A steam sterilizer tends to last a lot longer than most other equipment. Some facilities haven't changed theirs out in more than 20 years. As the workhorse of your sterile processing department and the cornerstone to your continued case volume, you'll want to choose an autoclave that will serve your needs over the long haul. Here's some advice on making a wise investment.

When is it time?
As with a surgical table or a set of OR lights, a steam sterilizer is a capital expenditure that doesn't show up in every budget year. But how do you know it's time to replace your autoclave?

One ideal time to consider an equipment upgrade would be during new construction or renovation. The advantages offered here are threefold. First, you can build space and utilities into the sterile processing area for whatever model you want. Second, if you're renovating or building on, it's likely due to expanding business and increasing case volume, so you may benefit from new equipment. Third, from an aesthetic if not entirely functional standpoint, new equipment will show off the new structure better.

Another reason you might consider replacing your steam sterilizer is to improve the efficiency of your facility's workflow. Not everyone will find themselves in this situation, but a center with an autoclave whose chamber is too small to accommodate the surgical schedule's demands will soon notice the evidence: The machine is running constantly, loads of instruments and devices are arriving late and reprocessing staff have to work overtime. In this scenario, buying a sterilizer with a larger chamber and increased load capacity will bring more efficient practices.

When it comes to equipment, inefficiency is one obstacle, but inoperability is quite another, especially when it's occurring more and more often and repairs are growing more and more costly. Any downtime is inconvenient, but a broken-down steam sterilizer can slow or even shut down your ORs for the day. When sterilizer malfunctions threaten your case flow, it's time to seek a replacement. That is, unless you enjoy making moment's-notice arrangements with the nearby hospital to share their reprocessing equipment in order to get through the day's surgical schedule.

The necessary dimensions
As mentioned above, the capacity of an autoclave's chamber will play an important part in your purchasing decision. Too small and you're hobbled by inefficiency, running loads all day. Too large and you're also running inefficiently, generating too much steam and using too much electricity to process a half-empty chamber.

In order to select the right-sized chamber for efficient use, maximize your throughput and decrease the number of cycles you're running daily, consider the following questions. How many cases do you host each day? How much equipment do they generate for reprocessing? Given a sterilizer's 45-minute full cycle, can you reprocess a day's entire load in a maximum of 8 runs? Alternatively, are you prepared to purchase a second sterilizer or staff 10-hour days?

Don't forget to ascertain that all of your trays and devices fit into the chamber of the autoclave you're considering. Orthopedic surgery, for instance, employs huge trays of instruments. The instruments used in ophthalmic cases, on the other hand, tend to be smaller. Some sterilizer manufacturers have modified the shape of the chamber, from rectangular to elliptical, in order to accommodate larger items and more of them per cycle.

In addition to internal size, you must also take external measurements into account. Will the sterilizer you choose fit where you want it? Depending on the space allocated to your sterile processing department, the size of the sterilizer itself may weigh even more heavily on your decision than chamber capacity.

If you're building new, of course, you have the luxury of planning the space to fit the equipment (even though a sterile processing department's need for floor space tends to be underestimated in the interest of cost containment). But if you're renovating a structure — or if you're not renovating — you're limited to the existing available space.

As a result, pay particular attention to the aspects of configuration in the sterilizers you're considering. Are they freestanding models or designed for recessed installation? Note which way the door opens: to the right, to the left or perhaps pass-through style. (While the pass-through concept offers an admirably efficient solution to the logistics of segregating non-sterile instruments from sterile ones and dirty rooms from clean ones, it can be limited in its applications when it is not specifically built for.)

Keep in mind also the necessity of planning installation to, or budgeting for the reconstruction of, your plumbing infrastructure, including water lines, steam lines and drains.

Working conditions
While reading product literature or visiting the exhibit hall at a professional organization's conference can give you a sense of a sterilizer's capabilities, the fact that it's a heavy piece of equipment that requires significant connections in terms of utilities means that in order to see it in action, you'll have to visit the vendor's showroom or a facility that's installed it.

Getting some in-person contact with a product offers a view into whether it'll be easy for your staff to use. Ideally, you should be able to learn the ropes in the course of a single in-service session.

Most autoclaves currently on the market are relatively simple to use, designed with features to simplify sterilization, such as push-button or touchscreen operation to select cycles and start the process. It should be easily programmed to run the types and durations of cycles that your reprocessors use most frequently, and a machine that's programmable to run vacuum leak tests or Bowie-Dick air removal tests can prove convenient as well, since it'll help to keep testing routine. Also, display screens should be easy to read and understand in order for staffers to ensure that a sterilization cycle's time, temperature and pressure parameters have been met.

If you haven't been shopping for a steam sterilizer in the last few years, you may be impressed by the ability of the latest models to process not only instruments but also data. Some autoclaves can now transfer sterilization cycle data to your facility's electronic recordkeeping system and, through bar-code scanning, automatically track the items that have been sterilized. As an alternative to handwriting entries in log books or filing and saving load receipts, this paperless interface can be a real timesaver.

Power doors that operate by way of a push button or foot pedal may seem like a personal preference, but they can make the job a lot easier than manually cranking the door shut and making sure it's sealed securely, and (in the case of foot pedals) can lend a sterile step to the process.

A good manual is very important for the proper operation of a steam sterilizer, especially if it includes a section on troubleshooting common (and minor) malfunctions. Quite a few manufacturers post their equipment manuals online now, so reviewing them may even help you to choose one autoclave over another. Another resource to take advantage of is the manufacturers' representatives with whom you've arranged the purchase. Ask them to stick around for a day or two after the sterilizer's been installed to observe your staff while it's in use. They might be able to point out more efficient ways to do the jobs you're using it for.

Service for the steam
Even if you don't tend to buy service contracts for your new equipment, it's highly advisable to do so with a steam sterilizer. While it may seem like a hefty sum added on to the purchase price, a sterilizer's parts can be costly. Also, make sure you get acquainted with the manufacturer's service representative. Trust his advice and recommendations on repairs and preventive maintenance, and consult with him even on external issues such as steam pressure, water quality or instrument pitting.

Lastly, if your facility relies on an in-house boiler or piped-in steam to provide the means for sterilization, consider purchasing a small, electric autoclave with a self-contained steam generator built in. This backup option will let your sterile processing department — and your ORs — keep running in the event the boiler fails or the quality of the outsourced steam drops, until the issue is resolved.

Consolidated Sterilizer Systems
Advantage Series Steam Sterilizers
(617) 782-6072
www.consteril.com
List price: $30,000 to $75,000
FYI: All of Consolidated's rectangular chamber sterilizers are available with the Advantage Series Sterilizer Control Suite, an advanced, user-friendly, programmable logic controller. This digital system features a menu-driven touchscreen for programming and monitoring sterilizer functions and is pre-programmed with sterilizer cycles and tests. In addition to its simple, dependable technology — made entirely in the United States — Consolidated also offers equipment consultation and design assistance.

Midmark Corporation
Ritter M11 UltraClave Automatic Sterilizer
(800) MIDMARK
www.midmark.com
List price: $5,838
FYI: As the largest member of the Ritter autoclave family, the M11's 11-inch-by-18-inch chamber has the most sterilizing capacity of any standard countertop model on the market, says the company. Its automatic opening door makes it easy to use and provides a rapid drying time. Steam-flush pressure pulse air removal ensures proper steam penetration. Programmable controls let the operator set different cycle parameters to meet specific instrument processing needs, while pre-programmed controls offer convenience.

Primus Sterilizer Company
Healthcare Steam Sterilizers
(402) 344-4200 x1229
www.primus-sterilizer.com
Price range: Small, single-door model, $25,000; large, floor-loading, double-door model, $197,000
FYI: Primus offers sterilizers in 12 sizes, with chambers ranging from 4 to 2,040 cubic feet; equipped with single or double and power or manual doors; in freestanding, cabinet, recessed or floor-loading configurations; and with integrated shelving or ancillary loading equipment to fit specific needs. Designed and built in the United States, the machines feature PRI-Saver to reduce the equipment's water usage and PRI-Pure to filter the water used to extend the chamber's life.

Steris Corporation
Amsco Evolution Steam Sterilizer
(800) 548-4873
www.steris.com
List price: not disclosed
FYI: Steris's redesigned Amsco Evolution sterilizer offers increased throughput, reduced downtime and improved efficiency as compared to earlier models, says the company. Its 1-touch controls and displays include high-resolution graphics and a PC control interface for remote monitoring and predictive maintenance. The round or elliptical chambers promote even pressure distribution and allow wide instrument sets or large amounts of instruments with minimal utility usage. The Evolution features 12 programmable cycles, including gravity, pre-vacuum, liquid and optional steam flush pressure pulse as well as a faster, deeper vacuum for improved conditioning and drying.

Tuttnauer USA
Model 5596 Steam Sterilizer
(800) 624-5836 x112
www.tuttnauerusa.com
List price: not disclosed
FYI: The Model 5596 features a 20-inch-by-20-inch-by-38-inch chamber size in a space-saving footprint for efficiency in the ASC or office. All Tuttnauer autoclaves are made from 316L grade stainless steel and operated with a user-friendly control system. Reliable, non-proprietary components minimize downtime and reduce the costs of maintenance and repair. The sterilizers can be customized with flexible door designs, eco-friendly systems and advanced cycles.