INSTRUMENT STERILISATION AND DECONTAMINATION
Could UV-C LEDs light up decontamination?
Paul Chivers of PCC Sustainable Solutions – an independent SME and Programme / Project manager for innovation and sustainability across PPE, medical devices, and facilities, discusses recent work to examine, and then verify, the effectiveness of novel ways to reprocess reuseable anaesthetic masks, other PPE, and medical devices, using technologies such as UVC, in the process considerably reducing energy and water consumption across the NHS.
The NHS has been utilising a combination of washer- disinfectors (WDs) and autoclaves for over 50 years, with obvious industry improvements over time to reduce power and water consumption. They are the accepted ‘go-to’ solution for sterilisation of reusable surgical equipment from operating theatres, as well as reusable devices that do not require sterilisation. Many NHS organisations, however, have no other process to clean and disinfect them for safe re-use. Although some of the most sophisticated WDs and autoclave models now on the market are more efficient than earlier models, many devices installed in NHS hospitals and in daily use consume between 150 and 700 litres of water per cycle.1
They also consume the same
power per cycle as an average UK domestic house uses in a 24-hour period.2
Neither of these consumption levels
are sustainable or environmentally responsible. Until these WDs and autoclaves reach the end of their economic life, or fail to the point of being beyond economic repair, the cost to replace them is prohibitive. Unnecessary usage should thus be avoided whenever possible, and now there is a genuine alternative.
Potentially damaging temperatures The reason for such excessive power and water consumption is that the temperature for thermal disinfection currently is 90 °C3
for 1 minute, or 80 °C for 10 minutes
in a WD, and 117 °C (steam) for an autoclave. These temperatures are potentially damaging for many materials, and contribute to reducing the life of products being subjected to them.
WDs and autoclaves are inherently deployed in on-site Sterile Services Departments (SSDs), where many products and medical devices (MDs) are transferred to and from for sterilisation. These products require SSD specialists who often strip, pre-clean, and reassemble, the devices post-sterilisation. They are also responsible for inspecting the MDs before returning them to the relevant departments. However, in the same way that many laundry services were removed from NHS hospital sites (only 10 on-site NHS laundries now exist), many hospitals now outsource their SSD reprocessing to a third-party provider. This involves procuring multiples of the equipment, to support the time taken to transport to and from the provider, as well as the reprocessing time, and this can be a factor of 4 or 10 times the number of items required for daily use, dependent on the turnaround times. The road miles and increased manufacturing of additional items to sustain the supply chain for reprocessing is in addition to the carbon footprint of
the sterilisation equipment’s high power and water consumption. For devices unable to be subjected to these processes due to the ingress of water and steam, as well as the high temperatures, or that only require High Level Disinfection (HLD),4
there is the regular use of three-stage
wipes or other chemical disinfection materials. Examples of these devices subjected to three-stage wipes are ENT video rhino-laryngoscopes and video laryngoscopes, and ultrasound probes, both cabled and cordless. Again, there is the potential over time for material damage caused by strong chemicals being used, and the operatives wear three sets of gloves to reprocess one device.
A counter-intuitive process What has also become more prevalent over the years is the reprocessing of non-sterile items through the SSD, which is counter-intuitive. These are devices that can withstand the harsh environment, but by the device categorisation of ‘non-sterile’, do not need to be sent to an SSD. However, until very recently it has been the only recognised option for cleaning and disinfecting, to achieve HLD consistently, through a recognised and certified manual and automated process. Examples are scissors used in outpatient departments, reusable anaesthetic masks, and personal protective equipment (PPE) P3 half- face respirators. However, through work
that began during the pandemic with the PPE Reuse, Innovation and Sustainability Team that I headed up, things may be changing.
My team became responsible for identifying innovative, reusable PPE, suitable for health and care workers, with, at, or near, the point-of-use cleaning and disinfection. We engaged with numerous companies responding to the COVID pandemic. Many were switching production from core business activity or setting
June 2025 Health Estate Journal 63
A UV-C Minibox reprocessing anaesthetic masks.
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