Sterilization by ethylene oxide and hydrogen peroxide plasma: cost analysis and its impact in the operating room

Abstract

Introduction: Sterilization through low-temperature methods entails high costs. Identifying the activities and inputs involved presents an opportunity for optimizing these processes and designing future improvement strategiesObjectives: Evaluate the costs of ethylene oxide (EO) and hydrogen peroxide plasma (HPP) sterilization methods. Compare the frequency of use of both by the surgical unit before and after cost analysis.

Materials and Methods: An observational, descriptive, cross-sectional study was conducted in July 2022 at the Maternal and Child Interzonal Hospital "Don Victorio Tetamanti" in the city of Mar del Plata. Direct costs (DC), indirect costs (IC), and total costs (TC) were calculated for EO and HPP sterilization. An ad hoc database was developed to record the materials used, personnel involved, and time taken for each stage. A "test package" (TP) of established dimensions similar to those processed daily was designed, and based on this, the number of sterilized TP units was determined for 80% capacity of each equipment. The costs of sterilizing a TP and running it at 80% capacity for each stage of the methods were calculated. The number of loads performed by the surgical unit was reviewed and recorded during the May-June 2022 period and the period following the cost analysis in August/September 2022.

Results: DC, IC, TC for EO respectively: per TP ($1127.3; $4880.5; $6007.8), 80% capacity ($4602.2; $4880.5; $9482.7). DC, IC, TC for HPP respectively: per TP ($7047.6; $3205; $10252.6), 80% capacity ($7345.6; $3205; $10550.6). Argentine pesos, July 2022. 

Discussion: TyvekRR paper shows an inverted quantity/cost relationship compared to the pouch used in EO sterilization. The EO cartridge used per load is 10 times cheaper than the pair of cells used per load in HPP. These cost differences between methods are more pronounced when comparing the number of TP units admitted due to the capacities of their chambers. In our case, a change in frequency of use of both methods was observed; HPP implies a higher cost than EO per TP and at equal capacity. No similar studies were found for comparison. As a limitation, washing costs (DC) and the purchase of machines, depreciation, and services (IC) were not considered, which would result in a higher TC. 

Conclusion: HPP is the method with the greatest economic impact, and therefore, its proper management within the Sterilization Department (SD) is of vital importance.