Infection Control and Sterilization Across the Continuum: A Narrative Review of Protocols for Reusable Medical-Dental Equipment in Crisis Settings
Abstract
Background: The effective reprocessing of reusable medical and dental equipment (RMDE) is a cornerstone of infection prevention and control (IPC). In crisis settings—characterized by resource limitations, infrastructural damage, and patient surges—established sterilization and disinfection protocols are profoundly challenged, escalating the risk of healthcare-associated infections (HAIs). Aim: This narrative review aims to synthesize and analyze IPC protocols for RMDE across the healthcare continuum (medical, dental, nursing/EMS, laboratory, pharmacy, emergency medicine) during crises, focusing on interdisciplinary challenges, standardized guidance, and the critical roles of microbial surveillance and disinfectant stewardship. Methods: A comprehensive literature search was conducted in PubMed, Scopus, CINAHL, and Web of Science (2010-2024). Keywords included reusable medical devices, sterilization, disinfection, crisis, surge, and healthcare-associated infections. Articles were thematically analyzed to construct a narrative across defined professional domains. Results: The review identifies significant vulnerabilities in RMDE reprocessing during crises, including protocol fragmentation, equipment sharing across specialties without unified standards, and supply chain failures for disinfectants. It highlights the laboratory's pivotal role in environmental surveillance and the pharmacist's responsibility in managing disinfectant efficacy and safety. Gaps in evidence-based, crisis-adapted protocols for cross-continuum equipment (e.g., laryngoscopes, suction units) are identified. Conclusion: Ensuring RMDE safety in crises requires an integrated, "One Health" approach to IPC. Recommendations include developing crisis-specific, interoperable reprocessing guidelines, strengthening laboratory capacity for rapid microbial testing, and formalizing pharmacy-led disinfectant stewardship programs to mitigate HAI risks across all care settings.
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References
Antonini, M. J., Plana, D., Srinivasan, S., Atta, L., Achanta, A., Yang, H., ... & Sorger, P. K. (2021). A crisis-responsive framework for medical device development applied to the COVID-19 pandemic. Frontiers in digital health, 3, 617106. https://doi.org/10.3389/fdgth.2021.617106
Assadian, O., Harbarth, S., Vos, M., Knobloch, J. K., Asensio, A., & Widmer, A. F. (2021). Practical recommendations for routine cleaning and disinfection procedures in healthcare institutions: a narrative review. Journal of Hospital Infection, 113, 104-114. https://doi.org/10.1016/j.jhin.2021.03.010
Association for the Advancement of Medical Instrumentation. (2017). ANSI/AAMI ST79: 2017: Comprehensive Guide to Steam Sterilization and Sterility Assurance in Health Care Facilities. AAMI.
Barbee, L. A., & St. Cyr, S. B. (2022). Management of Neisseria gonorrhoeae in the United States: Summary of evidence from the development of the 2020 gonorrhea treatment recommendations and the 2021 Centers for Disease Control and Prevention sexually transmitted infection treatment guidelines. Clinical Infectious Diseases, 74(Supplement_2), S95-S111. https://doi.org/10.1093/cid/ciac043
Bianconi, I., Aschbacher, R., & Pagani, E. (2023). Current uses and future perspectives of genomic technologies in clinical microbiology. Antibiotics, 12(11), 1580. https://doi.org/10.3390/antibiotics12111580
Browne, K., & Mitchell, B. G. (2023). Multimodal environmental cleaning strategies to prevent healthcare-associated infections. Antimicrobial Resistance & Infection Control, 12(1), 83. https://doi.org/10.1186/s13756-023-01274-4
Carlson, K. J., Klute, L. M., Dowdall, J. R., Pate, S., Lyden, E. R., Stobbe, B. B., ... & Barnes, C. A. (2022). Just-in-time simulation training for nasopharyngeal specimen collection during the SARS-CoV-2 pandemic. Journal of Continuing Education in the Health Professions, 42(1), e88-e91. DOI: 10.1097/CEH.0000000000000385
Cuny, E. (2023). Core Practices for Infection Prevention and Control in Oral Healthcare. Compendium of Continuing Education in Dentistry (15488578), 44(1).
Dighriri, I. M., Alnomci, B. A., Aljahdali, M. M., Althagafi, H. S., Almatrafi, R. M., Altwairqi, W. G., ... & Alshahrani, A. F. (2023). The role of clinical pharmacists in antimicrobial stewardship programs (ASPs): a systematic review. Cureus, 15(12), e50151. DOI: 10.7759/cureus.50151
Dylus, D., Pillonel, T., Opota, O., Wüthrich, D., Seth-Smith, H. M., Egli, A., ... & Lebrand, A. (2020). NGS-based S. aureus typing and outbreak analysis in clinical microbiology laboratories: lessons learned from a Swiss-wide proficiency test. Frontiers in microbiology, 11, 591093. https://doi.org/10.3389/fmicb.2020.591093
Guharoy, R., & Krenzelok, E. P. (2021). US Food and Drug Administration (FDA) emergency use authorization: glass half full or glass half empty?. Clinical Infectious Diseases, 73(3), 549-552. https://doi.org/10.1093/cid/ciaa1653
Heil, E. L., Kuti, J. L., Bearden, D. T., & Gallagher, J. C. (2016). The essential role of pharmacists in antimicrobial stewardship. infection control & hospital epidemiology, 37(7), 753-754. doi:10.1017/ice.2016.82
Hennein, R., Goddard, E., & Sherman, J. D. (2022). Stakeholder perspectives on scaling up medical device reprocessing: A qualitative study. Plos one, 17(12), e0279808. https://doi.org/10.1371/journal.pone.0279808
Hick, J. L., Hanfling, D., Wynia, M. K., & Pavia, A. T. (2020). Duty to plan: health care, crisis standards of care, and novel coronavirus SARS-CoV-2. Nam Perspectives, 2020, 10-31478. https://doi.org/10.31478/202003b
Issa, M., Dunne, S. S., & Dunne, C. P. (2023). Hand hygiene practices for prevention of health care-associated infections associated with admitted infectious patients in the emergency department: a systematic review. Irish Journal of Medical Science (1971-), 192(2), 871-899. https://doi.org/10.1007/s11845-022-03004-y
Jacob, S. T., Crozier, I., Fischer, W. A., Hewlett, A., Kraft, C. S., Vega, M. A. D. L., ... & Kuhn, J. H. (2020). Ebola virus disease. Nature reviews Disease primers, 6(1), 13. https://doi.org/10.1038/s41572-020-0147-3
Kampf, G., Todt, D., Pfaender, S., & Steinmann, E. (2020). Persistence of coronaviruses on inanimate surfaces and their inactivation with biocidal agents. Journal of hospital infection, 104(3), 246-251. https://doi.org/10.1016/j.jhin.2020.01.022
Liang, S. Y., Theodoro, D. L., Schuur, J. D., & Marschall, J. (2014). Infection prevention in the emergency department. Annals of emergency medicine, 64(3), 299-313. https://doi.org/10.1016/j.annemergmed.2014.02.024
Long, R., Manchanda, E. C. C., Dekker, A. M., Kraynov, L., Willson, S., Flores, P., ... & Rhodes, K. (2022). Community engagement via restorative justice to build equity-oriented crisis standards of care. Journal of the National Medical Association, 114(4), 377-389. https://doi.org/10.1016/j.jnma.2022.02.010
Lyman, M., Forsberg, K., Sexton, D. J., Chow, N. A., Lockhart, S. R., Jackson, B. R., & Chiller, T. (2023). Worsening spread of Candida auris in the United States, 2019 to 2021. Annals of internal medicine, 176(4), 489-495. https://doi.org/10.7326/M22-3469
Ofstead, C. L., Wetzler, H. P., Snyder, A. K., & Horton, R. A. (2010). Endoscope reprocessing methods: a prospective study on the impact of human factors and automation. Gastroenterology Nursing, 33(4), 304-311. DOI: 10.1097/SGA.0b013e3181e9431a
Patel, P. K., Advani, S. D., Kofman, A. D., Lo, E., Maragakis, L. L., Pegues, D. A., ... & Meddings, J. (2023). Strategies to prevent catheter-associated urinary tract infections in acute-care hospitals: 2022 Update. Infection Control & Hospital Epidemiology, 44(8), 1209-1231. doi:10.1017/ice.2023.137
Pereira, L. J., Murata, R. M., Pardi, V., & Mattos, F. F. (2021). Streamlining the dental care during COVID-19 pandemic: updated clinical recommendations and infection control management framework. Brazilian Oral Research, 35, e046. https://doi.org/10.1590/1807-3107bor-2021.vol35.0046
Pineau, L. (2023). Endoscope reprocessing: Retrospective analysis of 90,311 samples. Endoscopy International Open, 11(03), E247-E257. DOI: 10.1055/a-1991-1391
Popovich, K. J., Aureden, K., Ham, D. C., Harris, A. D., Hessels, A. J., Huang, S. S., ... & Calfee, D. P. (2023). SHEA/IDSA/APIC Practice Recommendation: Strategies to prevent methicillin-resistant Staphylococcus aureus transmission and infection in acute-care hospitals: 2022 Update. Infection Control & Hospital Epidemiology, 44(7), 1039-1067. doi:10.1017/ice.2023.102
Rutala, W. A., Boyce, J. M., & Weber, D. J. (2023). Disinfection, sterilization and antisepsis: An overview. American journal of infection control, 51(11), A3-A12. https://doi.org/10.1016/j.ajic.2023.01.001
Sivek, A. D., Davis, J., Tremoulet, P., Smith, M., Lavanchy, C., Sparnon, E., & Kommala, D. (2022). Healthcare worker feedback on duodenoscope reprocessing workflow and ergonomics. American Journal of Infection Control, 50(9), 1038-1048. https://doi.org/10.1016/j.ajic.2022.01.012
Sprung, C. L., Joynt, G. M., Christian, M. D., Truog, R. D., Rello, J., & Nates, J. L. (2020). Adult ICU triage during the coronavirus disease 2019 pandemic: who will live and who will die? Recommendations to improve survival. Critical care medicine, 48(8), 1196-1202. DOI: 10.1097/CCM.0000000000004410
Teymourian, T., Teymoorian, T., Kowsari, E., & Ramakrishna, S. (2021). Challenges, strategies, and recommendations for the huge surge in plastic and medical waste during the global COVID-19 pandemic with circular economy approach. Materials Circular Economy, 3(1), 6. https://doi.org/10.1007/s42824-021-00020-8
Uyeki, T. M., Bundesmann, M., & Alhazzani, W. (2020). Clinical management of critically ill adults with coronavirus disease 2019 (COVID-19).
Vukelich, D. J. (2016). Lessons Learned from FDA's Regulation of ‘Single-Use’Device Reprocessing. Biomedical Instrumentation & Technology, 50(s2), 32-34. https://doi.org/10.2345/0899-8205-50.s2.32
World Health Organization. (2016). Decontamination and reprocessing of medical devices for health-care facilities. World Health Organization.
World Health Organization. (2021). Infection prevention and control during health care when coronavirus disease (COVID-19) is suspected or confirmed: interim guidance, 12 July 2021 (No. WHO/2019-nCoV/IPC/2021.1). World Health Organization.
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Copyright (c) 2024 Hanan Moaper Alrabhi, Njod Ahmed Ghamari, Sultan Saleh Afnan Alazmi, Afaf Lujayyan Faleh Alsharari, Khaled Shalouf Shutaywi Alsharari, Badr Mlihan Muflih AlSharari, Muzhir Qublan Awadh Alsharari, Ali Fulayyih Duwayshir Alsharari, Abdullah Onayzan Qumaysh Alazmi, Mohammed Raja Dughaybish Alsharari, Mohammad Mosad M Alshaarari, Fahd Sari K Alsharari
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