Hospitals using all varieties of sterilants and disinfectants - Products & Services

Sometimes, a simple definition can make a major difference in a product, a technique, and in an outcome. That's true for the definitions of sterilants and disinfectants, and it's also true of the result of the use of these liquids.

"The two are not one and the same," says Diana Chamberlain, R.N., C.N.O.R, director of clinical services for Pilling Surgical in Fort Lauderdale, FL. She cites references that say disinfectants refer to products that reduce the level of disease-causing microorganisms. Not all microorganisms are killed when an instrument or other device is disinfected, however, Sterilants, meanwhile, are simply products that kill all microorganisms and spores.

That settled, hospitals use a variety of both to do the job of cleaning instruments (see accompanying chart of approved products). "Hospitals have to maintain a high level of sterilization not just because of their mission of providing quality care, but because if they don't Joint Commission can shut them down," she says. "So hospitals use every method out there."

Those methods include glutaraldehyde, ethylene oxide, steam, and hydrogen peroxide plasma In fact, in the coming months a new entrant into that lineup could appear. That is ozone, a product already in use in Europe. Sources say that in the next six months, suppliers should be receiving FDA marketing clearances to sell ozone sterilization technologies in the U.S. Those products are said to be more cost-effective than current methods such as EtO, and act faster to boot.

Some hospitals have eliminated the use of ethylene oxide, while keeping other products on hand. But others in the sterile processing profession, like Bryant Broder, manager of surgery processing at Saint Mary's Mercy Medical Center, a 300-bed facility in Grand Rapids, MI, is not among them. "I want one of every method in our hospital," he says. "The CS department should make the decision on what is best, least expensive and what will provide the optimal results. Some hospitals get rid of EtO and it ends up costing them money because they are forced to contact with outside vendors."

"Sterilization can be a nightmare," Richard Schule, surgical processing manager for The Cleveland Clinic, says flatly. He says, for example, that high-alkaline versus neutral base products need extra cycles at high Ph levels. But beyond that, Schule offers a simple reason why some good sterilization cycles and products go bad and money and time are wasted. "Hospitals spend a lot of money on equipment designed to decontaminate instrumentation, yet people still spend a lot of money on presoaking when all you have to do is use a wet towel," he says.

According to Schule, soaking instruments at the point of use makes a major difference in results, alluding to a logistical issue that his hospital, which performs a staggering 35,000 surgical procedures each year, appears to have solved. Cleveland Clinic has three locations for its sterile processing department. One can be found in the basement (the operating room is on the second floor). Another is alongside the second floor O.R., while the third sterile processing unit is actually within the O.R. itself.

Schule says that the SPD inside the O.R. is the optimum configuration. "It builds teamwork and camaraderie between SPD staff and clinicians, and as a result we have outstanding relations between our staff and the O.R." he says. "In the basement, you are out of sight, out of mind."

Cleveland Clinic is a participating member of the GPO Premier Inc., and the hospital utilizes those group contracts for sterilants and disinfectants. Schule is a supporter of the products and equipment from STERIS Corp., Mentor, OH. Products from Calgon-Vestal, which is now owned by STEMS, have been used at the institution for at least five years. More recently, Huntington-brand products from Ecolab, St. Paul, MN, have made an entry, in particular a "consolidated brick" form of disinfectant that Schule says is simple to use and reduces spillage.

The sterilant and disinfectant market is one that is by and large led by three suppliers, STERIS, Ruhof Corp., Mineola, NY, which manufactures a line of enzymatic cleaners designed to eliminate bioburden, and Metrex, Orange, CA. According to Schule, pricing is "simply a matter of who wants the business," Naturally, an enormous facility that performs 35,000 surgeries a year will get its choice, but competition in this market is still strong and many hospitals, once settled on a particular brand, are usually reluctant to switch.

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