Special Edition on Sterile Processing Imperatives Special Edition- Sterile Processing Imperatives | Page 12
Tony Thurmond, CRCST, CIS, CHL,
central services manager at The Christ
Hospital in Cincinnati, Ohio, and 2019-
One of
2020 IAHCSMM president, says one
the most
of the most significant mistakes that
are being made in the SPD related to
significant
mistakes that are being processing is “time constraints, and the
belief that they must rush to compete
made in the SPD a task,” he says. “It’s important to
related to processing is understand that if an IFU requires a flush
“time constraints.” of one minute, for example, anything
less than one minute is shortcutting
— Tony Thurmond, CRCST, the proper process. This often happens
CIS, CHL when technicians are pressured to do
a quick turnover, often as a result of inadequate quantities
of instruments/trays or poor case scheduling. Incomplete
cleaning and prepping of an instrument or tray can lead to
an opportunity of cross contaminating the patient. What
may be a simple in and out procedure may develop into a
surgical site infection, leading to more complex procedures
and long suffering to the patient,” Thurmond says.
Brian M. Reynolds, CRMST, CRCST,
CIS, CHL, CER, assistant chief of sterile
processing service for the West Palm
We need to
Beach U.S. Department of Veterans
Affairs, points to a lack of equipment
have enough
as being a significant burden on
instruments
sterile processing staff. “I see some
and equipment in our of the top mistakes as not having
inventories to keep the equipment needed to sustain the
up with scheduled volume of cases being scheduled and
having to rely on immediate-use
procedures.” then
steam sterilization just to make it
— Brian M. Reynolds, through the day,” Reynolds says. We
CRMST, CRCST, CIS, need to have enough instruments and
CHL, CER equipment in our inventories to keep
up with scheduled procedures and we need to be able
to prepare for what is needed 24 hours in advance. With
rushed processes and a lack of time given to process a tray
appropriately, mistakes are bound to happen, and patient
safety will become jeopardized.”
Marjorie Wall, MLOS, CRCST,
CIS, CHL, CSSBB, a sterile processing
director for a large health system in
California, says that the top mistakes
Anytime
made by sterile processing technicians
there is
generally fall into the categories of
bioburden
bioburden, wrong instruments, missing
in the operating room, instruments, damaged instruments, and
patients are put at packaging errors.
“Anytime there is bioburden in the
risk for surgical site operating room, patients are put at
infections.” risk for surgical site infections,” Wall
— Marjorie Wall, MLOS, says. “Even if the bioburden is caught
CRCST, CIS, CHL, CSSBB early, before the procedure starts, the
back table and surgical field becomes
contaminated. It must be broken down and rebuilt, which
created a delay in care and adds stress to the patient and
surgical team. Worse, if bioburden is identified after the
patient is under anesthesia, it results in extended anesthesia
12
time for the patient, which increases the risk for the patient.
Wrong instruments, unidentified missing instruments, and
damaged instruments create an environment for a concealed
error. The surgical team may not catch the problem until
they are well into the procedure. Even assuming there are
back-up instruments available, this creates a delay in care
and extended anesthesia time. If instruments are unavailable,
this can result in the procedure being canceled, the surgeon
having to change surgical techniques (having to do a lateral
plating instead of a femoral rodding, for example), or cause the
surgical team to perform immediate use steam sterilization,
which can increase the risk for surgical site infection.”
Marrs enumerates the many other factors contributing
to improper processing: “A lack of education, training and
lack of equipment (washer disinfectors, ultrasonics and
sterilizers) as well as insufficient instrument inventories, pay
inequalities and finally, a lack of leadership support up to
and including administration,” he says. “At the top would
be the lack of leadership support. Leadership is ultimately
responsible for ensuring that departments have the right
people, processes and products to perform their job correctly.
These departments have been neglected for decades. Even
with all the media attention to errors that have caused patient
harm, hospital leadership still refuse to take the time and
effort to bring these departments into the 21st century. It
is time for hospital leadership to step up, do the right thing
and give sterile processing the fiscal attention that it needs
and deserves.”
“I see multiple factors contributing to these improper
processes, including not having enough staff; inadequate
education for staff; starting technicians in their roles without
adequate training; and setting unreasonable expectations for
proper instrument processing (demanding faster turnaround
times, having more procedures scheduled than what
instrument and equipment inventory can allow, etc.), says
Patricia Taylor, CRCST, CIS, CHL, CFER, clinical supervisor for
central sterile at MHP Medical Center in Shelbyville, Ind. and
a member of the IAHCSMM board of directors.
Thurmond points to “Poor planning, inadequate timing,
lack of understanding between departments, heightened
expectations, and a demanding surgical team” as exacerbating
inability to perform at a high-functioning level. There are
times where rushing the process is more preferred than
upsetting the surgeon by delaying their case, or not having
what they need at a critical point. It is not an attempt to
intentionally do anything incorrectly, but rather aiming to
meet the expectation of the waiting surgical team.”
Wall says inaccurate or insufficient data can trip up even
the best sterile processing professionals. “Many hospitals do
not have accurate tray menus or data to set technicians up for
success. Without clear manufacturer information, leadership
cannot build instructions for use-driven competencies and
trainings, which results in training/knowledge gaps for
technicians. Without clearly written, complete descriptions
of instrument names, sterile processing technicians may have
difficulty differentiating between instruments, which can
lead to the wrong instruments making their way into trays.
Without data and systems monitoring preventive mainte-
nance, organizations are at risk for normalized deviation,
leading to rusted/pitted instruments being seen as ‘normal’ or
Sterile Processing Imperatives 2020 • www.healthcarehygienemagazine.com