Annetta L. McKnight, MHA, BSN, CRCST, CER, is a leader in sterile processing with extensive experience in perioperative nursing, minor procedures within clinical environments, sterile processing operations, the governance of reusable medical devices, and various multidisciplinary initiatives aimed at enhancing patient safety. 

Her professional focus includes aligning standards, conducting risk assessments, developing quality management systems, and fostering collaboration between sterile processing departments and infection prevention programs. 

Notably, she presented a poster at the 2025 Healthcare Sterile Processing Association (HSPA) National Conference and, in 2026, received 2 poster recognitions and delivered a mini-session presentation at the same conference.

Annetta L. McKnight, MHA, BSN, CRCST, CER

When a sterilization cycle fails or a high-level disinfection process is interrupted, the immediate instinct is often to focus on the equipment, the load, or the technician. However, in many instances, these occurrences are not isolated failures but rather early warning signs that a more extensive system may be operating outside its validated parameters.

In sterile processing services (SPS), risk is often imperceptible. It often resides within assumptions—assumptions that utilities are dependable, environmental conditions remain within acceptable ranges, manufacturer instructions for use (IFUs) are adhered to in conjunction with local procedures, and validated processes continue to function as intended. When these assumptions fail, the resulting consequences may not be immediately apparent; nonetheless, the threat to patient safety is significant.

Staff adherence depends on sound processes.

 Local procedures, equipment conditions, and workflows must remain aligned with manufacturer IFUs and validated reprocessing requirements.

Operational disruptions warrant shared risk assessment.

 Utility failures, environmental changes, and equipment malfunctions require input from sterile processing, infection prevention, engineering, and leadership.

Early involvement strengthens prevention.

 Integrating infection prevention into policy review and governance helps teams identify vulnerabilities before they contribute to patient harm.

This underscores the indispensable role of infection prevention and control (IPC).

While SPS and IPC are often described as collaborative entities, this characterization does not fully encapsulate their relationship. They are interdependent components within the same infrastructure dedicated to patient safety. SPS oversees the operational execution of validated reprocessing activities. In contrast, IPC assesses how variations in processes, environmental conditions, and system failures may influence the risk of infection transmission and patient exposure.

The importance of their collaboration becomes particularly evident under conditions of systemic stress. For example, a reduction in water pressure impacting automated reprocessing equipment is not merely an operational inconvenience; it could disrupt validated cleaning or disinfection parameters established by the device manufacturer. Similarly, fluctuations in temperature or humidity within sterile storage environments may initially appear environmental, yet IPC must evaluate whether such conditions could compromise storage integrity or heighten contamination risks. Approaches such as workflow redesigns, equipment failures, utility disruptions, and deviations from IFUs necessitate multidisciplinary evaluation, as operational decisions can rapidly influence patient safety outcomes.

According to standards such as American National Standards Institute (ANSI)/Association for the Advancement of Medical Instrumentation (AAMI) ST79, sterilization procedures must adhere to validated parameters and be subject to routine monitoring.

 ANSI/AAMI ST108 also emphasizes water as a critical variable that requires multidisciplinary oversight.

 ANSI/AAMI ST90 reinforces that these activities operate within a quality management system that continuously evaluates procedures, monitoring mechanisms, competency levels, and opportunities for ongoing improvement.

From an SPS standpoint, these standards delineate the procedural framework for performing reprocessing activities. Conversely, from an IPC perspective, they serve as criteria to appraise the integrity of conditions supporting safe reprocessing.

A prevalent vulnerability within reprocessing programs is the disconnect between manufacturer IFUs and local standard operating procedures (SOPs). While documentation may suggest alignment, in practice, minor operational modifications, workflow adjustments, environmental constraints, or undocumented workarounds can gradually shift processes outside their validated state. If SOPs no longer align with the manufacturer’s IFU specifications, the process may become indefensible, regardless of staff adherence.

This highlights the critical importance of IPC review of SPS policies and SOPs.

In well-established reprocessing programs, IPC is integrated into governance structures rather than functioning solely as external oversight. Infection prevention professionals often serve as voting members on reusable medical device (RMD) committees, contributing risk-based evaluations to multidisciplinary discussions involving SPS, engineering, clinical services, safety, and leadership. Their participation ensures operational decisions are scrutinized not only for workflow efficiency but also for infection transmission risk and patient safety implications.

Risk assessment processes are where this partnership becomes operational. Whenever process deviations occur, such as utility disruptions, environmental fluctuations, equipment malfunctions, or compromised workflows, multidisciplinary teams must determine whether these issues are manageable operational disturbances or potential patient safety events. Effective organizations do not rely on assumptions or isolated decision-making; rather, they utilize structured risk assessments that evaluate likelihood, potential consequences, transmission risks, impact on validated processes, and mitigation strategies.

SPS offers technical expertise concerning equipment functionality, validated cycle parameters, workflow considerations, IFU adherence, and process monitoring. IPC evaluates the potential for microbial transmission, breaches in infection control, patient exposure risks, and consistency with evidence-based practices. Engineering assesses infrastructure reliability, while leadership and safety personnel evaluate operational continuity and mitigation measures.

This multidisciplinary approach transforms isolated operational failures into structured, defensible decisions focused on patient safety.

The infection chain described in ANSI/AAMI ST79 Annex B underscores the significance of these deliberations.

 Infection transmission involves multiple interconnected elements: an infectious agent, a reservoir, a portal of exit, a mode of transmission, a portal of entry, and a susceptible host. Reprocessing failures can affect several of these elements concurrently. When utilities become unstable, environmental controls fail, or validated cleaning parameters are interrupted, the risk extends beyond mere workflow interruption into the broader framework of infection prevention.

The most effective programs proactively identify vulnerabilities before adverse events occur. They do not wait for failed surveys, outbreaks, or recalls to recognize weaknesses. Instead, they proactively evaluate systems, routinely review IFUs, involve multidisciplinary stakeholders early, and escalate concerns before process deviations result in patient harm. Robust organizations understand that adherence alone is insufficient; systems must remain operationally aligned, be subject to continuous evaluation, and be able to withstand scrutiny.

From the perspective of SPS, IPC is not external oversight but a vital partner in ensuring patient safety. SPS staff recognize when a process is unstable, and IPC assesses the implications for patient safety. Collectively, they transform isolated process failures into multidisciplinary decisions grounded in established standards, risk assessment, and patient protection. Because a single department seldom safeguards patient safety in sterile processing, it is achieved through the early identification of vulnerabilities and collaborative action among SPS, IPC, engineering, and leadership to prevent process variation from escalating into patient harm.

Comprehensive Guide to Steam Sterilization and Sterility Assurance in Health Care Facilities.

 ANSI/AAMI ST79:2017 with amendments A1, A2, A3, and A4:2020 (consolidated text). Association for the Advancement of Medical Instrumentation; 2020.

Water for the Processing of Medical Devices.

 ANSI/AAMI ST108:2023. Association for the Advancement of Medical Instrumentation; 2023.

Processing of Health Care Products—Quality Management Systems for Processing in Health Care Facilities.

 ANSI/AAMI ST90:2017. Association for the Advancement of Medical Instrumentation; 2017.

Doran B, Santana JR. The invisible threats: an IP’s guide to advocating for sterile processing. 

. Published December 18, 2025. Accessed May 7, 2026. 

https://www.infectioncontroltoday.com/view/invisible-threats-an-ip-s-guide-advocating-sterile-processing

The Joint Commission Guide to Reprocessing Reusable Medical Devices.

Articles

A followed procedure can still leave patients at risk if it no longer matches validated requirements. Annetta L. McKnight, MHA, BSN, CRCST, CER, examines how infection prevention and sterile processing can identify process drift, assess disruptions, and strengthen shared oversight of medical device reprocessing.

Annetta L. McKnight, MHA, BSN, CRCST, CER

Articles

When Reprocessing Processes Drift: Why IPC and Sterile Processing Must Act Together