Special Edition on Sterile Processing Imperatives Special Edition- Sterile Processing Imperatives | Page 16

Implementation Science
in Sterile Processing:
Q
& A
A Q&A With Epidemiologist Cori Ofstead
By Kelly M. Pyrek
I
Cori Ofstead,
MSPH
We know
that
endoscopes
and surgical
instruments
are commonly
not properly
processed
for use,
even though
adequate
training
programs
exist.”
16
mplementation science, viewed through the
lens of infection prevention and control,
can boost compliance, and is a viable approach
for improving quality in the sterile processing
department. At its essence, it focuses on factors
that promote the systematic uptake of research
findings and implementation of evidence-based
practices into routine care.
As Geerligs, et al. (2018) observe, “Health
service interventions that are effectively imple-
mented are associated with improved patient and
staff outcomes and increased cost-effectiveness
of care. However, despite sound theoretical basis
and empirical support, many interventions do not
produce real-world change, as few are successfully
implemented, and fewer still are sustained long-
term. The ramifications of failed implementation
efforts can be serious and far-reaching; the
additional workload required by implementation
efforts can add significant staff burden, which
can reduce the quality of patient care and may
even impact treatment efficacy if interventions
disrupt workflow. Additionally, staff who bear the
burden of implementing new interventions may be
reluctant to try alternatives if their first experience
was unsuccessful. A thorough understanding of
the barriers and facilitators to implementation, as
well as an ongoing assessment of the process of
implementation, is therefore crucial to increase the
likelihood that the process of change is smooth,
sustainable, and cost-effective.”
 Hospitals are unique microcosms, with their
specialized populations, processes and microsys-
tems, which may encounter unique barriers to
implementation science.  Geerligs, et al. (2018)
assert that, “Translation of evidence-based
interventions into hospital systems can provide
immediate and substantial benefits to patient care
and outcomes, but successful implementation is
often not achieved.”
  They point to a number of barriers and
facilitators to the implementation process, and in
their systematic review, they identified relation-
ships between these barriers and facilitators to
highlight key domains that need to be addressed
by researchers and clinicians seeking to implement
hospital-based, patient-focused interventions.
The researchers grouped staff-identified barriers
and facilitators to implementation into three
main domains: system, staff, and intervention.
Barriers identified by Geerligs, et al. (2018) directly
related to the hospital environment and included
workload and workflow, physical structure, and
resources: “Staff workload and lack of time for
implementation were the most commonly cited
barriers. Staff shortages, high staff turnover, or
changes in roster compounded this issue, resulting
in burden for implementation falling on small
numbers of staff who were most interested,
rather than generating change at the institution
level. Several studies targeted this issue by hiring
additional staff, such as a research coordinator,
or delegating parts of the intervention to the
research team. In contrast, support provided
at the institutional level for staff to have time
for implementation was believed to be a more
sustainable facilitator.”
 The researchers found that barriers related to
workplace culture centered around system-level
commitment and change readiness: ”Low levels
of commitment often occurred in response to
structural changes, such as high turnover, which
left staff feeling demoralized and unable to accept
additional challenges required by implementing
the intervention. Support from management
regarding the importance of change and orga-
nization-level commitment to new processes was
crucial to combating this. Several interventions
also used champions or coordinators to facilitate
motivation, although some staff reported experi-
encing negativity from colleagues as a barrier to
carrying out this role effectively.
Geerligs, et al. (2018) also noted that work-
place culture barriers also included the level of role
flexibility and trust between different clinicians
involved in the intervention: “Congruence
between the intervention requirements and staff
roles was important. Staff who reported that
implementation required them to carry out duties
beyond their role reported struggling, especially
if they anticipated judgment from colleagues.
However, other respondents felt that building trust
across the team could address these concerns.”
 The efficacy of communication was an import-
ant factor in the success of implementation science
in healthcare, particularly where interventions
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