sterile processing
By David Taylor III , MSN , RN , CNOR
Who ’ s Responsible ? Broken Processes Create More SPD Workload , Obstacles
Too often , healthcare workers in procedural areas fail to understand and take ownership of their roles in the process , which can place additional burdens on SP technicians and impede their ability to process and manage instrumentation and medical equipment efficiently , safely and in accordance with the instructions for use and latest standards , guidelines and best practices .”
Sterile processing ( SP ) operations and work systems are critical to hospital and healthcare organizations ’ surgical and procedural programs , and SP professionals ’ daily contributions factor heavily into patient outcomes . Despite this critical role in the surgical “ ecosystem ,” many SP departments lack the financial support , respect and understanding needed to help their technicians keep pace with customer and procedural demands and the rapidly changing aspects of surgical care .
The tasks for which SP technicians are primarily focused are numerous and include ( but are not limited to ) decontamination , inspection , assembly , preparation , equipment loading , process verification , sterilization or high-level disinfection , biological testing , distribution , and storage . Much of that work is a shared responsibility , even though the SPD is often expected to own those responsibilities solely . Too often , healthcare workers in procedural areas fail to understand and take ownership of their roles in the process , which can place additional burdens on SP technicians and impede their ability to process and manage instrumentation and medical equipment efficiently , safely and in accordance with the instructions for use and latest standards , guidelines and best practices .
Those in the SPD must interact with numerous other departments and professionals every day . SP professionals must have the support to ensure they have the proper tools , technologies , work environment , processes and procedures to manage their challenging workloads effectively each day and across all shifts . Reaching that goal requires an interdisciplinary commitment and an understanding that many departments are responsible for quality outcomes , not just those managing instrumentation in the SPD .
Water quality
Water quality is an organizational responsibility . If water quality standards fail to meet the end users ’ needs , SP processes will break down , causing delays in instrument reprocessing . Often , those working in procedural areas do not focus on water quality and related issues — they just want to receive the instruments and equipment needed to perform their work . Still , it is necessary for all departments to know how water quality issues impact the workload within the SPD , and the instruments used to perform patient care .
If water is improperly treated , the impact on surgical instrumentation can be profound . If instrumentation is stained or showing signs of corrosion , for example , those devices must be pulled from circulation and promptly addressed to minimize patient risk . If there is no back-up set or instrument to replace the stained , corroded or otherwise damaged device , patient cases may be delayed or canceled altogether .
Point-of-use treatment
Point-of-use treatment , formerly referred to as point-of-use cleaning , refers to the removal of gross contamination ( blood , tissue , bone , etc .) from reusable medical or surgical instrumentation in areas where patient care procedures are performed . This process should occur either periodically ( during the procedure ) or immediately after use , but before instruments are sent to the decontamination area in the SPD .
Removing gross soil — and moistening instrumentation with an approved wetting agent or even covering instruments with a water-moistened towel — helps prevent organic material and debris from drying on instruments , including lumened devices . It is much more difficult to remove organic material and debris from surgical instruments when they are allowed to dry , and residual soil can affect the efficacy of disinfection and sterilization . Removing organic debris also helps prevent the formation of biofilm , an accumulated biomass of bacteria and extracellular material that adheres tightly to a surface and cannot be removed easily . Note : The term “ point-of-use treatment ” was adopted in standards and guidelines in recent years because it better encompasses the activities that should take place at the procedure site to prepare instrumentation for transport to the decontamination area . “ Point-of-use cleaning ” terminology led to confusion because some assumed that thorough device cleaning should be performed in the surgical suite or other patient care areas following the procedure , which was not the intended purpose .
Once the instrumentation has been prepared for transport , it is critical that the devices be moved to the decontamination area immediately or as soon as possible to ensure the instruments don ’ t dry and can be subjected to prompt and thorough cleaning . Making the sterilization process less complex and more visible , managing interruptions during case cart preparation , improving communication with the procedural areas such as the OR , and improving workspace and technology design could further enhance reprocessing performance .
Low-quality , inadequate instrument repair
Organizations that adopt proactive instrument maintenance practices can positively impact physician and employee satisfaction , operational and capital