Why solving water problems upstream can reduce failures, delays, and costs downstream
At the 2026 ASHE Health Care Facilities Innovation Conference, keynote speaker Paul Epstein shared a message with direct relevance to SPD water quality for Hospital Facilities teams:
“It may not be your fault. But it’s always your responsibility.”
Facilities may not cause every water quality problem inside the Sterile Processing Department, or SPD. However, Facilities professionals play an essential role in solving those problems.
They understand the hospital’s incoming water, boilers, treatment equipment, piping, storage tanks, recirculation loops, system pressures, maintenance history, and infrastructure limitations. SPD depends on that expertise to manage water quality and support ANSI/AAMI ST108.
More importantly, Facilities can help prevent an upstream water issue from becoming a costly downstream failure.
Why SPD water quality matters to Hospital Facilities
SPD cleans, inspects, assembles, sterilizes, and distributes reusable medical devices. Because water supports nearly every stage of that work, its quality can influence the entire process.
Therefore, water quality is not simply an SPD concern. It can affect processing equipment, surgical instruments, sterile packaging, instrument availability, and operating room performance.
A facilities-focused article on ANSI/AAMI ST108 explains that improper water quality can contribute to:
- Incomplete cleaning
- Rust and corrosion
- Staining
- Hardness deposits
- Instrument damage
- Processing-equipment problems
Mineral contaminants in water or steam can also stain sterilization-container liners and blue tray wrap. When the perioperative team sees an unexplained stain, it may reject the tray and return it to SPD for reprocessing.
As a result, that rejected tray represents more than a cosmetic concern. SPD may need to clean, inspect, package, and sterilize the instruments again. The hospital may also absorb additional labor, utility, chemistry, maintenance, and equipment costs.
Meanwhile, the surgical team may be waiting for the set.
Because, like Paul Epstein taught, “We’ve always done it this way” can be a costly mindset when SPD water conditions, standards, and operational demands have changed. Facilities and Sterile Processing should regularly challenge old assumptions, review the entire water system, and ask whether current practices are still protecting instruments, throughput, and patient care.
SPD water problems do not stay in SPD
When a required instrument set is unavailable, the consequences can move quickly beyond Sterile Processing.
For example, the surgical schedule may fall behind. In more serious situations, a procedure could be delayed or rescheduled. A missed processing problem could also create a broader patient-safety concern.
Water quality may not be the only cause of rejected trays or surgical delays. However, it is an upstream variable that hospitals should not overlook.
The Health Facilities Management article connects poor water and steam quality with stained instruments, rejected kits, emergency shutdowns, unplanned maintenance, instrument replacement, and additional hand-cleaning labor.
It also cites a 2017 economic analysis published in Infection Control & Hospital Epidemiology. That analysis evaluated the financial impact of losing sterile processing capacity after steam-quality problems forced a department offline. For a 110-bed hospital performing about 5,000 procedures annually, first-year disruption costs could approach $1 million.
Not every water deviation will create a million-dollar event. Still, the example shows why hospitals should not evaluate SPD water investments only by the cost of testing, service, or treatment equipment.
The better question is:
What downstream costs could the hospital avoid by making its upstream water system more reliable?
Fix SPD water upstream to protect the OR downstream
Hospitals often discover water quality problems through their visible effects.
SPD may notice staining, spotting, residue, equipment alarms, inconsistent washer performance, or unusual water test results. The operating room may notice a questionable tray, an unavailable instrument, or a delay in case readiness.
However, the root cause may exist much farther upstream.
Potential contributors include:
- Changing municipal water conditions
- Stagnant piping
- Incomplete recirculation
- Shared water-system connections
- Improper pressure
- Aging infrastructure
- Treatment-equipment failures
- Inadequate system sanitization
- Construction, shutdowns, or long idle periods
Therefore, Facilities professionals are often best positioned to investigate these conditions. They can help map the system, identify infrastructure vulnerabilities, review maintenance events, and determine what changed.
As a result, Facilities involvement can shorten the path from symptom to root cause.
An RO system does not guarantee SPD water quality
One of the most persistent misconceptions is that an SPD must be producing acceptable water because the hospital has a reverse osmosis system.
However, treatment equipment is only one part of the water system.
The 2026 HSPA presentation, “Critical Water Quality: A Case Study—How One Healthcare System Achieved Reliable Results at Two Locations,” demonstrated that point. Lisa Pawlowski, DNP, RN, CRMST, examined water quality challenges at two locations within the Cheyenne VA Health Care System.
At the Cheyenne VA Medical Center, the organization experienced conductivity, bacteria, and endotoxin problems despite having water treatment infrastructure. The team disinfected and replaced storage tanks, changed treatment media, and adjusted pressure.
However, those interventions did not produce lasting improvement.
Lasting improvement did not occur until the team mapped the full system.
That investigation revealed stagnant sections of piping, commonly called dead legs, connected to other hospital systems. It also showed that the recirculation loop did not reach the farthest point in the system.
In addition, excessive pressure across the RO media allowed ions to pass through and increase conductivity. A malfunctioning polishing system created another problem.
Therefore, the team corrected the pressure, removed the polisher, added deionization, and addressed the distribution design.
Ultimately, the case shows why hospitals must evaluate the entire water path—not only the equipment that generates Critical Water.
Even a new system can experience serious failures
The second location in the HSPA case study was the Northern Colorado VA Outpatient Clinic, a newer facility that opened in 2022.
Its SPD did not begin operating until approximately eight months after the RO system became active. During that period, water sat stagnant in the distribution lines.
The authors connected that stagnation and incomplete recirculation with chronic bacterial counts, staining, heating-element problems, sterilizer failures, and temporary closures.
The team extended recirculation to the outermost point of the system. Following that correction, bacterial counts stabilized. According to the authors, the facility also experienced no further staining or sterilizer heating-element failures.
This example is especially relevant to Facilities teams.
A newly installed system can still fail when design, commissioning, recirculation, idle time, monitoring, and maintenance do not work together. Therefore, the presence or age of the equipment does not prove that the system is performing as intended.
Facilities and SPD see different parts of the same problem
SPD personnel often see the outcome first:
- A stained instrument
- An unexplained residue
- A failed water result
- A rejected tray
- A washer fault
- A recurring sterilizer problem
Facilities sees the system behind that outcome:
- Incoming water conditions
- Treatment processes
- Distribution piping
- Storage and recirculation
- Water pressure and temperature
- Shared connections
- Maintenance and construction history
- Utility interruptions
Consequently, neither department has the complete picture alone.
The HSPA case-study authors stated that water quality is not one person’s responsibility. Several disciplines hold information needed to manage the system effectively.
Likewise, the facilities-focused ST108 article explains that SPD professionals are not building-water-system or water-treatment experts. Facilities supports everything from steam generation to washer feedwater and Critical Water production.
Therefore, the hospital needs shared accountability rather than isolated ownership.
What shared responsibility looks like
Responsibility does not mean Facilities must solve every SPD water issue alone.
Instead, Facilities can help create a structured response.
That could begin with several practical actions:
- Invite SPD to the hospital’s water management meeting.
- Map the water and steam systems that support medical device processing.
- Identify Critical Water points of generation and points of use.
- Review water results and trends together.
- Discuss recurring staining, residue, equipment alarms, or tray rejections.
- Establish alert levels, action levels, and escalation pathways.
- Define who investigates, communicates, documents, and verifies corrective actions.
The facilities-focused article encourages Facilities leaders to invite SPD representatives into the hospital’s broader water management program.
It also describes shared responsibility as a way to combine technical expertise, time, budget, labor, and multiple viewpoints when making water quality decisions.
This approach moves the organization away from blame.
More importantly, it helps the hospital respond before a water trend becomes a processing failure.
Compliance is the framework—not the only reason to act
ANSI/AAMI ST108 gives hospitals an important framework for managing water and steam used in medical device processing.
However, compliance may not be the most compelling reason for Hospital Facilities teams to prioritize SPD water. The operational case is much broader:
- Protect surgical throughput.
- Reduce rejected instruments and rework.
- Protect processing equipment and instrument assets.
- Reduce avoidable labor, maintenance, and utility expenses.
- Improve coordination between Facilities, SPD, Infection Prevention, and perioperative leadership.
- Support ANSI/AAMI ST108 expectations.
In other words:
“Solve the water problem before it becomes an instrument problem. Solve the instrument problem before it becomes an OR problem. Solve the OR problem before it becomes a patient-care and profitability problem.” —Jeffrey Paquet, CEO, VERDA Water Quality Systems
It may not be Facilities’ fault that the issue started.
However, Facilities is essential to making sure it does not continue.
Bring SPD water quality training to your local ASHE chapter
Hospital Facilities professionals bring deep expertise in building systems, utilities, infrastructure, and risk management.
Yet many have received limited orientation to the specialized water needs and operational pressures inside SPD.
Local ASHE chapters can help close that knowledge gap.
VERDA Water Quality Systems offers educational presentations that introduce Facilities teams to:
- How SPD uses water during medical device processing
- The differences among Utility Water, Critical Water, and steam
- The role of Facilities within ANSI/AAMI ST108
- How infrastructure conditions can affect processing outcomes
- Why an RO system alone does not confirm water quality
- How Facilities and SPD can establish shared oversight
- How upstream water problems can create downstream operational and financial consequences
We encourage Hospital Facilities teams to ask their local ASHE chapters to host an SPD water quality training or orientation session.
Bringing Facilities and Sterile Processing into the same educational conversation can build shared understanding, clarify responsibilities, and help hospitals address water risks before they affect instruments, operating rooms, patients, and financial performance.