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Crossing the red line can feel like stepping into a high-speed choreography— masks and eye shields fog, alarms and beeps are constant, and you’ re instantly worried about where to stand, what you might contaminate, and whether someone will call you out. That sensory overload can make even confident IPs go quiet.”— Amber Wood
DeGraw notes that,“ An IP’ s absence from the SPD can lead to a gap in understanding when and how medical devices should be processed. Although the main customer for the SPD is the OR, there are dozens of other areas throughout the health system that the SPD is responsible for. Not knowing the extent to which other departments use, transport and store surgical instruments or other medical devices puts the organization at risk of a citation from an accreditation organization, such as The Joint Commission, if they aren’ t properly maintained. Having a closer relationship with SPD will help IPs identify these areas and devices. Additionally, SPD can assist IPs in setting expectations and developing workflows that align with sterile processing standards and hospital policies and procedures.”
Parker points to hand hygiene becoming suboptimal as a result of IPs’ lack of presence.“ I cannot say it enough, but it must occur for every patient, every time. Are the staff performing the surgical hand scrub according to the MIFUs and as facility policy dictates? Are the staff wearing the correct PPE per location( ex. operating room, decontamination area)? The clinical ramifications in the operating room could put the patient at risk for infection, and infections could lead to a loss of revenue for the hospital. Not wearing the correct PPE could have a similar impact on staff, who could suffer injuries from splashed chemicals or blood and body fluids. This could also lead to fiscal ramifications if staff must collect workers’ compensation. Operationally, if staff do not have the necessary equipment to safely do their job, they could risk losing accreditation status.”
Taylor says that when IPs are not routinely present in the OR / SPD,“ they miss early warning signs of systemic failure such as workarounds, staffing fatigue, equipment limitations, and process drift,” he emphasizes.“ These latent risks can accumulate quietly until they result in SSIs, instrument recalls, or outbreaks. The clinical consequences include preventable patient harm; operationally, they lead to case delays and regulatory scrutiny; fiscally, they expose organization to significant costs from extended length of stay, litigation and staff turnover.”
Additionally, Taylor points to silent process failures that can occur, such as micro-failures in cleaning, packaging, or storage that do not trigger alarms.“ These don’ t show up until an outbreak or recall occurs,” he says. He also warns of a cumulative risk, in that“ Multiple small deviations across cases create systemic exposure,” he says.“ IPs may focus on single-event investigations rather than trend-level risk.” This could have serious ramifications such as Increased SSIs and case delays and cancelations, resulting in lost revenue. Taylor also warns against moral distress and burnout in the SPD.“ When staff know shortcuts are unsafe but feel powerless to stop them results in disengagement and higher turnover, resulting in higher risk,” he says.
Communication, collaboration and cooperation represent the operational lubricant between the various departments of a healthcare institution of system, and these three Cs are essential
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march-april 2026 • www. healthcarehygienemagazine. com •
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