Contingency Methods for Cleaning Single-Use Medical Equipment in Crisis, Disaster, or War

Shortages of disposable medical equipment can critically impair health care delivery during disasters or armed conflict. Although reprocessing single-use medical devices (SUDs) may represent the only feasible option under such conditions, evidence supporting simple, field-adapted cleaning methods is limited.

In this exploratory study, 90 clinically used SUDs - endotracheal tubes (ETT), laryngeal mask airway (LMA), intravenous administration sets (IVS), syringes (SYR), indwelling urinary catheters (IDC), and nasogastric tubes (NGT) - were collected after surgery in a regional hospital. Devices were randomly allocated to cleaning with peracetic acid (PAA), 70% ethanol, or dishwashing detergent. Each item was brushed, immersed for ten minutes, and then air-dried. Microbiological sampling included pre-cleaning and post-cleaning cultures, and airway devices underwent Polymerase Chain Reaction (PCR) testing for 28 respiratory pathogens. Functional integrity was assessed after cleaning.

All three cleaning agents achieved statistically significant reductions in bacterial load (P < 0.05) with no difference between methods. The PCR testing detected Hemophilus influenzae (H. influenzae) and Staphylococcus aureus (S. aureus) among other pathogens in 47% of airway devices before cleaning; all post-cleaning samples were negative. No structural or functional damage was observed.

Basic cleaning procedures with commonly available agents substantially reduced microbial contamination without impairing device function. These methods cannot replace validated sterilization but may serve as the only viable option when medical supply is critically constrained, such as in disasters or in armed conflict. Preparedness planning should encompass strategic stockpiling, surge production capacity, and resilient supply chains, together with rationing and substitution strategies, and - only as a last resort - protocols for cleaning and reusing single-use medical equipment.