TRUST THE PROCESS Resist the temptation — and the pressure — to skip steps in the washing and sterilization process to keep up with surgical demand.

Some things, like instrument reprocessing, you simply can't rush. But try telling that to an overbooked, over-the-top surgeon who's doing a slow burn waiting for his tools to return from central sterile so he can start the next case already. What's an OR manager to do?

1. automate some of the tasks your reprocessing techs have traditionally done by hand
2. buy more instrument sets
3. educate your surgeons about the washing and sterilization process
4. all of the above

All of the above, of course (isn't that almost always the answer in these multiple-choice questions?). Let's look at why each answer makes sense for you.

Automate some reprocessing tasks
One way to shave minutes off your cleaning, disinfection and sterilization times is to invest in technologies that aid in cleaning. Some examples:

• Flushing aids. Instead of using disposable syringes to repeatedly push water and air through endoscopes and narrow-lumened instruments like phaco handpieces, vitrectomy cutters and I/A handles, flushing aids provide continuous hands-free channel flushing of cleaner, distilled water and air. "This can save you 30 seconds per instrument," says Sherry White, RN, BSN, CNOR, infection prevention team leader at Imperial Calcasieu Surgical Center in Lake Charles, La. Flushing aids are also less prone to human error, as they deliver a set amount of fluid and air to the connected instrument or tubing.
• Automated endoscope reprocessors. Instead of using brushes to painstakingly clean the cracks and crevices of your scopes, high-level disinfect them in an automated endoscope reprocessor (AER). "For endoscopes, the AER is far superior to other forms of high-level disinfection and certainly allows for faster turnover of scopes," says Phenelle Segal, RN, CIC, president of Infection Control Consulting Services in Delray Beach, Fla.
• Ultrasonic washers. Instead of pre-cleaning instruments by hand, you can clean and rinse them in a tabletop ultrasonic machine — "provided the instrument manufacturer allows in their IFUs for use of the ultrasonic," says Ms. Segal — before you disinfect and sterilize them.
• Rapid readout biological indicators. You no longer have to wait hours to release instruments while you're waiting for the results of the biological indicator (BI). New BIs tell you in 1 hour, not 3 or 24 hours, if your sterilizer met the time, temperature and pressure parameters. "We don't have to hold instruments for 3 hours anymore," says Ms. White.

GOOD SOAK After you transport instruments to the decontam room, soak them in enzymatic solution, and then scrub and wipe them to get rid of the bioburden.

Buy more instruments
Tim Brooks, BS, CSPM, senior manager of sterile processing at Banner University Medical Center in Tucson, Ariz., says OR leaders often overlook 2 universal truths about reprocessing.

• You can't bring in new doctors without bringing in new instruments for those doctors. The return on investment on a $10,000 set of laparoscopic instruments is "tremendous," says Mr. Brooks, "and it can last for 15 to 20 years," but the faulty logic is that SPD can keep up with demand.
• You can't overbook your instruments, meaning you can't schedule more cases than your instrument inventory or your reprocessing capacity can accommodate. The day won't go well if you've scheduled 12 cataract cases and you only have 2 eye sets.

"You have to build up inventory to meet your needs," says Mr. Brooks. "Instead, we respond to demands instead of managing demands. You're managing a factory. You need a materials management understanding to make it work."

Mr. Brooks points out that a sterilization department can manage thousands of different instruments from dozens of different manufacturers, each with its own cleaning, testing and sterilization instructions.

"The surgical demand is never consistent with the inventory, and the sterile processing department typically doesn't have the capability to respond to unpredictable demands," says Mr. Brooks. "It doesn't matter what machines you have and how fast you go. It all goes off of how many sets of instruments do you need today."

Educate your surgeons
Your surgeon wants to know why it takes 3, 4 and sometimes 5 hours from the time an instrument set leaves the OR until it ends up back on the shelf or case. And he wants to know why you can't just wash that piece of equipment by hand and toss it in the sterilizer. And he wants to know why can't you turn down the dry times on the washers and sterilizers to speed things up a bit.

Or maybe you're kidding yourself thinking your docs even care to know all that it takes to get their instrument sets up to the operating room. They just want them. Now.

"They don't care!" says a reprocessing manager. "It's our job to get it done quickly and ready for their next case."

More so than others, Ms. White knows the impatience the OR feels (What's taking so long?) and the pressure sterile processing feels (You need those instruments sterilized by when?). "Doctors want these instruments now, and they don't want to hear that they have to be reprocessed," says Ms. White, who splits her time working cases and washing instruments at her 6-OR, 2-procedure-room, freestanding ASC. "A lot of times, there's a disconnect between the SPD and the OR."

To help her new reprocessing techs better understand what the OR team's up against, Ms. White has them dress out and observe cases. "That's when they see the fast pace and appreciate how quickly the OR needs instruments," she says. "So when the doctor says he needs instruments now, they understand the urgency. It's not something that can wait, especially in short, fast cases like tonsils or cataracts."

Reprocessing's middle name is process, meaning you must carry out steps in sequence and for set times: sorting, disassembly, washing (manual, sonic, automated), cooling, wrapping and packaging, sterilization and monitoring.

"We're trying to force a process that shouldn't have to be forced," says Mr. Brooks. "Speeding up things is not the answer. Any time you take that sort of focus, you start losing quality real quick."

What will you say the next time a surgeon asks you to move heaven and earth to hurry his instruments back? "No, we cannot do that and provide safe care for your patient," is what Judith L. Clayton, MSN, RN, CNOR, manager of surgical services at Morgan Memorial Hospital in Madison, Ga., tells her docs. OSM