New London — Washing, it turns out, can be a life-or-death activity.

Just ask the employees of Lawrence + Memorial's central services department, where every surgical tool, robotic part and instrument that touches a patient in the hospital is cleaned and sterilized in an intricate, multi-step ballet that goes unnoticed by most people who pass through the hospital.

Whether patients are at L+M for heart surgery or stitches, any nondisposable item that medical staff use to treat them has been cleaned and disinfected in several ways — rinsed, soaked, cleaned with ultrasonic waves, rinsed again and put through a hyper-advanced dishwasher-like machine that removes any trace of the previous patient's body fluids and bacteria, so the implement can be used on the next patient.

And every item is tracked as part of a tray with bar-coded tags that, when scanned, shows when the tray was sterilized. The process is so thoroughly tracked and regulated that, if a tray is found without a tag attached confirming what it's for and that it has been sterilized, it goes unused and the sterilization process starts over; a whiteboard on the wall of the central services department at L+M indicates that the last time that happened, as of Wednesday, was 40 days ago.

The supervisors in the department estimate that in the first five months of 2018, the department sterilized pieces of equipment about a million times. Each one was then placed in a tray along with everything that the hospital's nurses and doctors might need for a particular surgery or procedure.

The department's staff keep close track of every tray of tools, each of which can be customized for an individual patient's needs or the preferences of a doctor.

"Every doctor has their own recipe, depending on what the case is," said Nina Trambowicz, the department's nurse manager.

"It's always going to be something different, depending on the patient," added Judi Goldberg, the department's director. "If you're doing a hernia, you might need different sutures, you might need different size instruments."

Not everyone is cut out to work in central services, Timothy Holmes, a supervisor in the department, said. Applicants for jobs in the department, which employs about 20 people, are taken on tours of the facility. Interviewers make sure to take them to the room where trays of tools come in fresh from surgery.

"One of the first questions we ask is: 'Are you squeamish? Do you have a problem with blood, tissue, guts?'" Holmes said.

Whole joint replacements — where surgeons remove a damaged hip or knee and replace it with artificial parts — result in "the most patient left on the instruments," Holmes said.

The contents of each tray also can be adjusted for age, including child-size versions.

Barbara Palumbo, a supervisor in the department who has worked at L+M for two decades, said she had no idea what she was getting into when she first took a job in central services, which she calls a "silent partner" in the hospital. She was not one of the applicants put off by the blood and guts, or by the intimidating cupboards of dozens of variations of clamps, or by the futuristic sterilizing machines.

"When I interviewed, it was completely the opposite of what was described to me," she said. "It just fascinated me."

The department is staffed in three shifts over 24 hours a day on weekdays, and for two shifts on each day of the weekend.

"There's (always) either somebody physically here or a phone call away," Holmes said.

The development of surgical techniques with robotic equipment, used increasingly every year to make more procedures less invasive, have posed new challenges for sterilization experts.

"As they develop new instruments that give people better recovery times, the harder they are for us to clean," Holmes said.

The department is not the hospital's most well-understood. Most hospital employees see only the window where they drop off and pick up the trays, and, if everything goes as planned, it will never occur to the hospital's patients that hours of work has gone into preparing the scalpel their surgeon holds or the IV pump sending medicine into their veins.

"We service every patient in every department in this hospital," Holmes said. "And nobody will ever know it because all they know is that they're just picking up a phone and asking for something, and it appears."

But its employees, whose scrubs symbolically match the color of the ones worn by operating room staff, take the process as seriously as a surgeon takes their first cut. When a call comes in announcing an emergency surgery, everyone in the department stops what they are doing to help put together the needed tools. That can take up to 20 minutes for a particularly complicated tray, and every minute counts.

"If they're waiting in the operating room, it can seem like hours," Palumbo said.

"The worst-case scenario is that someone could die if we don't have what they need," Holmes added.

The best-case scenario, he said, is quiet — except for the humming of the futuristic washers.

"When everything's quiet, we know we're doing a good job," he said.

m.shanahan@theday.com