sterile processing
By David Taylor III , MSN , RN , CNOR
SPD Renovation : Building in Quality , Safety , Infection Prevention
Despite the critical role sterile processing departments
( SPDs ) play in the delivery of safe , high-quality service and patient care , many healthcare organizations are making the mistake of overlooking these departments for renovations or new construction . The space an SPD has available can have a significant impact on its operations . Far too many healthcare organizations have grown in scope and size over the years while the SPD ’ s space needs have been neglected . If health systems fail to support SPDs ’ role and build adequate space to allow SP professionals to properly handle their daily workloads , it ’ s not just SP professionals who will be adversely affected . Healthcare customers such as the operating room and endoscopy suite can experience service challenges that lead to procedure delays and poorly functioning or contaminated instruments , and patients can experience extended procedure times , potentially life-threatening infections and other negative outcomes .
When it comes to SPD renovation or expansion , facility administrators face some difficult questions , including whether they should allocate financing to improve the SPD space or dedicate funding for other potential revenue-generating specialties ( e . g ., emergency department , endoscopy , interventional radiology ). Whatever the decision , organizations must realize that failing to include SPD in their expansion or renovation plans is a short-sighted decision that will increase the odds for negative outcomes .
Expanding the department ’ s capacity ( square footage ) and improving the infrastructure to support modifications in the SPD will improve efficiencies within the department ( and downstream ) and help improve processes in the OR and other procedural areas , thereby creating greater revenue streams .
Some of the challenges administrators must consider and address include :
● Advances in surgical approaches and new or specialized instrumentation and technology , all of which require specific sterilization equipment and processes ( e . g ., robotic-assisted surgical systems )
● Changes in recommended practice guidelines and standards by industry organizations and regulatory agencies
● Hospital or health system growth
● Increased case volumes or the addition of new surgeons and specialties , resulting in increased tray volume
● Increase in surgical schedules ( extended hours and weekend schedules )
● Inadequate and deteriorating infrastructure ( mechanical , electrical , plumbing , technology ) that prevent the installation of newer , high-capacity equipment and technologies
● Inadequate space and inefficient workflow processes
SPD zone planning How an SPD is laid out can have a significant impact on its productivity . Most SPDs are configured in either a two- or three-zone layout that follows a dirty-to-clean path and complies with industry standards and guidelines or regulatory practices . Departmental configurations vary and can include straight or L- , U- or Z-shaped flow patterns . Unfortunately , too many SPDs have been squeezed into spaces that may have been appropriate many years prior but are now inadequately sized to accommodate their organization ’ s growing needs .
SPD layout must provide physical separation between work areas to allow technicians to handle soiled material effectively and safely , clean , prepare , assemble , sterilize , store , and dispatch goods . SPD space planning should be based on the roles and responsibilities the department is expected to assume . Some crucial questions to be asked include :
● How many surgical ( and other ) procedures are projected daily and how many instrument sets are projected to be reprocessed by SP daily ?
● How many procedures require vendor tray support ?
● How many case carts , transport carts and / or container racks will be reprocessed daily ?
● Will the SPD reprocess rigid and flexible endoscopes from non-surgical areas ?
● Will pass-through sterilizers and cart washers be used ?
● Will the SPD be responsible for durable medical equipment and supplies ?
● Will the SPD manage restocking and reassembly of implants ?
● How many full-time equivalents ( FTEs ) will work on the SPD ’ s peak shift ?
● Is an area dedicated to donning and doffing personal protective equipment ( PPE )?
● Are there dedicated receiving , breakout and inspection areas ?
● Is an area dedicated to chemical storage ?
● Is there adequate office space ( private , shared , cubicle ) and conference and classroom space ?
● Is there dedicated space for instruments , containers and equipment in need of repair ?
● Is a transitional space available for receiving and delivery ?
● Is a dedicated holding and pick-up space available ?
● Is enough storage space allocated for sterile consumables and durables ?
● How is the department managing case cart assembly and dispatch ?
Soiled drop-off / transition
Transition zones are often inadequate in the SPD , with many sharing space with the decontamination room , which creates areas of exposure and risk . Separating the main corridor from the decontamination workspace accommodates the temporary holding area for soiled carts , totes , medical equipment and vendor trays — without directly entering the decontamination workspace . More importantly , it creates a buffer zone that is a perfect location for instrument and equipment inventory and electronic tracking