Resilient surgical instrument reprocessing during healthcare disasters and outbreaks: a systematic review of barriers, preparedness gaps and policy strategies.

BACKGROUND: Surgical instrument reprocessing is essential for infection prevention and continuity of surgical care. However, evidence on barriers and adaptive strategies for maintaining reprocessing capacity during healthcare disruptions remains fragmented. This systematic review synthesized evidence on reprocessing vulnerabilities, barriers, and adaptive strategies across infectious outbreaks, emergency preparedness contexts, infrastructure disruptions, and resource-constrained settings. METHODS: PubMed, Scopus, Web of Science, and Google Scholar were searched through February 2026 in accordance with PRISMA 2020 guidelines. Eligible studies evaluated reusable surgical instrument reprocessing during infectious outbreaks, infrastructure disruptions, emergency preparedness contexts, or other healthcare disruption settings. Two reviewers independently performed study screening and quality appraisal, with data extraction conducted by one reviewer and independently checked by a second reviewer, using Joanna Briggs Institute (JBI) appraisal tools appropriate to study design. Given substantial methodological and contextual heterogeneity, findings were synthesized narratively. The review protocol was prospectively registered in PROSPERO (CRD420261324153). RESULTS: Eleven studies from nine countries were included, comprising outbreak investigations, preparedness surveys, cohort and case-control studies, case series, and quasi-experimental or implementation-oriented studies. Most studies focused on infectious outbreaks associated with failures in reprocessing complex reusable devices. Recurrent barriers included incomplete cleaning workflows, inadequate lumen decontamination, equipment malfunction or contamination, contaminated water or rinsing systems, limited emergency preparedness, workforce gaps, and incomplete instrument-tracking systems. Infrastructure disruptions and limited sterilization capacity were associated with delays or interruptions in surgical services. Reported adaptive strategies included standardized multistep cleaning protocols, environmental monitoring, workforce training and simulation, instrument traceability systems, mobile or container-based sterilization capacity, and contingency reprocessing approaches. CONCLUSION: Current evidence suggests that challenges in surgical instrument reprocessing across healthcare disruption contexts are associated with interacting operational, infrastructural, technological, and organizational factors rather than isolated technical failures alone. Strengthening routine reprocessing reliability, workforce preparedness, environmental monitoring, infrastructure reliability, instrument traceability, and flexible reprocessing capacity may support continuity and safety of surgical services during healthcare disruptions. However, the evidence base remains small and heterogeneous and is weighted toward infectious outbreak investigations and observational studies. Further empirical research is needed to evaluate scalable and context-appropriate approaches to reprocessing preparedness across diverse emergency, disaster-related, and resource-constrained settings.