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On-site Versus Off-site: The Battle for the Future of Sterile Processing Services

Two different color balls of fire coming toward each other.

There are few questions as hotly debated today than the question of “where?” Where should sterile processing departments be located? Where do we find the potential for the greatest efficiencies? Where should hospitals be looking to invest (in real estate) and where should construction planners recommend these instrument-reprocessing engines be built?

This is not just a national debate. Off-site reprocessing has been going on in Europe for more than a decade now, if not longer. As with most comparisons, we need to be careful because the US is more than twice the size of the EU, with half as many people. In terms of population density, the EU has around 111 people per square kilometer, and the US only around 35. Just because something like off-site reprocessing works elsewhere doesn’t prove that it will have the same success somewhere else.

With that out of the way, let’s look at what kind of market forces are driving this debate in the U.S., and provide some critical perspective on the question on so many people’s minds these days.

What, if anything, is wrong with the status quo? If the current state of affairs for sterile processing departments isn’t broken, why fix it? For those of us who have worked in multiple departments around the region or around the country, this question answers itself. Many of our current physical department layouts and locations are thoroughly broken. The examples of this are quite diverse, from 60-year-old, landlocked departments built in the basement of a community hospital now trying to service an entire health system to ambulatory surgery centers that built their reprocessing areas as a mere afterthought, literally plugging them into an unused closet space. There are departments out there with three or four different satellite reprocessing locations scattered throughout the hospital building, none of which are large enough or constructed to support the entire surgical volume of the facility on their own. Some departments are technically on-site, but the distance in which case carts need to be pushed or pulled to the operating room is in excess of a quarter of a mile.

For decades of hospital construction planning, sterile processing priorities were constantly subverted beneath any number of competing interests, leaving a great number of our departments with long-term layout and location challenges. That being said, there are high-functioning, well-planned, on-site reprocessing departments in existence today. I will list a few key factors that impact the success of on-site and off-site departments at the end of this article. But first, let’s look at some of the current solutions we see coming into the market.

Difference, distance, and disruption In light of the challenges mentioned above, facilities and third-party vendors have worked hard to solve these problems in a number of different ways.

Building better and smarter on-site When space and funding allow, hospitals reprioritize the value of locating and laying out the sterile processing department with real strategy, instead of architectural afterthoughts. Both in new construction and renovations, department leaders are being engaged more and more in the full planning process so that historic department “oopsie daisies” are identified and remedied on the front end, instead of being forced to manage with manual workarounds.

Building better and smarter off-site If the facility volume or combined volume from other hospitals in the health system is large enough and there is no viable on-site alternative, some hospitals have purchased an off-site, warehouse-type location to centralize their reprocessing services. As an owned location, the facility still has full oversight over the department services, and the contaminated or sterile goods are transported back and forth throughout the day to support the surgical volume.

Partnering smarter with third-party off-site A similar option to owning the off-site reprocessing location is contracting with a third-party service organization to supply the same sterile processing services, but without having responsibility for facility, maintenance, human resources, etc. These partnerships are typically done under large, multiyear service contracts to provide dependable service levels to the facility and protect the large upfront investment made by the third-party provider. Larger third-party, off-site centers such as this may even support multiple different healthcare clients at one time.

Strategic third-party off-site support Another recent solution popping up across the market is targeted, strategic off-site reprocessing models that do not intend to replace full sterile processing services, but instead look to support workflows that are the most challenging or highest risk for facilities. The primary examples of these we have seen are vendor instrument off-site reprocessing services, and flexible endoscope reprocessing. Both workflows are dramatically impacted by the types of poor planning and layout mentioned in many on-site departments, so these off-site services seek to step in and give the departments more breathing room.

Who will win and how can it be done? I believe the future of sterile processing in the US is going to transition to a predominantly off-site model of reprocessing. The reasons for this have everything to do with the value of existing (and limited) hospital real estate, the economies of scale created by building efficiencies into the construction of off-site facilities (rather than trying to squeeze efficiency out of a poorly planned on-site department), and the growing number health systems gobbling up previously independent hospitals and ASCs. All signs point to major opportunity in this space.

However, as has been argued before, simply taking bad practices, processes, data, and layouts outside of a hospital and duplicating them in a warehouse setting doesn’t fix anything.

Whether you are trying to build better on-site or change the world off-site, here are some key factors you should keep front and center:

  • Your surgical asset and scheduling data must be accurate

  • Frontline users (SPD) and customers (OR) must be engaged in the workflow planning

  • Systemic challenges with hospital dock and logistics must be addressed

  • Emergent exceptions and critical inventory access must be accounted for on-site

  • Volume growth potential must be hardwired into the plan

  • Compliance must be viewed as the starting point, with continual improvement the goal

Wherever you land on this debate, make sure you land on the side of patient safety, and everything else will take care of itself.

What say you?


Hank Balch is the Founder & President of Beyond Clean. He began his career in instrument reprocessing as a frontline technician in 2009, and has served as an Instrument Database Specialist, Department Manager, and System Director for various SPD departments across the country. Hank is an award winning Sterile Processing leader (2016 Healthcare Purchasing News "CS/SPD Department of the Year"), twice nominated for IAHCSMM President (now HSPA), founder of two state-wide IAHCSMM chapters, conference speaker, and well-known industry writer, blogger, and social media connoisseur. He has written over 150 Sterile Processing articles, with his work being published in Becker's Hospital Review, Infection Control Today, Healthcare Purchasing News, Communique, Outpatient Surgery Magazine, AAMI BI&T Journal, SteriWorld, and other publications across the globe. His passion is seeing frontline Sterile Processing professionals equipped to #FightDirty, every instrument, every time.


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