Disclaimer

This content is provided for information only. The authors make no representation or warranty regarding the accuracy, completeness or currency of the content. No information in this whitepaper should be construed as medical advice. Readers should seek appropriate professional guidance before acting on any information contained in this document. The authors expressly disclaim all liability for any direct or indirect loss or damage arising from the use of or reliance on this information.

Executive Summary

Sterilisation services are a critical backbone of hospital operations, without properly sterilised surgical instruments and equipment, patient care and safety are immediately compromised. This whitepaper examines how regional Australian hospitals (public and private) can prepare for and respond to disruptions in their sterilisation services. It highlights lessons learned from past incidents and provides forward-looking strategies to ensure continuity of sterilisation in rural and remote settings. Key recommendations include establishing robust backup systems e.g. redundant sterilisation equipment and alternative processes, developing flexible staffing and training plans, fostering cross-facility support agreements, and adhering to regulatory requirements for emergency management and notification.

Key Points:

• Risks of Sterilisation Disruption: Equipment failures, power/water outages, environmental issues, or staff shortages can halt instrument reprocessing, leading to surgery delays or cancellations. Past incidents in Australia have shown hundreds of surgeries can be affected when sterilisation services fail. Rural and remote hospitals face amplified risks due to limited local redundancy and delayed technical support.

• Backup Systems: Hospitals must invest in redundancy and backup equipment e.g. at least two sterilisers and washers on-site to avoid single points of failure. Contingency plans should include alternative sterilisation methods (low-temperature or chemical processes) and maintaining stocks of single-use sterile instruments to cover critical needs.

• Staffing and Training: Staffing continuity plans are essential. Cross-train technicians and perioperative staff to perform essential sterilisation tasks in emergencies. Maintain an on-call roster or mutual aid agreements to bring in experienced sterile processing staff from other facilities or agencies if local staff become unavailable.

• Cross-Facility Support: Develop regional support networks so hospitals can assist each other. This includes formal agreements to share sterile supplies or reprocess instruments at a partner facility during outages. Examples include public hospitals sending instruments to a larger hospital’s CSSD or outsourcing to private/third-party reprocessing centers in emergencies. In some regions, public and private hospitals have co-developed shared sterilisation units to serve both facilities.

• Regulatory and Communication: Ensure compliance with Australian standards (AS/NZS 4187 and related guidelines) and integrate sterilisation outage scenarios into the hospital’s emergency and business continuity plans. Immediate notification of major service disruptions to health authorities is crucial in public hospitals, alongside transparent communication with affected surgeons, staff, patients, and if required the broader community.

Overall, regional hospitals should treat sterilisation service continuity as a patient safety priority and invest in proactive contingency planning. By implementing the strategies in this paper, hospital administrators and sterile services teams can minimise downtime, maintain surgical services during crises, and uphold safety standards even under challenging rural and remote conditions.

Introduction

Sterile processing (also known as Central Sterilising Services or CSSD) is fundamental to safe hospital practice. It ensures that all reusable surgical instruments and medical devices are meticulously cleaned, disinfected, and sterilised to eliminate any risk of infection for patients. Any disruption in sterilisation services can have immediate and far-reaching consequences: elective surgeries may be postponed, emergency procedures complicated, and patient safety jeopardised. This is especially pertinent in regional Australia, where hospitals often operate with fewer redundancies and are geographically isolated from backup options available in metropolitan centers.

This whitepaper focuses on emergency preparedness and contingency planning for sterilisation service disruptions in regional Australian hospitals. It encompasses both public and private hospitals across Australia, with emphasis on rural and remote facilities. These hospitals face unique challenges, from limited on-site resources and workforce constraints to the tyranny of distance when seeking external support. The goal of this document is to help hospital administrators and technician teams anticipate potential failures and implement robust plans to maintain sterilisation capabilities during crises.

We begin with an overview of the risks and potential causes of sterilisation service disruptions, including real-world Australian examples that highlight the severity of such events. We then delve into key strategic areas for contingency planning: backup systems and equipment, staffing plans, cross-facility support arrangements, and communication protocols including regulatory notifications. Differences and similarities between public vs. private hospitals, and between rural vs. more remote settings, are explored to tailor recommendations to various contexts. Finally, the paper consolidates best-practice recommendations, informed by both past incidents and forward-looking strategies, in a structured format for hospital leaders to adopt.

By understanding the risks and preparing accordingly, regional hospitals can ensure that even if the unexpected occurs such as an autoclave breakdown, a power failure, or a contamination scare, there will be a clear plan to sustain sterilisation services and keep patient care on track.

Risk Overview: Causes and Impacts of Sterilisation Service Disruptions

Maintaining continuous sterilisation services involves managing complex equipment, utilities, and processes. Various risk factors can disrupt these services, including:

Equipment Failures: Autoclaves (steam sterilisers), washer-disinfectors, drying cabinets, and other CSSD equipment are mechanical systems prone to breakdown if not properly maintained, and sometimes even despite maintenance. For example, at Austin Hospital in Melbourne, five of seven surgical instrument washers failed unexpectedly in 2019, forcing the hospital to cancel nearly 500 elective surgeries to avoid running out of sterile instruments. In that case the sterilisation machines themselves remained functional, but without clean instruments coming out of the washers, surgical schedules could not be maintained. Such incidents illustrate how a single point of failure can cascade into a hospital-wide service disruption.

Utility Outages and Environmental Issues: Sterilisation units depend on critical utilities, steam, electricity, water, and climate control. Loss of steam or electricity will halt most sterilisation processes immediately. Even a loss of water supply or drop in water quality (e.g. a boil-water alert) can force a shutdown, since sterilisers and washers require high-purity water. HVAC failures leading to excessive humidity or temperature in sterile storage areas also pose a risk. High humidity can compromise the sterility of packaged instruments; one regional hospital in NSW highlighted the need for contingency plans if air-conditioning fails and humidity rises beyond safe thresholds. Without proper environment control, previously sterilised stock might have to be quarantined or reprocessed, reducing available instrument inventory.

Contamination and Quality Incidents: Not all disruptions are due to outright equipment failure, sometimes the process can be working but the output is suspect. A notable example occurred at Princess Alexandra Hospital (Brisbane) in 2019, when an unknown chemical residue was found on the packaging of sterilised instruments. Investigations traced it to a change in boiler chemicals; while the instruments were confirmed sterile, the residue prompted a halt in using those packs. Within 24 hours at least 46 surgeries were postponed. In such scenarios, a sterilisation service may choose to suspend operations or recall instruments out of caution until the issue is resolved, effectively creating a self-imposed disruption to protect patients. This underscores the importance of quality assurance and monitoring and having a backup plan for processing instruments elsewhere if the primary unit’s sterility assurance comes into doubt.

Staffing Shortages: Highly trained sterilisation technicians are essential to run CSSD operations. In smaller rural hospitals, the sterilising unit might be staffed by a single technician or a very small team. Sudden staff unavailability due to illness, emergencies, or even something like a COVID-19 outbreak, can therefore cripple the service. Unlike larger hospitals, a small facility may not have other staff readily able to step into the role. Furthermore, the learning curve for sterilisation practices is steep, requiring knowledge of infection control, machinery, and strict protocols, so reassigning nurses or other support staff in a crisis is challenging unless they have received prior training. Workforce issues are an ever-present risk that must be part of contingency planning, especially in remote areas where hiring temporary replacements can be extremely difficult.

Supply Chain Interruptions: Sterilisation units rely on a steady supply of consumables, packaging materials, chemical indicators, detergents, sterile wraps, etc. In remote hospitals, these supplies are often delivered on infrequent schedules. If shipments are delayed due to weather, transport strikes, etc. or if a particular item is unexpectedly out of stock, the CSSD might be unable to wrap and sterilise instruments properly. In addition, loan sets of surgical instruments often used for complex surgeries like orthopaedics pose logistical risks: regional facilities may hold loan instrument sets for longer periods to accommodate courier delivery schedules, requiring additional storage and coordination. A failure in the loan set return/delivery process could leave a hospital without the needed instruments or with unprocessed sets on hand.

Emergency Events and Disasters: Regional Australia is prone to natural events, bushfires, floods, cyclones that can directly or indirectly affect hospital operations. A disaster might cause physical damage to sterilisation equipment or cut off the power and water for an extended period. Even if the hospital is not damaged, it may become isolated e.g. roads cut by floodwaters, preventing transfer of instruments or resupply of sterile stock. Emergency events also often create surges in patient presentations, e.g. trauma from a disaster precisely when the hospital’s infrastructure is under strain. Thus, disaster planning must account for how critical services like sterilisation will be sustained in adverse conditions.

Impact on Hospital Services: When sterilisation capability is lost or limited, the most immediate impact is on surgical services and any other procedures that require sterile instruments (obstetric deliveries, endoscopy, emergency trauma care, etc.). Hospitals typically respond by prioritising emergency and urgent cases and postponing elective surgeries, as seen in the Austin Hospital case, where only essential surgeries continued and all non-urgent procedures were cancelled for about a week. Patients awaiting surgery can suffer prolonged pain or illness as a result of cancellations, and the hospital may face a growing backlog of cases. In some instances, patients have been transferred or redirected to other hospitals. For example, during the Austin Hospital washer failure, the Victorian Department of Health arranged for dozens of the most urgent patients to be treated at private hospitals with the costs covered by the public system. This kind of workaround is resource-intensive and may not always be feasible, especially in remote regions where alternate hospitals are far away.

Loss of sterilisation services can also trigger safety and regulatory consequences. If there is any chance that non-sterile or improperly processed equipment reached a patient, it becomes a reportable incident with infection control follow-up, and potentially a sentinel event if patient harm occurred. Even if no patient is directly harmed, such disruptions are often of high interest to health regulators and the public, requiring formal incident investigations and external notifications. For example, hospital administrators may need to provide urgent briefs to the state health department if the incident has major implications or media attention. All these impacts underscore why robust contingency planning for sterilisation interruptions is not just an operational issue, but a patient safety imperative and a governance responsibility.

In summary, the risk landscape for sterilisation services in regional hospitals spans mechanical, environmental, human, and external factors. The following sections discuss strategic areas to address these risks proactively, ensuring that hospitals can continue safe operations even when the unexpected occurs.

Key Strategic Areas for Contingency Planning

To mitigate the risks outlined above, hospital leadership and sterile services departments should develop comprehensive contingency strategies. The following are key strategic areas, each covering specific actions to prepare for or respond to a sterilisation service disruption. These strategies should be formalised in the hospital’s Business Continuity Plan (BCP) or emergency preparedness plans, and tested regularly through drills or simulations.

1. Backup Systems and Redundant Equipment

Ensure Redundancy in Sterilisation Infrastructure: A fundamental principle of continuity planning is avoiding single points of failure. For sterilisation services, this means having multiple sterilisation units and critical equipment wherever feasible. National health facility guidelines recommend that even small hospitals install at least two sterilisers and supporting equipment like washers so that “at all times a backup is available”. This is especially important in rural and remote hospitals where service technicians and replacement parts may not be readily available, therefore built-in redundancy is needed to bridge the potentially long repair times. In practice, a regional hospital might have two steam sterilisers sized to handle its surgical load, or a combination of one steam autoclave and one low-temperature steriliser for example, hydrogen peroxide plasma as a fallback. Washer-disinfectors should also be duplicated if possible. The 2022 Australasian Health Facility Guidelines explicitly note that for smaller and rural/remote hospitals, “two WDs…and two steam sterilisers, and if required one low temperature sterilizer, are the preferred solution, as this allows redundancy for equipment maintenance and breakdown”.

Preventative Maintenance and Monitoring: Alongside having spare capacity, a vigorous maintenance program reduces the chance of sudden equipment failure. Regular servicing and calibration of sterilisers and washers should be ensured per manufacturer guidelines. Many modern sterilisers have built-in diagnostics; hospitals should respond promptly to alarms or suboptimal performance indicators e.g. failed Bowie-Dick tests, slow cycle times before a total failure occurs. Maintenance contractors in regional areas should be part of the contingency plan for instance, have arrangements for priority call-outs or fly-in servicing when critical equipment is down.

Emergency Power and Utilities: Backup power generators for hospitals must supply essential clinical services, and sterilisation should be considered part of that critical load. In some facilities, older backup generators only power lights and life-support equipment, not large electric sterilisation machinery. Hospitals should assess their emergency power circuits and, if needed, reconfigure to provide emergency electricity to at least one steriliser and one washer during a mains power outage. Similarly, storing reserve supplies of treated water or having a secondary water treatment unit can be invaluable, since sterilisers require high-purity water. Bigger hospitals might invest in a redundant water purification system for CSSD, whereas a small rural hospital could keep a tank of distilled water for a tabletop steriliser in a pinch. Environmental controls (like HVAC for sterile storage) should also be on emergency power where possible; if not, contingency steps must be outlined e.g. relocating sterile stock to a climate-controlled area during an extended HVAC failure, as queried by NSW health staff.

Alternate Sterilisation Methods: Identify and prepare for using alternative methods of reprocessing if the primary sterilisation modality is unavailable. For example, if steam autoclaving is down, can a low-temperature steriliser if available on-site handle some of the load for heat-sensitive or small loads? Some rural hospitals have benchtop sterilisers or tabletop autoclaves in other departments (dental clinics, endoscopy units), these could be leveraged to sterilise a limited selection of instruments in an emergency. In extreme situations, chemical high-level disinfection or sterilants might be used as a last resort for certain items. For instance, a business continuity plan might state that if all sterilisers fail, the hospital will “investigate alternative sterilisation methods e.g. chemical sterilisation” for equipment like dental or respiratory devices. It must be noted that chemical solutions (like peracetic acid or glutaraldehyde soaks) have significant limitations and safety concerns, so they are only stop-gaps. Nonetheless, including instructions for their use in a controlled manner with Infection Control oversight can add an extra layer of resiliency.

Stockpile Critical Disposable Supplies: Increasing the use of single-use sterile instruments and consumables can help bridge short disruptions. Items such as disposable procedure kits, sterile single-use surgical instruments (e.g. scalpel handles, suction tips), and pre-sterilised linens or gowns can be life-savers if the CSSD is out of action. Hospitals in rural/remote areas should maintain a buffer stock of these disposables. For example, a small facility might keep on hand a number of pre-packaged sterile suture kits, delivery kits, or even minor surgery kits that require no reprocessing. These can be used for low-complexity cases or in emergencies. Event-related stock rotation should be practiced i.e. the stockpile items have expiry dates or sterility assurance periods, so use and replace them periodically. The goal is that if sterilisation stops, the hospital has, say, a few days’ worth of the most common instruments in disposable form to carry on urgent work. Indeed, contingency plans often state “ensure stock at maximum levels” for disposable sterile consumables when an outage is anticipated.

Mobile or Offsite Sterilisation Units: In some scenarios, bringing in outside sterilisation capacity can resolve the crisis faster than repairing on-site equipment. Larger health systems and private companies have mobile CSSD units or trailer-mounted sterilisers that can be deployed. In the Austin Hospital incident, for example, the hospital arranged for two mobile instrument washer units to be delivered within days to restore cleaning capacity. Regional hospitals should know in advance if such mobile units are available through the state health department or a contracted provider and how to request them. Alternatively, offsite reprocessing services can be utilized: Australia now has commercial reprocessing centers that take used instruments, sterilise them in a central facility, and return them, even offering 24-hour turnaround via courier for nearby regions. While typically set up for routine outsourcing, these centers could also serve in an emergency. A hospital would need to arrange transport of soiled instruments out and inbound sterile supplies, which requires careful logistics and quality controls, but it is a viable contingency if local options are incapacitated.

In implementing backup systems, prioritisation is crucial. Not every regional hospital can afford duplicate state-of-the-art sterilisers or a full inventory of disposable instruments. However, by analyzing which surgeries and instruments are absolutely mission-critical, the hospital can target investments smartly for instance, ensuring redundancy for the steriliser that handles emergency caesarean section instruments, or stocking disposable drapes for trauma kits. Table 1 provides a summary of common backup solutions and how they apply in practice:

Table 1. Backup Solutions for Sterilisation Disruptions, Examples and Use Cases.

2. Staffing Resilience and Emergency Workforce Plans

Cross-Training of Personnel: Wherever possible, hospitals should cross-train other staff in basic sterilisation duties. For example, operating theatre nurses or aides can be given orientation to the CSSD, learning how to wrap instrument trays, load an autoclave, or perform biological indicator tests. In a small hospital, it may be feasible to train a few interested nurses or allied health staff to act as auxiliary sterile processing technicians when needed. This cross-training ensures that if the sole CSSD technician is unexpectedly unavailable, someone else can at least run the steriliser for critical instrument sets even if efficiency is lower. It also helps during surge periods: for instance, if a large number of instrument sets need reprocessing quickly, perhaps after an emergency surgery influx or when clearing a backlog post-downtime, extra hands from nursing or dental staff can assist the core sterilisation staff. Hospitals should document which staff have received such training and what tasks they are competent to perform.

Relief Staffing Agreements: For public hospitals, health services can create staff-sharing arrangements within their Local Health District (LHD) or region. An infection control or sterilisation technician from a larger hospital could be dispatched to a smaller facility in an emergency. Some jurisdictions maintain a register of staff willing to be deployed to other sites. For private hospitals, if part of a larger group e.g. Ramsay Health, Healthscope, staff might be flown or driven from one hospital to another to provide temporary cover. These options require administrative planning, including how to handle travel, lodging, credentialing, and remuneration for temporary staff. The contingency plan should include contact details of nearby hospitals or corporate sister facilities and possibly agencies that can provide locum CSSD staff at short notice.

Succession and Skill Maintenance: In remote hospitals where one person may hold the only expertise, a common scenario, e.g. one sterilisation officer who’s been on the job for 20 years, it’s vital to have a succession plan. Encourage that specialist to mentor at least one other staff member. Consider sending staff to periodic training courses, such as those offered by the Sterilizing Research & Advisory Council of Australia so that the knowledge base is not lost if someone retires or is away. Building redundancy in skills is just as important as redundancy in equipment.

Task Shifting During Crises: Clearly define how duties will be redistributed during a sterilisation service interruption. For instance, if the CSSD staff must focus solely on processing emergency instruments during a recovery phase, other routine duties like ward equipment sterilisation or outpatient instrument reprocessing might be put on hold or assigned to another clinic. Nurses may need to take on more instrument checking or aseptic packaging tasks. The plan should spell out these shifts in responsibility. This avoids confusion; staff should know in advance, “If we activate the sterilisation downtime plan, these are your additional duties…”.

Fatigue Management: A subtle but important aspect, in a crisis, say an autoclave breakdown that creates a backlog, there is a temptation for available CSSD staff to work around the clock to catch up. Supervisors must monitor for fatigue and enforce rest, possibly by using those cross-trained helpers or bringing in relief as mentioned. An overtired technician could make critical mistakes e.g. missing an instrument in a set or not noticing a steriliser failing a cycle indicator, which could create an infection risk. So the human factor needs just as much oversight during emergency operations.

Communication and Leadership: Identify a chain of command for decision-making in a sterilisation disruption. Typically, the CSSD manager or senior tech will be part of the incident command for the event. However, in small hospitals that person might not be on site or available; thus an alternate leader, like the Theatre Nursing Unit Manager or Infection Control Practitioner may need to coordinate the response. Make sure all relevant managers know the contingency plan and can step in to lead it. Regular emergency drills can include a sterilisation failure scenario to practice this coordination.

In summary, a resilient staffing strategy means no single individual is irreplaceable in an emergency, and there are predefined ways to get help. By investing in cross-training and networking with other facilities, a regional hospital can dramatically reduce downtime due to staffing issues. Moreover, staff-related contingencies cost relatively little to implement, mainly training time and reciprocal arrangements, but pay huge dividends when a crisis hits.

3. Cross-Facility Collaboration and Resource Sharing

One of the strongest assets for regional hospitals is collaboration, leveraging other facilities for mutual support. No hospital needs to face a sterilisation crisis in isolation if proper linkages are established. There are several models for cross-facility support:

Public-Public Support Networks: Within state public health systems, hospitals are increasingly linked in regional networks. Contingency planning should designate backup “buddy” facilities. For example, a small rural hospital might pair with a larger regional base hospital: if the small site’s steriliser fails, they immediately courier their instrument sets to the base hospital for processing and borrow pre-sterilised sets if available. This was effectively demonstrated when Brisbane’s Princess Alexandra Hospital faced the chemical residue issue, they reached out to other Metro South hospitals and the Royal Brisbane and Women’s Hospital to help process instruments at those sites. With neighboring hospitals “very kind enough to help us process those instruments at their facilities,” PA Hospital managed to re-sterilise all packs over a weekend and kept emergency surgeries going with reserve stock. Such cooperation is possible because public hospitals share the same standards and often the same supply chains. To formalise this, hospitals can establish Memoranda of Understanding (MOUs) for emergency support, including how to transport soiled and clean instruments safely between sites, and agreements on cost reimbursement if any.

Public-Private Partnerships: In regions with both public and private hospitals, partnering can increase resilience for both parties. An excellent case is in Griffith, NSW, where a new private hospital, St Vincent’s Private Community Hospital built a state-of-the-art sterilising unit that also services the adjacent public Griffith Base Hospital. The formal sterilising services agreement means that the public hospital’s instrument reprocessing was effectively outsourced to the private hospital’s CSSD, following a funding arrangement to modernise the facilities. While this is a permanent shared-service model rather than an ad-hoc emergency swap, it shows how public and private resources can be pooled for mutual benefit. In an emergency context, a public hospital could likewise send urgent instrument loads to a private hospital in the same town or vice versa if one has capacity. Administrators should identify the nearest alternate CSSD (public or private) and have emergency contact procedures ready. One consideration is compatibility, differing instrument tracking systems or packaging methods can be a hurdle. It’s wise to discuss these details in advance, for instance, ensure that if Hospital A’s trays go to Hospital B, they meet the receiving CSSD’s criteria and that there’s a process to document and return them.

Third-Party Sterilisation Services: As mentioned, independent companies now offer off-site reprocessing, primarily to private hospitals and day surgeries. These can also be a resource for public hospitals in a crunch. A hospital could arrange an emergency pickup of used instruments and receive them back sterilised by the next day. This approach “de-risks reprocessing” by having a highly specialized team handle it externally. However, reliance on this method in a remote emergency depends on transport logistics (roads being open, etc). Still, establishing a contract or at least a line of communication with such a service in advance can add an extra layer to your contingency options, particularly for private facilities that might not have a public sister hospital to lean on.

Sharing of Sterile Stock and Loaners: Hospitals can also support each other by sharing ready-to-use sterile supplies. For example, if one hospital’s autoclave fails, a nearby hospital might lend sealed sterile instrument sets, especially standardized ones like basic laparotomy sets or caesarean section trays to tide over a few surgeries. In return, the borrowing hospital later replaces those sets or covers the cost. Another angle is coordinating the use of loan instrument sets for surgeries like orthopaedics. If a rural hospital holds a loan set for an orthopaedic case and can’t sterilise it, it might send the set to a larger hospital that has similar cases, get it sterilised there, and even have the patient temporarily diverted for surgery at the larger hospital. Inter-hospital transfer of patients is indeed a valid contingency: in the worst-case scenario, patients should be moved to where sterile instruments are available rather than using instruments of questionable sterility. This is essentially what happened in the Austin Hospital incident, the government facilitated some patients’ surgeries to occur at private hospitals to ensure they weren’t indefinitely delayed.

Communication and Transportation Logistics: Central to cross-facility help is a robust communication plan. The affected hospital must rapidly notify the partner facility of the issue and the kind of help needed, e.g., “Our steriliser is down, can you process 10 trays for us tonight?”. There should be a clear contact list with names of key people (sterile services manager, nursing supervisor, etc.) at each supporting facility. Additionally, transportation protocols need to be sorted out. Consider how instruments will be packaged for transport using tamper-proof sealed transport cases, according to Australian standards for moving contaminated medical devices, who will drive or courier them, and how tracking will be maintained. Hospitals should allocate funds in their contingency budget for couriers or fuel as needed. In remote areas, more creative solutions may be necessary, e.g., utilizing the Royal Flying Doctor Service or ambulance services to ferry critical instruments to a functioning steriliser site, if that could be life-saving.

Cross-facility collaboration, when planned in advance, can significantly shorten the downtime experienced during a sterilisation outage. It effectively enlarges the safety net beyond the single hospital. To illustrate differences in how various types of hospitals leverage such support, Table 2 in the next section compares public vs private approaches and highlights additional challenges in rural vs remote settings.

4. Communication, Reporting and Regulatory Compliance

Maintaining open communication and fulfilling regulatory obligations during a sterilisation service disruption are not only ethical duties but also legal ones in many cases. Hospital leadership teams must ensure that their contingency plans include protocols for internal communication, external notification, and documentation as required by oversight bodies.

Internal Communication and Incident Command: As soon as a sterilisation failure or risk is identified, an incident management structure should be activated. This often takes the form of a Hospital Incident Management Team or a crisis huddle involving executives (CEO or delegate), perioperative leaders, infection control, biomedical engineering, and communications staff. The situation must be clearly communicated to all relevant departments: surgical teams need to know which cases are affected, nursing units must be aware if certain reusable equipment like sterilised procedure trays are not available, and procurement/pharmacy might need to help marshal disposable alternatives. A status update system e.g. brief calls or messages every few hours can keep everyone informed as the contingency measures progress. This helps coordinate the response, for example, surgeons will understand why cases are being rescheduled and can explain it to patients, and the emergency department can divert certain patients if needed because they know the surgical capacity is limited for the time being.

Notification of Health Authorities: In Australia, public hospitals are typically required to notify the state health department of any serious service disruption or incident. NSW Health, for instance, mandates that serious clinical or corporate incidents with potential to affect patient safety or attract public interest be escalated to the Ministry via a Reportable Incident Brief within 24 hours. A sterilisation service failure that leads to widespread surgery cancellations or any risk of unsterile equipment use would certainly qualify. The hospital’s chief executive or their delegate should prepare a brief explaining the situation, immediate mitigations, and assistance required if any. In some cases, the Department may coordinate state-level resources like accessing mobile sterilisation units or authorizing patient transfers to other facilities as part of the response. Private hospitals, though not under direct government management, also have obligations, they are licensed by state authorities and must report incidents that significantly compromise patient care. Additionally, any incident involving potential patient harm, e.g. a contamination event would be reported through licensing/accreditation channels and possibly to the Australian Commission on Safety and Quality in Health Care (ACSQHC) if it meets criteria for a sentinel event or requires broader notification. Bottom line: the contingency plan should have a step to inform the appropriate regulatory body and outline who is responsible for that, usually the General Manager or Director of Clinical Services.

Open Disclosure to Patients: Transparency with patients and families is crucial. If a patient’s surgery is delayed because of sterilisation issues, they deserve to know the reason in honest but reassuring terms. Hospitals should follow the Australian Open Disclosure Framework, which encourages apologizing for the inconvenience and explaining the measures being taken to remedy the problem. In cases where a patient might have been exposed to improperly sterilised equipment, even if the risk is theoretical, prompt disclosure and a plan for monitoring or prophylaxis if needed must be provided. Thankfully, with proper contingency actions, exposure of a patient to unsterile instruments should be exceedingly rare, it’s more likely that patients are inconvenienced by delays rather than harmed by infection. Still, the communication to those affected should be empathetic and clear.

Adherence to Standards and Guidelines: Even during crises, hospitals must maintain compliance with core sterilisation standards to the extent possible. The Australian Guidelines for the Prevention and Control of Infection in Healthcare (2019) and AS/NZS 4187:2014 set out requirements that remain relevant in contingencies, for example, any alternate reprocessing method used should still achieve the required level of disinfection/sterility for the item’s intended use. If a hospital uses flash sterilisation or chemical disinfection as a temporary measure, it should do so under strict protocols that align with evidence-based practices. ACSQHC’s advice is that organisations need to have “contingency plans for service failures or disruptions for example, water, power supply, fires, delays in material supply, industrial action” and integrate these into risk management systems. This is essentially an accreditation expectation under the National Safety and Quality Health Service (NSQHS) Standards, specifically Standard 3 (Preventing and Controlling Infections) requires that reprocessing of reusable medical devices is safe, and by implication, that there are plans to manage it safely even in unusual circumstances. Auditors or accreditation surveyors may ask to see these contingency plans.

Regulatory Notifications for Equipment Issues: If the disruption is caused by a device malfunction or quality issue, for example, a steriliser that failed to reach temperature, or the chemical residue case at PA Hospital, there may be a need to notify federal agencies like the Therapeutic Goods Administration (TGA) or the manufacturer for investigation. Hospitals should document the incident thoroughly, cycle printouts, test results, photographs of any anomalies to support root cause analysis. This documentation and reporting is often done via the hospital’s risk management system and equipment management logs. In some instances, the manufacturer may issue hazard notices or recall advice, for example, if a particular model of steriliser is found to have a defect. Staying abreast of such notices via TGA alerts or the state’s health alerts is part of preparedness; implementing them promptly can prevent incidents.

Post-Incident Review and Improvement: After any major sterilisation service disruption is resolved, the hospital should conduct a debrief and investigation to identify lessons. This should involve the CSSD team as well as stakeholders from surgery, infection control, and administration. The review might ask: What caused the disruption? What worked well in our response and what didn’t? How can we bolster our plan for next time? These findings should be used to update the contingency plans. Often such an incident is a trigger to secure funding for improvements, for example, a hospital that suffered a breakdown may build a business case for purchasing an additional steriliser or upgrading infrastructure, noting how the incident demonstrated a risk to patient care. Demonstrating continuous improvement in emergency preparedness is also looked upon favorably in accreditation processes.

In essence, regulatory and communication strategies ensure that a sterilisation disruption, despite being a negative event, is managed in a way that upholds patient trust and safety standards. By proactively planning these aspects, hospital leaders can avoid secondary harm such as misinformation, panic, or regulatory non-compliance. Table 2 below summarizes some differences in how public vs private hospitals and rural vs remote settings might handle the challenges discussed so far, including regulatory context and support mechanisms:

Table 2. Comparative Challenges and Approaches, Public vs Private, Rural vs Remote.

Conclusion and Recommendations

Sterilisation service disruptions pose a serious threat to hospital operations and patient safety, but with diligent preparedness, their impact can be contained. Regional Australian hospitals, whether a small remote clinic or a large regional base must view sterilisation continuity as a critical component of their emergency planning. This whitepaper has reviewed the risks, strategies, and case studies to guide hospitals in strengthening their contingency plans. In conclusion, we distill the findings into key recommendations for hospital leadership and technician teams:

1. Develop a Formal Sterilisation Contingency Plan: Every hospital should have a written plan specifically for sterilisation service failure, as part of its broader business continuity documentation. This plan should address scenarios such as equipment breakdown, power/water loss, environmental control failure, and staff shortage, and delineate step-by-step actions for each. It must be regularly updated and readily accessible to all relevant staff.

2. Invest in Redundancy and Backup Capacity: Secure funding and approval to maintain at least two sterilisation units (autoclaves) in any hospital performing surgery. Similarly, have backups or alternatives for washers, dryers, and water treatment systems. Where adding a full second unit is not feasible, consider lower-cost backups e.g. a smaller steriliser or advanced tabletop unit that can sterilise a limited load in an emergency. Ensure critical utilities for CSSD have emergency power supply or alternative sources.

3. Pre-stock and Pre-position Emergency Supplies: Keep an emergency store of disposable sterile instruments, gowns, drapes, and other consumables that can be used if reusables cannot be processed. Focus on items for life-saving and common urgent procedures. Monitor expiry dates and rotate this stock. If your hospital is in a remote area, work with suppliers to possibly station extra consumables locally before the wet season or periods of isolation.

4. Establish Mutual Aid Agreements: Coordinate with other hospitals (public and/or private) in your region to support each other during sterilisation outages. Draft MOUs that outline how instruments, staff, or even patients will be shared or transferred. Identify contact persons in each facility. For private hospitals, consider agreements with the nearest public hospital and vice versa for emergency reprocessing services or surgical backup. Test these pathways with occasional drills or small-scale transfers to ensure viability.

5. Utilize External Reprocessing Services: Particularly for private hospitals or day surgeries, set up a relationship with an external sterilisation provider if nearby as a contingency. Even if you do not use them routinely, having the paperwork and validation in place means you can quickly dispatch instruments to them when needed. Ensure a validated transport protocol is in place for moving contaminated and sterile items safely.

6. Enhance Staff Training and Relief Coverage: Cross-train a pool of staff in basic sterilisation tasks, for example, have two theatre staff capable of running a cycle and doing instrument packing if needed. Conduct periodic competency assessments so they remain familiar. Additionally, maintain an updated call list for emergency staffing whether it’s contacting a retired local technician for short-term help or accessing a corporate float pool. Incorporate sterilisation failures into emergency drills so staff practice communication and role-switching under those conditions.

7. Engage Biomedical Engineering Early: At any sign of sterilisation equipment issues, involve technicians or biomedical engineers immediately. Sometimes proactive maintenance or quick fixes can avert a larger outage. Keep critical spare parts on site if possible e.g. replacement seals, filters for sterilisers. If a major repair is needed, activate contingency plans while the fix is in progress, do not wait to see if it can be fixed last-minute. Have the vendor’s support line and service contract details readily available for 24/7 emergencies.

8. Prioritize and Ration During Outages: When disruption hits, swiftly prioritize surgeries and procedures. Convene surgical and medical leadership to categorize what can be delayed and what must proceed. Implement rationing of any existing sterile goods, for example, open a new sterile kit only when absolutely needed, and consider keeping certain instruments in limited reuse by the same patient if safe to do so e.g. keeping a sterile catheter for that same patient’s later procedure rather than opening a new one. Use immediate-use sterilisation (flash) only for truly urgent, unplanned needs and with full adherence to infection control guidelines. Clearly communicate to all departments about the conservation measures in effect.

9. Communicate Early and Often: Ensure that internal alerts are sent out as soon as a problem is confirmed, including to executive on-call, department heads, and clinicians, so everyone understands the constraints and plan. Simultaneously, prepare external communications: notify your local health authority contact or regulator as required, and designate a spokesperson to handle any media or public inquiries if the situation becomes known publicly. Transparent communication will help manage expectations e.g. patients will be more understanding about delays if they know it’s due to an unforeseen equipment failure being addressed.

10. Uphold Safety and Documentation: Do not compromise on monitoring and indicators during a crisis. If you must run unusual sterilisation cycles or use alternative methods, document each load, result of biological/chemical indicators, and any deviations. Continue to follow validation protocols for instance, if using an older backup steriliser, ensure it’s still within its validation date or re-qualify it before use if needed. After the event, conduct a full incident analysis and share lessons learned with the team and across the network. Use those lessons to update the contingency plan, and consider advocating for any system-level changes such as state-level instrument loan pools or funding for upgrades that would improve future resilience.

By implementing these recommendations, hospital administrators and sterile services teams can create a robust safety net for one of healthcare’s most indispensable functions. The ultimate measure of success is that even if sterilisation services are disrupted, patient care continues safely, perhaps on a limited basis, but without catastrophic failure. Regional and remote hospitals owe it to their communities to be ready for such challenges. As the saying goes in emergency management: Hope for the best, but plan for the worst. With the strategies outlined in this whitepaper, hospitals can confidently ensure that a sterilisation service disruption, however unwelcome, will be met with a swift, organised, and effective response that safeguards patients and upholds the standards of care.

Sources:

1. Austin Hospital equipment failure case - ABC News (2019)
2. Princess Alexandra Hospital sterilisation incident - ABC News (2019)
3. Australasian Health Facility Guidelines (2022) - Sterilising Services Unit recommendations
4. Mackay HHS Business Continuity Plan (2013) - CSSD contingency excerpt
5. St Vincent’s Private Hospital Griffith - Facilities description (2021)
6. NSW Health Incident Management Policy (2020)
7. ACSQHC Infection Prevention Workbook (2023) - risk management guidance
8. ACIPC Forum discussion (2017) - contingency planning for CSSD environment failure
9. ABC News – Griffith base hospital sterilisation partnership (2013)