Innovations in dosing aiming to reduce waste

The decontamination of surgical instruments, medical devices, endoscopes, and dental tools is an essential process in ensuring patient safety, preventing healthcare-associated infections (HCAIs), and maintaining the integrity and longevity of medical equipment. Modern dosing equipment plays a pivotal role in today’s sterile service departments, and advancements in this technology, such as Radio Frequency Identification (RFID) and automated monitoring systems, have further enhanced the accuracy, efficiency, and safety, of dosing systems.

Two primary methods are used for dosing in 
healthcare settings. Centralised dosing systems are 
used primarily in larger NHS hospital Trusts and by outsourced dedicated decontamination and sterilisation providers. Smaller, more localised dosing systems, where canisters are located within or near the washer-disinfectors, are still used in the majority of healthcare settings. Each approach has its advantages and challenges, and their suitability depends on the unique nature of the environment where the system will be used, the volume of instruments routinely being processed, and infrastructural capabilities and limitations.

With an increasing focus on sustainability and cost-effectiveness in healthcare, new innovations in dosing aim to reduce waste, optimise energy consumption, and improve real-time monitoring. The integration of artificial intelligence (AI) and Internet of Things (IoT) technologies promises to further support data-driven decision-making, ensuring that dosing is more precise and adaptable to varying needs.

A role in occupational health

Dosing systems also play a crucial role in occupational health — by reducing healthcare workers’ exposure to hazardous chemicals, and preventing lifting and strain injuries caused by carrying heavy containers. In the UK, lifting and handling injuries are a significant concern. According to the Health and Safety Executive (HSE), there were approximately 122,000 work-related injuries attributed to lifting, handling, or carrying, in 2022/23. These injuries often can have long-term impacts on workers’ health and productivity.

By implementing controlled dosing procedures, NHS Trusts can further align with Net Zero targets and legislation, as these systems optimise chemical use and reduce waste, leading to lower carbon emissions associated with transport within the supply chain.

Moreover, the data recorded from dosing systems provides sterile service managers with valuable insights to enhance regulatory compliance and improve operational efficiency. Real-time tracking of chemical usage ensures that decontamination processes meet strict hygiene standards while supporting more informed decision-making for audit and compliance procedures.

This article explores the advantages and challenges of central dosing systems and integration of dosing equipment for smaller healthcare departments. It also considers the latest innovations in dosing technology, the role of advanced hybrid chemical formulations in dosing, emerging technologies that are shaping the future of dosing in medical decontamination, and key considerations for department managers to enhance efficiency and prevent the need for rewashing.

Understanding dosing in decontamination

Dosing technology refers to the controlled, precise delivery of process chemistry into washer-disinfectors, immersion, or ultrasonic baths, during the reprocessing of medical instruments. Accurate dosing ensures the efficacy of decontamination processes, maintaining the balance between sufficient microbial eradication and the preservation of instrument integrity. The effectiveness of decontamination is highly dependent on the correct balance of chemistry, water, temperature, mechanics, and time (as per Dr Herbert Sinner’s recognised ‘Sinners Wheel’). Under-dosing can leave residual contamination, leading to potential infection risks, while over-dosing may result in chemical residues, equipment degradation, and unnecessary expense.

Accurate dosing in cleaning and disinfection processes is essential for achieving the highest levels of cleaning efficiency and overall performance. When detergents and disinfectants are dosed accurately, and in accordance with the manufacturers’ Instructions For Use (IFU), they work at their optimal efficacy, engaging their ability to remove both organic and inorganic contaminants from instruments. This precise application ensures that even the most stubborn residues are effectively eliminated, leading to a more thorough and reliable cleaning process.

In addition to this, adhering to manufacturers’ IFU dosing guidelines plays a crucial role in preventing chemical waste and reducing unnecessary expenditure. The use of excessive cleaning agents not only incurs additional costs, but also poses a risk of damaging sensitive equipment. By maintaining the correct dosage, healthcare providers can avoid the pitfalls of overuse, and ensure that resources are utilised in the most efficient and cost-effective manner. This makes an important overall contribution to environmental and resource savings.

The safety of healthcare workers is another important benefit of the use of a dosing system. The integration of automated dosing systems minimises the need for direct handling of chemicals, thereby reducing the risk of exposure to potentially harmful substances; with all chemistry being held within a central secure storage location — ultimately contributing to a safer working environment.

‘Smart’ technology

Modern dosing systems often incorporate ‘smart’ technology and monitoring software, which provide the option of real-time feedback on chemical use. The information logged by dosing systems provides Sterile Service Managers with crucial insights for quality control, enabling them to identify trends, detect inefficiencies, and implement corrective measures sooner. This integration also supports robust tracking and management practices that are essential for regulatory compliance, ensuring facilities maintain the highest standards of decontamination, while reducing department risk exposure during audits.

A commitment to proper dosing is also linked with sustainability efforts. Contemporary dosing solutions can be designed to use less chemicals and minimise excess waste, thereby reducing the environmental impact of cleaning operations. By embracing these practices, organisations can contribute to a greener future, while still maintaining the rigorous decontamination standards required in today’s healthcare and industrial settings. This is particularly relevant for NHS Trusts aiming to meet their Net Zero commitments by helping to reduce chemical and energy usage.

Central dosing systems

A central dosing system supplies multiple washer-disinfectors and/or individual workstations from a single centralised storage and distribution point. These systems use large reservoirs containing concentrated cleaning agents, which are automatically distributed through a network of pipes and pumps.

This type of system offers numerous advantages in enhancing efficiency and ensuring safety in cleaning and decontamination processes. One of the key benefits is its ability to maintain consistent supply levels of cleaning agents throughout all connected reprocessing equipment. This level of uniformity guarantees that each instrument undergoes the same thorough decontamination procedure, reducing the potential for variation across different equipment, and improving the overall reliability of the process. In terms of cost-effectiveness, central dosing proves to be a more economical option in the long term. By purchasing cleaning agents in bulk, facilities can reduce the need for multiple small containers, significantly lowering costs.

Additionally, this bulk purchasing approach helps cut down on packaging waste, contributing to a more sustainable operation. The system also reduces the frequency of deliveries, further minimising its environmental impact. Safety is another vital aspect positively impacted by central dosing systems. With their closed-loop design, these systems significantly reduce the risk of healthcare workers directly handling concentrated chemicals. This greatly diminishes the likelihood of exposure to hazardous substances, such as skin irritants or respiratory irritants, as well as the chance of accidental spills that could cause harm.

Another major advantage is the integration capabilities of modern central dosing systems. These systems can be connected to hospital and/or department networks, creating a more cohesive and efficient workflow across the facility, improving operational effectiveness.

Central dosing systems, while beneficial in many ways, come with certain considerations, such as space constraints that can pose a challenge for some facilities; a centralised system requires substantial space to store large chemical reservoirs, and the associated infrastructure and also requires ease of access. Restricted space can be a significant limitation unless adjustments can be made to the available infrastructure. An ongoing regular maintenance programme is crucial to ensuring the system continues to operate smoothly and effectively.

Dosing systems for smaller departments

Smaller departments, clinics, or dental practices, may find it difficult to accommodate large dosing systems. Typically, these departments utilise the washer-disinfectors’ on-board peristaltic dosing system, with cleaning agents being stored in small to medium-sized containers either within the dosing system itself, or close by.

Dosing systems specifically designed for smaller departments offer key advantages that make them an attractive option. One of the primary benefits is flexibility. Smaller dosing systems can be specifically designed and tailored to meet the unique needs of individual departments or units. This enables adjustments to be made based on the particular types of instruments being processed, ensuring that each department’s requirements are met efficiently and effectively.

Another significant advantage of a smaller system is their ability to be located in an optimal position that does not necessitate a large or dedicated central location. Dosing units can be situated close to the washer-disinfector being supplied, located on the floor, or being wall mounted. Installation is quick, and can be completed within a day; this type of system has simple maintenance needs, and is a more affordable solution for smaller departments or facilities.

Innovations in dosing technology for decontamination

Recent innovations have given rise to significant advancements in dosing technology. Developments in precision dosing, automation, and digital integration have led to more accurate, efficient, and safe dosing systems. These new technologies drive efficiency, sustainability, and innovation across the decontamination sector, and will continue to shape the future of dosing technology.

Modern automated dosing systems integrate advanced technologies, including sensors and real-time monitoring to optimise chemical delivery. Innovations such as digital dosing pumps ensure high precision in chemical delivery, reducing human error, while flow-based proportional dosing adapts chemical concentrations to changes in water flow for greater efficiency. Connected monitoring systems enable remote tracking, logging, and data analysis, allowing for better control and refinement of dosing requirements over time.

Safety and efficiency in dosing technology have also improved with the development of closed-loop dosing systems. By eliminating manual chemical mixing and dilution, these systems prevent cross-contamination and minimise exposure risks for staff handling concentrated solutions. Digital logging of chemical usage ensures accurate dosing and regulatory compliance. Many manufacturers now incorporate RFID-tagged dosing containers that verify the use of approved chemicals, track which chemical batches are used, and prevent errors associated with incorrect selection of chemistry.

How advanced chemistry supports the decontamination process

Sustainability has become a key focus in dosing technology, and chemical manufacturers have also developed new and innovative super-concentrated formulations providing more effective, safer, and environmentally friendly solutions. Coupled with smart dosing algorithms, these can help optimise water and energy consumption, minimising waste.

High-performance chemical formulations play a crucial role in effective decontamination, with modern advancements introducing safer and more efficient solutions. Traditional alkaline detergents, often harsh on delicate instruments, have been replaced by hybrid alkaline alternatives that prevent corrosion on stainless steel and surgical-grade plastics. The additional inclusion of corrosion inhibitors helps protect instruments from long-term damage, ensuring material compatibility, and extending the lifespan of expensive medical devices.

As many decontamination processes require cleaning at lower temperatures to preserve sensitive medical devices and robotic surgical instruments, innovations in cleaning chemistry have prioritised maintaining efficacy without compromising material integrity. Low-temperature enzymatic solutions perform effectively, while non-foaming surfactants minimise potential cavitation within the program cycles. Accelerated drying agents further enhance the process — by reducing cycle times and improving turnaround speeds for reprocessed instruments.

Pre-treating surgical instruments with specialised solutions has played an increasingly important role in recent years in many healthcare settings, preventing the drying of organic residues, and ensuring effective subsequent cleaning. This pre-cleaning step is particularly important when immediate reprocessing is not possible, as blood, proteins, and other biological materials, can adhere to instruments, making removal more difficult. Chemical pretreatments are designed to keep these contaminants moist, reducing the risk of biofilm formation, and improving the overall efficacy of enzymatic and chemical detergents used later in the cleaning cycle. Formulations are designed to be gentle on materials, ensuring compatibility with stainless steel, surgical-grade plastics, and delicate instrument surfaces. By integrating a reliable pre-treatment solution into the decontamination workflow, healthcare facilities can enhance cleaning efficiency, prolong instrument lifespan, and reduce the risk of inadequate sterilisation.

These innovations collectively enhance the efficiency, safety, and sustainability of decontamination processes in modern medical settings.

Key considerations for department managers

There are some key questions Sterile Service Managers should ask when looking to implement changes to their decontamination processes:

• Would the department’s efficiency be enhanced by implementing a dosing system?
• Do you have the infrastructure to allow the integration of a central dosing system, or would you need to have a localised compact system?
• Would a dosing system help you attain your financial and sustainability targets?
• Would your department’s wellbeing and occupational health benefit from a dosing system?

Following an update or change, regular training sessions and competency assessments help employees develop the necessary skills for handling a new dosing system. Establishing Standard Operating Procedures (SOPs) further reduces the risk of dosing-related errors, and ensures uniform cleaning standards across departments.

The increasing availability of data from dosing systems allows managers to optimise processes through continuous monitoring and analysis. Smart technologies and connected devices provide real-time insights into dosing performance, enabling the detection of inefficiencies or incorrect dosing patterns. Trend analysis can highlight areas for improvement, while digital documentation supports audits and compliance checks, ensuring accountability and regulatory adherence. Investment in future-proof technologies is crucial for long-term efficiency and adaptability. Dosing technology data contributes to hospital management information, allowing for centralised oversight and improved coordination. Additionally, customisable dosing software ensures flexibility, enabling healthcare facilities to adapt to evolving cleaning protocols and regulatory requirements. These considerations collectively enhance the effectiveness, safety, and sustainability of decontamination processes.

Conclusion

Modern dosing technology is transforming decontamination processes across healthcare settings by ensuring precise, efficient, and sustainable cleaning. The evolution from traditional manual methods to advanced central and local dosing systems has not only improved cleaning efficacy and instrument longevity, but also bolstered staff safety through reduced chemical exposure and automated monitoring. The integration of cutting-edge technologies — such as RFID, AI, and IoT — enables real-time data-driven adjustments that optimise chemical usage, minimise waste, and support rigorous compliance with hygiene and safety regulations.

Furthermore, the advancements in cleaning chemistry and automated dosing systems underscore the critical balance between effective decontamination and the preservation of delicate medical instruments. As healthcare facilities continue to face challenges such as rising operational costs and the need for sustainability, investing in future-proof dosing solutions and staff training will be paramount. By leveraging dosing data for compliance tracking and resource optimisation, NHS Trusts can better align with Net Zero targets while maintaining high standards of infection prevention.

Ultimately, embracing these innovative practices promises not only to enhance patient safety, but also to set new benchmarks in operational excellence within the evolving landscape of medical decontamination.

Acknowledgement

•  This article, titled ‘Dosing and decontamination in the 21st Century’, first appeared in a Decontamination & Sterilisation supplement within the April 2025 issue of HEJ’s sister publication, The Clinical Services Journal. HEJ thanks the magazine’s editor, Louise Frampton, and the author, for allowing its re-publication in slightly edited form here.