INFECTION PREVENTION
instrument, but it was happening to all of the new instrumentation throughout a vari- ety of manufacturers. The SPD team leaned into the project trying to figure out what was happening but also trying to communicate to all customers to alert them of the issues. At the end of 2022, an Aesculap Technical Process Analysis (TPA) was conducted to see what was happening. The results con- cluded that the water conductivity was three times as high as it should be. To remedy this problem, Aesculap has recommended
switching to all critical/RO water for the entire washer cycle. In experimenting, this has eliminated the rusting on the instru- mentation that hasn’t built up the passiv- ation layers.
Buskol is now known as a water quality expert at Sanford Health. The advice she gives to SPDs? “All over the nation, people right now don’t even realize that maybe the situation that they’re having with their instruments involves water,” she states. “But it does a lot of times. It often goes to
Q&A: Air/Steam/Water Quality
Healthcare Purchasing News had the opportunity to connect with Jonathan A. Wilder, Ph.D., managing director, Quality Processing Resource Group, LLC on air, water, and steam quality, as well as his experience contributing to AAMI ST108
What are the risks of contaminated air/water/steam? The most important thing in instrument pro- cessing is not to put anything into or leave anything in the patient that doesn’t belong there. This includes lubricating oil or water condensate from air compressors, high levels of water-borne or steam-borne chemical impu- rities and water-borne biological contaminants like bacteria and endotoxins. Any of these can result in pyrogenic or infectious outcomes for the patient. These can lead to infection, pain due to local poisoning or even death.
What contributes to contaminated air/ water/steam in a hospital/facility? The starting materials for air, water, and steam are never ideal for the end use of each. Each must be cleaned up before it is used. Before air is compressed, it should be filtered
to remove dust, bacteria and other contami- nants. Compressing air generally involves using compressors that require oil for their proper function. This oil can be taken up into the com- pressed air. Similarly, humidity in the air that is compressed tends to condense as the air is com- pressed and can rust the compressed air tank. Air as delivered to points of use by the
HVAC system should always be suspected as a carrier of pathogenic organisms. Because it can carry them. Water as it comes from municipal or well supplies is generally good for drinking, but even that is sometimes questionable. Water that meets the EPA drinking water standards can have far too much in the way chemical or biological contaminants to be appropriate for patient use. High chemical loads hinder the action of detergents or require using a lot of detergent which can be difficult to remove from the instruments. High biological loads can cause pyrogenic reactions (endotoxins) or infection (bacteria). Steam is made from water. But how it is made requires attention to the end use. In normal
usage in healthcare, large, central boilers are used that need chemical additives to be used to maintain the boiler’s integrity and avoid corrosion. Some of these have no effect on patients or instruments. Some, like amine addi- tives, can be problematic leading to staining of instruments if there is an overdose. The needs of sterile processing are more exacting than the needs of the rest of the steam system. For local boilers, using tap water is not a good idea since any chemical contaminants will tend to be left in the boiler or sterilizer or on instruments, leav- ing a stain or encrustation that compromises instrument function.
What are the main challenges/solutions to dealing with this problem? Like anything else, the details matter. But everyone in the chain of provision of com- pressed air, HVAC air, water and steam must be aware of these details, i.e., the requirements for these utilities as they apply at the point of use to ensure that they are supplied in accor- dance with what is needed.
Have there been any advancements recently in this area? Some solutions are old, and some are new. For air, the use of UV to eliminate disease-carrying organisms is relatively new as applied in HVAC systems. Older solutions are valid solutions to the problem of keeping air safe for its use. These include HEPA filtration for local delivery of HVAC air to critical areas, coalescing filters and chillers for compressed air. For water, it’s a matter of attending to filtra- tion and modifying chemistry if needed. This is not new, but it is becoming more and more evident that it is needed. For steam, the story is mostly the same as
always except that some sterile processing departments are migrating to process (clean) steam that is generated from RO or better water. This requires adequate supplies of deaerated RO or better water and stainless
steel boilers, piping, and sterilizer plumbing, valves, and chambers.
Jonathan Wilder
Can you tell me about air/ water/steam quality when it comes to hospital audits? AAMI ST79, “Comprehensive guide to steam sterilization and sterility assurance in health care facilities” and AAMI ST108, “Water for the processing of medical devices” set the acceptance criteria for these utilities. Auditing on the technical side requires that the different utilities be measured for the quantities listed as critical in these standards. Sometimes, the measurements show that some items are com- pliant, but on the margin of acceptability. In these cases, an audit should recommend that measures are taken to get the item in question away from the margin and provide a safety margin to ensure that things don’t go wrong if a minor disturbance to the supply takes place.
Can you share your experience with your contribution to AAMI ST108? Helping to create ST108 was an honor and a lot of fun, because I was able to help create something that will help many people get their instrument processing to a better place. My specific contributions included but were not limited to being instrumental in creating new language around risk analysis, structure of the document, water quality for steam, and, in collaboration with a team of other experts, creating at least one of the annexes.
Any parting words of wisdom? Good processing begins and ends with good utilities like air, water and steam. Sterile pro- cessing’s needs are different than other parts of the healthcare facility. Sterile processing is the only place in the healthcare facility where these utilities actually contact things that are used on and in patients. So, the bar is higher, because patient outcomes can be affected.
hpnonline.com • HEALTHCARE PURCHASING NEWS • December 2023 19
that whether it’s the steam coming out of the boilers, whether it’s your RO system, whether it’s your water that you use straight from the sink, your city water that comes in, those were all things that I looked at investi- gated with. I tried to find the leading experts around our area to pick their brains and fig- ure out what kind of information there is.” Buskol concludes, “And don’t be afraid
to have a voice. You have a voice in ster- ile processing. You just need to be brave enough to use it.” HPN
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