sterile processing
By David L . Taylor III , MSN , RN , CNOR
Common SPD and OR Missteps Place Patients at High Risk
Surgical instruments , endoscopes and durable medical equipment that are of subpar quality place patients at risk every day . As a consultant , I have the good fortune of working with health systems across the country and I see a lot of good things and not-so-good things in this role . This article will share some of my experiences when consulting with numerous facilities , and will , hopefully , lead readers to examine their own practices and make necessary changes to improve quality and keep patient safety the top priority .
For decades , thousands of patients have been negatively impacted by healthcare systems that neglected to properly support and manage the sterile processing department
( SPD ).
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Today , hospitals are larger and more complex , with many moving parts . Everything works in tandem , until corners are cut ( e . g ., staffing , training , education ) and those shortcomings lead to negative outcomes . For decades , thousands of patients have been negatively impacted by healthcare systems that neglected to properly support and manage the sterile processing department ( SPD ). Many healthcare systems don ’ t believe it will ever happen to them , but they are mistaken . We continue to see too many infections , retained foreign objects , life threatening injuries , and even death – all the result of actions that could have been avoided .
Healthcare leaders and their staff members who perceive their departments are running well are often surprised when a consultant comes in with a fresh set of eyes and tells them differently . It is not uncommon for organizations to be unaware of their problems because the jobs they perform are difficult , even under the best of circumstances . What follows are some of the most valuable lessons I routinely share in my consultant role :
Cleaning should begin at point of use . Bioburden such as blood and tissue , as well as medication and saline , are the primary causes of pitting , staining and discoloration of instruments . Instrument cleaning should begin during the surgical procedure to prevent blood , soil and debris from drying on the surface and within lumens . Point-of-use care means where the instruments are used . Operating rooms ( OR ) have many time pressures and it is very easy to neglect cleaning and proper care of instrumentation used during a procedure . Blood and tissue that are allowed to sit and dry on an instrument make that device more difficult to
Items should be stored flat , not upright .
process . Its presence can also cause pitting and other problems , reducing the instrument ’ s life expectancy and usefulness and costing hospitals thousands of dollars every year in expensive repairs and premature View more replacement . If bioburden isn ’ t properly removed prior examples of OR / to sterilization and that instrument is subsequently SPD missteps used on a patient , life-threatening infections can result . Remember , an instrument cannot be effectively sterilized if it hasn ’ t first been thoroughly and properly cleaned .
Tape is often misused . Healthcare workers do love their tape . Whether that tape is scotch , masking or medical varieties , it seems it is often used on everything except for which it was intended . Autoclave tape is used to secure packaging materials ( e . g ., wrapped , container or pouch systems ), allow penetration of the sterilizing agent and maintain sterility of the processed item after sterilization . Autoclave tape consists of colored Kraft paper with a rubber resin adhesive that resists moisture and most solvents . The tape can withstand broad temperature and environmental extremes ( including steam sterilization ) and is not intended for internal use ( it ’ s not validated for such use ). The importance of this cannot be overemphasized because tape can block the disinfectant or sterilizing agent from making complete contact with the surface of instruments . Still , it is often being used to secure integrators and pouches on instrument baskets and trays . Load stickers and office-based label makers used to identify instrument sets are also being used inappropriately – and these practices are unacceptable . If tape is found on the inside of wrapped , container or pouch systems , it should be considered contaminated .
Rigid containers , blue wrapper and peel packs are often mishandled . Wrappers , containers and pouch systems have been used in our industry for decades . Unfortunately , many leaders and staff members do not understand the importance of their proper handling and care . They fail to recognize that containers , wrap and peel packs require as much care and attention as the instruments themselves .