional scope maintenance and repairs. These consequences and costs are preventable, since there are HLD formulations available that are free-rinsing, safe to dispose of without additional treatment and non-fixative in their action.

3. Is my chemistry and process inhibiting my department's productivity? Some HLD products require activation by heating the disinfectant solution to a specific temperature needed for efficacy. In addition to the added cost of the utilities needed to heat the solution, the heating phase adds to cycle time, which accumulates over a day or a week and can reduce the overall number of cycles that there is time to run. If your chemistry requires an extra rinse cycle, another cumulative time loss can occur. If your chemistry is a fixative solution, additional time may also be needed for pre-cleaning of the lumens and surfaces to assure that bioburden is fully removed. In addition, the accumulation of stubborn biofilm on a delicate device can affect its ability to function properly and result in the need for added maintenance, which will reduce your scope inventory temporarily. These time-wasting steps may be eliminated by simply selecting a different HLD formulation.

4. Is the chemistry environmentally friendly? With today's sensitivity to environmental issues, as well as the heightened awareness of the healthcare industry's specific contributions to toxic and dangerous waste, it is more important than ever to select healthcare products that are environmentally conscientious. Some HLD chemistries pose a risk to the department and to the environment unless they are chemically deactivated. If the chemistries are not biodegradable or water-soluble, they will continue to be a potential environmental risk for landfills and water supplies even when detoxified. These issues can be avoided because there are HLD formulations available that are biodegradable and disposable without dilution or deactivation. These formulations also pass aquatic toxicity standards.

Make a deliberate, educated decision

Using these four questions as a guide, take the time to gather detailed and thorough information about your current products and processes, and investigate the HLD options available for your ASC applications. If you are thorough, your answers to these four questions may provide the business case you need to justify a change to a different high-level disinfection formulation with less risk and more benefits for your facility. The more you know, the stronger your decision will be.

About the authors
Christopher Antonucci is a market manager for STERIS Corporation’s GI business, part of its Infection Prevention Technologies division. He is responsible for all aspects of his products’ life cycles, including market analysis, product development, product launch and ongoing promotion. He holds a Bachelor of Science in Business Administration from Xavier University in Cincinnati, Ohio and a Master of Business Administration from Baldwin Wallace College in Berea, Ohio.

Inga Magiday
is an associate market manager for the STERIS Infection Prevention Technologies division. She provides support for all aspects of IPT product life cycles, including market analysis, product development, product launch and ongoing promotion. She holds a Bachelor of Business Administration and a Master of Business Administration, both with a focus on marketing, from Cleveland State University, Cleveland, Ohio.

Learn more about STERIS.

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