The steam sterilizer is the workhorse of the sterile processing department, reprocessing the majority of a facility's instruments and running constantly throughout the workday to meet the demands of the surgical schedule. In light of this heavy use, you need autoclaves that not only provide reliable sterilization but also offer bottom-line benefits. Here are 5 factors that can boost a steam sterilizer's efficiency.

1 Understand energy consumption. Steam sterilization may be the least expensive reprocessing method, but sterilizers still consume relatively large amounts of steam and electricity, says Steve Johnson, manager of sterile processing for Tacoma General and Mary Bridge Hospitals in Tacoma, Wash. The cost of these utilities will vary from facility to facility, depending on the local power and water supplier for each, with public utilities skewing less costly than the private sources often found in rural areas.

"It takes a lot of energy to turn water into steam," says Chris Lavanchy, engineering director for the Plymouth Meeting, Pa.-based ECRI Institute's health devices group. "The amount of energy needed to run a sterilization system is quite significant," especially when projecting its footprint over the course of a surgical day, a workweek, the 15 to 20 years of an autoclave's expected lifespan.

Sterilizers that use slightly smaller amounts of utilities have become available, but the possibility for efficiency gains through energy usage may be limited, since sterilization's requirements for electricity and steam are largely fixed. "You need the same amount of electricity to run a cycle time and to generate the same temperatures, regardless," says Nancy Chobin, RN, AAS, ASCP, CSPDM, sterile processing educator for St. Barnabas Health Care System in West Orange, N.J., and executive director of the Certification Board for Sterile Processing and Distribution. "And if you cut down the amount of steam used, you'd experience a sterilizer failure."

2 Consider the capacity. Capacity can have a considerable effect on a sterilizer's resource and cost efficiency. Select a sterilizer with the appropriate chamber size, says Mr. Lavanchy.

The capacity you choose should be guided by your facility's specific case volume and sterile processing needs. A larger chamber can accommodate more instrument trays and possibly mean that fewer cycles are necessary in a day. "But if the chamber's too big, you'll consume too much steam for a small load," he says, or instruments may need to wait until the chamber is full before they're sterilized. If it's too small, on the other hand, you'll have to run more cycles and may run late in providing the surgical team with the instruments it needs.

For facilities with busy ORs, sterilizers with roomier chambers can have a big impact on reprocessing throughput, says Mr. Johnson. "This increased capacity can result in a significantly decreased volume of loads per day. It can be as much as a 30% to 40% decrease [which] can translate directly into a savings in utility consumption from sterilization equipment as well as increased staff productivity, freeing up time for other tasks."

Some sterilizers feature a redesign of the shape of the chamber, which also provides efficiency opportunities. "Changing the chamber configuration from rectangular to a more oval-shaped interior can allow for an increased tray capacity of larger or longer sterilization trays or instrument sets," says Mr. Johnson. "Previously, they had to be processed lengthwise in rectangular chambers, but now can be processed in a crosswise layout." This modification offers to increase the load of each cycle for fewer loads per day, reducing utility costs and the need for flash sterilization while increasing the availability of instrument sets and trays.

3 Look for space-saving designs. When considering a sterilizer's internal capacity, though, don't forget to account for its external footprint. "Sterile processing is not a revenue-producing area, and we don't have a lot of real estate," says Vangie Dennis, RN, CNOR, CMLSO, clinical manager for procedural nursing at Gwinnett Medical Center Duluth in Duluth, Ga.

"That's sometimes a big disconnect," she says, because the reprocessing room might not have the space to install equipment that would boost its capacity and efficiency. When available, however, a sterilizer that is more economical on space may permit the addition of other reprocessing equipment.

If your facility's layout and structure will allow it, installing a pass-through sterilization system will offer efficiency gains in your reprocessing workflow. One of the chief aims of a sterile processing department is the segregation of the dirty instruments that arrive on case carts from the OR and the clean ones that will be returned to the surgical suite. A sterilizer with a single-door, like a single reprocessing room that handles both breaking down used instruments and shipping out clean, blue-wrapped packages, demands conscious and continuous precautions to maintain the sterile end result. A pass-through sterilizer, in which items are loaded through a door in a non-sterile room and removed through another door on the sterile side of the wall, accomplishes this transfer automatically.

"What's important in the sterile processing department is not just the basic requirements, but also efficiency," says Ms. Dennis. "The flow of the department. How trays are transported through. Handling the turnover with efficiency can prevent your staff from having to take steps all over the room and around equipment."

4 Reduce water usage. As the active element in autoclave sterilization, a lot depends on your steam. Where that steam is generated can have an impact on the efficiency of your sterilizer and the effectiveness of its cycle.

A sterilizer's steam comes from 1 of 2 places. It's either produced by an electrical steam-generating component built into the sterilizer itself or, as seen in larger hospitals or on healthcare campuses, piped in from a central steam boiler.

For smaller facilities that aren't equipped with an in-house, freestanding boiler, a sterilizer with its own steam generator is a solution that may present additional expenses in the way of a higher purchase price and higher facility electrical consumption. But it avoids the drawbacks that piping in external steam may present, such as steam that's too cool, excessively moist or otherwise degraded in quality along the way, says Mr. Lavanchy, which can affect the sterilization cycle. Central sterile departments with sterilizers that generate their steam locally should, however, be sure to have the water quality evaluated before the sterilizer is installed and periodically thereafter to ensure the steam generated is free from contaminants.

Depending upon the air removal mechanism a sterilizer employs, it's possible for it to be purchased with an added option or retrofitted to limit the amount of water it uses. During the final phase of the sterilization cycle, the 30 to 45 minutes of drying time, water runs continuously in some units to activate the pump that draws a vacuum in the chamber. "Water isn't free," says Ms. Chobin. "You're paying for that water to come in, and paying for it when it drains out." Instead of tapping and dumping water throughout the length of the drying phase, this modification recirculates the water. It may add $5,000 to the cost of your sterilizer, she says, but your reduced water consumption may earn you a return on investment within a year.

5 Verify efficiencies. "Because reprocessing equipment is so expensive, it has to be efficient for a hospital to justify the purchase," says Ms. Dennis. "We have to get the manufacturer to prove, or we have to prove, that there is a return on investment. They should be able to tell you the hard costs, and a sterile processing department manager will have to look at the cost of operation and the details of the service contract."

"When you determine the total cost of ownership, you may find you'll spend more up front, but may also find that you'll recover those costs over a reasonable period of time through lower utility usage," says Mr. Lavanchy. It's highly advisable, he says, to ask manufacturers for a list of references and contact their previous customers to inquire whether they're seeing the savings they were promised.

Also make sure you follow up on those claims once you've installed the equipment in your own facility. "A simple monitor for evaluating sterilizer efficiency," says Mr. Johnson, "can be monthly utilities consumption, observing for a reduction in the number of sterilizer cycles per day and checking for a possible decrease in the number of flash cycles per day or month. All of these measures can be easily evaluated and analyzed."

A lasting trend?
"Sterile processing is an area that people tend to forget about," says Ms. Chobin, "but you can see some significant savings there." Mr. Lavanchy believes sterilizer manufacturers will try to find ways to make steam sterilizers more efficient if the market demands that, but over time the market will also decide whether those improvements are worthwhile. "Green initiatives in healthcare technology come and go," he says. "And healthcare facilities have to be careful where they spend their money. In the end, they'll adopt the green initiatives that save them money."