TL;DR: Basic brushing plus a 10-minute soak cut contamination in used single-use devices

Basic brushing, immersion for ten minutes and air-drying reduced bacterial contamination in 90 clinically used single-use devices, with no functional damage observed, according to the study published on Cambridge Core on 14 September 2026. The work tested peracetic acid, 70% ethanol and dishwashing detergent on endotracheal tubes, laryngeal mask airways, intravenous administration sets, syringes, indwelling urinary catheters and nasogastric tubes collected after surgery in a regional hospital. All three agents produced statistically significant reductions in bacterial load at P < 0.05 with no difference between methods, while polymerase chain reaction testing for 28 respiratory pathogens turned negative after cleaning in airway devices that had been 47% positive before cleaning. The authors stated the procedures cannot replace validated sterilization and should enter preparedness planning only as a last resort after stockpiling, surge production, resilient supply chains, rationing and substitution, a framing reinforced by separate United States reprocessing audits and end-of-life research summarized by MarketScale and AAMI.

Publication identified the question as supply failure in disaster and war

What Cambridge University Press posted on 14 September 2026

The paper titled Contingency Methods for Cleaning Single-Use Medical Equipment in Crisis, Disaster, or War was published online by Cambridge University Press on 14 September 2026 in Prehospital and Disaster Medicine, according to Cambridge Core. The listed authors were Karl Chevalley, Knut Taxbro, Sara Mernelius, Peter Sigfridsson and Göran Sandström, according to Cambridge Core. The corresponding author was identified as Karl Chevalley, MD, of the Department of Anesthesiology and Intensive Care at the Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg in Gothenburg, Sweden, according to Cambridge Core. Affiliations named on Cambridge Core included the Sahlgrenska Academy, the University of Gothenburg Centre for Disaster Medicine, Helicopter Emergency Medical Service in Västra Götaland Region, Linköping University Department of Biomedical and Clinical Sciences, the Department of Anaesthesiology and Intensive Care Medicine at Ryhov County Hospital in Jönköping, and the Swedish Defence University in Stockholm. The background section stated that shortages of disposable medical equipment can critically impair health care delivery during disasters or armed conflict, according to Cambridge Core. The same background stated that reprocessing single-use medical devices may represent the only feasible option under such conditions, while evidence supporting simple, field-adapted cleaning methods is limited, according to Cambridge Core.

Why the authors linked the test to crisis care

Sufficient supply of medical equipment was described as essential to perform medical care for sick and wounded in crisis, disaster and war, according to Cambridge Core. Contingency planning for the health care system was described as including large-scale storage, the ability to scale-up production and robust logistics, according to Cambridge Core. Shortage of medical supply was described as a major problem for the health care system in wartime, according to Cambridge Core. During the COVID-19 pandemic, health care systems were compelled to rapidly adopt methods for cleaning and reusing medical supplies, according to Cambridge Core. Sweden was described as having maintained extensive emergency stockpiles and a well-prepared capacity to transition to domestic production of critical medical supplies during the Cold War, according to Cambridge Core. In light of the deteriorating global security situation, Sweden and other countries rebuilt the civil defense, including enhancing the health care system's resilience and operational endurance, according to Cambridge Core. Despite adequate preparedness planning, single-use medical equipment may still become depleted during crises or armed conflicts, according to Cambridge Core. Changes in clinical protocols, strict prioritization, rationing and the repurposing of applicable equipment may be required in that setting, according to Cambridge Core. In the face of an impending disaster, reprocessing and reusing single-use items may become the only viable option, according to Cambridge Core. During wartime, such practices might need to be carried out under rudimentary and field-like conditions, even within hospital settings, according to Cambridge Core.

How the 90-device test was organized

Devices collected and agents assigned

The report described the work as an exploratory study using 90 clinically used single-use medical devices, according to Cambridge Core. The six device types were endotracheal tubes abbreviated ETT, laryngeal mask airway abbreviated LMA, intravenous administration sets abbreviated IVS, syringes abbreviated SYR, indwelling urinary catheters abbreviated IDC and nasogastric tubes abbreviated NGT, according to Cambridge Core. The items were collected after surgery in a regional hospital, according to Cambridge Core. Devices were randomly allocated to cleaning with peracetic acid abbreviated PAA, 70% ethanol or dishwashing detergent, according to Cambridge Core. Each item was brushed, immersed for ten minutes and then air-dried, according to Cambridge Core.

Sampling and function checks used

Microbiological sampling included pre-cleaning and post-cleaning cultures, according to Cambridge Core. Airway devices underwent polymerase chain reaction testing for 28 respiratory pathogens, according to Cambridge Core. Functional integrity was assessed after cleaning, according to Cambridge Core.

What changed after brushing, soaking and drying

Bacterial cultures fell with every agent

All three cleaning agents achieved statistically significant reductions in bacterial load at P less than 0.05, according to Cambridge Core. No difference was found between methods in bacterial-load reduction, according to Cambridge Core.

Respiratory panels turned negative in airway devices

Polymerase chain reaction testing detected Hemophilus influenzae and Staphylococcus aureus among other pathogens in 47% of airway devices before cleaning, according to Cambridge Core. All post-cleaning samples from those polymerase chain reaction tests were negative, according to Cambridge Core.

No breakage or loss of function was recorded

No structural or functional damage was observed after cleaning, according to Cambridge Core. Basic cleaning procedures with commonly available agents substantially reduced microbial contamination without impairing device function, according to the conclusion on Cambridge Core. The same conclusion stated that these methods cannot replace validated sterilization, according to Cambridge Core. The methods may serve as the only viable option when medical supply is critically constrained, such as in disasters or in armed conflict, according to Cambridge Core.

Authors placed reuse last in preparedness planning

Stockpiles, production and rationing came first

Preparedness planning should encompass strategic stockpiling, surge production capacity and resilient supply chains, together with rationing and substitution strategies, according to the conclusion on Cambridge Core. Protocols for cleaning and reusing single-use medical equipment were listed only as a last resort, according to Cambridge Core.

What that order means for a bug-out medical loadout

A reader building an evacuation bag should treat sealed, unused supplies as the primary plan and any cleaning procedure as a contingency for critically constrained supply, because the authors ranked stockpiling and surge capacity ahead of reuse, according to Cambridge Core. A loadout informed by the study would prioritize intact endotracheal tubes, laryngeal mask airways, intravenous administration sets, syringes, urinary catheters and nasogastric tubes in sterile packaging rather than plans to reuse them, because the test items had started as clinically used devices collected after surgery, according to Cambridge Core. The tested cleaning sequence paired mechanical brushing with ten-minute immersion and air-drying, so a contingency kit reflecting the report would need a brush, a container permitting full immersion for ten minutes and a clean area for air-drying, because each item in the study was brushed, immersed for ten minutes and then air-dried, according to Cambridge Core. The study allocated devices to peracetic acid, 70% ethanol or dishwashing detergent, so no single agent was shown superior for bacterial-load reduction in that comparison, because no difference was found between methods, according to Cambridge Core. Airway equipment deserves particular caution in any contingency plan because 47% of airway devices carried detected pathogens including Hemophilus influenzae and Staphylococcus aureus before cleaning in polymerase chain reaction testing for 28 respiratory pathogens, according to Cambridge Core.

U.S. audits show why cleaning discipline matters

Joint Commission findings focused on people and ownership

A MarketScale report published on 14 September 2026 stated that most reprocessing audit gaps trace back to training, turnover and leadership, rather than sterilizers alone. Joint Commission findings on reprocessing standard IC.02.02.01 pointed mostly to training, turnover, leadership and missing ownership, with CDC epidemiologists and a 2019 review adding cleaning verification and manufacturer instructions as steps to watch, according to MarketScale. At least eight items in the Joint Commission list of reasons hospitals miss standard IC.02.02.01 concerned people, priorities and management, supporting inclusion of competency records and a named process owner in an audit alongside sterilizer logs, according to MarketScale. The requirement under standard IC.02.02.01 is to reduce infection risk from medical equipment, devices and supplies, as compiled by the Joint Commission Office of Quality Monitoring and relayed in a 2017 Infection Control Today article by infection prevention consultant Chuck Hughes, according to MarketScale. Hughes drew on more than 25 years of auditing surgical, dental and endoscopic reprocessing, according to MarketScale. The findings he relayed included staff believing the risk of passing pathogens to patients is low, staff lacking training, no access to evidence-based guidelines, no leadership support, turnover that pushes sterilization down the priority list, no safety culture that encourages reporting, shortcuts, timeframes not followed, nobody assigned to own the process, and facility design or space that gets in the way, according to MarketScale. At least eight of the ten findings were about people, priorities and management, while only the last one was a building problem, according to MarketScale.

Deadlines and corrections after a failed survey

Hughes wrote that Joint Commission surveyors were increasingly citing non-compliance with IC.02.02.01 and that many immediate threat to life findings in 2013 traced directly to improperly sterilized or high-level disinfected equipment, according to MarketScale. When a surveyor makes such a finding, the organization receives a preliminary denial of accreditation and has 72 hours to either eliminate the threat or implement emergency interventions, with 23 days as the outer limit to eliminate it entirely, according to MarketScale. The corrective actions listed by Hughes included reprocessing every instrument involved in the breach, evaluating staff competency and retraining, and implementing an equipment tracking process that traces items used back to the patient, according to MarketScale.

Cleaning verification and device complexity

Michelle Alfa's 2019 State of the Science review in the American Journal of Infection Control described a shift over the preceding decade toward a quality management systems approach to reprocessing, according to MarketScale. Under that model, device manufacturers must supply validated cleaning instructions that are feasible in a real hospital, and reprocessing staff must monitor cleaning on an ongoing basis, according to MarketScale. The review's central warning was that inadequate cleaning can cause sterilization or high-level disinfection to fail, according to MarketScale. The review reported that endoscopes may carry up to 10 to the seventh power colony-forming units per square centimeter of bacteria after patient use, while patient-used surgical instruments were reported at 10 to the second power colony-forming units per square centimeter or less, according to MarketScale. CDC epidemiologists Matthew Stuckey and Isaac Benowitz, writing in Prevention Strategist in 2019, listed the problems they see most often as failure to follow standards, guidelines and manufacturer instructions for use, not understanding how to monitor and interpret quality indicators such as sterilization parameters and controls, and device designs including some duodenoscopes that are simply hard to reprocess, according to MarketScale.

What a 189-cycle audit measured

A 2020 study in BMC Health Services Research built an audit instrument for medical device reprocessing and steam sterilization and applied it to 189 reprocessing cycles across 13 primary and secondary care public hospitals in Nepal, scoring percentage compliance for each standard practice, according to MarketScale. Mean compliance came to 25.9%, with a 95% confidence interval of 21.0% to 30.8%, according to MarketScale. Individual hospitals ranged from 14.7% to 46.0%, and lower levels of care scored significantly lower at P less than 0.01, according to MarketScale. The hospitals did better on cleaning used devices and on transporting and storing sterilized ones than on the steps in between, according to MarketScale. A structured audit tool that scores compliance step by step shows where training hours should go, according to MarketScale.

End-of-life research limits reuse assumptions

AAMI described a standard gap on 10 September 2026

An AAMI report dated 10 September 2026 stated that reusable medical devices can be cleaned, disinfected and sterilized hundreds or even thousands of times over their working lives, but there is no globally recognized standard for determining when a device has reached the end of its working life. That gap was the subject of a paper by Alpa Patel and Daniel Olsen of Nelson Labs, published in the peer-reviewed journal Biomedical Instrumentation and Technology, according to AAMI. Patel discussed the research on a recent episode of AAMI's Below the Hospital podcast, hosted by Garland-Rhea Grisby Sr., according to AAMI. Patel said one of the biggest challenges is that there is currently no globally harmonized detailed regulatory framework specifically defining how end-of-life evaluation should be conducted for reusable medical devices, according to AAMI. Regulators agree manufacturers need to address the issue because ISO 10993-1:2021 requires biological safety evaluation across a device's maximum validated number of processing cycles, and ISO 17664-1:2021, the European Union Medical Device Regulation 2017/745 and FDA guidance all direct manufacturers to determine whether repeated processing degrades a device enough to limit usable life, according to AAMI. None of those documents spell out how to design and perform that evaluation, leaving laboratories, reviewers and manufacturers to build their own approaches, often with little consistency among them, according to AAMI.

One hundred-cycle coupon test and material wear

Historically the industry focused heavily on validating cleaning, disinfection and sterilization processes for devices processed up to six times before validation, according to Patel as reported by AAMI. Reusable devices are rarely new in clinical practice, and end-of-life evaluations help understand whether the device continues to function as intended after years of real-world reprocessing, according to Patel as reported by AAMI. Material degradation, damaged surfaces, loss of functionality or changes in cleanability can potentially affect patient safety if not identified, and all of that responsibility falls on sterile processing departments, according to Patel as reported by AAMI. To address the gap, Patel and Olsen designed a protocol meant to mirror how devices are actually soiled, cleaned and sterilized in a hospital rather than an idealized laboratory process, according to AAMI. The study put eight coupon materials common to reusable devices, including aluminum, stainless steel and several polymers, through a theoretical 100-cycle service life involving soiling with a blood-based test soil, a manual pre-clean rinse that intentionally left some residual soil behind, an automated wash and steam sterilization, according to AAMI. Coupons pulled at set intervals were checked against ANSI/AAMI ST98 criteria for residual protein, hemoglobin and total organic carbon, and against ISO 10993-5 biocompatibility testing for cytotoxic reactions, according to AAMI. Across all 100 cycles, the coupons showed negligible to nondetectable residual soil and no biological reactivity, according to AAMI. Aluminum surfaces lost their finish, and lower-grade stainless steel began to pit and degrade faster than medical-grade material, according to AAMI. Patel concluded that end-of-life evaluation should be risk-based rather than cycle-based, stating that in 100 cycles there was no risk but material started to degrade, according to AAMI. A device's true end of life depends less on a fixed cycle count than on how, and how often, it is actually used, with a scope reprocessed several times a day facing a very different risk profile than one used once a month, according to AAMI. SPD professionals are often the first people to recognize when a device is approaching the end of usable life and are the frontline people, according to Patel as reported by AAMI. Cosmetic wear like discoloration did not correlate with lost function or safety among the study's coupons, but routine inspection and clear communication to manufacturers about what sterile processing staff are seeing remain critical safeguards, according to AAMI. Grisby noted that instruments dating back to when he entered the field are still in circulation in some departments and that wear is inevitable, according to AAMI.

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