Critical Water Quality Challenges in Sterile Processing: HSPA 2026 Case Study Highlights Lessons From VA Health Care Facilities

At the 2026 HSPA Annual Conference, a poster presentation explored one of the most overlooked but essential components of sterile processing: water quality.

Titled “Critical Water Quality: A Case Study – How One Healthcare System Achieved Reliable Results at Two Locations,” the presentation was authored by Lisa Pawlowski, DNP, RN, CRMST, along with Tyler Anderson and Danny Conrad. The poster examined persistent water quality issues within the Cheyenne VA [Veterans Affairs] Health Care System and detailed how multidisciplinary collaboration ultimately resolved recurring contamination and conductivity problems.

The presentation emphasized that water quality management extends far beyond simply installing a reverse osmosis (RO) system. “Facilities and Sterile Processing need to work together to ensure water quality meets the parameters defined in (Association for the Advancement of Medical Instrumentation) AAMI ST108,” the authors wrote, noting that source water, system age, infrastructure, purification methods, and maintenance all influence outcomes.

The case study focused on 2 facilities: the Cheyenne VA Medical Center (CVAMC), originally built in 1934, and the Northern Colorado VA Outpatient Clinic, a newer facility that opened in 2022.

At CVAMC, the health care system faced ongoing struggles with conductivity, bacteria, and endotoxin levels after implementing water testing. Several interventions were attempted, including disinfecting and replacing reverse osmosis (RO) storage tanks, changing media, and modifying pressure levels. However, long-term success remained elusive.

According to the poster, one of the major breakthroughs came when teams mapped the entire water system and identified multiple “dead legs,” or stagnant sections of piping, connected to hospital humidity systems. The system was eventually dedicated solely to sterile processing critical water, and the dead legs were eliminated.

“It also was discovered that the recirculation on the system was a small loop that did not reach the furthest out point of the system,” the authors explained. “This was corrected.”

Further analysis revealed excessive pressure across the RO media, allowing ions to pass through the system and increasing conductivity. Teams also identified a malfunctioning polisher using more salt than expected. Pressure was reduced, the polisher was removed, and a deionized (DI) water system was added to stabilize conductivity within AAMI ST108 standards.

Persistent bacterial contamination at the point of use required additional interventions. The facility installed ultraviolet (UV) light and endotoxin filtration systems, but bacteria remained especially problematic in storage tanks. Ultimately, ozone injection before storage tanks, combined with removal afterward, helped achieve consistent zero bacterial levels throughout the loop.

The Northern Colorado VA Outpatient Clinic experienced a different but equally challenging problem. Although the facility was newly constructed, the sterile processing department did not open until approximately 8 months after the RO system became operational. During that time, water remained stagnant within the lines.

“Water sitting in the line for several months, and lack of recirculation are believed to have contributed to a chronic issue with high colony count throughout the system,” the authors stated.

The stagnant water and incomplete recirculation contributed to repeated equipment failures, including staining, heating element problems, and sterilizer issues severe enough to trigger temporary closures.

The solution again centered on recirculation. By extending recirculation to the outermost point of the system, bacterial counts stabilized within acceptable limits.

“Since installation of the recirculation line, there have been no further instances of staining or heating element failure in the sterilizers,” the poster’s authors reported.

The presentation concluded with several practical lessons for sterile processing and facilities teams. Among them: map the entire system, ensure recirculation reaches the furthest end point, routinely disinfect faucets and sampling ports, and prevent stagnant water whenever systems are idle.

The authors also stressed the importance of multidisciplinary collaboration. “Water quality is not one single person’s responsibility,” the poster’s authors stated. “Several disciplines hold valuable information to managing the system.”

The case study underscored the growing recognition that sterile processing water systems require proactive oversight and ongoing monitoring. As health care facilities continue implementing standards such as AAMI ST108, the experiences shared at HSPA 2026 serve as a reminder that even sophisticated systems can fail without careful design, communication, and maintenance.

Perhaps most importantly, the presentation reinforced a simple but critical reality: Water quality directly impacts patient safety, instrument integrity, and the reliability of sterilization processes across health care systems.