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