Enhanced SPD Cleaning Practices Aid Infection Control Efforts

By David Taylor III, MSN, RN, CNOR

This article originally appeared in the December 2022 issue of Healthcare Hygiene magazine.

Preserving our commitment to patients requires significant moral courage and years of exceptional preparation. Today’s sterile processing (SP) technicians practice in very complex, stressful environments, which can lead to missed steps or complacency and create the potential for a high-risk environment that can jeopardy employee and patient safety. SP professionals are exposed to potentially deadly bloodborne pathogens, healthcare-acquired infections (HAIs), and a host of other environmental exposures. Operational factors and clinical characteristics in sterile processing departments (SPDs) can influence outcomes, including the risk for surgical site infections (SSIs) and an increase in morbidity and mortality rates.

Cleanliness is imperative in any healthcare setting, and in the SPD, that pertains to instruments, equipment and the environment itself. Unfortunately, nosocomial infections continue to harm patients. SSIs alone continue to affect 2 percent to 5 percent of surgical patients.1 It is estimated that 40 to 50 million surgical procedures are performed annually in the U.S.2 Statistically that totals 800,000 to 2.5 million SSIs per year, which cost U.S. hospitals an estimated $3.3 billion, extend hospital lengths of stay by 9.7 days, and increase the cost of hospitalization by more than $20,000 per admission.3 How many of those infections are attributed to SPD is unknown; however, failing processes, missed steps or poorly managed departments can be a factor.

SPD cleaning often falls short

In the second half of the 19th century, Florence Nightingale’s developed the environmental theory focusing on external conditions that suppressed or contributed to disease or death. Using mathematical statistics to prove cleanliness made a difference; she found that soldiers were 10 times more likely to die from “filth diseases,” such as cholera, dysentery, typhoid and typhus, than those who were injured by bullets or cannon fodder.4-5

Although environmental services (EVS) professionals are responsible for more thorough departmental cleaning, it is still the role of every SP profession to ensure that their workspaces are kept clean, and orderly and that trash and other debris are picked up from floors and other surfaces, and properly disposed. Unfortunately, in my consultant role, I’ve seen countless instances where SPDs and other areas where instrument reprocessing occur are not being cleaned and maintained properly. In fact, when working with numerous clients throughout the country over the past several years, I have rarely seen SP staff damp-dust their workstations or even restock their supplies as they should. I’ve also witnessed sticky substances from tape and chemicals are often found on various surfaces (workstations, instrument pans and baskets, computers, and even on instruments) and unclean and clutter workspaces are all too common—and many facilities fail to notice.

Work areas (decontamination, assembly/sterilization and storage areas) must be cleaned daily, prior to the start of each shift. Individual workstations should be cleaned daily and as needed. Sticky residues, tape and other substances must be removed prior to cleaning devices and other surfaces to ensure the appropriate chemicals used for cleaning come in contact with the surface. Equipment should also be wiped down daily, and areas behind and around processing equipment should be free from dust, dirt, dead insects, wrappers and other debris.

Budgets’ impact on cleanliness

Hospital procedural areas are revenue generators. In some cases, surgical services can generate two-thirds of topline revenues and as much as 60 percent of an organizations margin.6 As reimbursement opportunities continue to erode, hospitals are faced with making difficult decisions to maintain their budget, and non-revenue-generating departments, such as the SPD, may face the most budgetary restrictions. If budgets affect hiring, for example, there may be too few technicians in the department to keep up with the instrumentation volume and also properly and consistently maintain the departments. It’s a slippery slope that can negatively affect employee and customer satisfaction, while also increasing the risk for contaminated surfaces and devices.

Daily, weekly and monthly cleaning should be supported by shift leaders. They should ensure employees across all shifts understand the cleaning requirements and why they are so important to infection prevention and patient and staff safety. Documenting routine cleaning is important and SP supervisors and managers should consistently review cleaning logs to ensure they are being maintained. Terminal or deep cleaning of walls, ceilings, light fixtures, shelving units, underneath and behind equipment and so on occur on a regular schedule (weekly, monthly, quarterly or as needed/determined by the facility). If areas or surfaces in the department remain unclean after EVS treatment, the SP manager should consider taking photographs of the issues and sharing them with the EVS manager.

In conclusion, maintaining clean, well-organized departments is essential for operational efficiency and productivity, but more important, for helping prevent infections. SP leaders must ensure that their teams have the training, resources and support they need to keep their department and work areas clean and tidy. Doing so will help promote employee satisfaction, while also improving patient care and positive outcomes.

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 an HSPA contributing author since 2019.

References:

Nosocomial infections: Epidemiology, prevention, control and surveillance. https://ac.els-cdn.com/S2221169116309509/1-s2.0-S2221169116309509-main.pdf?_tid=6aa11690-0dd8-11e8-90f1-00000aab0f27&acdnat=1518208559_38b0d1a3414db0fa63e9bf467593db09
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7388795/#:~:text=Globally%2C%20a%20staggering%20310%20million,and%2020%20million%20in%20Europe.
https://www.cdc.gov/nhsn/pdfs/pscmanual/9pscssicurrent.pdf
The Florence Nightingale’s Environmental Theory: A Critical Analysis http://www.scielo.br/scielo.php?pid=S1414-81452015000300518&script=sci_arttext&tlng=en
How Florence Nightingale cleaned up “hell on earth” hospitals and became an international hero. https://www.pbs.org/newshour/health/florence-nightingale-cleaned-hell-earth-hospitals-became-international-hero
Perioperative Leadership: Managing Change with Insights, Priorities, and Tools, AORN Journal, July 2014 Vol 100 No 1

For further reading:

Central Service Leadership Manual, Third Ed. “Maintaining a Clean Environment.” pp. 141–142. HSPA. 2020.
Central Service Technical Manual, Eighth Ed. “Work Area Cleanliness.” pp.113–114. HSPA. 2016.

 

Honorary Weeks for SP, IP, OR Disciplines Offer Unique Ways to Strengthen Teamwork

By Julie E. Williamson

This article originally appeared in the November 2022 issue of Healthcare Hygiene magazine.

Sterile Processing Week and International Infection Prevention Week were both celebrated a day apart in October, and November brings Perioperative Nurse Week (Nov. 13–19). All three consecutive events create a perfect opportunity to improve interdisciplinary support, appreciation and recognition.

The Healthcare Sterile Processing Association (HSPA) encourages sterile processing (SP) professionals to extend their reach beyond their department walls and strive to bridge gaps and strengthen partnerships with operating room (OR) professionals, infection preventionists and other interdisciplinary teammates. The OR relies heavily on SP professionals to provide clean, sterile, well-functioning, and properly maintained and managed instruments and equipment to meet patient and procedural needs throughout the day. Each SP professional’s dedication to following the latest industry standards, guidelines, best practices, and instructions for use (IFU) directly affect infection prevention and control efforts, quality customer service and patient outcomes. At the same time, OR team members can contribute to the success of their SP partners by performing proper point-of-use treatment on instruments during and immediately following their use and then ensuring all used devices are transported as quickly as possible to the SPD’s decontamination area to help prevent bioburden from drying and hardening on instruments and difficult-to-remove biofilm from developing on their surfaces.

Although SP and OR professionals—and even infection preventionists (IPs)—have different core roles, each shares an essential mission: preventing infections and promoting safe, timely, high-quality patient care. The close interworking of these three allied professions accentuates the value of taking time to honor each during their official celebratory weeks and then fostering strong and productive teamwork throughout the year.

Amp up the appreciation, education

In October, HSPA and Healthcare Hygiene magazine partnered for the 2022 virtual Symposium on Sterile Processing & Infection Prevention, which provided free top-quality education (worth six continuing education credits) and valuable networking opportunities. The three-day live event launched during Sterile Processing Week (Oct. 11-13), with all content now provided on-demand for registered participants through Dec. 31, 2022. Some of the event’s education addressed the critical importance of aligning SP professionals with their IP and OR peers and other allied departments, and even fostering more effective relationships with those in the C-suite. (If you missed any of the sessions, they are now also accessible on the Healthcare Hygiene magazine website at: https://www.healthcarehygienemagazine.com/test-2/sp-symposium-sessions/)

During each discipline’s honorary week, it is beneficial to invite broader participation and support through departmental tours, targeted educational offerings and open house events. For Sterile Processing Week, for example, HSPA encourages SP managers to invite other departments and facility executives to the department for a tour of each SP area, educational in-services, potlucks, and other activities promoted by the SP team that can help demonstrate the profession’s many vital roles and contributions.

“When people who aren’t overly familiar with the SPD come to the department, they are often shocked by all that takes place there, and how much detail and expertise is required to complete every step and stage in the process,” said HSPA director of education Natalie Lind, CRCST, CHL, FCS. “Including customers, executives and others to the SPD helps promote valuable teaching and communication moments. The OR and other direct patient care areas the SPD serves can receive valuable hands-on training about proper point-of-care treatment and prompt delivery of used instruments to the SPD, effective management of loaned instruments, biofilm risks, standards updates, facility policies, avoidable instrument damage, and more.

With Infection Prevention Week immediately following Sterile Processing Week, and Perioperative Nurse Week approaching shortly thereafter, reciprocal arrangements are a prudent pursuit. As Lind points out, SP managers can invite their IPs and healthcare customers to present their own brief education during Sterile Processing Week, and then those departments can invite their SP teammates to their events to learn more about how the devices processed in the SPD are used in patient care. OR nurses, for example, can speak directly with SP staff during Perioperative Nurse Week to educate about particular instrumentation-related issues that challenge the OR team.

Of course, there are many other ways to recognize interdisciplinary partners and patient safety allies during their honorary weeks and throughout the full year. Each department can consider giving heartfelt cards and letters of appreciation—all signed by departmental teammates, across all shifts. [Note: HSPA created free, downloadable and customizable Sterile Processing Week templates, including certificates, awards, thank-you cards, and wall posters that can serve as templates for yearlong recognition and even be tailored to acknowledge the SPD’s support of IPs and OR nurses, for example. Visit https://myhspa.org/about/sp-week.html to access the downloadable items.]

“Thoughtful notes with a plate of baked good or other seemingly small tokens of appreciation can be very meaningful and help make all of our dedicated professional weeks of honor even more special and memorable,” Lind added, noting that not only should managers and supervisors take time to recognize their staff members, but they should also encourage their employees to recognize their peers. “People do good things every day, all year, so we should draw attention to that frequently. If we see someone going above and beyond, let’s recognize that and support their efforts. This is true of our own internal teams as well as those in the departments we serve.” Indeed, it does not take much to say, Thank you for your help or Thank you for your patience and understanding, or We appreciate the work you do and your willingness to partner even stronger for patient safety, Lind continued.

“This type of positive reinforcement and recognition, provided verbally and in writing, is what builds long-lasting camaraderie, promotes effective knowledge sharing and facilitates more effective teamwork. All that plays a significant role in quality service, patient safety and other positive outcomes.”

Julie E. Williamson is director of communications for the Healthcare Sterile Processing Association (HSPA).

 

Workplace Wellbeing: Overhauling Sterile Processing Employee Engagement Strategies

By David Taylor III, MSN, RN, CNOR

This article originally appeared in the October 2022 issue of Healthcare Hygiene magazine.

Employee engagement and satisfaction are critical components of any organization’s success and necessary ingredients for retaining and attracting top talent. A survey conducted by the American Psychological Association (APA) found that feeling valued at work is directly linked to better physical and mental health, higher levels of engagement, satisfaction and motivation.1 For that reason, today’s healthcare leaders must work to develop strategies that will inspire and empower their staff members to deliver their very best work every day and on every shift.

When an employee feels valued, it can significantly improve their workplace experience, leading to a healthy and productive relationship between the organization and employees. In turn, this directly benefits the company through improved productivity, efficiency, and staff retention.

Lead by example
Sterile processing (SP) leaders should lead by example and bring the same level of passion and energy to their roles as they expect from their employees. Showing employees what is expected of them always carries more weight than simply telling them what to do. When a leader is willing to pitch in and perform daily tasks of staff members to help ease their burdens, employees tend to respect those leaders more. Engaging employees is as much about giving them meaningful work as it is about creating an environment where they experience engagement daily.

If leaders are not passionate about their employees or are not adequately engaged in their own role, it’s going to be hard for anyone reporting to them to remain engaged. Author’s note: In my leadership positions, I never want to see my employees waiting for something do you. When they respond with, “Everything is done,” after being asked if more work must be done, that is my cue to engage them in other areas. I don scrubs and PPE and those staff members who are caught up with their tasks tour the department with me. During these tours, it’s not uncommon to identify disorganized or outdated supplies, tape or sticky residue on walls and equipment, or dusty and dirty areas that require attention. At that point, I start assigning the employees to various tasks and I share with them my philosophy: “If you have time to lean, you have time to clean.” It is important to note that I also tackle some of those tasks and clean and organize alongside them. This gives me an opportunity to remember what it is like to be a technician and understand their roles and challenges. When the tasks are complete, I share with them that a clean and organized department is an expectation and, going forward, they must manage that expectation. When employees know their clear expectations, they can rise to meet them and take pride in the work they do.

Create a culture of gratitude, respect
SP leaders and other organizational leadership and executives who show gratitude for the work employees perform daily can significantly improve staff members’ workplace. Gratitude shared among employees also pays big dividends. Leaders who develop peer-to-peer recognition platforms can make recognition more authentic and deeply focused on individual qualities and contributions. When praise is given to employees, satisfaction can improve, and new opportunities can emerge.

One effective strategy I recently discovered and added to my engagement initiatives was to encourage staff to recognize one other with notes and words of wisdom and appreciation. This public display of appreciation can build confidence, recognition and on-the-job satisfaction.

Another tool, known at the Gratitude Tree, was invented by a former Hewlett-Packard engineer,2 and features a colorful, attention-grabbing display that reminds departmental and interdepartmental employees to recognize and appreciate one another. Alongside the tree, staff members and even visitors can express their gratitude to employees, teams and departments for a job well done. Expressing gratitude in this way lifts spirits and reminds all team members of what is important.

Author’s note: In my leadership role, I worked with a local sign company and produced a colorful design that matched our unit’s personality and displayed it in a public area that could be easily seen by employees coming to and from work, and also for patients and their family members. We placed blank vinyl stickers and a pen in a tray near the tree for anyone (patients, staff, leadership, and employees from other departments) to write a personalized message and place it anywhere they wish on the tree.

Aim for public recognition
The work provided by healthcare workers, including SP professionals, is challenging, so it is important for leaders to incorporate fun activities that help their teams bond with one another. Consider providing activities that allow employees to relax and cut loose briefly. This could include a pizza party or ice cream social, team-based games that test SP-related knowledge, and the development of creative inspiration boards that employees decorate for others to read and explore.

Daily or shift huddles provide additional opportunities to recognize employees and give recognition for the contributions and successes. It is helpful for employees to hear from their managers that they successfully meet expectations when performing their various roles. Providing this type of reassurance can reduce employee stress, reinforce performance expectations, and promote enduring engagement. Reduced stress and improved satisfaction can also lead to better work outcomes because calmer employees may make fewer mistakes.

During one of my department’s huddles, an employee whose performance stood out during the previous shift received a rubber wristband with the message, “Bring Your ‘A’ Game.” At the next day’s huddle, that employee had the opportunity to recognize another team member’s exemplary performance by passing the wristband to that colleague. This public display of acknowledgment allows employees to share witness of their peer’s excellent performance and build camaraderie among the team.

Another effective way to show employee gratitude is through an article or advertisement in a monthly newsletter. The newsletter, which can either be issued only to SP staff or included as part of a facility-wide correspondence, allows for leaders to communicate important information to more individuals, including employee of the month mentions, words of appreciation for new certifications attained by employees, promotions, and other noteworthy accomplishments. Employee spotlights helps everyone get to know each other on a more personal level.

If budgets allow, leaders may also consider providing monetary incentives (movie or car wash tickets, gift cards, etc.) or snacks and meals during targeted meetings, education and training.

When employees have a safe space to share ideas you communicate that you appreciate the time and effort they put into their work and the ideas they have. If you as a leader respond to their communication in a positive way or implement an idea they had, it is likely they will feel an even greater sense of loyalty in and pride for their organization. In addition, these opportunities show your employees that you are vested and care about them and their careers.

When employees feel appreciated and supported by their leaders and teammates, they are more likely to recognize and communicate their appreciation with their colleagues and customers. This, in turn, can have a significant impact on workplace culture, employee satisfaction and retention, and improved work processes and outcomes.

David Taylor III, MSN, RN, CNOR, is an executive healthcare consultant for Resolute Advisory Group LLC, based in San Antonio, Texas. He has served as a contributing author for HSPA since 2019.

References:
1. https://www.apa.org/news/press/releases/2012/03/well-being
2. https://www.bizjournals.com/washington/news/2018/07/18/a-local-woman-invented-a-gratitude-tree-now-shes.html

 

Who’s Responsible? Broken Processes Create More SPD Workload, Obstacles

By David Taylor III, MSN, RN, CNOR

This article originally appeared in the September 2022 issue of Healthcare Hygiene magazine.

Sterile processing (SP) operations and work systems are critical to hospital and healthcare organizations’ surgical and procedural programs, and SP professionals’ daily contributions factor heavily into patient outcomes. Despite this critical role in the surgical “ecosystem,” many SP departments lack the financial support, respect and understanding needed to help their technicians keep pace with customer and procedural demands and the rapidly changing aspects of surgical care.

The tasks for which SP technicians are primarily focused are numerous and include (but are not limited to) decontamination, inspection, assembly, preparation, equipment loading, process verification, sterilization or high-level disinfection, biological testing, distribution, and storage. Much of that work is a shared responsibility, even though the SPD is often expected to own those responsibilities solely. Too often, healthcare workers in procedural areas fail to understand and take ownership of their roles in the process, which can place additional burdens on SP technicians and impede their ability to process and manage instrumentation and medical equipment efficiently, safely and in accordance with the instructions for use and latest standards, guidelines and best practices.

Those in the SPD must interact with numerous other departments and professionals every day. SP professionals must have the support to ensure they have the proper tools, technologies, work environment, processes and procedures to manage their challenging workloads effectively each day and across all shifts. Reaching that goal requires an interdisciplinary commitment and an understanding that many departments are responsible for quality outcomes, not just those managing instrumentation in the SPD.

Water quality
Water quality is an organizational responsibility. If water quality standards fail to meet the end users’ needs, SP processes will break down, causing delays in instrument reprocessing. Often, those working in procedural areas do not focus on water quality and related issues—they just want to receive the instruments and equipment needed to perform their work. Still, it is necessary for all departments to know how water quality issues impact the workload within the SPD, and the instruments used to perform patient care.

If water is improperly treated, the impact on surgical instrumentation can be profound. If instrumentation is stained or showing signs of corrosion, for example, those devices must be pulled from circulation and promptly addressed to minimize patient risk. If there is no back-up set or instrument to replace the stained, corroded or otherwise damaged device, patient cases may be delayed or canceled altogether.

Point-of-use treatment
Point-of-use treatment, formerly referred to as point-of-use cleaning, refers to the removal of gross contamination (blood, tissue, bone, etc.) from reusable medical or surgical instrumentation in areas where patient care procedures are performed. This process should occur either periodically (during the procedure) or immediately after use, but before instruments are sent to the decontamination area in the SPD.

Removing gross soil—and moistening instrumentation with an approved wetting agent or even covering instruments with a water-moistened towel—helps prevent organic material and debris from drying on instruments, including lumened devices. It is much more difficult to remove organic material and debris from surgical instruments when they are allowed to dry, and residual soil can affect the efficacy of disinfection and sterilization. Removing organic debris also helps prevent the formation of biofilm, an accumulated biomass of bacteria and extracellular material that adheres tightly to a surface and cannot be removed easily. Note: The term “point-of-use treatment” was adopted in standards and guidelines in recent years because it better encompasses the activities that should take place at the procedure site to prepare instrumentation for transport to the decontamination area. “Point-of-use cleaning” terminology led to confusion because some assumed that thorough device cleaning should be performed in the surgical suite or other patient care areas following the procedure, which was not the intended purpose.

Once the instrumentation has been prepared for transport, it is critical that the devices be moved to the decontamination area immediately or as soon as possible to ensure the instruments don’t dry and can be subjected to prompt and thorough cleaning. Making the sterilization process less complex and more visible, managing interruptions during case cart preparation, improving communication with the procedural areas such as the OR, and improving workspace and technology design could further enhance reprocessing performance.

Low-quality, inadequate instrument repair
Organizations that adopt proactive instrument maintenance practices can positively impact physician and employee satisfaction, operational and capital budgets, instrument lifespan, and patient safety. Failure to support a robust surgical instrument repair and maintenance program can affect not only instrument/device quality but also the duration in which an instrument or set is unavailable due to extensive repairs or need for replacement.

The time it takes SP professionals to locate an adequate instrument replacement can also jeopardize patient safety. When instruments in use aren’t properly maintained, patients can experience longer procedures, extended anesthesia exposure and other negative outcomes. One example: if insulation in laparoscopic insulation becomes compromised, patients can experience life-altering thermal injuries.

Inadequate instrument inventory
Many organizations fail to invest in the appropriate number of instruments or sets to support their surgical programs and case volume. As a result, SP professionals must repeatedly reprocess the available sets in inventory, which again can result in case delays (or unsafe rushing of processes to meet demand), device overuse, added work, diminished staff and physician satisfaction, and increased patient risk. Additionally, healthcare organizations often fail to effectively address SP needs and growth patterns, surgical volume changes or the addition of new physicians and specialties.

To better support these programs, SP leaders must be kept informed of changes so they can prepare for and meet customers’ evolving needs. New physician recruitment is critical for advancing surgical programs and offering specialties communities need; however, those in the SPD cannot support physicians effectively and efficiently in the absence of proper information, tools, equipment, space/workflow, and staffing. SP leaders must also be involved in instrument purchasing discussions to ensure that the SPD has the necessary resources to process and manage the new devices or equipment according to IFU and standards.

As surgical procedures become increasingly complex, and the instruments required to support those programs become more sophisticated and challenging to clean, inspect and otherwise manage, it is imperative that organizations give SP professionals the deeper support needed to perform their daily responsibilities safely, effectively and efficiently.

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 an HSPA contributing author since 2019.

 

Core Skills to Scale the Sterile Processing Leadership Ladder

By Tony Thurmond, CRCST, CIS, CHL

This article originally appeared in the August 2022 issue of Healthcare Hygiene magazine.

Sterile processing (SP) technicians observe their departmental leaders every day and witness their responses to challenges and how they support the team. They may also routinely see their fellow technicians rise up and assume an informal leadership role, sharing their knowledge and skill sets with their colleagues for the sake of quality and professionalism. This can then help light a spark for other SP professionals who may seek more responsibilities and, perhaps, even a formal or informal leadership role of their own.

SP professionals of all titles and tenures know the qualities they hope to see in a leader: strength in character and integrity, knowledgeable and eager to continue learning, willingness to mentor and encourage employee growth, empathetic to their team’s needs, and a willingness to roll up their sleeves and assist when needed. Those interested in attaining a leadership role will need to bring those same qualities to their own daily routines and hold themselves to the same high standards and behaviors. They should begin by examining the motivation behind their interest in a leadership position. If increased pay is the primary driver—as opposed to having a sincere desire to help support and serve the department in a way that promotes quality, safety and understanding, employers and teammates will see the truth. SP professionals should look inside themselves and ask questions that will help determine whether they are ready for this next move.

What follows are some leadership strengths and approaches that will help prepare SP professionals to climb higher in their careers.

Set a realistic pace. Climbing the SP leadership ladder is not a one-size-fits-all endeavor. The goal for some will be reach the very top and then keep aiming for even loftier career pursuits; for others, fewer rungs will need climbing to reach their goal. Regardless, the following traits and skill sets will help them succeed and build necessary trust.

Sharpen knowledge through experience. Sterile processing is a career where one does not just arrive and become an immediate expert. Knowing the role of the technician is the first step toward becoming a strong, effective leader. ANSI/AAMI ST79, Comprehensive guide to sterilization and sterility assurance in health care facilities, states that supervisory personnel should be competent and qualified for the supervision of all preparation and sterilization functions (i.e., decontamination, inspection, preparation, packaging, sterilization, storage, and distribution). Education, training and experience prepares them for this responsibility. ANSI/AAMI ST79 also recommends that the minimum recommended qualifications include certification, demonstration of job knowledge and adequate relevant experience in healthcare-related work. Knowledge of and experience with state and federal regulations — such as those from the Occupational Safety and Health Administration (OSHA) —are also required. Leaders, like all other SP professionals, must continue making education, knowledge and professionalism a top priority throughout their entire career.

Listen well. The ability to listen well is paramount to becoming a successful, respected leader. Hearing and listening are two very different abilities. A leader should be able to hear and listen as staff members come to them with a situation, challenge or idea. Leaders and would-be leaders must be prepared to ask the right questions and dissect the true meaning of what’s being conveyed. At times, employees may have an idea or solution they’d like to share—perhaps one that deviates from current practice or the status quo. Effective leaders are always willing to listen to new ideas and perspectives and be open to challenging “the way things have always been done.” Determining what the team needs and asks for comes from experience.

Hone decision-making skills: When situations within the department arise, solid decision-making skills are needed set the best plan into action. Many decisions that must be made will already be addressed in the department’s policies and procedures; however, some individuals may be asked to circumvent those policies and procedures to satisfy another person’s or department’s needs. It will always be necessary to stick to safe, standards-based processes and best practices and explain why some requests or proposed changes cannot be made. Simply stating “because it is in our policy” will not be effective or adequate. Explaining why the process must be followed (and backing that with standards, best practices, instructions for use, and internal policies and procedures) will help sidestep any risks and reaffirm one’s commitment to doing what is best for the patient.

Serve as a trusted advocate. Patient safety must be every healthcare professional’s priority and must always serve as the foundation for all that is done within the department. Maintaining that focus will guide SP professionals to become the best leaders possible. Effective leaders also advocate for their employees. Telling the operating room team that the SP team accomplished a monumental task and was able to prepare everything needed in a short period of time, for example, helps build the respect and interdisciplinary teamwork, and shows the employees that they are supported and appreciated. The same is true when problems arise. If an employee is berated by a customer for a mistake or an unwillingness to rush a process to meet unrealistic turnaround demands, for example, intervening on the employee’s behalf (or guiding them toward an effective discussion/response) can help improve future service delivery and expectations.

Demonstrate fairness: Leaders must always strive to treat each member of the team as equally valuable contributors. Frequent rounding of the department is a great way to engage and interact with all members of the team and to keep a steady finger on the pulse of what’s happening each day and with all employees.

Maintain integrity: Integrity is an essential trait for every SP professional, regardless of title. A leader whose integrity never wavers helps clearly show what is expected of the entire team, regardless of the challenges that may arise. It also demonstrates that separate rules don’t apply for leaders and technicians—a point that helps instill trust and mutual respect. A leader that possesses and demonstrates strong integrity, respect and a desire to treat everyone fairly and equally creates a healthy atmosphere of “psychological safety.”

As one aims to climb the SP leadership ladder, practicing and perfecting these traits and skills will not only positively define them as a professional, but as an effective leader. Good leaders will always be needed and if an SP professionals is willing to put in the work, their time will certainly come.

Tony Thurmond, CRCST, CIS, CHL, is central service manager at Dayton Children’s Hospital.

 

SPD Transparency Delivers Facility-Wide Benefits

By Tony Thurmond, CRCST, CIS, CHL, FCS

This article originally appeared in the July 2022 issue of Healthcare Hygiene magazine.

Every sterile processing (SP) professional understands that cleaning instruments properly requires meticulous adherence to instructions for use and industry standards and diligent inspection to ensure any hidden bioburden is detected and addressed. Doing so also helps ensure that devices function well, consistently and as intended.

If SP technicians could hold up each instrument and see through it as if it were glass, that transparency would allow bioburden to be easily seen, which would facilitate proper cleaning. Fewer errors would be made, technicians’ jobs would be significantly less challenging, and patient safety and infection prevention would be improved. Certainly, clear instruments aren’t available; however, if SP professionals were to strive for greater transparency in their roles and within the workplace, positive developments would surely result. Being able to clearly see what is expected of SP technicians and their teammates is a crucial factor in the department’s success, as is communicating more transparently with SPD customers and instrument end users.

Workplace transparency can be loosely defined as functioning in a way that creates openness and honesty between managers, employees and other departments. Promoting and practicing transparency in the workplace pays big dividends but it takes planning and commitment. Transparency enhances trust, improves communication and employee participation and helps instill a desire to go the extra mile. This it is not a simple switch that gets flipped on but a day-by-day process that is nurtured by all sides in a quest for improved, bi-directional communication, planning and outcomes. How a manager defines and pursues transparency in the workplace may differ, but the underlying goal remains the same: to unite teams to openly discuss concerns, issues or ideas.

Determine the details to share. Managers know which types of information can and should be shared with all employees. Examples include short- and long-term goals and expectations for the department; daily needs to meet schedules/customer demands; quality improvement initiatives; policy and procedure updates; standards changes; new equipment and training needs; and so on. Conversely, some information may only need to be shared with mid-level management to help prepare them for an upcoming change or a plan of action that has not been finalized. Such instances do not erode departmental transparency; it’s simply unnecessary or unhelpful to bog all employees down with details and information that doesn’t directly affect them. Each manager should determine the level of transparency/communication for each circumstance and then filter information to employees when more details can or should be shared. If questions arise and managers lack complete details or are otherwise unable to share more at that time, it is best to be honest and explain that more details will be given later. Similarly, when an SP leader or technician fields a question from a customer that cannot be immediately answered, it is best to admit that more research is needed before an appropriate answer can be given.

Promote team integrity. Integrity it can be loosely defined as doing the right thing at all times, even when no one else witnesses it. Leaders and employees from other departments are expected to demonstrate integrity and they expect the same of those in the SPD. Admitting a shortcoming or taking responsibility for an error is more admirable than denying personal involvement and it’s an action that will be far more respected by the SPD’s colleagues and customers. When SP technicians and leaders consistently act with integrity and professionalism, fewer issues occur, problems and risks are mitigated, and teams can work collaboratively toward an effective resolution. It is also important that technicians not only demonstrate integrity with their own actions but encourage and promote it in their teammates. If they see someone taking a shortcut, for example, they should be politely reminded of the proper way.

Educate about the SPD. Those in the SPD should share their story and educate others about their many roles, responsibilities, successes and challenges—and how the way instruments are handled during and after use can affect reprocessing outcomes. If user departments fail to perform point-of-use treatment on instruments or transport devices improperly, for example, or they routinely schedule back-to-back procedures even though the facility lacks adequate instrumentation inventories, staffing and processing equipment to keep up with the demands safely, negative outcomes can result.

Cultivating a culture of transparency is vital in the healthcare environment where patient lives are stake, and it’s certainly essential in the SPD. Trust and respect are gained when information is shared openly and honestly, and when all employees take ownership for their mistakes and shortcomings. Further, positive outcomes and improved processes result when interdepartmental teammates understand others’ roles and challenges and work together on improvements.

Tony Thurmond, CRCST, CIS, CHL, FCS, serves as central service manager for Dayton Children’s Hospital. He is a columnist for the Healthcare Sterile Processing Association (HSPA) and past-president, and currently serves as a director on the HSPA board. He received his HSPA fellowship in 2021.

 

Sterile Processing Department PPE: A Shared Responsibility for Infection Prevention and Safety

By David Taylor III, MSN, RN, CNOR

This column originally appeared in the June 2022 issue of Healthcare Hygiene magazine.

The Occupational Safety and Health Administration (OSHA) requires employers to evaluate workplace hazards and gauge the risk of employee exposure. Employers must also implement a plan to mitigate exposure to hazards, select the appropriate protective equipment and ensure workers use those items to avoid exposure.1

Personal protective equipment (PPE) minimizes exposure to hazards that can cause serious workplace injuries, illnesses and death. These injuries and illnesses may result from contact with chemical, radiological, physical, electrical, mechanical or other workplace hazards or the spread of infection or illness. Examples of sterile processing-related PPE include but are not necessarily limited to the following:

• Scrub attire (depending on facility policy, a cover gown/lab coat may be worn to protect scrub attire when leaving the department for another area in the same facility)
• Moisture-resistant gowns and/or aprons
• Masks, face shields and/or goggles
• Gloves (of appropriate type, length and size for the task and individual employee)
• Shoe covers (to be worn with sturdy, non-skid shoes; to prevent contamination, it is wise to have shoes dedicated to the work area and not worn outside)
• Disposable, bouffant-type head covering to cover all head hair, minus eyelashes and eyebrows. Note: Skull-types caps are not recommended because they may not cover all head hair. Facial hair should be fully covered with an appropriate beard cover.

Healthcare organizations are responsible for providing the appropriate types of PPE as well as adequate supply levels and sizes for employee use. Since the COVID-19 pandemic, ensuring adequate supplies has been challenging due to supply chain shortages and increased supply demands; however, healthcare organizations must work diligently and proactively to help ensure they are doing everything possible to provide employees with the PPE needed to stay safe in the workplace. On April 1, 2021, a California law took effect requiring that hospitals maintain a three-month supply of PPE and create and maintain a three-month stockpile of N95 respirators, gowns and other PPE.2

While it is vital that healthcare organizations are held accountable for protecting their employees, employees also share in the responsibility of proper, consistent PPE use.

Donning and doffing steps

Careful donning and doffing of PPE in the correct sequence is essential for preventing contamination and exposure. Note: For a downloadable/printable reference on proper PPE use, including donning and doffing diagrams, visit: www.cdc.gov/hai/pdfs/ppe/ppe-sequence.pdf.

Unfortunately, some employees fail to perform proper hand hygiene after wearing PPE, neglect to wear proper eye protection or fully cover their hair or fail to use gloves properly when handling items containing blood or body fluids. Observations of healthcare workers in a university hospital in Germany revealed deficiencies in the use of recommended PPE among all observed healthcare workers while caring for COVID-19 and non-COVID-19 patients.3 Deficits in everyday handling of PPE have been observed previously, especially in regard to fitting and correct sequencing and use, and were found in 90 percent of personnel.3.4 Most commonly, errors occurred in the correct removal of gowns (65 percent) and contact with potentially contaminated surfaces (48 percent).4

In my consultant role, I have seen some alarming PPE-related missteps in various healthcare facilities. The following photos were taking over two days at a prominent teaching hospital in the Northeast. PPE was in disarray and employees spent several minutes sorting through the mess to locate the appropriate PPE when entering their decontamination area. When needed PPE was unavailable, they would search other areas of the hospital to try and locate the correct item. Employees at this facility were forced to use PPE that was either nonexistent, old and in disrepair, or improvised with other items that were often inappropriate for the task at hand. One example: when removing the rack from their steam autoclaves, employees used an old silicone protective glove designed for home use (or a hand towel) to protect themselves. All these silicone gloves in use in the department were torn and, when asked, employees admitted several co-workers had suffered burns while at work—and management was aware.

Assessments are essential

All healthcare organization and departmental managers must ensure that PPE is provided and used in accordance with the latest industry standards, guidelines, best practices, instructions for use, and policies and procedures. Diligent assessments of PPE supplies, storage and organization, donning, doffing and disposal should be conducted to keep employee and patient safety a top priority (this should also entail ensuring that proper sizes are available to meet all employees’ needs).

If supply and usage gaps are identified, additional employee training should be provided, ongoing assessments should be conducted, and managers should work closely with their materials management and infection prevention partners to help ensure all employees in the department have ready access to all necessary PPE.

David Taylor III, MSN, RN, CNOR, is an executive healthcare consultant for Resolute Advisory Group LLC, based in San Antonio, Texas. He has served as a contributing author for the Healthcare Sterile Processing Association (HSPA) since 2019.

References:
1. COVID-19 - Control and Prevention - Healthcare Workers and Employers | Occupational Safety and Health Administration (osha.gov)
2. New law requiring hospitals to maintain a three-month supply of PPE takes effect April 1 | National Nurses United
3. Adherence to personal protective equipment use among healthcare workers caring for confirmed COVID-19 and alleged non-COVID-19 patients | Antimicrobial Resistance & Infection Control | Full Text (biomedcentral.com)
4. Personal protective equipment doffing practices of healthcare workers: Journal of Occupational and Environmental Hygiene: Vol 16, No 8 (tandfonline.com)

 

A Case for Cost Analysis & SBARs: Ensuring SPD Gets What It Needs

By Julie E. Williamson

This column originally appeared in the May 2022 issue of Healthcare Hygiene magazine.

Many sterile processing departments (SPDs) struggle to attain the appropriate resources, products, staffing and equipment to ensure their teams are able to manage their processes and practices safely and efficiently. But experts assure that cost analyses, when implemented executed properly, can help sway the C-suite’s purchasing decisions in a positive direction.

As Jamie Zarembinski, clinical educator for sterile processing for Key Surgical, pointed out during her April 25 session at the 2022 HSPA Annual Conference, an effective cost analysis can significantly help SP leaders leverage data to help paint a clear picture of what the SPD needs and why allocating the resources can help the department, its customers and patients and the collective healthcare organization.

“The pressure is on the SPD to not only say ‘We need this,’ but also to share why,” she said, noting that the right information presented on a cost analysis sheet can help set SP leaders up for success when meeting with those in the C-suite, especially when the request can result in improved safety, infection prevention and process efficiency.

Cost analysis is more than just asking for money for resources, however. Zarembinski reminded that it is a tool that helps organizations analyze and make informed decisions related to potential new products and requested resources. Put simply, it’s a process that helps decisionmakers quickly determine the value of a particular request. “It isn’t enough to just say, ‘I want that.’ A cost analysis can help you build a story, so you know where your money is going,” she reasoned. If you can’t answer the question, ‘why do we need it?’ you won’t be able to get to the how.” To start, SP leaders can work on resource requests with their teams to determine wish lists and perceived necessities for the department. Zarembinski advocates for the creation of vision boards, allowing all team members to express visually and in writing their wants and needs, regardless of budget. “Imagine $10 million was put into your budget and then determine what you want most and why. There is no goal too big for you to put on a vision board.”

From there, the team should explore their existing processes and practices to ensure safety and efficiency are being prioritized. Without that, improvements won’t be made, regardless of the new product, piece of equipment or resource acquired. “You may want five new employees or another washer, for example, but you really need to assess your practices and [rely on standards, best practices and instructions for use] to help determine whether something else is going on that won’t be fixed by some new product or equipment. Otherwise, the new resource will just be a Band-Aid, and nothing will get better.”

Hit the High Notes
While telling the true story on a cost analysis sheet is essential for stacking the acquisition odds in the SPD’s favor, experts stress the importance of sticking to vital details, eliminating extraneous information that could muddy the request, and using data and scores that can be readily attained on the internet (such as the facility’s healthcare-associated infection scores provided by the Centers for Medicare & Medicaid Services) as a driving force behind the need.

A cost analysis sheet is relatively basic, and it should clearly help the C-suite determine the return on investment and value proposition for the facility. If a new washer is being requested, for example, it would be helpful to detail the department’s throughput and procedural volume to help establish the need and impact of the purchase—as well as the risks to the organization and patients if the acquisition does not happen (e.g., inability to meet surgical procedural volume, perils of operating a dated or poorly performing unit, and the increased risk of healthcare-associated infections as a result).

One common and effective resource request technique is known as the SBAR, which stands for Situation, Background, Assessment, and Recommendations. The Situation portion is a brief and factual statement of the problem (i.e., a dated and poorly functioning washer that cannot keep up with the facility’s demands and patient safety needs). The Background is used to highlight evidence-based guidelines and best practices (essentially explaining that without the adequate tools, equipment and/or well-trained technicians, the SPD cannot safely and effectively perform its vital roles). The Assessment portion allows SP leaders to share and interpret their findings. This should be written so that a person who doesn’t know much about day-to-day SPD operations can easily understand the basis of the concerns, noted Marie Brewer, CST, CRCST, CIS, CHL, CER, GTS, CLSSGB, Sterile Processing Manager for St. Luke’s Hospital.1

The Recommendations section is the “show me the money” portion—the full-time equivalents, tools, machines and products SP professionals need to follow IFU and protect patients and staff members.1 Proper documentation is also essential for making the case to the C-suite, Brewer explained, adding that photographs can be an effective way to document a problem and help connect the decisionmaker with the pain points of the Background section. She further stressed how citing or attaching evidence-based guidelines and publications that support the need for what is being requested can have a positive impact on the decision to sign off on a request.1

Turning a No into a Yes Sometimes, the C-suite declines resource requests, regardless of how well the request was executed. Fortunately, perseverance can pay big dividends for SP leaders.

Zarembinski shared a story of one manager who, after being promptly turned down for a request for a new cart washer, immediately concluded the resource request meeting by inviting the CFO to the SPD to see the department in action. The CFO accepted the invitation and after spending just a brief period in the SPD and witnessing the processes—and bottlenecks associated with wiping down the case carts—responded quickly to ensure funds were allocated for a new cart washer.

“Sticking your neck out a little and asking others to come in the department so they can see and understand the processes a bit and what goes on there can be very effective. Even if you get a thousand no’s, you can still get that yes.”

Julie E. Williamson serves as editor and communications director for the Healthcare Sterile Processing Association (HSPA).

 

SPD Renovation: Building in Quality, Safety, Infection Prevention

By David Taylor III, MSN, RN, CNOR

This column originally appeared in the April 2022 issue of Healthcare Hygiene magazine.

Despite the critical role sterile processing departments (SPDs) play in the delivery of safe, high-quality service and patient care, many healthcare organizations are making the mistake of overlooking these departments for renovations or new construction. The space an SPD has available can have a significant impact on its operations. Far too many healthcare organizations have grown in scope and size over the years while the SPD’s space needs have been neglected. If health systems fail to support SPDs’ role and build adequate space to allow SP professionals to properly handle their daily workloads, it’s not just SP professionals who will be adversely affected. Healthcare customers such as the operating room and Endoscopy can experience service challenges that lead to procedure delays and poorly functioning or contaminated instruments, and patients can experience extended procedure times, potentially life-threatening infections and other negative outcomes.

When it comes to SPD renovation or expansion, facility administrators face some difficult questions, including whether they should allocate financing to improve the SPD space or dedicate funding for other potential revenue-generating specialties (e.g., emergency department, endoscopy, interventional radiology). Whatever the decision, organizations must realize that failing to include SPD in their expansion or renovation plans is a short-sighted decision that will increase the odds for negative outcomes. Expanding the department’s capacity (square footage) and improving the infrastructure to support modifications in the SPD will improve efficiencies within the department (and downstream) and help improve processes in the OR and other procedural areas, thereby creating greater revenue streams.

Some of the challenges administrators must consider and address include:
• Advances in surgical approaches and new or specialized instrumentation and technology, all of which require specific sterilization equipment and processes (e.g., robotic-assisted surgical systems)
• Changes in recommended practice guidelines and standards by industry organizations and regulatory agencies
• Hospital or health system growth
• Increased case volumes or the addition of new surgeons and specialties, resulting in increased tray volume
• Increase in surgical schedules (extended hours and weekend schedules)
• Inadequate and deteriorating infrastructure (mechanical, electrical, plumbing, technology) that prevent the installation of newer, high-capacity equipment and technologies
• Inadequate space and inefficient workflow processes

SPD zone planning
How an SPD is laid out can have a significant impact on its productivity. Most SPDs are configured in either a two- or three-zone layout that follows a dirty-to-clean path and complies with industry standards and guidelines or regulatory practices. Departmental configurations vary and can include straight or L-, U- or Z-shaped flow patterns. Unfortunately, too many SPDs have been squeezed into spaces that may have been appropriate many years prior but are now inadequately sized to accommodate their organization’s growing needs.

SPD layout must provide physical separation between work areas to allow technicians to handle soiled material effectively and safely, clean, prepare, assemble, sterilize, store, and dispatch goods. SPD space planning should be based on the roles and responsibilities the department is expected to assume. Some crucial questions to be asked include:

• How many surgical (and other) procedures are projected daily and how many instrument sets are projected to be reprocessed by SP daily?
• How many procedures require vendor tray support?
• How many case carts, transport carts and/or container racks will be reprocessed daily?
• Will the SPD reprocess rigid and flexible endoscopes from non-surgical areas?
• Will pass-through sterilizers and cart washers be used?
• Will the SPD be responsible for durable medical equipment and supplies?
• Will the SPD manage restocking and reassembly of implants?
• How many full-time equivalents (FTEs) will work on the SPD’s peak shift?
• Is an area dedicated to donning and doffing personal protective equipment (PPE)?
• Are there dedicated receiving, breakout and inspection areas?
• Is an area dedicated to chemical storage?
• Is there adequate office space (private, shared, cubicle) and conference and classroom space?
• Is there dedicated space for instruments, containers and equipment in need of repair?
• Is a transitional space available for receiving and delivery?
• Is a dedicated holding and pick-up space available?
• Is enough storage space allocated for sterile consumables and durables?
• How is the department managing case cart assembly and dispatch?

Soiled drop-off/transition
Transition zones are often inadequate in the SPD, with many sharing space with the decontamination room, which creates areas of exposure and risk. Separating the main corridor from the decontamination workspace accommodates the temporary holding area for soiled carts, totes, medical equipment and vendor trays—without directly entering the decontamination workspace. More importantly, it creates a buffer zone that is a perfect location for instrument and equipment inventory and electronic tracking systems (delivery and pick up). Note: It only takes a few vendors to claim instruments and implants are missing from their trays to understand that the investment in such a dedicated space will pay big dividends.

Decontamination area
The decontamination area is used for unloading case carts, containers, etc. and cleaning, preparing and inspecting instruments. This area’s size should be based on the expected production requirements and range from small (approximately 600 square feet) to large (over 900 square feet). For example, SPDs that process fewer than 150 instrument trays daily may require a smaller footprint, while those that process 150 to 400 trays or more will need additional space. Keep in mind, surgical programs are expected to grow exponentially as the U.S. population ages, and there will be a growing need for more equipment to meet the demands and keep up with technological advancements. If an SPD is responsible for endoscope processing, additional square footage will likely be needed. Equipment needs (including automated cart washers) will help dictate the proper size of a space; it is important to consider the manufacturer, type and quantity of the equipment (currently in use and what may be needed in the future).

The decontamination area should include:
• A handwashing sink with emergency eyewash fixture
• Counter space or storage racks to prepare instruments and equipment for their first phases of cleaning
• At least one pass-through window large enough to accommodate all instrumentation and equipment
• A pass-through door for durable medical equipment
• Dedicated space if endoscope reprocessing will occur

Assembly area
SPD leaders should understand the various aspects the assembly area will accommodate. Like in decontamination areas, space needs will depend on the number of sets processed in a 24-hour period. Consider space needed for an instrument washer and pass-through window, an instrument unloading and preparation station, an instrument set assembly area, a workstation for inspection and quality assurance validation, a workstation for containerizing and wrapping sets, a dedicated space for telecommunication, computers, barcode readers/trackers and printers, and storage for supplies, instrument containers, wrappers, pouches, clean linen, etc.

Sterilization area
When considering space needs in this area it is important to know the type of equipment that will be processed, and which sterilization modalities will be used. Additionally, space should be allocated for biological monitoring and proper documentation. Again, space needs in this area will depend on the number of sets processed over 24 hours.

All-inclusive approach
Healthcare organizations must understand the SPD’s needs and workflow demands before determining renovation needs and next steps. When considering a renovation project, relocating the department, or building a new facility, healthcare leaders should first consider creating new-and-improved processes and workflows to help immediately resolve inefficiencies (this should always be done before beginning a construction project). When a renovation, expansion or new build is in order, a collaborative approach is vital and should include strong SP representation and other stakeholders (e.g., nurses, doctors, leadership, facilities and maintenance department, and construction personnel).

Collectively, the team must determine whether the project can be completed without disrupting services. It will also be necessary to update preference cards; determine instrumentation inventory for each surgeon and specialty (based on current and projected volumes per specialty); reassign, rebuild or decommission instrument sets from surgeons no longer working at the facility; evaluate instrument sets with each surgeon and determine changes in their practice that could impact instrumentation and equipment needs; standardize trays (adding new instrumentation as needed, removing excess instrumentation to speed production, and meeting set weight limits); evaluate containerization versus wrapping of instrument sets; review vendor tray opportunities (ensuring appropriate space for instrument arrival/check in and pickup/check out and removing excessive vendor tray storage.

When determining equipment needs and proper layout, it is also vital to identify instrument workflow and equipment paths, standardize workstation location and layout, and determine supply and equipment needs for inspection and assembly. Determining the SPD’s mission and fully understanding the customers they will serve—all while anticipating future space and resource needs—is also essential, as is a thorough evaluation of storage needs and options (e.g., vertical versus horizontal and automated versus manual). Facilities will also need to consider how the SPD will transport clean and dirty instruments (e.g., use of dedicated elevators or ensuring adequate staffing to facilitate transport to and from user areas), how many FTEs are needed to perform effectively in the new space, and whether the new SPD will require automated processes and perhaps even robotic assistance.

In conclusion, many factors come into play when considering SPD renovations or new construction. A team approach with representation from SP professionals and other stakeholders is critical to ensure that the SPD’s current and future needs are understood and supported. When organizations take time to carefully examine current processes, equipment and spaces and future requirements, they will experience a far greater return on investment.

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 an HSPA contributing author since 2019.

 

Current, Accessible Safety Data Sheets Critical for Safe SPDs

By Tony Thurmond, CRCST, CIS, CHL, FCS

This column originally appeared in the March 2022 issue of Healthcare Hygiene magazine.

Quality- and safety-focused sterile processing (SP) professionals arrive at work each day with the intent of performing their many critical duties to the best of their ability and with the hope that no safety issues befall them or their teammates. They don’t go to work, change into their personal protective equipment (PPE) and say to themselves, for example, “Today is the day I will receive a dangerous chemical burn.”

But what if today actually is the day a chemical-related safety event occurs? Is there a proper plan in place for managing the situation and preventing future injuries and incidents? Make no mistake, the numerous chemicals, sterilants and products SPDs rely on daily can present a serious safety threat, and everyone working in the department must know how to protect and care for themselves or their colleagues if an accident or exposure occurs. Knowing where to look for guidance is paramount for stemming the risks—and ensuring ready access to manufacturer safety data sheets (SDSs) should rank among the SPD’s highest priorities.

The Occupational Safety and Health Administration (OSHA) requires each employer to make SDSs available for every chemical used in a working facility and department. SP leaders must ensure all SDSs are readily accessible to their employees and that all team members know how to access SDSs for the products used in their department. If the SPD has a manual for the chemicals used, it must be readily accessible, and if SDSs are kept on a computer, all employees should have computers available for quick access and reference. All SDSs must be current and include the most up-to-date information (chemical manufacturers are required to provide an SDS for every chemical produced, and these vendors must update their SDSs as often as required to remain OSHA compliance). SP leaders should regularly review SDS content to ensure all employees are using the latest version.

SDS versus IFU
To promote a safe workplace, it’s essential that SP professionals understand the differences between SDSs and instructions for use (IFU) and not confuse their purpose. IFU provide directions of how to use the product whereas SDSs are directives that guide through proper storage, exposure, care and management of an exposure, and proper disposal of the chemical.

According to OSHA’s Hazard Communication Standard, SDSs must be presented in a user-friendly, 16-section format.
Section 1 – Identification: Identifies the chemical on the SDS as well as the recommended uses and supplier contact information.
Section 2 – Hazard(s) identification: Includes chemical hazards and warnings related to those hazards.
Section 3 – Ingredient composition/information: Identifies product ingredients outlined on the SDS, including impurities and stabilizing additives. This section also includes information on substances, mixtures and all chemicals where a trade secret is claimed.
Section 4 – First-aid measures: Describes the initial care that should be administered by untrained responders to an individual who was exposed to the chemical.
Section 5 – Fire-fighting measures. Includes recommendations for fighting a fire caused by the chemical, including suitable extinguishing techniques, equipment and fire-related chemical hazards.
Section 6 – Accidental release measures: Provides recommendations on appropriate response to spills, leaks or releases, including containment and clean-up practices to prevent or minimize exposure to people, property or the environment. It may also include recommendations that distinguish between responses for large and small spills (for incidents where spill volume has a significant impact on the hazard).
Section 7 – Handling and storage: Provides guidance on safe handling practices and conditions for safe storage of chemicals (including chemical incompatibilities).
Section 8 – Exposure controls/personal protection: Indicates exposure limits, engineering controls and PPE measures that can minimize employee exposure.
Section 9 – Physical and chemical properties: Identifies physical and chemical properties associated with the substance or mixture.
Section 10 – Stability and reactivity: Describes reactivity hazards of the chemical and the chemical stability information.
Section 11 – Toxicological information: Identifies toxicological and health effects information or indicates that such information is unavailable (includes routes of exposure, related symptoms, acute and chronic effects, and numerical measures of toxicity).
Section 12 – Ecological information: Provides information to evaluate environmental impact of the chemical if released into the environment.
Section 13 – Disposal considerations: Provides guidance on proper disposal practices, recycling or reclamation of the chemical(s) or its container, and safe handling practices.
Section 14 – Transport information: Includes guidance on classification information for shipping and transporting of hazardous chemical(s).
Section 15 – Regulatory information: Identifies safety, health and environmental regulations specific for the product that is not indicated anywhere else on the SDS.
Section 16 – Other information: Indicates when the SDS was prepared or when the last known revision was made and may also state where changes have been made to the previous version.

When evaluating and purchasing a new chemical product, the SDS should be carefully reviewed to ensure the department can meet the storage requirements and also ensure the department has the required PPE for use with the chemical. Chemical spill kits must also be readily available and visible to departmental staff. Because the IFU provides directions for proper product use, and the SDS provides directions for the exposure or spill of a chemical product, there will be times when SP professionals will need to refer to both. SPDs would benefit by holding in-services to discuss new products, explore details of the SDS and address employee questions and concerns.

SPDs must strive to keep employees safe. Engaging in safe practices and ensuring all SP professionals understand the steps involved in mitigating risks and addressing safety incidents when they occur is essential for positive outcomes—and the SDS is an essential tool to help meet that critical goal.

Author’s note: SDSs’ 16 sections provide an abundance of information that can seem daunting to the reader/user. These data sheets can be broken down further to simplify reading. For example, Sections 1–3 describe basic chemical details; Sections 4–8 describe recommended actions in the event of an accident; Sections 9–11 describe technical details such as nature of the material and where the hazards exist; and Sections 12–16 contain information for specific needs. I advocate reviewing the complete SDS, but it is vital to focus on sections 1–8 because these sections are needed for preparation or quick action.

Tony Thurmond, CRCST, CIS, CHL, serves as central service manager for Dayton Children’s Hospital. He is a past-president and current board member of the Healthcare Sterile Processing Association (HSPA). He attained his HSPA fellowship distinction in 2021.

 

Sterile Processing: Tying Customer Service to Care Quality, Safety Mission

By David Taylor III, MSN, RN, CNOR

This column originally appeared in the February 2022 issue of Healthcare Hygiene magazine.

For sterile processing departments (SPDs), customer service revolves around their skilled technicians providing instruments and equipment that are on time, complete, well-functioning, clean and sterile (or high-level disinfected).

SPDs are highly complex departments that manage many responsibilities to service numerous areas of the hospital. In fact, the SPD’s scope of responsibilities often extend far beyond the operating room (OR) to include all procedural areas, including but not limited to the Emergency Department, intensive care unit, Endoscopy, and on- and off-site surgery centers and clinics. Many SP professionals are also responsible for the cleaning, sterilization and maintenance of durable medical equipment, maintenance of crash carts and trauma and hemorrhage carts, restocking of supplies, and material management support for the organization. Each area served by the SPD has different needs and expectations from the SPD, which can make SP professionals’ jobs even more challenging.

For SP professionals to best meet their various customers’ needs and expectations, it is important that their customers understand the processes and time constraints associated with fulfilling daily requests. If an SPD customer schedules multiple procedures in a particular day but only has enough instruments or equipment to comfortably support half that scheduled amount, expedited turnover of those devices could likely be required. The question is can SP professionals realistically turn over those items in a safe way, while still supporting the customer’s needs and keeping schedules on track (and on time)? Doing so might be unrealistic, depending on the time of day, whether enough technicians are available to handle the workload, or whether the equipment needed to reprocess the devices is available and not already in use. Sometimes, customers may assume that their needs take priority over others’, and they may fail to understand all that goes into fulfilling their request; therefore, it is necessary for SP professionals to manager customer expectations through improved communication and as-needed education that is rooted in the latest standards, best practices and the facility’s policies and procedures.

Reprocessing instrument sets, rigid and flexible endoscopes and other reusable devices and equipment requires multiple steps that cannot be rushed or skipped. Each step must be performed in accordance with the manufacturer’s instructions for use (IFU), and enough time and resources must be allocated to safely and consistently allow technicians to perform all steps (e.g., sorting, cleaning, drying, inspection, preparation and packaging, sterilization, distribution or storage). Also to be considered: the need for manual precleaning; soaking time requirements; number of times channels must be brushed; drying times; and number of cycles specific items must go through an automated process, to name a few. It is essential that SP technicians and their customers recognize that even the initial inspection of the item—to ensure it is in good working order and not received damaged—takes time, and that the decontamination process can take numerous steps, each requiring specific time requirements or motions (brushing a channel 10 times, for example).

Cleaning instruments to remove all gross contamination (e.g., blood, bone, proteinaceous material) is a critical step and requires keen attention to detail. For some instrumentation, ultrasonic cleaning is a necessary next step to help remove contaminants that manual cleaning may have missed. Placing instruments in the washer-decontaminator is the final cleaning. Note: For endoscope reprocessing, once the manual cleaning and flushing steps are done, many hospitals activate their “Cleaning Claim” cycle in their automated cleaning equipment. The cleaning claim is an automated process that mimics the manual cleaning process. This added step adds time to the process but puts endoscopes through a more rigorous process to ensure proper cleaning and high-level disinfection are met.

All reprocessing steps take time and are dependent on the size, complexity and fragility of the instruments and equipment, as well as each SPD’s available resources (instrument inventory, reprocessing equipment availability, and staff availability). Inspection and assembly of an instrument set will also add time to the process, and these steps must also never be rushed or skipped. Further, sterilization and high-level disinfection cannot be rushed or interrupted; when that happens, the process must start over. Other steps that need to be factored into the reprocessing timelines and customer expectations include the need for proper documentation, cooling, and storage.

Additional factors that can add time to these processes are dependent on mechanical mechanisms. For example, the IFU provided with a certain brand of flexible gastrointestinal (GI) endoscope requires multiple specific steps (i.e., once the procedure is completed, the first step in the cleaning process is to wipe the outer portion of the endoscope and suction pre-cleaner through the channels. This starts a one-hour timer. If the endoscope is not submerged and cleaning begins, that endoscope will be required to soak for between one and 10 hours before the cleaning process can begin).

SP leaders should invite their customers to tour the SPD and spend quality time in each area to see firsthand all the steps required to process an instrument (from the moment an item arrives in decontamination to the time it is ready for pickup or delivery to the user area). Each SPD area must tackle specific sequential tasks before the next step can begin. Educating customers about each of these steps and their critical importance, as well as the type of equipment and resources needed to accomplish each step safely and effectively, is a valuable approach. It is also beneficial for SP leaders to introduce the customer to the technicians responsible for processing their items. Doing so helps put a face to a name and strengthens professional relationships and accountability.

The key to creating positive, enduring relationships with SPD customers is to build bridges through education and ongoing, two-way communication. SP professionals and their customers will gain a better understanding of and appreciation for one another’s needs and will help keep expectations in check and aligned with safety and quality goals. Having customers that better understand what goes into reprocessing will also help SPDs and their customers determine resource shortcomings, which can help prioritize future needs (such as additional equipment and instrumentation) to ensure items can be processed safer and more effectively and efficiently.

David Taylor III, MSN, RN, CNOR, has served as a contributing columnist for HSPA since 2019. He is the principal of Resolute Advisory Group LLC, a healthcare consulting firm in San Antonio, Texas. Questions or comments about this article can be directed to david@resoluteadvisorygroup.com or Julie Williamson, HSPA’s Editor and Director of Communications (jwilliamson@myhspa.org).

 

Overcoming the Challenges of Loaned Instrumentation

By Julie E. Williamson

This column originally appeared in the January 2022 issue of Healthcare Hygiene magazine.

Managing loaned instruments and trays safety, effectively and efficiently is a common struggle for many sterile processing (SP) professionals—and one that has grown more problematic due to complex and often heavy sets filled with complicated and sophisticated instrumentation.

Proper care, processing and handling of these devices from the time they are received at the facility to when they are picked up after their use hinges on proper planning and the provision of adequate resources. This includes having enough time, staff, processing equipment, supplies and storage space, as well as ready access to manufacturers’ instructions for use. Beyond that, facilities will need multidisciplinary involvement and adherence to policies and procedures specific to loaned devices (e.g., from those in the SPD, operating room, purchasing/materials management, and infection prevention), reminds Damien Berg, BA, BS, CRCST, AAMIF, vice president of strategic initiatives for the Healthcare Sterile Processing Association (formerly the International Association of Healthcare Central Service Materiel Management). In his previous sterile processing leadership roles, most recently as regional manager of sterile processing for University of Colorado Health, he saw his fair share of loaned instrument-related challenges and he and his interdisciplinary teammates worked hard to overcome them.

“Over the years, I saw how important it was to have policies and resources in place to help mitigate some of the problems associated with loaned instruments,” Berg said, noting that some of the hospitals his team supported averaged 40 to 50 surgical procedures a day, many of those orthopedic and spinal procedures that involved an overwhelming number of loaned instruments.

Although managing loaned instruments may seem relatively simple on the surface (with items delivered in advance of the procedure and then picked up by the vendor(s) afterward), the process is often quite complex. There are many opportunities for miscommunication and errors if prudent policies aren’t adopted and all stakeholders aren’t committed to ensuring successful receipt and post-procedure pickups of loaned devices.

Berg reminds that loaned instruments don’t always come from vendors or distributors; they can also come from sister facilities. This allows different hospitals or surgery centers within the same organization to share inventory and reduce the need for costly capital expenditures. With loaned instruments and implants accounting for up to 80 percent of the total cost of orthopedic surgery and the fact that SP professionals are largely responsible for receiving and managing loaned instruments, communicating needs and pertinent updates, and then reprocessing the sets before and after the procedure, it is vital that the SPD has a prominent seat at the table when conversations and policies surrounding loaned instruments take place. Having the right data surrounding loaned instruments—including statistics and information regarding late drop-offs/arrivals and late post-procedure pickups and the reasons behind them, and the ready availability of IFU—can generate necessary improvements and change and help SP professionals gain the essential resources needed in their departments, Berg said.

Loaned instrument data can be tracked and attained through instrument tracking software/programs, well-managed manual processes, or both (manual approaches require more time dedicated to the process, however). Regardless of whether a facility uses a manual or automated approach, a commitment to establishing an effective loaned instrumentation program will positively impact compliance, device traceability and accountability, Berg explained. Note: Facilities seeking guidance on how best to draft an effective management process and policy for loaned instruments can rely on AAMI Technical Information Report (TIR) 63, Management of loaned critical and semi-critical devices that require sterilization or high-level disinfection.

It is also necessary to build into the facility’s loaned instrument policy key elements to ensure accountability, compliance and safety for all parties involved. The policy should clearly outline requirements and expectations, and facilities should ensure vendors and all other key stakeholders receive a copy of the policy and sign off that they read the content and agree to the terms. Time requirements associated with loaned instrument drop-off must be established upfront and included in the written policy. Although SP professionals are not often involved in the earliest stage (the request for the loaned devices), they must still be aware of the details to ensure the SPD can safely and effectively meet the need within an adequate timeframe. It all comes down to what’s requested, says Berg. If a surgeon is performing a total knee procedure, for example, Company X will bring in a certain amount of trays for the case. In Berg’s previous facility role, he said that if the instruments were needed in the OR by Tuesday at 7 a.m., the SPD would need those total knee trays in the department by Monday at 7 a.m. because facility policy stated that instruments must arrive at least 24 hours before the procedure. If a drop-off occurred last-minute or at any point under 24 hours, that incident was documented (with the time of actual delivery and the reason for the late arrival). Some late deliveries are no fault of the vendor/distributor, Berg acknowledges, and are often due to an add-on procedure or other late request from the OR. Even so, recording those details is vital for recognizing trends and communication or compliance gaps, which can then be proactively addressed.

“If loaned instruments frequently arrive late despite advance notice from the OR, the SPD can take the data directly to the vendor and re-educate them on the policy and then work together to prevent future occurrences,” he noted, adding that surveyors will look to see what the facility’s loaned instrumentation says and review documentation of when the SPD receives loaned instruments. “If you have a 24-hour or 48-hour policy on when loaned instruments should be arriving in your facility [in advance of the procedure] and surveyors discover that policy is not being followed, you’ll be in violation of your own policy.”

Weight limits for loaned instrument sets should also be outlined in the policy. The Association for the Advancement of Medical Instrumentation (AAMI) recommends that instrument sets and trays prepared for sterilization not exceed 25 pounds (the weight of the container that houses the instruments is included in the 25-pound limit). Nonetheless, it is not uncommon for loaned sets to arrive that exceed that weight limit (sometimes, by only a couple pounds but, often, by significantly more). Working with the vendor to determine how best to reduce the set weight (perhaps by splitting the contents into two trays or working with the OR to determine whether any routinely unused instruments in the set could be removed from the tray and packaged separately in the event they are needed) is an effective strategy.

Ready access to current IFU is essential for ensuring SP professionals have the right information to manage and process all instrumentation safely and effectively, including loaned instruments. This IFU requirement should be expressly addressed in the loaned instrument policy, and SP professionals should verbally reiterate this need with their vendors. Before the procedure and the delivery of any loaned devices, SP professionals must also be able to verify they have the right equipment, supplies, education/IFU and other necessary resources to handle and reprocess those devices safely and properly. According to Berg, not all instruments and cycles (e.g., wash, sonic, sterilization) are created equally; therefore, SP technicians must have a clear understanding of which cycles are needed, and they should also have some knowledge of how the device is used. Further, they must know how instruments are disassembled, so they can be cleaned properly when they arrive to the facility (and again after being used in the procedure).

Instruments in loaned sets should be carefully inventoried upon receipt and when the vendor picks them up after use, and those contents should be documented. A manual or electronic count sheet that is readily available at the location where loaned instruments arrive and depart the facility helps SP professionals track set contents, and the list/count sheet should not be signed or otherwise approved without visual confirmation that all contents are not only in place but also not damaged. Taking photos of the set contents is wise for tracking and documenting all instruments upon arrival to and departure from the facility.

“If an instrument turns up missing or damaged after leaving your facility, imagine the benefit of being able to visually show they were present and undamaged at the time of pickup,” Berg explains.

Even with the best policies in place there will be times when rules aren’t followed, and the policy needs to be recommunicated. Berg recommends SP professionals work with their Infection Prevention partners, OR clinicians, and Materials Management/Purchasing partners to ensure all parties understand the policy and are held accountable when deviations occur. Circumstances will sometimes arise that result in loaned instruments arriving late, for example, and Berg stressed the importance of strong communication when such incidents arise. In his previous roles, when he knew the SPD would receive loaned instruments on Friday for a Monday procedure, for example, he would schedule more help in the department for Friday to avoid leaving all the work for the Saturday shift.

“It is critical to give enough time to check in the instruments, inspect them and make sure you have the IFU and everything else needed to process them properly,” he said. “Loaned instruments need to be viewed just like instruments in your facility’s inventory, with proper controls and care being given to them when they’re [in your possession].”

Julie E. Williamson serves as editor and communications director for the Healthcare Sterile Processing Association (formerly the International Association of Healthcare Central Service Materiel Management).