Central Supply is Not What It Used to Be
By Mary Olivera , MHA , CRCST , CHL , FCS
The role of a central service ( CS ) technician used to revolve around taking supplies to the medical units and washing utensils like bedpans and basins . We spent much of our time folding and de-linting wrappers , distributing laundry , inspecting for holes in sealed packaging , and using the naked eye to check for contamination . While there were processes in place , there were not universal standards , and there certainly were not requirements to learn complex decontamination processes that adhered to manufacturers ’ instructions for use ( IFU ). In fact , we did not even know what IFUs were !
Thankfully , all that has changed , and central supply is not what it used to be .
Several states now require education and certification before technicians can work in the sterile processing department ( SPD ), and IFUs and their updates are required reading . Gone are the days of using handheld magnifying glasses to inspect life-saving instruments , and new technologies and tools for even better decontamination are being incorporated all the time .
There has also been a cultural shift in our field ; SPD techs are now taught about their professional responsibility , in that they must produce a safe and error-free environment for their patients , and medical professionals and facility staff are encouraged to work in tandem with SPDs to ensure seamless decontamination and sterilization processes . But getting to this point was never a sure thing . In the early 1990s , my team of SPD techs knew that we could raise the bar of our department ’ s surgical instrument processing and began to dig into how we could make our processes safer and more efficient for all involved . We were shocked to learn that although we were preparing surgical trays that could impact the safety of a patient and the life-or-death outcome of a surgical procedure , there were little to no regulations like those imposed on medical device manufacturers .
We saw those manufacturers ’ regulations as the gold standard of quality ; their commitment to zero defects mirrored our goals for our department . So , we visited a major medical device manufacturer to learn from their processes . And learn we did .
We studied their approach to quality audits and became instant believers in the Lean Six Sigma process , a methodology that relies on a team ’ s collaboration to improve overall processes and a shared goal of reaching near perfection . Like the manufacturer we were studying , we could see how we could use Lean Six Sigma ’ s statistical approach to eliminate waste , defects , over-productions , time waiting to assemble , issues with transportation , inventory , too much motion , and extra-processing in the SPD .
We watched in awe as the manufacturer ’ s complex processes were made simple , and as they subjected their devices and their own manufacturing processes to regular inspection audits throughout production . We marveled at how the company had rearranged the workspace to include “ cells ” that strategically eliminated unnecessary steps in the manufacturing process thereby creating efficiency at every stage .
In short , we were inspired to transform our department into a manufacturer so that we could deliver to the operating room
( OR ) surgical instrument trays that are 100 percent cleaned , 100 percent completed , and 100 percent on time .
We began to make our processes more efficient by setting internal standards , cutting down waste , and streamlining processes , and then the industry shifted even further . Regulatory and accreditation bodies began to publish metrics by which quality could be measured and facilities could be marketed . We had goals to reach and key performance indicators to live by . Ever-increasing caseloads demanded that we upped our game and new surgical technology required new specialized sterilization and inspection instruments .
The more recent emphasis and reliance on standards set forth by the Association for the Advancement of Medical Instrumentation ( AAMI ) has made patients safer from contaminated tools than they have ever been , and the leaps and bounds in inspection instruments ensure that improperly sterilized tools don ’ t leave the SPD .
Below are some of the best tools for verifying the safety of OR instruments , many of which did not exist just 25 short years ago .
Chemical test for verification
● Protein indicators : The presence of protein means that an instrument has not been fully decontaminated and is not yet safe for use in the OR . One of the most efficient ways to test for protein is protein indicator test . The test requires a sample to be swabbed then introduced to a reactive solution that will change color in the presence of protein . There are a variety of commercially available products to chemically test for and detect levels of protein on surfaces of medical devices that would otherwise go unseen . Some even include the swap and reagent in one tool .
● Adenosine triphosphate ( ATP ): The ATP method is used to measure levels of cleanliness of a surface or a cavity , and to verify the cleaning process for cannulated medical devices like orthopedic shavers . Many hospitals use this method in their quality audits for GI endoscopes before they are put through the high-level disinfection process . The ATP process uses a special swab to take samples of the area being inspected for bioburden . ( These test swabs for lumen come in different sizes to correspond to the diameter of the lumen .) The sample swab is inserted into an enzyme solution , which will produce a light signal if protein is present . This signal is measured in relative light units ( RLUs ) by a handheld luminometer and is measured against pass / fail benchmarks established by the ATP test manufacturer . Usually , the passing value for an ATP test is between 0-100 RLUs for scopes and surgical instruments . Depending on the manufacturer some ATP handheld devices may require calibration and all require adherence to IFUs .
Chemical tests like the ones above can often be synced to computer tracking programs that allow for straightforward data-driven quality audits .