sterile processing
By David Taylor III , MSN , RN , CNOR
Sterile Processing : Tying Customer Service to Care Quality , Safety Mission
SPDs are highly complex departments that manage many responsibilities to service numerous areas of the hospital .
In fact , the SPD ’ s scope of responsibilities often extend far beyond the operating room ( OR ) to include all procedural areas , including but not limited to the Emergency Department , intensive care unit , Endoscopy , and on- and off-site surgery centers and clinics .
For sterile processing departments ( SPDs ), customer service revolves around their skilled technicians providing instruments and equipment that are on time , complete , well-functioning , clean and sterile ( or high-level disinfected ).
SPDs are highly complex departments that manage many responsibilities to service numerous areas of the hospital . In fact , the SPD ’ s scope of responsibilities often extend far beyond the operating room ( OR ) to include all procedural areas , including but not limited to the emergency department , intensive care unit , endoscopy suite , and on- and off-site surgery centers and clinics . Many SP professionals are also responsible for the cleaning , sterilization and maintenance of durable medical equipment , maintenance of crash carts and trauma and hemorrhage carts , restocking of supplies , and material management support for the organization . Each area served by the SPD has different needs and expectations from the SPD , which can make SP professionals ’ jobs even more challenging .
For SP professionals to best meet their various customers ’ needs and expectations , it is important that their customers understand the processes and time constraints associated with fulfilling daily requests . If an SPD customer schedules multiple procedures in a particular day but only has enough instruments or equipment to comfortably support half that scheduled amount , expedited turnover of those devices could likely be required . The question is can SP professionals realistically turn over those items in a safe way , while still supporting the customer ’ s needs and keeping schedules on track ( and on time )? Doing so might be unrealistic , depending on the time of day , whether enough technicians are available to handle the workload , or whether the equipment needed to reprocess the devices is available and not already in use . Sometimes , customers may assume that their needs take priority over others ’, and they may fail to understand all that goes into fulfilling their request ; therefore , it is necessary for SP professionals to manager customer expectations through improved communication and as-needed education that is rooted in the latest standards , best practices and the facility ’ s policies and procedures .
Reprocessing instrument sets , rigid and flexible endoscopes and other reusable devices and equipment requires multiple steps that cannot be rushed or skipped . Each step must be performed in accordance with the manufacturer ’ s instructions for use ( IFU ), and enough time and resources must be allocated to safely and consistently allow technicians to perform all steps ( e . g ., sorting , cleaning , drying , inspection , preparation and packaging , sterilization , distribution or storage ). Also to be considered : the need for manual precleaning ; soaking time requirements ; number of times channels must be brushed ; drying times ; and number of cycles specific items must go through an automated process , to name a few . It is essential that SP technicians and their customers recognize that even the initial inspection of the item — to ensure it is in good working order and not received damaged — takes time , and that the decontamination process can take numerous steps , each requiring specific time requirements or motions ( brushing a channel 10 times , for example ).
Cleaning instruments to remove all gross contamination ( e . g ., blood , bone , proteinaceous material ) is a critical step and requires keen attention to detail . For some instrumentation , ultrasonic cleaning is a necessary next step to help remove contaminants that manual cleaning may have missed . Placing instruments in the washer-decontaminator is the final cleaning . Note : For endoscope reprocessing , once the manual cleaning and flushing steps are done , many hospitals activate their “ cleaning claim ” cycle in their automated cleaning equipment . The cleaning claim is an automated process that mimics the manual cleaning process . This added step adds time to the process but puts endoscopes through a more rigorous process to ensure proper cleaning and high-level disinfection are met .
All reprocessing steps take time and are dependent on the size , complexity and fragility of the instruments and equipment , as well as each SPD ’ s available resources ( instrument inventory , reprocessing equipment availability , and staff availability ). Inspection and assembly of an instrument set will also add time to the process , and these steps must also never be rushed or skipped . Further , sterilization and high-level disinfection cannot be rushed or interrupted ; when that happens , the process must start over . Other steps that need to be factored into the reprocessing timelines and customer expectations include the need for proper documentation , cooling , and storage .