While it’s not being suggested that computers, robotics or some other electronic means replace such interactions, the increasingly prominent and overwhelmingly positive role automation is playing throughout the healthcare environment is undeniable. Advanced automation technology has prompted the gravitation toward electronic medical and laboratory records, computerized drug and supply dispensing, electronic ordering and replenishment, and automated patient flow management, to name just a few functions. Automation has become so common, in fact, that it can likely be found, to some degree, in virtually every hospital department, including sterile processing – the discipline historically, and unfortunately, lagging behind on the innovative technology front.

While it’s true that many SPDs have been somewhat slow to board the advanced automation bandwagon — a fact that can be attributed in great part to facilities aiming the lion’s share of capital equipment expenditures, automated or otherwise, toward revenue-generating areas — progress is being made in the decontamination area, particularly in regard to cleaning and disinfection, sources told Healthcare Purchasing News.

"Certainly, I think more facilities are recognizing the value of automation in the SPD," said Charles Hancock, medical device sterilization consultant and president of Charles O. Hancock Associates Inc., Fairport, NY. "Years ago, [SPDs] were having to rely on manual washing and even the first automated systems weren’t all that automated. A lot has changed since then."

Reliance Vision Multi-Chamber Washer/Disinfector from STERIS

"Automation helps streamline the instrument cleaning process and reduce the likelihood for human error," said Hancock, adding that this is an extremely important benefit because quality processes and successful outcomes are at the very core of the SPD’s function. "Simplifying a process doesn’t matter if the end result is [adversely] affected."

Although some version of automated washer-disinfector and washer-sterilizer systems has existed for several decades, the latest models are far more advanced than their predecessors.

As Linda Clement, consulting service manager for Mentor, OH-based STERIS Corp. explained, when washer-sterilizer technology entered the marketplace in the 1970s, it succeeded in providing a means to render instruments safe to handle with the incorporation of a gravity-displacement steam sterilization cycle following the washing cycle. The downside? The washing process was not as efficient or as effective as the washer-disinfectors today, and required surgical instruments to be manually cleaned prior to processing through the washer-sterilizer. "If any debris was left on the instruments following the cleaning cycle, the sterilization cycle would bake the debris onto the instrument’s surface, making it difficult, if not impossible, to remove," Clement said.

As a result, washer-sterilizers have somewhat fallen out of favor with many facilities. Aside from requiring manual pre-cleaning and their inability to process many of today’s more complex devices, they may also pose an ergonomic hazard – particularly back strain caused by loading and unloading to and from automated stations, according to Michael Cain, senior product manager for infection control, Getinge USA, Rochester, NY.

The latest washer-disinfectors help solve many of the earlier challenges by offering superior cleaning by coupling an automated washer unit with a thermal disinfection cycle that renders instruments safe for handling.

Continued Clement, "These washers, [when] used with proper loading techniques, good water quality and appropriate cleaning chemistries, provide an almost hands-free means to clean and decontaminate [many] surgical instruments." Still, she was quick to point out that manual cleaning is still necessary for complex devices, those with lumens or those that tend to harbor bone.

Single-chamber washers and the development of automated material handling systems that support that technology, in particular, have been a boon for SPDs. While facilities with just one or two automated washer/disinfectors can be well-served by straight in-line loading, in-line unloading or the combination of both (a modular approach and a cost-effective option for building automation in stages), larger facilities with several or more single-chamber washer/disinfectors can greatly benefit from automated systems that position a row of washers side by side to maximize floor space. The automated material handling systems feature a single feed conveyor that provides automated single-point loading and unloading.

Getinge USA’s 8666 Air Glide Shuttle system, used in conjunction with the company’s 8666 washer/disinfectors, features an upper rail-mounted traveling shuttle that picks up the next wash cart at the end of the conveyor and moves it down the line of washers. "It’s a self-seeking system that finds an available chamber and loads it automatically," said Cain. "Once it loads a chamber, it returns back to wait for the next load." When the cycle concludes, the chamber door opens automatically and the load is moved to a dispatch conveyor on the opposite side of the barrier wall.

The AGS system continues to function automatically, as long as loads need to be reprocessed, and each process can be automatically documented for full traceability. Because the system does the work, staff is free to work on other tasks. Another plus, Cain noted, is that because the AGS seeks out available chambers, it’s not necessary to shut down all washer-disinfectors unless all of them require maintenance. "If one or two are down, it doesn’t matter because the system will simply move the load to the next available chamber."

Single-chamber systems may be capturing a great deal of attention, but that doesn’t mean multi-chamber systems have fallen by the wayside. STERIS’ new Reliance Vision Multi-Chamber Washer-Disinfector, an extension of the Reliance Synergy single-chamber design introduced four years ago, delivers enhanced productivity by doubling washing capacity while requiring less floor space and using just a fraction of the utilities and detergents of older models.

"Overall, our goals for new washer product development focus on offering the lowest possible cost of equipment ownership while also improving operator and patient safety, and assuring reliable performance," said STERIS group product manager Jeffrey Pollis.

Even specialty instruments and devices, which have historically posed numerous cleaning challenges, can now be subjected to automated washing, thanks to innovative manufacturer designs.

Device-specific processors and accessories for existing washer-disinfector equipment, such as specialized racks that allow direct flow to lumens, make it possible to accommodate specialty instruments. Although Clement stressed that pre-cleaning specialty devices is still necessary because it is not possible to visually inspect all internal surfaces of complex devices following processing – and because it is difficult to control the time between a device’s use for a patient and the subsequent decontamination process – being able to automate to accommodate specialty devices in automated washer/disinfectors is nonetheless a big plus for SPDs.

Where specialty instrumentation is concerned, it’s the systems designed for endoscopes that have made the most significant advancements, both in terms of ease of use and operator safety. STERIS’ new Reliance EPS Endoscope Processing System and its Reliance DG oxidizing chemistry, for example, eliminates staff exposure hazards associated with aldehyde-based processes. According to Clement, the system ensures the efficacy of every cycle with a single-use chemistry and "safely accelerates scope processing throughput by high-level disinfecting up to two endoscopes at a time."

Sterile processing professionals will also be pleased to know there’s a soon-to-be-released system that aims to make manual scope cleaning a task of the past. In November, Advanced Sterilization Products announced that the U.S. Food and Drug Administration had cleared for use the company’s new EvoTech
Endoscope Cleaner and Reprocessor, making it the first and only washer/disinfection system in the U.S. to eliminate manual cleaning of endoscopes. ASP notes that EvoTech ECR establishes a consistently high standard of automated endoscope cleaning that is comparable to professional society guidelines for manual cleaning.

"The EvoTech ECR reduces the risk of human variation in cleaning endoscopes, an important consideration in infection prevention," noted Barbara Trattler, R.N., director of education at ASP. Beyond eliminating the need for manual cleaning, the system performs automated leak and block detection at the start and finish cycles, and features automated cycle parameter verification to document each step of the process for consistency. Other features include Automated Channel Blockage and Disconnect Detection through independent monitoring of each channel; single-shot high-level disinfection using CIDEX OPA Concentrate; and the ability to perform comprehensive cleaning, reprocessing and cycle parameter verification procedures in 30 minutes.

"The many features will provide staff with the confidence of knowing that the processes are performed consistently each and every time," Trattler said. She explained that if any parameter is not met, the cycle will automatically cancel.

Despite significant advancements
in decontamination automation, sources predict even more positive developments will surface in the not-so-distant future. Trattler pointed to the possibility of even more simplified and efficient solutions – and even the potential for systems that speak to the user and provide verbal instructions to improve ease of use and boost productivity even further.

Hancock is hopeful that the future will bring more universal technologies capable of handling a broader range of devices, as opposed to having to rely solely on the dedicated models offered today. "I think we’ll continue to see these dedicated systems for a period of time, but there’s a lot of work going on to develop technology with a more universal approach."

Beyond that, Hancock is also awaiting improved products that are able to better determine just how well the washers actually performed their job.