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reprocessing systems found in a central services department:

Steam sterilizers Steam sterilizers are still considered the gold standard for sterilizing medical instruments and other items that can withstand the high temperatures of steam cycles without sustaining damage. However, since “au- toclaves” were first developed more than 100 years ago, manufacturers and users have learned that more is required for ef- fective, consistent steam sterilization than the “box,” a power source and a water supply. In today’s department, the direct costs for steam sterilizers must include not only the installation and plumbing costs for the sterilizers; it must potentially include the purchase and installation of additional systems for filtration, high quality water and steam production, and drainage cool- ing. These costs will vary depending on the quality of incoming municipal water. Many steam sterilizers have a long useful life — 20 years or more if properly maintained. This allows a long depreciation period that can be factored into the TCO. They can also be remanufactured (rebuilt to their original specifications), which makes them valuable to the original manufacturer as trade-ins. Recurring expenses for steam sterilizers typically include biological/chemical indi- cators and sterilization wraps/containers for daily use, maintenance contracts and services, and standard replacement parts. Departments also need to provide ongoing personnel training to assure proper opera- tion and maintain compliance with current best practices.

Ethylene oxide (ETO) sterilizers This method has been available since the 1950s as a low-temperature alternative to steam sterilization for delicate devices. At that time, it was the gold standard for low- temperature sterilization and was compat- ible with many device materials. ETO is an effective sterilant, but it requires extremely long cycle times (2 ½ hours plus 8-12 hours of aeration time) to allow desorption of toxic residual ETO from the loads. In addition to the unit itself, direct costs for an ETO system include the purchase and installation of special ventilation, exhaust, and disposal systems. It also requires the use of specific validated sterilization containers. In addi- tion to maintenance costs, required recur- ring costs include the sterilant, personnel monitoring and testing supplies, biological

monitoring and testing supplies, and special wraps to package devices. The use of an ETO system can also result in the need to invest in additional device inventory, which as- sures enough instruments to maintain the surgical schedule while accommodating the longer cycles.

Hydrogen peroxide (H2 O2 ) sterilizers

sterilizers). But there will be cost con- siderations based on your needs, your device inventory and other factors specific to your department. Let’s explore what to consider for a thorough evaluation of H2

O2 O2 systems.

TCO in detail: hydrogen peroxide sterilizer example

Direct Costs to include These are costs that your department is responsible for when you acquire the new system. • Capital acquisition cost: This refers to the direct cost of the capital equipment alone. Some sterilizer manufacturers may offer to trade in existing equipment for newer technology, which reduces the acquisition cost.

• Installation costs: In some cases, a depart- ment may need to make changes to its available space and/or utilities to accom- modate a new sterilizer. Consider the following: ° Electrical requirements: do you have the right outlet and voltage, or will you need to pay for additional work to meet the requirements of the new sterilizer?

° Space/footprint: Do you have the floor space needed for the sterilizer and related convenience products such as loading carts?

° Additional utilities: Does the steril- izer require any additional utilities? For example, if an oxygen tank is needed, is additional plumbing or installation necessary?

• Training costs: All new sterilizers require that the staff using the equipment be trained on the safe and proper operation of the sterilizer. This is often offered at a cost

Indirect costs to consider • Device inventory costs: You will need to review your devices to determine whether or not they are compatible with the type of sterilant being used by the target system. All “gas” sterilants are not created equal — ETO is not the same as H2 is not the same as H2


/ozone. You may Page 44

O2 and H2 O2

no costs related to major installation, special plumbing, special exhaust systems, or special water quality equipment (water is not used in H2


These systems, designed for heat and moisture-sensitive devices, have been in the healthcare marketplace long enough that there are now a number of system options to evaluate for use in your department. Un- like steam sterilizers, H2

sterilizers have


by the equipment manufacturer or a third party, but is also offered online by some at no added cost. If your clinical engineering team will be servicing and performing maintenance on the system, they will need to purchase certified training, usually from the original equipment manufacturer or an authorized agent, to maintain the system’s warranties and operational compliance. They may also be required to participate and pay for annual re-certification.

• Packaging costs: H2

cific validated sterilization packaging such as containers, wraps and pouches. If you are not already using the same system in your SPD, you will need to purchase new containers, trays, wraps or pouches for the new sterilizer. When considering trays, select the products that will allow you to maximize use of shelf space in the sterilizer chamber. Getting more out of each cycle will allow you to increase productivity and possibly reduce the number of cycles (and consumable costs) needed to achieve the same throughput.

O2 sterilizers require spe- • HEALTHCARE PURCHASING NEWS • July 2016 43

Self-Study Test Answers: 1. D, 2. E, 3. E, 4. A, 5. B, 6. A, 7. A, 8. C, 9. D, 10. A

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