The Green Revolution in SPD: From Hidden Cost to Frontline Change

Sterile Processing Perspectives With Marjorie Wall, EDBA, MLOS, CRCST, CIS, CHL, CSSBB

Climate change is increasingly threatening global health, and sterile processing professionals are uniquely positioned to lead health care’s sustainability transformation. Sterile processing departments (SPDs), often invisible to patients but essential to safe surgery, represent a nexus of resource use, energy consumption, and environmental opportunity.

The US health care sector alone accounts for 8.5% of national greenhouse gas emissions, the highest per capita among industrialized nations.¹ Much of this burden stems from the supply chain and support services, where sterile processing plays a significant role. As we collectively work toward climate-resilient, value-based care, sustainability in sterile processing must move from aspiration to action.

Understanding the Footprint

Sterile processing touches everything from surgical instrument reprocessing to packaging choices, sterilizer use, and waste management. Despite its behind-the-scenes role, the SPD plays a critical and often underrecognized part in shaping a hospital’s environmental footprint. Every decision, from how trays are assembled to how they are packaged, sterilized, and stored, has cascading effects on energy consumption, material waste, and carbon emissions.

Steam sterilization, for example, is energy- and water-intensive, requiring high temperatures, long cycle times, and significant utility infrastructure. While necessary for patient safety, inefficient use of this modality can lead to unnecessary environmental harm. Improper machine loading, where sterilizers run without being full, wastes energy and water, increasing the carbon footprint per instrument processed. Likewise, individually wrapping instruments rather than incorporating them into standardized, optimized sets can triple the carbon emissions associated with their reprocessing.²

Packaging choices further influence both the sustainability and financial burden of SPD operations. A comparative case study where 2 German hospitals evaluated 4 different packaging methods found that reusable rigid containers without inner wraps were the most cost-effective and environmentally sustainable option, costing just €2.05 per use. In contrast, dual-layer sterilization wraps, the most commonly used alternative, cost nearly twice as much at €3.87 per use.³ These cost differences may seem modest on the surface, but when multiplied across hundreds or thousands of trays per day in a large medical center, the economic and ecological implications become profound.

Moreover, disposable packaging materials contribute significantly to medical waste streams, much of which is misclassified and unnecessarily processed as regulated medical waste, further increasing cost and environmental impact.⁴ Transitioning to reusable, standardized, and lifecycle-conscious systems supports fiscal responsibility and aligns SPD practice with global efforts to decarbonize healthcare and improve public health outcomes.

Overproduction and Overuse

A major contributor to SPD waste is found upstream in the operating room. Over the years, surgical trays have grown in size, often in an attempt to anticipate every possible need during a procedure. While the intent of ensuring clinical preparedness is understandable; however, the result is often the over-inclusion of untouched instruments. In fact, studies have shown that in more than 80% of cases, a significant portion of the instruments in a standard surgical tray go unused.⁵ Tray overbuild is a silent but substantial driver of waste, labor inefficiency, and cost.

Each additional instrument, whether used or not, must be decontaminated, inspected, packaged, sterilized, transported, stored, and eventually reprocessed again. This process consumes human resources and chemical and utility inputs and extends equipment wear, all without adding clinical value. When multiplied across hundreds of procedures, these redundancies significantly burden SPD throughput and environmental sustainability.

Operating rooms are among the hospital's most resource-intensive spaces, generating up to 30% of a facility's total waste.⁴ Compounding the problem is improper waste segregation: items that could be recycled or disposed of as general waste are often mistakenly discarded into regulated medical waste bins, which are more expensive to process and more harmful to the environment. SPDs, by necessity, inherit this inefficiency in the form of increased instrument reprocessing and unnecessary packaging waste.

However, SPD professionals are not powerless in this equation; they are critical. By leading data-driven initiatives such as surgical tray audits and real-time usage tracking, SPD teams can partner with perioperative stakeholders to identify instruments that are rarely, if ever, used. This enables the creation of streamlined trays tailored to actual procedural needs. This reduces the environmental and financial cost of reprocessing and improves operational flow by lightening the workload, reducing error rates during assembly, and freeing up equipment that might otherwise sit idle on oversized sets.

Furthermore, this collaboration opens a pathway to greater cross-departmental alignment. When SPD, OR, and materials management teams work together to assess usage patterns and align expectations, the results are often transformational in terms of sustainability and efficiency, staff satisfaction, and patient care quality. By reframing tray optimization as a shared responsibility, SPD professionals can drive a culture shift that embraces smarter resource use and positions sustainability as a core clinical value.

The Case for Reuse and Reprocessing

For decades, infection prevention concerns have driven a widespread preference for single-use disposable medical devices, particularly in the US. This shift is primarily motivated by the perceived risk of cross-contamination and has resulted in a reliance on linear, throwaway consumption models. While protecting patients from infection is undeniably critical, the pendulum has swung so far toward disposability that it has created an unsustainable system rife with environmental and financial consequences. The irony is that many of these disposable products replace reusable alternatives that, when properly cleaned and sterilized, are equally safe and far less damaging to the planet.

Today's evidence and available technologies paint a very different picture than the one that shaped early infection control policies. Advances in sterilization science, process automation, and quality assurance have made high-level disinfection and sterilization more reliable and traceable than ever before. As such, a shift back toward reusability, anchored in evidence-based practice, is a safe, more responsible, and sustainable path forward.

One framework that continues to influence infection control protocols is the Spaulding classification system. Introduced in 1957, Spaulding’s model stratifies medical devices into three categories, critical, semi-critical, and non-critical, based on their intended use and level of patient contact. While its logic remains sound, the framework has not kept pace with modern device design, emerging pathogens, or evolving sustainability imperatives.⁶ The complexity of today’s reusable medical devices, many with delicate electronics, long lumens, and mixed-material construction, requires reprocessing protocols that go far beyond the original intent of Spaulding’s model.

Experts are calling for an updated version of the Spaulding classification, incorporating new technologies such as real-time process monitoring, integrated automation, and metrics for environmental sustainability. Such a modernization would improve patient safety and incentivize manufacturers to design devices that are easier to clean, reprocess, and reuse.

At the same time, the healthcare industry must confront the limitations of its current economic model. The prevailing "take-make-waste" linear supply chain has proven both environmentally harmful and operationally fragile, as demonstrated during COVID-19 when global supply disruptions left hospitals without access to critical disposable supplies. Transitioning to a circular economy offers a powerful solution.

Medical devices and packaging are designed for durability, disassembly, and repeated use in a circular system. Materials are recaptured and reintroduced into the production cycle through refurbishment, remanufacturing, or recycling. This approach doesn't just reduce waste, it extends product life cycles, conserves raw materials, and builds resilience in the healthcare supply chain. According to MacNeill et al,⁷ adopting circular economy principles can substantially reduce greenhouse gas emissions, improve supply continuity, and lower the public health burden caused by health care-generated pollution.

To fully realize this vision, healthcare systems must address policy and product innovation. Regulatory frameworks that currently favor disposables must evolve to support and incentivize reusable solutions. Procurement contracts should prioritize lifecycle cost and environmental impact rather than purchase price. Meanwhile, manufacturers must be held accountable for designing products with reprocessing and sustainability in mind, from the first computer-aided design drawing to end-of-life disposal.

The shift from disposability to durability is not a compromise but a clinical, ethical, and ecological imperative. SPD professionals, working alongside infection preventionists, supply chain managers, and clinicians, have the knowledge and vantage point to lead this change from within. By championing a more circular approach to medical device use and reprocessing, they help ensure that patient safety and planetary health go hand in hand.

Powering Change Through Practice

Operational improvements within the SPD offer immediate, actionable opportunities to reduce environmental harm without compromising patient safety. By focusing on more innovative resource use, process efficiency, and collaborative partnerships, SPDs can make meaningful progress toward sustainability goals, starting with what’s already within their control.

Optimized Machine Loading:

Maximizing sterilizer efficiency through proper load configuration is one of the most impactful yet underused strategies for reducing energy and water waste in SPD operations. Sterilizers, especially steam units, are high consumers of energy and water. When cycles are run with only partially loaded trays or baskets, the environmental cost per instrument dramatically increases. Rizan et al² found that carbon emissions per tool could be significantly reduced by improving machine loading protocols and ensuring each cycle processes as many instruments as safely possible. This practice also reduces equipment wear and increases throughput, providing ecological and operational benefits.

Packaging Evaluation:

Packaging decisions are another area for improvement. Disposable wraps, while convenient, generate large volumes of waste and require high-energy incineration if treated as regulated medical waste. Reusable rigid containers offer a more sustainable alternative, especially when paired with effective inspection and maintenance practices. When correctly managed, containers can last for years, drastically reducing procurement and waste management costs. SPDs should regularly evaluate their packaging mix and seek opportunities to phase out single-use options wherever appropriate.

Set Streamlining:

Instrument overuse is a well-known contributor to reprocessing waste. By collaborating with surgical teams to review tray contents, SPD leaders can identify rarely or never-used instruments. These can be safely removed from standard sets, reducing the labor required for inspection, assembly, and sterilization. Set streamlining not only cuts environmental impact, it also shortens case setup times, improves tray turnover, and reduces the likelihood of errors. Data-driven tray audits and direct observation of surgical procedures can support the clinical case for consolidation and drive long-term practice change. There are even Artificial Intelligence solutions to help track instrument utilization and recommend optimized trays.

Energy and Water Management:

SPDs are among the most utility-intensive departments in any hospital. Sterilizers, washers, ultrasonic units, and HVAC systems consume large volumes of water and electricity. By partnering with facilities or engineering teams, SPD leaders can gain insight into usage patterns and identify areas where efficiencies can be gained. Transitioning to low-carbon or renewable energy sources, installing water recirculation systems, and scheduling preventive maintenance on sterilizers and washers can reduce emissions and lower utility costs. Even simple measures like turning off idle equipment can make a difference over time.

Education, Engagement, and Culture Shift:

Sustainability cannot thrive without a culture that supports it. Education is needed to build awareness, shift mindsets, and inspire action. Interdepartmental "Green Teams" or sustainability committees create a platform for sharing ideas, tracking progress, and recognizing success. These groups can also champion pilot projects, such as waste audits or packaging trials, and help secure buy-in from leadership.

Data transparency is equally important. Dashboards, monthly scorecards, or process improvement boards that track waste reduction or resource use empower frontline staff to understand their impact and contribute to solutions. In many facilities, appointing a dedicated "sustainability champion" within SPD leadership has proven successful. These individuals serve as internal advocates, bridging operations with environmental stewardship and aligning departmental practices with broader organizational goals.⁴

Together, these operational and cultural strategies demonstrate that sustainability is not an add-on, but a core component of high-quality, forward-thinking, sterile processing. By embedding environmental responsibility into daily operations, SPD professionals can drive systemic improvements that benefit patients, staff, and the planet.

Policy, Metrics, and Momentum

Systemwide sustainability cannot occur without measurement. Leading institutions, like the NHS in England, have reduced healthcare emissions by 26% since 1990 through national-level tracking and accountability.⁸ The US lags in this effort. Eckelman et al. (2020) emphasize the need for standardized emissions reporting, benchmarking, and facility-level action plans. SPDs should advocate to be part of these conversations, driving improvements that extend beyond departmental boundaries.

A Call to Action

Sustainability in sterile processing is not a luxury, but a responsibility. As professionals committed to patient safety and public health, we must embrace our role in building a greener, more resilient healthcare system.

SPD leaders can drive measurable change by evaluating packaging, optimizing processes, championing reuse, and engaging in policy reform. It starts with asking bold questions, challenging outdated norms, and viewing every sterilized tray as an opportunity to make healthcare not just safer but more sustainable.

References

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2. Rizan C, Lillywhite R, Reed M, Bhutta MF. Minimizing carbon and financial costs of steam sterilization and packaging of reusable surgical instruments. Br J Surg. 2022;109(2):200–210. doi:10.1093/bjs/znab406
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6. Rowan NJ, Kremer T, McDonnell G. A review of Spaulding's classification system for effective cleaning, disinfection and sterilization of reusable medical devices. Sci Total Environ. 2023;878:162976. doi:10.1016/j.scitotenv.2023.162976
7. MacNeill AJ, Hopf H, Khanuja A, et al. Transforming the medical device industry: Road map to a circular economy. Health Aff (Millwood). 2020;39(12):2088–2097. doi:10.1377/hlthaff.2020.01118
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