as delayed meetings, dismissive language, or statements such as‘ We have always done it that way.’”
Taylor adds that the technical complexity and specialty knowledge in these departments can be scary as well.“ With instrument processing, IFUs, case cart assembly, flash / low-temperature sterilization, loaner workflows, biological monitoring, etc., it is a universe of detail. IPs may fear exposing gaps in their knowledge, particularly if they do not have SPD or OR experience. The SPD, in particular, has historically been underrepresented in IP training curricula, yet they criticize or hyper focus on one or two specific items not taking into account the entire responsibility of the department.”
These high-stake environments may add to IPs’ case of the nerves.“ Mistakes in the OR / SPD do not lead to minor infections, they can lead to SSI outbreaks, recalls or litigation,” Taylor emphasizes.“ IPs know that challenging these areas’ practices can escalate quickly to the C-suite or medical staff leadership.”
Finally, Taylor says access barriers can complicate matters.“ IPs may not have badge access to restricted OR / SPD areas. These areas often run 24 / 7, but IP staff do not. Physical separation( basement SPD, off-site reprocessing) plays a role and keeps IPs out of sight, out of mind.”
If fear of the OR / SPD persists, IPs may fall into avoidant patterns, thus undermining the provision of quality care and quality assurance / improvement that is facilitated through observation, risk management and mitigation. This can, in turn, foster neglected infection control-related aspects in the OR / SPD.
“ In the OR, the things that tend to get overlooked are the basics, like point-of-use instrument care or environmental cleaning,” Wood says.“ In the SPD, the issues are a little different. The big gaps usually show up where
Image courtesy of AORN the IFUs are hard to interpret, missing information, or unrealistic for the actual workflow. Full drying and cooling often get rushed. SPD teams work under heavy throughput pressure, and when instructions conflict or the volume is high, people naturally find workarounds just to keep things moving.”
Parker points to hand hygiene as one of the most neglected infection control-related aspects in the OR / SPD.“ That is the easiest and most important practice everyone can do better,” she says.“ It matters! Organisms can live on dry surfaces for extended periods of time. There are all sorts of surfaces in a hospital setting in addition to us touching our cell phones. Proper hand hygiene must be done before any work commences, before donning PPE, after doffing PPE, etc. We must do everything we can to prevent the spread
of infections to patients, visitors and staff.”
DeGraw points to instrument storage as a significant issue that can fall off IPs’ radar.“ Instrument storage is often an overlooked step in the instrument cycle and one that might be missed by IPs. Mishandling and improper storage of instruments can lead to package damage and contamination. I have entered storage areas where dust was visible on the shelves and packages were crushed and compressed, compromising sterility. In this instance, there were not clear expectations for cleaning and maintaining the instrument storage area, and the OR and SPD assumed the other was addressing it. Having a cleaning checklist and outlining correct storage conditions can eliminate these issues.”
Taylor says that“ Infection control gaps in the OR / SPD most often occur in the invisible process, instrument cleaning verification, adherence to manufacturers’ instructions for use( IFUs), environmental cleaning quality, and the management of loaner instruments. These areas are neglected because they are labor intensive to evaluate, occur under intense time pressure, and rarely produce immediate, visible harm. As a result, deviations become normalized, especially when productivity and case throughput are prioritized over process reliability.”
Taylor points to the following issues as trouble areas that require attention of IPs: Instrument processing fidelity
• Failure to fully follow IFUs due to time pressure, equipment limitations or volume demands
• Deviations normalize as workarounds.
• IPs may audit outcomes( such as for SSI) s but not processes that lead to the problems. Environmental hygiene in the OR
• Inconsistent terminal cleaning practices
• OR turnover pressure incentivizes speed over thoroughness. Loaner instrumentation
• Incomplete IFUs
• Short turn-around times
• Late arrivals that force rushed reprocessing or sterilization shortcuts
Sterilization monitoring and documentation
• Overreliance on pass / fail indicators without trend analysis.
• Missed opportunities for proactive risk identification. Human factors
• Fatigue in the OR / SPD, 24 / 7 operations, late cases, on-call requirements, etc.
• Repetitive motion and heavy lifting injuries that impact attention to detail.
• Staffing ratios and competency drift. As to why these are neglected, Taylor adds,
“ IPs are often pulled toward surveillance, reporting and regulatory readiness. Additionally, OR / SPD issues are process-heavy and time-intense to assess properly, and many IPs lack confidence to challenge perioperative norms without deep subject-matter grounding.”
There are many risks that are not on IPs’ radar as a result of their absence from the OR / SPD and this can have significant clinical / patient-safety, operational, and fiscal ramifications.
“ When IPs aren’ t present, we miss upstream signals: missed hand hygiene opportunities, environmental cleaning breakdowns, residual bioburden from rushed point-of-use care, HVAC or traffic drift in the OR, rushed drying and tray readiness issues in SPD, and the slow normalization of IUSS,” Wood says.“ Clinically, that translates to pathogen transmission and higher SSI risk; operationally, to case delays, rework, and burnout; financially, to lost OR minutes and the high cost of preventable infections.”
16 • www. healthcarehygienemagazine. com • march-april 2026