Securing Funds for SPD Capital Purchasing to Help Keep Operations Running Optimally

By Marie Brewer, CST, CRCST, CIS, CHL, CER, GTS, CLSSBB

This article originally appeared in the December 2023 issue of Healthcare Hygiene magazine.

Sterile processing (SP) leaders often experience budgetary cuts or see their requests for capital purchases denied, but tapping alternate sources of funding can help bridge the budgetary gaps and set up the Sterile Processing department (SPD) for greater operational success, safety and efficiency.

Grants are an excellent option for obtaining critical funding, and learning to effectively and efficiently write a grant proposal is the secret to success. There are several common approaches to grant writing, including:
• Letter of inquiry (LOI) – An LOI is a brief letter written to discuss the main points of a full proposal; this allows the funding organization to determine if the request meets their grant criteria. Some facilities use an LOI as the first step toward obtaining funding for capital purchases.
• Full proposal: This approach follows a standard format (as outlined by the funder) that typically includes a cover letter, statement of need, project summary and budget. A full proposal can range from five to 25 pages.
• Letter proposal: This format may be used to propose a scholarship for education or capital equipment requests. Often, a two– to four-page letter is sufficient. The letter should describe the team or organization, outline the detail(s) of the project and define the sponsorship proposal.
Note: To ensure the best outcomes, SP leaders should research each prospective funding organization. Most funders have guidelines for eligibility and will provide their preferred proposal format and a list of required documentation or supporting material. They are also likely to state their submission deadline(s) and general timelines for notification and grant payment.

This article focuses on letter-writing because it is the method that has garnered me and my department the most success. To date, through our grant writing, we have received more than a dozen awards for capital items, such as borescopes, height-adjustable workstations and sinks, and additional surgical instrument sets to improve processes, safety and efficiency. The smallest grant we received was $2,000 for education-based scholarships, and the largest exceeded $75,000 for height-adjustable sinks. In 2022, our department received a $15,000 grant for a new height-adjustable workstation. Additionally, educational scholarships and grants have funded trips for several technicians to attend the Healthcare Sterile Processing Association (HSPA)’s annual conference.

Grant-proposal writing tips
Before starting the letter-writing process, SP leaders should work to avoid common mistakes that can derail grant attainment. Some examples include repeating exact phrases from the funder’s guidelines, failing to read and understand the grant guidelines, using industry jargon that may not be understood by grant-funding personnel, focusing more on problems than solutions (or suggesting general solutions to specific problems), submitting the letter after the stated grant proposal submission deadline, and submitting the letter with typos or insufficient or inappropriate information.

Before writing and submitting a letter proposal, SP leaders should carefully review the grant’s requirements to determine eligibility and ensure the letter is focused and tailored to the audience. It is vital to always proofread the letter to ensure the content is concise, easy to understand and clearly advocates for the SPD’s needs by laying out the specific goals and needs. Finally, define the budget accurately to ensure all associated project costs are included.

Prior to writing the official letter proposal, prepare a grant letter outline and include these core elements: Briefly introduce your organization (health system, hospital, surgery center, etc.); tell the funder how much money is being requested by why; succinctly explain what sterile processing entails and describe the work performed by technicians in the department; and include research-based content and data to support the team’s needs and funding request.

When writing the grant letter, it is best to start by briefly explaining how securing capital needs will advance the quality of patient outcomes and employee safely and satisfaction. In my own grant-writing experience, my letters include a description of our department, including the number and type of staff and the target population we serve. Also included is some simple data such as the number of annual admissions or patient visits the department supports, along with an explanation about the project or program, an identification of the specific need(s) and how the grant will support those needs. A project timeline is also included as is justification about how the project aligns with the mission or the funding organization. Finally, be sure to provide an explanation about what the funds will cover. For capital equipment, include a description and photograph of the equipment, how often the equipment will be used, and the life expectancy of the equipment (include warranty information). Also, provide a detailed budget (consider incorporating accurate figures/data into a table or chart), and a detailed quote and bids for additional installation or renovation costs.

Following the writing of the grant proposal, ask two or three independent readers to review the writing critically to ensure it is easy to understand, accurate, error– and typo-free, compelling and meets the funder’s guidelines and requirements.

Grant writing can be an intimidating process for SP leaders, especially those who are new to the process. It is, however, a practice that can be learned and mastered and lead to notable departmental improvements that can increase process safety, efficiency and efficacy. The more grant letters are written, the more proficient leaders will become at the practice. Even a denial from a funding organization can provide valuable lessons to help sharpen and perfect future grant-writing attempts.

Marie Brewer, CST, CRCST, CIS, CHL, CER, GTS, CLSSBB, serves as sterile processing manager at St. Luke’s Hospital in Cedar Rapids, Iowa. She has served as a columnist for the Healthcare Sterile Processing Association (HSPA) since 2022.

 

Instrument Maintenance: Inspected, Tested and Repaired

By David Taylor III, MSN, RN, CNOR

This article originally appeared in the November 2023 issue of Healthcare Hygiene magazine.

With shrinking healthcare budgets and the ongoing quest for infection prevention and the delivery of safe, high-quality patient care, the need to effectively maintain (and sustain) a robust and proactive instrument maintenance and repair program has become even more critical. More specifically, it is imperative that all sterile processing (SP) professionals recognize the importance of proper device care and handling, cleaning, inspection and testing of all items they manage and process.

Having a well-educated staff that knows how to properly manage instruments and identify issues before they become bigger problems is key to a successful instrument maintenance program—and to healthcare organizations’ broader quality, infection prevention and safety initiatives. The delicate nature of surgical instruments and devices and the high cost associated with preventable damage and subsequent repairs and replacement warrants focused training and attention by SP technicians as well as the surgeons, nurses and other staff members in procedural areas.

Aligning resources
Having adequate instrumentation inventories, time and other resources to meet procedural volume —and ensuring that devices are processed and managed according to instructions for use (IFU), standards, guidelines and internal policies and procedures — is critical; however, in my consulting experience, I have seen many facilities fail to invest in adequate instrumentation to support their surgical programs, which results in device overuse and reduced life expectancy for instrumentation.

Every device being reprocessed should undergo thorough inspection before being packaged for reuse or storage. The importance of thoroughly inspecting each instrument cannot be overemphasized. Instruments are subjected to a great deal of abuse over their life cycle, and repeated use and rough handling can damage instruments over time, increasing the risk for device failure during the procedure and, potentially, device contamination that may cause patient infections.

The following steps should be performed routinely by SP technicians:
• Hinged instruments (single or double) should be checked for cleanliness and stiffness (they should move smoothly and easily). Ensure that jaws and teeth are in proper alignment.
• Box locks, serrations, and crevices should be inspected for proper function and cleanliness. Bioburden and other debris can significantly impact the proper function of the box lock function.
• Instruments with cutting edges, such as scissors, rongeurs, chisels, curettes, and the like, should be checked for sharpness. Cutting surfaces should be straight and aligned and absent of nicks, chips or dents.
• Ratcheted instruments should open and close easily. When closed, they should hold firmly.
• Instruments with pins or screws should be carefully inspected to ensure they are intact and functioning as intended.
• Plated instruments should be inspected for chips, worn spots or sharp edges. Defects in the plating can harbor debris and bioburden (and rust over time).

In-house or outsourced?
There are two options when establishing an instrument maintenance and repair program. The first is to create an in-house program, employing a skilled instrument repair technician (or technicians) to work for the SPD/organization. This option may not be financially feasible for a small- or medium-sized facility; however, it may be better suited to large hospitals and health systems.

The second option is to outsource the program. Many third-party companies provide instrument repair and maintenance programs (and, of course, original equipment manufacturers also service their own equipment*). It is essential to investigate the quality and depth of the services provided and ensure that their technicians are skilled and well educated—and then take time to compare the various options and service providers. Remember that the least expensive option is not always best. Also, before choosing a maintenance and repair provider, it is prudent to understand the current state of existing instrumentation by completing a thorough assessment of all devices and equipment in inventory. This process will ideally include:
• Assessing current instrument inventory and comparing it to the number of specialties each instrument set supports. Do you have enough instruments (loose or in sets) to support your surgical program?
• Asking how many times an instrument set has been reprocessed in a day to meet the needs of the operating room (OR). Does current inventory support the workload?
• Evaluating the current condition of the instrument inventory.
• Identifying which devices have been repaired previously. If they were repaired, how many times?
• Understanding the rotation cycle (weekly, monthly, quarterly) for each instrument set to be inspected, repaired if necessary, and returned for reprocessing.
• Tracking and documenting repairs.
• Assessing the current repair and maintenance process and asking what is and is not working well for the SPD and its customers.
• Ensuring that SP staff and end users have knowledge about how to safely handle devices and identify issues proactively instead of reactively.

Completing the assessment will help determine whether an in-house maintenance and repair program is feasible or whether an outside provider is the better option. Before selecting a vendor, it is advised to seek competitive bidding (again, being careful to weigh the cost estimates with the precise services that will be provided). Bids may include the initial evaluation and repair of all instruments, with ongoing routine maintenance. Whichever program is chosen, the repair technician(s) should be able to provide ongoing education and preventive maintenance training as part of their employment or contracted service.

The cost of properly maintaining instruments is far less than that of procedural delays, extensive repairs and premature replacement of devices—and above all, negative outcomes for the patient. A proactive instrument maintenance and repair program helps prevent issues before they arise (or develop into more extensive damage that requires costlier repairs, downtime or premature device replacement). Organizations that proactively adopt a robust instrument maintenance and repair program directly and positively impact productivity, customer satisfaction and profitability.

*Be sure to carefully read manufacturers’ warranties and contact the manufacturer if further clarification is needed. Some device and equipment manufacturers will void warranties if their products are repaired by another party.

David Taylor III, MSN, RN, CNOR, has served as a contributing author for the Healthcare Sterile Processing Association (HSPA) since 2019. He is an independent hospital and ambulatory surgery center consultant and the principal of Resolute Advisory Group LLC, in San Antonio, Texas.

 

Sterile Processing Leaders, Do You Know How ST108 Affects Device Processing?

By Susan Klacik, BS, CRCST, CIS, CHL, ACE, FCS

This article originally appeared in the October 2023 issue of Healthcare Hygiene magazine.

It is essential that sterile processing (SP) professionals have ready access to the latest standards and guidelines and work to ensure that recommended best practices are understood and consistently followed. One of the most anticipated standards to be released was ANSI/AAMI ST108:2023 Water for the processing of medical devices, an upgrade from the water quality technical information report TIR 34.

Water is a primary resource used for medical device processing, relied upon heavily in the cleaning process and to generate steam for sterilization. The risks associated with poor-quality water being used on a medical device during processing can result in ineffective cleaning and disinfection, device malfunction during use, toxic residues remaining on a device, patient infection, and pyrogenic reactions. ST108 addresses various levels of water quality and steam purity suitable for medical device processing and describes water treatment processes that can be used to produce water that meets quality requirements for medical device processing. It is an especially valuable resource because it addresses water quality at the point-of-use and for cleaning, rinsing, disinfecting and sterilizing medical devices.

Water-type differences

ST108 defines three types of water quality and provides the specific performance

qualification levels of water quality for each. All levels are required to meet the water quality

measurement values as defined in this standard. The three levels include:

Utility water—Water that comes from the tap and is the type recommended for cleaning

medical devices. It can also be used for the initial rinse to remove soil loosened by the cleaning

process and for removing cleaning agent residues. This water may require further treatment at

the facility to achieve the specified water quality. This water is mainly used for flushing,

washing and intermediate rinsing (rinsing between cleaning and disinfection). Note: Tap water may not meet the requirements of utility water as defined in ST108. For that reason, tap water used in SP areas should be analyzed to determine its characteristics and whether treatment is needed to meet the requirements for utility water. The water treatment system manufacturer should be consulted to validate that the treatment process will be adequate for the specific characteristics of the incoming tap water.

Critical water— Water that meets the water quality measurement values as described in

AAMI standards. To achieve these values, water generally requires a level of purification that

can only be achieved by removing ionic contaminants from the water (this process is referred to as reverse osmosis or deionization). There are instances where both technologies may be used together to meet the water characteristics needed to be classified as critical water. There will also be other forms of treatment that can be found with systems that produce critical water. Softening, carbon filtration, coarse filtration, ultrafiltration, UV lighting are some of the technologies that could be found with these systems. This water is mainly used for the final rinse after high-level disinfection and/or for the final rinse for critical devices prior to sterilization. For automated endoscope reprocessors (AERs), it is important to understand the equipment IFU to ensure equipment compatibility with critical water. Note: Much of today’s equipment is not designed to handle the corrosive nature of critical water; therefore, utility water is specified for the final rinse.

Steam—Vaporized water produced by a centralized boiler or a generator/heat exchanger near the

sterilizer. Most steam used in a Sterile Processing department (SPD) is piped from a centralized system for many other purposes (known as plant or house steam). The steam is generated in this

centralized system and transferred through piping to the sterilizer. Other types of steam are

located close to the sterilizer; based on the design of the equipment and the respective IFU,

utility or critical water may be used in a pure steam generator.

Water quality for SP equipment, core functions

ST108 provides water quality factors for washer-disinfectors. Washer-disinfectors are often

equipped with at least one control valve for hot water and another for cold water. A separate

control valve is for the final rinse.

Ultrasonic (sonic) cleaners are also useful for removing soil from joints, crevices, lumens and other areas that are difficult to clean by other methods. Utility water can be used unless otherwise indicated by the ultrasonic or medical device manufacturer’s written instructions for use (IFU). The key water-quality factors to consider for ultrasonic cleaning include water hardness and physical appearance (color, clarity and absence of particulates/sediment). If the ultrasonic cleaner does not provide a final rinse, the device manufacturer’s written IFU for manual rinsing of the device should be followed.

Routine monitoring is necessary to ensure that the water quality is maintained and does not deteriorate over time. If water quality is not monitored, the water treatment storage and distribution system could become heavily contaminated with metals, microorganisms or other contaminants and could contribute to corrosion, staining and increased microbial levels after processing. ST108 provides guidance on what requires monitoring, how often it should be performed and by whom; the standard features a chart to outline those functions. Utility water in medical device processing should be monitored quarterly at each point-of-use location, such as a sink, by collecting a water sample in a specially designated collection cup that is then sent to a lab for analysis, with a daily visual inspection of the interior of processing equipment to check for residues, staining, scaling, and discoloration.

Critical water requires more frequent monitoring; if not properly maintained, water treatments can result in heightened microbial levels, biofilm development and endotoxins. In addition, the making of critical water will affect the chemical attributes of water including the pH, conductivity, total alkalinity, and total hardness. As such, point-of-use critical water should be tested monthly for endotoxins and bacteria by submitting a water sample. Daily visual inspections should also be performed that include inspecting the interior of processing equipment to check for residue, staining, scaling and discoloration.

ST108’s annexes A through I provide information to assist SP professionals and others with the understanding and implementation of the standard. The annexes include guidance on the application of the normative requirements, risk analysis, automated endoscope reprocessors, water used in cleaning and moist-heat process, typical presentation of water quality issues during medical device processing, and more.

To purchase the standard, visit www.aami.org.

Susan Klacik, BS, CRCST, CIS, CHL, ACE, FCS, is a clinical educator for the Healthcare Sterile Processing Association (HSPA).

 

KPIs Spur Powerful Sterile Processing Department Improvement

By David Taylor III, MSN, RN, CNOR, and Kristina Pirollo-Ketchum, AA, CRCST, CHL

This article originally appeared in the September 2023 issue of Healthcare Hygiene magazine.

Healthcare organizations across the U.S. are embracing performance monitoring and improving clinical outcomes through the measured approach of key performance indicators (KPIs). By leveraging the proper technologies, data can be leveraged to develop processes that optimize patient safety through real-time management and visibility of interdepartmental workflows— within the sterile processing department (SPD) and other procedural spaces such as the operating room (OR).

Measuring and assessing achievements in the SPD is a combination of both art and science. KPI and data analysis are elements designed to track and measure work performance. Specifically, KPIs refer to a set of quantifiable measurements used to gauge long-term performance and help determine strategic, financial and operational achievements over time, and then compare that performance to regulatory guidelines and standards and others within the profession. Having access to such quality information enhances the understanding of issues affecting the SPD and empowers the departmental team to make informed decisions. Moreover, data plays a vital role in achieving quality outcomes. When defining the metrics, it is important to gather and track specific data sets to guide data collection efforts.

SP leaders and their teams should:

Identify what to measure. Understanding what needs to be accomplished in one or more areas will help SP leaders determine the metrics that align with their departmental and customer goals and objectives. These could include productivity, daily throughput, number of sets processed per employee, error rates, inventory optimization, same-day instrument turnaround times, biological monitoring or sterilization cycle rates, equipment maintenance, documentation log completeness, and infection rates. Labor time studies that accurately predict staffing and capacity needs are also beneficial, allowing SP leaders to more accurately budget for all operational needs. KPIs should be selected and adapted to the department/facility to support the strategy and objectives, and they should be specific, measurable, achievable and relevant.

Choose the data collection methods. It is essential to select a technique for collecting data. Methods can include manual recording through observation, use of an automated electronic data gathering system (software or cloud-based), or a retrospective review of documents and records annotated on data-entry forms. Keep in mind, regardless of the method used, data collection must be consistent and accurate to ensure meaningful results. Finally, data must be entered in a timely fashion and reviewed throughout the process.

Secure education and training. It is critical to determine who will collect the data (leader, staff member, outside entity) and provide the proper training necessary for those who are a part of the process. SP leaders should also consider training staff on data collection procedures so they can be a part of the process and understand the end goal. Instructions on information gathering (utilizing data collection tools and addressing challenges or queries) is essential, and the SP team will also require instruction and training on data entry and analysis.

Lean on data management systems. Whether one enters data into an Excel spreadsheet or uses an electronic or cloud-based software system, it is imperative to adopt the right solution that can effectively analyze the department’s data and help support reliable solutions. There are many manufactures that specialize in data management systems, so SP leaders should do their homework to determine the best system for their needs. Advanced data management solutions include tracking systems, data analytics platforms and specialized data-processing software. Such systems can automate data collection and allow real-time reporting for informed decision making.

Analyze and present the data. It is critical to routinely and consistently analyze the collected data to identify gaps in practices that might contribute to over– or under-work. It is crucial to identify trends and any areas or processes that are not keeping pace with workflow expectations.
It is valuable to compare and measure the data against industry standards and best practices as well as like-sized facilities. This will provide insight into how one’s own SP operations are performing. Evaluating and comparing the data will allow SP leaders to identify areas for improvement and set goals that drive improvement initiatives for their department and facility.

Once reviewed, the findings should then be shared with SP staff. Present the data in a format everyone will understand; consider using charts, graphs or dashboards that will help employees better visualize the data. Doing so will help SP staff pinpoint areas where process improvement can be made, optimize workflows, improve interdepartmental communication, and provide senior leadership with the information they need to make informed budgetary and support decisions for the SPD.

Conclusion
SPD processes are complex, often involving multiple interconnected subprocesses in order to provide procedural areas the devices and equipment needed to perform their roles. SPD processes are also closely connected to patient safety and quality of care, workflow and stakeholder satisfaction (patient, physician/surgeon, registered nurse, perioperative staff, and hospital administration).

KPIs offer SP professionals unique insights into their departmental service and operations. By determining the KPIs for each departmental area, the SPD can identify areas of improvement and make informed decisions to optimize their processes and operations. The capture, analysis and dissemination of quality data is essential, as is establishing measurable objectives to monitor progress.

David Taylor III, MSN, RN, CNOR, has served as a contributing author for the Healthcare Sterile Processing Association (HSPA) since 2019. He is an independent hospital and ambulatory surgery center consultant and the principal of Resolute Advisory Group LLC, in San Antonio, Texas.

Kristina Pirollo-Ketchum, AA, CRCST, CHL, is interim leader for Novia Solutions.

KPI Data Examples for Various SPD Areas/Processes

Decontamination:
• Quality checks (e.g., tray completeness, accuracy)
• Throughput
• Instrument quality
• Tray weight
• Early release
• Cleaning logs

Sterilization:
• Equipment verification testing
• Load arrangement
• Documentation of load
• Biological testing
• Sterilization failures (e.g., time, temperature, pressure, wet loads)
• Rate of immediate use sterilization
• Cleaning logs

Storage area:
• Outdates
• Event-related issues
• Cleaning logs
• Temperature and humidity

Case cart builds:
• Number of carts completed per shift or 24-hour cycle
• Case cart accuracy
• Percentage of on-time case carts

 

Managing Loose Devices to Reduce Workload, Increase Throughput

By David Taylor, MSN, RN, CNOR; Kristina Pirollo-Ketchum, AA, CRCST, CHL; and Albert Huether, MBA, CRCST

This article originally appeared in the August 2023 issue of Healthcare Hygiene magazine.

Although the roles and responsibilities of sterile processing (SP) professionals can vary from one location to the next, their primary duties involve processing instrumentation and reusable medical equipment by removing gross contaminants (decontamination), inspecting and reorganizing instruments into their appropriate trays, sets and/or peel packs (reassembly), sterilizing or high-level disinfecting each item according to the manufacturers’ instructions for use (IFU); and storing that instrumentation and medical equipment for future use (sterilization and storage). Still, broken, missing or inappropriately prepared instruments—known as tray defects—can be a frequent problem for surgical and procedural teams, causing delays and negative patient outcomes.

On any given day, SP professionals can process thousands of surgical instruments over the course of a 24-hour period, depending on their organizations’ location and size. To process those items, SP technicians must work efficiently to ensure each instrument tray or set is assembled correctly for reuse. Unfortunately, many factors can impact an SP technician’s ability to perform their roles properly. For example, not all instruments are returned inside their proper tray, which can contribute to device damage and loss. Such issues must be corrected during the reassembly phase to prevent future problems for the operating room (OR) or procedural areas.

During the assembly phase, SP technicians often address issues with damaged or missing devices by replacing them with loose instruments in the organization’s inventory. These instruments are often located in the assembly areas in drawers, cabinets, containers, case carts or peg boards. Many loose instruments in inventory are disorganized, often mixed and in disarray, which makes finding a replacement instrument time consuming or, in some cases, impossible. Additionally, the condition of loose instruments may not always be much better than the devices they are replacing. Inappropriate storage practices can damage loose instruments, leading to lost items, costly replacement, and an increased risk for contamination. Redesigning loose instrument inventories can create opportunities, such as helping reduce instrument and instrument set defects, eliminating waste, over production and wasted steps, and speeding up production times.

A well-maintained physical environment is critical for managing loose instruments effectively and consistently. With demanding and sometimes daunting workloads, the last thing SP technicians need is to waste precious time searching for a device to complete a set or locating an essential instrument during an emergency. Standardization and systemization help the process and hold SP team members accountable for the work they perform.

When exploring ways to improve loose instrument inventory management, it is necessary to inventory all devices that are extra or deemed loose in inventory. Once inventoried, SP leaders can determine whether the available extra devices are enough to support the surgical specialties and procedural volume (if not, it will be necessary to budget for and purchase more). After inspection, damaged or malfunctioning instruments should be thoroughly repaired and maintained (as needed). It is important to permanently remove from inventory any instruments that are nonrepairable. Instruments of suboptimal condition that are not removed could find their way into an instrument set for patient use, adding to defect data and, most importantly, risk to patient safety.

Once all loose instruments are inventoried, purchased and/or repaired, they must be properly stored. There are multiple options for sterile processing departments (SPDs), so it is important to choose what is right for one’s own organization and to solicit feedback from employees across all shifts. Keep in mind, any storage solutions chosen must be sturdy, meet standards-based requirements and provide years of service. They must also be non-porous, so they can withstand routine cleaning with approved hospital disinfectants. Note: Storage solutions should not be comprised of wood, Masonite, cardboard or wood-based fiberboard-based product. If they are made of one or more of those materials, they must be removed and replaced with a solid, appropriate storage solution.

One method we’ve seen gaining traction in SPDs across the country is processing loose instruments in peel packs and organizing them on a peg board or in plastic bins hung on a louvered wall system. Such systems can be quite effective, while consuming minimal space. The plastic bins come in numerous colors, allowing them to be color-coded to their loose instrument inventories and alphabetized for each surgical service line. When using such a system, I suggest identifying each item in the bin with a unique code for improved identification (at minimum, consider adding a photo of the instrument, along with its name and description, manufacturer number or reorder number, and par level). Providing this information can help with location finding and reordering.

This storage approach can help SP technicians more rapidly respond to emergency instrument needs. For example, if an instrument breaks or is dropped while in use during a procedure, the SPD can immediately replace it with a sterile one by simply plucking a peel-packed replacement device from a dedicated bin. Peel packs also protect instruments from contact with other devices, which further prevents instrument damage or dulling. For SPDs that choose this method, it is essential that their leaders develop a process for routine bin cleaning (e.g., weekly, biweekly and as needed). This ensures the bins are kept clean and allows technicians to more easily inventory, inspect the peel packs for damage and restock as needed.

Whichever storage method an SPD used to manage loose instruments in inventory, it is important for supervisors and managers to maximize their employees’ efficiency and throughput, while minimizing the number of tray defects and procedural delays and improving patient safety. Disorganized storage of loose devices can diminish productivity and service quality, contribute to lost or damaged instruments, cause procedural delays, and increase costs and time associated with set reprocessing when well-functioning replacement devices cannot be located readily.

A well-designed, standardized approach to storage and retrieval of loose instruments is vital to an SPD’s ability to provide quality service to procedural areas and to ensure that all devices are processed, well-functioning and available when needed.

David Taylor III, MSN, RN, CNOR, is an independent hospital and ambulatory surgery center consultant and the principal of Resolute Advisory Group LLC, in San Antonio, Texas. He has served as a contributing author for the Healthcare Sterile Processing Association (HSPA) since 2019.

Kristina Pirollo-Ketchum, AA, CRCST, CHL, is interim leader for Novia Solutions.

Albert Huether, MBA, CRCST, is the sterile processing department director for Medical City Dallas.

 

Loaned Device Management is Crucial for Patient Safety

By David Taylor III, MSN, RN, CNOR

This article originally appeared in the July 2023 issue of Healthcare Hygiene magazine.

Loaned or borrowed instruments are medical devices owned by a manufacturer and temporarily loaned to an organization. In most instances, the loaned instruments come with little or no cost, particularly if the healthcare organization is paying for implantable devices (e.g., screws, plates, joints). The organization may agree to use the medical devices for a fixed number of interventions. If the items are loaned for several interventions or a longer period, a separate agreement—usually a consignment agreement—between the two parties is established.

Borrowing instrumentation is a common practice that can offer many advantages, including reduced costs and the ability to expand services. More specifically, borrowed specialty surgical instrumentation and subsequent implantable items can provide the much-needed inventory for healthcare organizations, without the need to purchase large quantities of expensive instrumentation to support robust surgical programs. Despite the positives, loaned instrumentation can pose numerous challenges, chief among them being hidden costs for the facility, and risks to patient safety. The costs associated with handling and processing loaned instrumentation appropriately can be substantial. Some costs can include increased staffing costs, particularly in Sterile Processing departments (SPDs). For example, when a manufacturer delivers numerous loaned trays late or unannounced, SP leaders often need to put other work on hold or use unscheduled overtime hours to process them.

Over the past several decades technological advancements have changed the face of surgery, and healthcare organizations have been forced to keep pace with those changes. One way for them to do so without adding significant costs to their bottom line is through a focused, comprehensive and effectively implemented loaned instrument program.

Follow organizational policies and guidelines

A formal and effective loaned instrumentation program hinges on having specific policies and established controls in place that allow SP professionals to effectively manage borrowed instruments and implants. Facilities should emphasize the importance of developing a standardized system that all parties (e.g., surgeons, nurses and SP staff) agree upon.

Providing effective management of loaned instrumentation processes and ensuring that those processes are standardized is critical. SP professionals must help establish and adhere to policies for all reusable surgical instruments that are not owned or consigned in their healthcare facility. One aspect of an effective policy is the time loaned instruments arrive in the SPD. To process loaned instrumentation thoroughly, loaned devices will ideally arrive at the user facility at least 24 hours ahead of the procedure (ideally, 48 hours in advance). This allows the SPD adequate time to properly receive, inspect, document, process and otherwise manage the loaned instruments. Note: For new sets not consigned to an organization, industry standards recommend that loaned instruments arrive 72 hours prior to the surgical encounter. This allows all parties involved with those instrument set(s) an opportunity to become familiar with them prior to use. For the SPD, special processing (disassembly, extended soak times, brushing, etc.) may be required. For the surgical team (technician, nurse, surgeon), it creates an opportunity to become familiarized with the instrumentation prior to the procedure.

Policy and procedure recommend that a loaned instrumentation program include (at minimum):
• Requesting loaned instrumentation or implant(s) when surgical procedure is scheduled
• Time requirements for pre-procedure processing (48 to 72 hours) and inservicing as needed
• Post-procedure processing and pickup (within 24 to 48 hours)
• Acquisition of loaned items, including a detailed inventory list (with photographs) and manufacturers’ detailed written IFU
• Cleaning, decontaminating, and sterilizing borrowed instrumentation performed by the receiving facility
• Transporting processed loaned instrumentation to the point of use
• Post-procedure decontamination, processing and inventorying
• Returning instrumentation to the representative of the company providing the loaned devices
• Maintaining chain of custody records for all transactions

Trust but Verify

Loaned instruments can be quite specific and complicated. It’s not uncommon for a procedure to require up to two dozen multi-layered instrument trays. Complicating matters further is that the SP technicians may be unfamiliar with the items, including what they are used for or how they should be arranged in the trays provided. Ideally, the manufacturer should provide a series of illustrations or photographs that align with the inventory list and corresponding product lot number. Those who validate and provide quality checks create robust processes that protect the organization financially. It is highly recommended that the SPD catalog and photograph every loaned item during receipt at the facility and release back to the vendor.

It is important for organizations to ensure that the loaned instruments they receive are complete and in good working order. Taking an inventory of the contents and cataloging each item keeps the process in check for both the vendor and the organization. Items in the set may be vital to the procedure; therefore, any missing, damaged or inoperable items could compromise patient care. Additionally, failure to inventory and document loaned items could needlessly cost the healthcare organization dearly if an item isn’t accounted for accurately.

Throughout this process, SP technicians assigned to intake (receipt) of loaned instruments should verify that the instruments are in good condition and free from discoloration, rust or pitting. If devices have been dipped or instrument taped, technicians must ensure that it has been applied correctly and is not damaged in any way. If an instrument is in poor condition, the issue must be documented clearly, and the vendor representative should replace it immediately.

Because loaned instrumentation may also travel frequently from one hospital to another, it is vital that the SP team inspects condition of the containers, baskets and trays, ensuring there are no dents, cracks or other signs of damage. It is essential to ensure that the lids fit securely, the seals are intact, and there is no rusting or sticky residue. Additionally, technicians must ensure that the locking mechanisms are functional, the valves or filter mechanisms are present and in working order, handles are intact and undamaged. Any issues identified should be reported to the company representative before accepting the loaned devices. Doing so will help prevent the facility from being billed for previous damage.

Power of labeling, weighing, communicating

Properly labeling and numbering trays with the requesting surgeon, procedure and patient allows the SPD and OR to keep track of loaned sets—keeping them together, organized and ready for use. If a procedure requires loaned sets from multiple manufactures, it will be necessary to label appropriately to ensure instruments are not mixed or combined.

All instrument sets, regardless of who owns them, should not exceed 25 pounds (this weight includes the container), according to ANSI/AAMI ST79. Heavier instrument sets may compromise the sterilization process, rendering instrument sets unsafe for use. In addition, sets exceeding 25 pounds may pose an ergonomic injury for employees.

For effective instrumentation management, open communication is always advised, and this is certainly important with loaned devices and when coordinating between multiple parties (e.g., surgeon, OR, vendor and SP) must occur. For example, in order for SPD to plan for the scope of work for which they will be responsible, it is important to know which loaned instrumentation is needed (the manufacture involved); the scheduled surgical procedure; patient; scheduled arrival time for the instrumentation; whether the instrumentation is consigned to the facility or will be arriving via a representative of the company or its courier; the number of instrument sets required for that particular procedure; and whether the manufacturer's IFU are available and accompanying the instruments’ arrival. Knowing this information in advance allows the SPD to plan accordingly. Planning may include but not be limited to increasing staffing to accommodate additional workload, training or in-servicing of staff (across all stakeholder departments) and ensuring IFU are provided and followed correctly.

Many factors must be considered when managing loaned medical devices, and thoughtful, comprehensive processes must be adopted and implemented to ensure timely use and safe, thorough processing. When all stakeholders agree to the policy, this prevents practice deviation and helps ensure that everyone involved has equal input and accountability.

David Taylor III, MSN, RN, CNOR, is an independent hospital and ambulatory surgery center consultant and the principal of Resolute Advisory Group LLC, in San Antonio, Texas. He has served as a contributing author for the Healthcare Sterile Processing Association (HSPA) since 2019.

Additional Considerations:

The growing prevalence of loaned instrumentation in hospitals today can stem from:
• Insufficient inventory and/or lack of financial ability to purchase instrumentation
• Growing demand for surgical specialties (orthopedic, spine, etc.)
• Lack of storage space in healthcare organizations
• Clinical trials
• Patient-specific needs
• Scheduling conflicts and multiple procedures scheduled per day
• Owned instrument sets with missing or damaged items that are out for repair

Ineffective loaned instrument and implant management, including last-minute arrivals and the failure to obtain manufacturers’ instructions for use, can result in a host of problems for Sterile Processing and Operating Room personnel, including:
• A lack of processing time, which can lead to inadequate processing
• No IFU to guide the process (cleaning, decontamination, assembly, packaging, sterilization)
• Insufficient processing staff to manage workload
• Inability to process loaned sets due to the lack of training to work with complex medical devices
• Missing information to correctly label, identify or correlate with the patient or procedure

 

Sterile Processing Beyond the Operating Room

By Jill E. Holdsworth, MS, CIC, FAPIC, NREMT, CRCST

This article originally appeared in the June 2023 issue of Healthcare Hygiene magazine.

The Healthcare Sterile Processing Association (HSPA) 2023 conference held in Nashville last month, had many recurring themes this year, but one seemed to stick out more than others -- Collaboration. When we see teams collaborating together, we find success, safety and prevention of infections and events. As attendees return to their busy roles and departments, it’s hard to remember the excitement and motivation felt when we were all in Nashville together, sharing ideas, listening to presenters, and learning together. If I can give one piece of advice post-conference, it is to stay connected with new friends, write down all of your new ideas and hopes from the presentations and conversations you had and never lose the excitement you felt after the conference.

In a session titled “Sterile Processing Beyond the Operating Room,” I took the audience on a journey through the hospital to all the areas that are not the actual operating room. What are these places? Where do you need to worry about having surgical instruments, scopes and other items that will be sent to sterile processing? The best way to find out is to go look! Some examples that all teams need to look at in their facility are nursing units, the Cath Lab, the EP Lab, Women’s Services, Interventional Radiology, Endoscopy, and the various clinics (ENT, Rad Onc, women’s clinics, etc.).

An example given was when the infection preventionist (IP) and sterile processing department (SPD) director when through every single nursing unit looking in the clean supply areas for sterile instrumentation. Not only will this give a chance to find sets that may be able to be retired (along with the surgeon who wanted that set to be created in the first place) but a chance to clean up the amount of one-time use and reprocessed instruments used in the ICU and medical units.
Second, perform an assessment in your clinical areas to see how instruments are being transferred to sterile processing; are the containers compliant with Association for the Advancement of Medical Instrumentation (AAMI) guidelines? Is there a pre-treatment spray being used? Do the team members know how to use the spray? Do they even know where the spray is? Many nursing teams have also learned that they will be asked questions by surveyors even if they are not using instruments on a regular basis on their clinical units—this is your chance to partner! Work on a routine schedule to provide education, in-services, fliers, etc., and a new partnership will be formed from this collaboration.

Through working with areas like Interventional Radiology and the Cardiology Cath Lab, it has become evident that there is a need for education on things like how to look for holes in a wrapped and reading the indicator on the inside of the tray—these are not topics of discussion as often as they may be in the operating room. Keeping track of compliance with transport and pre-treatment in these areas will be just as important, though lower volume than the OR, it will allow you to understand what the educational needs are.

A tip I learned many years ago as part of survey readiness was to always keep a list of all the scopes throughout the facility at any given time. This serves two purposes for the infection prevention and sterile processing team—you have a list you can use for auditing purposes, and you also have a list to provide any surveyor if asked when they come on site.

Working together, understanding the needs of our departments and teams and forming partnerships across the facility are all important aspects of collaborating for safety and success. HSPA 2023 in Nashville was a notable example of these partnership forming, collaboration happening and new ideas forming to move the sterile processing profession forward. The work we all do together, just like working together with departments and teams across our facilities, will keep our patients and team members safe in the future.

Jill E. Holdsworth, MS, CIC, FAPIC, NREMT, CRCST, is manager of the Infection Prevention Department at Emory University Hospital Midtown in Atlanta.

 

HROs and Just Culture: Core Concepts for SPD Quality

By Marie Brewer, CST, CRCT, CIS, CHL, CER, GTS, CLSSBB

This article originally appeared in the May 2023 issue of Healthcare Hygiene magazine.

Systems thinking, quality, patient safety, and high-reliability principles lead to sustainable process improvements because they help teams avoid serious safety events and continually improve patient and employee safety. Specifically, high reliability organization (HRO) concepts and “just culture” can serve as a strong basis for sterile processing (SP) programs and quality improvement and patient safety initiatives.

HROs effectively complete assignments in the face of high risk and complexity and use intricate procedures to manage their work and avoid failure or errors. HROs successfully handle near misses and address errors by implementing a mix of error-reduction methods that nurtures a safety-conscious environment.

Five key principles

HROs rely on the following five principles in daily operations, which lead to improved quality, safety and outcomes:

Sensitive to operations: Understanding conditions in real time, regardless of intentions, designs or plans. This promotes a heightened awareness of how systems and processes are performing and encourages frontline staff members to report a situation in real time.
Reluctant to simplify: Recognizing that work is multifaceted and refusing to dismiss or excuse failures without further investigation.
Preoccupied with failure: Actively searching for potential errors and exploring all failures. HROs proactively work toward identifying possible failures and developing mitigation strategies.
Deference to expertise: When patient safety is at risk, expertise is more important than the organizational hierarchy. HROs recognize that those who know the most about a subject should be entrusted to make the decisions.
Commitment to resiliency: HROs value the ability to recognize concerns and create effective solutions. They react swiftly to a problem to mitigate its negative impact.
The foundation of an HRO lies in its philosophy of collective mindfulness—a non-judgmental consciousness of a group’s purpose, dynamics and mission. When a healthcare organization is collectively aware, the unified team works to collectively achieve their mission, vision and values. SP teams that practice mindfulness see improve team dynamics and increasing productivity and morale. The goal is for awareness and acceptance to replace reactivity and judgement. When applied to sterile processing departments (SPDs), HRO concepts encourage frontline technicians to look for and report concerns or unsafe situations before they present a significant hazard.

Accountability comes from the top; therefore, high-reliability concepts must be endorsed by the top leaders of the organization. A culture rooted in safety and process improvement is vital for supporting collective mindfulness and beneficial behaviors. It is essential that SP leaders reflect on their organization’s past and future endeavors and have a clear understanding of how the team promotes and supports HRO concepts. Leaders should ask the following:

Do I round with employees directly? Rounding offers a direct line of sight to frontline staff concerns and allows time to share ideas with staff.
How often do I review safety data, including the frequency of bioburden found on sterilized devices, missing indicators, etc.? Safety reviews help reinforce the team’s commitment to resiliency.
Do I lead and participate in safety huddles to share concerns and communicate error mitigation strategies? Doing so helps ensure that the team defers to expertise and remains focused on preventing errors proactively.
HROs emphasize the need to follow standard operating procedures (SOPs), written instructions that detail a step-by-step process that must be followed to ensure a routine activity is performed properly and consistently, even during times of high stress. HROs make fewer mistakes; however, when errors do occur, critical information is disseminated to alert staff to the mistake and allow the team to fix the error(s) more effectively efficiently. Further, these organizations learn from mistakes by instituting just culture, which discourages penalties for reporting an honest mistake. What’s more, HROs rely on strong communication and problem-solving skills and realize that technical expertise alone is not enough. SP leaders must be able to communicate in a manner that earns trust and support.

Just culture promotes safety, collaboration, education, communication and teamwork, which means mistakes can be viewed as learning opportunities. All team members should be involved in the process and participate in after-action reviews (AARs); these are used to debrief a project or event to determine what occurred and why and how to improve it. Leaders should encourage improvement and idea sharing and avoid taking a punitive approach when mistakes occur. HRO managers design common goals and create social pressures to adhere to SOPs. Every individual should understand how their performance affects the team, and leaders should perform routine readiness reviews (RRRs) and explain how each member’s role affects the mission.

When a mistake is reported or identified, is helpful for the SP leader to pause and breathe before reacting. Being a calm and approachable leader who fosters a culture of psychological safety allows employees to feel more comfortable admitting their mistakes and encourages a team-based approach where SP technicians and leaders work together to identify ways to prevent recurrence.

Systems can fail and complex systems often fail in complex ways. Therefore, process improvement action planning should be robust, viable and sustainable. Effective action planning allows team members to do the right thing, even when it is difficult, and can be facilitated by adopting technology to increase efficiency and capture process-specific data; adding another technician to verify low-volume, high-risk procedures; and adding appropriate administrative and engineering controls. To make change sustainable, the reason behind the change must be explained to all employees, so its purpose is not questioned, and new processes are always followed properly.

HROs remain focused on long-term performance improvement across all stages of their work. They strive to remain resilient in their processes, even during disasters and other high-pressure events. These quality-focused organizations are also able to decrease mistakes by following SOPs, participating in AARs and increasing employee accountability in positive, non-punitive ways. The adoption of just culture and a thoughtful approach to quality and safety creates a departmental culture that is rooted in teamwork and accountability. The result is a shared understanding that all SP employees play a vital and equal role in quality service and positive patient outcomes.

Marie Brewer, CST, CRCT, CIS, CHL, CER, GTS, CLSSBB, serves as sterile processing manager at UnityPoint Health–St Luke’s Hospital, Cedar Rapids, Iowa.

 

SPD-Related Lawsuits: Who’s to Blame and How to Cut the Risks

By David Taylor III, MSN, RN, CNOR

This article originally appeared in the April 2023 issue of Healthcare Hygiene magazine.

Recently, a lawsuit was filed against another prominent healthcare organization after patients suffered postoperative complications due to contaminated instruments. The organization’s executives, as well as some leaders from other facilities that faced similar legal action, have been quick to admit sterile processing-related process gaps; however, it is essential to recognize that the blame should not be shouldered solely by sterile processing (SP) professionals.

As a healthcare consultant who assists dozens of hospitals across the U.S. each year, these so-called SP-related process gaps are often due to system-wide organizational failure. SP professionals across the country are asked to perform many challenging tasks with too few resources and inadequate support. Limited SP staff and instrumentation inventories, inadequate training and outdated equipment are all too common. I’ve seen so many SPDs that are woefully undersized and understaffed and have insufficient (outdated and malfunctioning) equipment, supplies and training that it’s little wonder negative processing outcomes occur.

One SPD I visited recently was so cramped, dated and underserved that the technicians prepared and stored case carts in unkempt, unrestricted basement hallway. Another I visited did not have enough sinks, failed to use the ultrasonic, and for six months had two broken spray arms in the washer-disinfector. When I presented the concerns to senior leadership, they admitted they were aware, but lacked the budget to replace or repair the equipment. What’s more, I’ve seen countless instances where SP technicians aren’t provided the latest standards and instructions for use (IFU), so, they are unaware of the correct processing procedures and best practices.

Equally troubling is that many facility executives and SPD healthcare customers do not understand the many vital processes and practices that must occur in the SPD to ensure successful processing outcomes—and how critical it is that end users manage devices safely and effectively during and after the procedures to assist processing efforts.

Although the SPD, OR and other procedural areas have different functions, they share the same goal: providing the safest, highest-quality patient care. Still, each department bears complex responsibilities and faces different challenges and expectations that can strain interdisciplinary relationships and, at times, lead to finger pointing when device-related incidents arise. It is vital that those from the SPD and user areas work together to educate about requests, needs and concerns, and partner to ensure everyone understands their role in effective handling, treatment and processing of reusable medical devices.

To uncover root causes of device contamination and resulting infections or other related complications, healthcare organizations should perform a multi-departmental process assessments to identify contributing factors for the incident(s). Many critical steps must be taken before instrumentation or other reusable devices can be re-sterilized or high-level disinfected, some of which are performed at the point of use.

Point-of-use treatment is an essential preliminary steps to effective instrument processing; spraying devices with moistening agents or enzymatic solutions whenever appropriate (or keeping instruments moist by covering them with a sterile–water-moistened towel) prevents bioburden and other material from drying and hardening on devices and making decontamination more difficult. This critical step is, unfortunately, often rushed or skipped altogether, making decontamination far more difficult and potentially impeding the sterilization process.

Device mishandling is another common occurrence by end users in procedural areas. Instruments may be misused, which can lead to breakage or patient injury; instrument sets may be carelessly mixed, increasing the likelihood for lost or misplaced devices; heavy instruments may be incorrectly placed atop delicate devices; cords may be too-tightly coiled; and more—all of which can contribute to costly damage and negative patient outcomes.

It is also helpful for SP leaders and physicians to work together to optimize instrument sets, remove duplicate or frequently unused devices from sets, and ensure that clinicians are educated on and comply with current standards, IFU and facility policies and procedures. This means ensuring they handle instruments and equipment with care, promptly returning post-procedure devices to the decontamination area and allowing enough time for instruments to be thoroughly processed for the next procedure.

Patients place their trust and lives in the hands of their healthcare providers. Infections and other negative patient outcomes can arise because of inadequate or incorrect practices, such as those related to instrument and equipment care and handling and processing, but the problem doesn’t rest solely on those in the SPD. To mitigate those risks, leaders must encourage interdisciplinary partnerships and proactively assess practices in the SPD and procedural areas to ensure each department has the training, resources and support to perform their duties safely, consistently and effectively.

David Taylor III, MSN, RN, CNOR, is an independent hospital and ambulatory surgery center consultant and the principal of Resolute Advisory Group LLC in San Antonio, Texas. He has served as a contributing author for the Healthcare Sterile Processing Association (HSPA) since 2019.

 

Prioritizing SPD Service Excellence Spurs Safety, Positive Outcomes

By Tony Thurmond, CRCST, CIS, CHL, FCS

This article originally appeared in the March 2023 issue of Healthcare Hygiene magazine.

In the absence of knowledgeable, skilled and safety-focused sterile processing (SP) professionals, Surgical services staff and those in other patient-care areas the sterile processing department (SPD) serves would not have the required instrumentation and equipment to perform surgical and medical procedures. What some SP professionals may not realize, however, is that the quality of the work they provide every day not only hinges on job competencies and standards knowledge but also the way they interact with their departmental and interdisciplinary teammates.

All healthcare workers, including those in the SPD, must consider what makes their encounters with others in the organization successful and productive. It is rewarding to provide services for a customer (and ultimately, the patient), but we can also benefit by reflecting on customer service and our ongoing exchanges with those we serve and with whom we work. It’s not uncommon to complete a task or service request and then move to the next one with little thought, especially during more demanding, hectic shifts (or when service is delivered without disagreement, discontentment or other challenges). However, becoming more aware of our customer and co-worker interactions and more intentional with how we respond during those interactions will strengthen relationships and prompt even greater communication and service delivery.

Service-oriented individuals anticipate and strive to appropriately meet the needs of co-workers, customers and others within the organization. They demonstrate integrity and compassion for those they serve and recognize that each interaction and instrument processed should be done in a manner that contributes to the safest, more effective and efficient patient care possible. SP teams committed to meeting the needs of all departments they serve within their organizations must exhibit some crucial traits to help them provide consistent, high-quality service, even when faced with seemingly insurmountable pressures and challenges. When practiced and honed, these traits and characteristics will contribute to improved service and positive patient outcomes.

Empathy: Empathy is the ability to understand another person’s view, feelings or experiences. While another individual’s perspective may not always align with our own, we should work to understand another’s perspective. Those who work (and lead) with empathy gain more understanding of customers’ needs, allowing them to respond to service requests more effectively and expeditiously. If an OR circulator requests an item by an incorrect name, for example, SP technicians should recognize that circulators do not routinely scrub for procedures and may not know the correct name of the device needed—and the item could be urgently needed. Understanding that the circulator’s current environment may be tense and uncomfortable and that their tone or mannerisms may reflect that situation will help those in the SPD to respond to the request calmly, helpfully and efficiently.

Adaptability: SP professionals’ ability and willingness to shift, remain flexible and learn new ways of meeting customer needs is crucial. Each SP customer differs in their needs and the urgency of their requests, and service-oriented SP professionals are prepared to adjust their approaches and communication with each encounter. SP professionals (technicians and leaders) must be able to readily adapt to handle new expectations, demands and challenges.

Communicating effectively: Communicating clearly and precisely with customer and co-workers is vital for effective, productive interactions and outcomes. Service requests should be viewed as opportunities, not interruptions, and SP professionals must convey information clearly and promptly. Those in the OR and other service areas where urgent care is provided may not always understand why instruments or equipment can’t be provided immediately or as expeditiously as they may like (following the procedure or at another less-hectic time, SP professionals can benefit by sharing with customers the latest standards and instructions for use and why they each step in the process must never be skipped or rushed). It is vital that SP professionals clearly explain all available options, while also sharing as accurately as possible how long it will take to fully process and deliver an instrument or set for patient care. Following up to confirm that the SPD effectively met the customer department’s needs (and working collaboratively to improve service if errors occurred) also strengthens interdisciplinary communication).

Trustworthiness: Being a collaborative, safety-focused, transparent problem-solver who aligns with the latest standards, guidelines and best practices should be every SP professional’s primary goal. Mistakes happen and challenges and conflicts arise, but all healthcare professionals must be honest and forthcoming when errors and obstacles occur so proper resolutions can be collaboratively sought. No person knows every answer, but those who seek to find effective and timely solutions will be viewed as reliable resources and trusted teammates.

Knowledgeable (without limits): Engaging in continuing education and less-structured knowledge-building opportunities advances professional growth, boosts personal confidence and helps SP professionals stay sharp and navigate new challenges. New knowledge is cultivated by positive and difficult experiences and outcomes, allowing staff members to learn from mistakes and difficult scenarios. SP professionals can also benefit themselves, their co-workers and customers by deepening their understanding of others’ roles, needs and responsibilities. Familiarizing oneself with less-common or more challenging medical and surgical procedures, for example, can help SP technicians broaden their instrumentation knowledge and respond more effectively to unique or urgent requests.

SP professionals’ commitment to delivering the best possible service and communication with customers and co-workers strengthens teams, enhances collaboration and builds better relationships. With practice and intention, each of these traits can be sharpened, service delivery will be improved, and better patient outcomes will result.

Tony Thurmond, CRCST, CIS, CHL, FCS, serves as central service manager for Dayton Children’s Hospital. He is a past-president of the Healthcare Sterile Processing Association (HSPA) and a current HSPA board member.

 

Service-Oriented Sterile Processing Professionals: What It Means for Positive Outcomes

By Tony Thurmond, CRCST, CIS, CHL, FCS

This article originally appeared in the February 2023 issue of Healthcare Hygiene magazine.

In the absence of quality-focused, dedicated and skilled sterile processing (SP) professionals, operating room (OR) staff and other patient care departments would not have the instrumentation and equipment required for patient care. Meeting those needs requires SP professionals to remain dedicated to their competencies and ongoing knowledge advancement in the name of service excellence—and also effective communication with their healthcare customers to ensure needs are met and challenges are proactively addressed.

What makes for successful customer support and interaction? It is satisfying to complete a task for our customers, but it’s also essential to reflect on the encounter to assess opportunities for improvement. Unfortunately, with hectic and harried schedules, many may move on quickly from a conversation or other interaction, especially if the encounter was a positive one. But every exchange presents opportunities for growth and improvement. We just need to seek those opportunities.

Being service oriented is a helpful activity to supplies aid as needed and leads individuals to anticipate challenges and future needs and recognize how to best serve our co-workers and customers. A service-oriented person cares about others and strives to be available to meet their needs, efficiently, effectively and empathetically. Put simply, they are committed to enhancing the service they provide, even when that service is considered exemplary by healthcare customers. There’s always room for improvement, especially in the healthcare segment when patients’ well-being lies in the balance.

To develop ourselves as stronger service-oriented SP professionals, it is helpful to consider our everyday interactions. We interact with Surgical staff daily, for example, and they often look to us for answers and solutions to challenges the arise. This approach is often rooted in need and demand, not necessarily one that promotes effective interdisciplinary exchange or improved service. SP teams require tools and support to help them provide exemplary service in the face of demanding and challenging situations. The tools—knowledge, empathy, adaptability, communication and trustworthiness—may seem simple to attain, but they take effort and practice. Let’s explore how each tool can positively impact SP service quality.

Knowledge: Continued efforts to build job knowledge helps guide SP professionals through situations that may at first seem impossible to overcome. New knowledge often comes from experience, both positive and negative. Learning new roles and responsibilities helps all professionals gain that knowledge and also more confidence in their day-to-day roles and customer encounters. For example, it is helpful for SP professionals to study unfamiliar procedures, brainstorm scenarios where their help might be most beneficial, networking with other professionals to share experiences and identify best practices, and then sharing that information with others, including teammates and customers. Knowledge is valuable but only when it is put to good use and shared.

Many of us focus on the OR and other procedural areas as our customers, but we should also consider our own departmental co-workers as customers and adopt ways to support them more effectively. Our departmental teammates benefit greatly from our help, guidance, knowledge, mentorship and solid communication skills.

Empathy: Empathy is the ability to understand another person’s view, feelings or experiences. While their perspectives will not always align with our own, we have the responsibility to attempt to understand one another’s stance and seek common ground. A person who leads with empathy better understands each customer’s role and environment and respond appropriately. For example, when an OR circulator calls the SPD and asks for an instrument by the incorrect name, it’s important to remember that circulators are often mere messengers who often do not scrub for procedures and may not know the exact item they are requesting. The circulator may sometimes call with an urgent request due to an incident arising during a critical point in the procedure. Understanding that the circulator’s (or other OR professional’s) current environment may be tense and that their tone and urgency is rooted in a high-pressure circumstance can go a long way toward servitude and improved understanding. Having empathy and compassion in such situations helps SP professionals navigate a request more calmly and efficiently.

Adaptability: Nearly every job description in the SPD either requires flexibility and an ability to adapt to various pressures and challenging circumstances. The ability and, more importantly, the willingness of SP professionals to shift, adapt and learn new ways of working with customers is necessary in today’s fast-paced, high-pressure environment. Each SP customer is different and has a variety of needs, so SP professionals must be prepared to adjust their approach with each interaction.

Communication: Communicating clearly and precisely is crucial for every customer interaction. Avoid approaching a service opportunity with the mindset that the request is an interruption or inconvenience, and work at bringing a solution to a problem. Explain the available options and maintain a pleasant, helpful tone. Equally important is following up with the customer to confirm that the service provided met their need. If not, openly discuss what would have been a better alternative.

Trustworthiness: Being a solutions provider for customers must be a top priority for all SP professionals. They will not always have an immediate answer to every situation, but they should commit to seeking answers in the name of service excellence, knowledge growth and professionalism. Showing consistent initiative to find the best solutions to problems in a timely manner builds interdisciplinary trust and more powerful relationships.

SP professionals’ willingness to continually improve their support for co-workers and external customers helps build a stronger, more unified team that stays focused on best practices and service excellence. Providing the very best service not only helps create more satisfied SP professionals but also fosters greater satisfaction from healthcare customers, while promoting the highest level of care for patients—the most important customer of all.

Tony Thurmond, CRCST, CIS, CHL, FCS, serves as central service manager for Dayton Children’s Hospital. He is an HSPA Past-President who currently serves as a director on the Healthcare Sterile Processing Association (HSPA)’s board of directors.

Key Updates to AORN’s Revised Flexible Endoscope Processing Guideline

By Susan Klacik, BS, CRCST, CIS, CHL, ACE, FCS

This article originally appeared in the January 2023 issue of Healthcare Hygiene magazine.

The Association of periOperative Registered Nurses (AORN) recently released its updated Guideline for Processing Flexible Endoscopes, which incorporates research-based recommendations on flexible endoscope processing. The revised document provides guidance across all stages of flexible endoscope processing, beginning with point-of-use treatment and followed by leak testing, manual cleaning, cleaning verification (CV), inspection, sterilization or high-level disinfection, drying, transport and storage. Further, the updated guideline provides recommendations for pre-purchase evaluation of reusable and single-use flexible endoscopes, the endoscope processing environment and related processing equipment.

Significant additions also made it into the revised guideline, beginning with the preliminary step of pre-purchase evaluation of flexible endoscopes, equipment or supplies that will be used for processing. Before any such items are purchased, AORN recommends gathering an interdisciplinary team to create a standardized process for product evaluation and selection. This team should include sterile processing (SP) professionals, and the product evaluation and review process should include examining criteria for flexible endoscopes, automated endoscope reprocessors (AERs), storage cabinets, borescopes, cleaning solutions, and detergents.

Sterilization and HLD updates

Similar to ANSI/AAMI ST91:2021 Flexible and semi-rigid endoscope processing in health care facilities, the updated AORN guideline recommends sterilizing reusable flexible endoscopes that have a manufacturer validation for sterilization whenever possible. The recommendation is consistent with the Spaulding Classification system, which labels items, such as flexible endoscopes, that come in contact with non-intact skin or mucous membranes as semi-critical devices and are recommended to be processed by sterilization or, at a minimum, by HLD. Additionally, flexible endoscopes and accessories that enter sterile tissue should be sterile when used or placed on a sterile field.

Not all flexible endoscopes can undergo sterilization according to their manufacturer’s instructions for use (IFU). Still, the recommendation notes that sterilization provides the highest level of assurance that processed items are free of viable microbes. If a liquid chemical sterilization (LCS) system will be used to sterilize an endoscope for a critical procedure, the endoscope should be immediately transported to the point of use in a closed processing container. Endoscopes used for a semi-critical procedure and are processed in a LCS system may be processed in the same manner as those that receive HLD.

Conversely, if processing flexible endoscopes using an HLD method, it is recommended to use a compatible Food and Drug Administration (FDA)-cleared AER per the manufacturer’s IFU. This process includes verifying that all connections are correct and then monitoring the cycle using all recommended monitoring tools. If manual HLD is performed, it is recommended to process endoscopes with a compatible FDA-approved high-level disinfectant in accordance with the manufacturer’s IFU and the AORN Guideline for Manual Chemical High-Level Disinfection. It is recommended to use an automated process for HLD instead of a manual process; automated processes may be more efficient and consistent and reduce employee exposure to high-level disinfectants. It is also recommended that flexible endoscopes be reprocessed the same way across all processing locations and shifts, including weekends.

Point-of-use treatment and leak testing updates

The point-of-use treatment recommendation now includes more point-of-use treatment steps. It includes a high-level diagram of a basic flexible endoscope and diagrams of three different types of flexible endoscope distal ends that emphasize their complex designs and differences.

Recommendations for endoscope transport to the decontamination area now include a hand-over process from the transporter to decontamination personnel. The process includes a list of information to accompany the endoscope; this should include the time that point-of-use treatment was completed, whether that treatment began immediately after the endoscope’s use, and whether the endoscope was kept moist until point-of-use treatment was performed. Another important point communicated in the guideline is what the endoscope was exposed to during the procedure (e.g., simethicone, lubricants, tissue adhesives).

Leak testing is an especially vital step in flexible endoscope processing. Verification of the leak tester’s pressure accuracy or calibration of automatic leak testers ensures that the leak tester is producing the correct pressure. Under-pressurizing an endoscope may allow a leak to go undiscovered, and over-pressurizing may stress the seals and damage the endoscope. A new recommendation was added to verify the pressure of the leak tester in accordance with the manufacturer’s IFU. When using an AER that has a mechanical leak test, it is also recommended that the leak test performed by the AER be considered as an adjunct to leak testing performed before manual cleaning. Note: Mechanical leak testing in an AER is not a substitute for leak testing performed before manual cleaning as recommended in the endoscope manufacturer’s IFU.

CV, drying, storage & transport

New recommendations for cleaning verification (CV) were added. The previous version of the guideline featured a conditional recommendation that internal channels may be inspected with a borescope, whereas the new version recommends using a clean borescope to visually inspect accessible channels of flexible endoscopes before sterilization or HLD. Healthcare organizations should identify high-risk flexible endoscopes and those devices should undergo CV testing after each use, with the results documented. If the endoscope does not pass the CV test, the endoscope should be re-cleaned and re-tested. If the device repeatedly fails CV testing, it should be removed from service and labeled as needing repair to prevent it from being used.
Research has shown that moisture retained in processed flexible endoscopes has been associated with patient infections, biofilm growth, microbial contamination and increased adenosine triphosphate (ATP) values. Thorough drying is so essential that there is a recommendation to perform drying even when using an AER with an air purge cycle or extended dry time feature. It is recommended to dry all accessible channels for at least 10 minutes and, if visible moisture is still present, to extend the dry time until visible moisture is no longer observed. The recommendation also provides guidance on using the endoscope immediately or placing it into storage. Storage time for endoscopes varies for each facility based on numerous factors. To help determine endoscope storage time, a new conditional recommendation was added on conducting a storage time risk assessment.

A new section was added on transporting the endoscope to the point of use. Recommendations are provided for how to transport endoscopes, which type of container to use, and how to properly clean and disinfect the container. A conditional recommendation is provided that does not require an endoscope to be placed inside a transport container when transporting it to the point of use as long as it is transported through a controlled and connected corridor within the Endoscopy suite.

Another section was added on prion transmission (e.g., Creutzfeldt-Jakob Disease). Evidence shows that flexible endoscopes may be used on patients who are at an increased risk for prion diseases as long as the devices are processed using standard procedures for cleaning and sterilization or HLD. The reason for this recommendation is that flexible endoscopes do not become contaminated with the high-risk tissue for prion transmission and, therefore, do not present a risk for prion transmission.

Education and competency recommendations

The revised guideline’s leadership recommendation states that leaders should ensure there is sufficient time and staffing to perform all processing steps in accordance with the manufacturer’s IFU, standards and regulations, and recommendations are provided to help leaders achieve those critical goals. With research showing the importance of point-of-use treatment, the revised version also features education-based recommendations for personnel at the point of use who handle flexible endoscopes.

Further, while the use of borescopes allows processing personnel to detect debris and other flaws within the channels of endoscopes that may otherwise go undetected, these inspection devices may present challenges regarding identification and interpretation of findings. In light of that, a recommendation was added for personnel who perform borescope inspection of accessible flexible endoscope channels before sterilization or HLD to receive education and complete competency verification on borescope activities.

This article provides only a high-level summary of some of the key changes to the revised AORN Guideline for Processing Flexible Endoscopes. The complete revised AORN Guideline for Processing Flexible Endoscopes provides more information and has been updated in the eGuidelines Plus at https://www.aorn.org/eguidelinesplus. The 2023 print version is available for purchase on the AORN website at www.aorn.org/.

Susan Klacik, BS, CRCST, CIS, CHL, ACE, FCS, is a clinical educator for the Healthcare Sterile Processing Association (HSPA).