You're probably all too familiar with what your surgical team thinks of your reprocessing techs (How long could it possibly take to sterilize instruments?) and how the techs view their perioperative colleagues (They wouldn't complain as much if they only knew how many trays we handle!). Part of the emotional disconnect between the groups is a product of the physical distance between them in many facilities, where nurses have never taken the long elevator ride down to the sterile processing department (SPD) and reprocessing techs have never stepped foot in an OR.

It's time to bring the two sides together, both literally and figuratively.

That's what leadership at Children's Hospital of Michigan in Detroit decided when they set out to include a culture change in the SPD that's under construction in the hospital's new $155 million clinical care tower that will have 4 ORs on the 2nd floor.

"We talked about how we could be more efficient in our instrument reprocessing unit," says Luanne Ewald, the hospital's CEO.

The hospital put the groundwork in place to match the flow of the ORs to the flow of instruments by designing the new SPD right next to the new ORs. This month, they plan to begin framing out a SPD that will cover 3,770 square feet and house a 2,281-square-foot instrument storage area. The proximity of the SPD to the ORs will allow for a more efficient system of moving instruments and will help to establish constant communication among staff members in both areas. Here are some other ways to ensure reprocessing techs get properly sterilized instruments back to the surgical team as quickly and as safely as possible. That alone will go a long way toward creating a positive culture.

1. Build based on volume

Reprocessing efficiency doesn't rely solely on relocating the SPD; you must also take into account how many instruments pass through the area on a daily basis. Children's Hospital estimates that it sterilizes around 50,000 sets of instruments a year.

But you can't tell how many instruments you'll be sterilizing on a daily basis simply by dividing 50,000 by the number of surgery days. Each day's surgical schedule might require a different number of instrument sets. Instead, track how many instruments your techs sterilize on an average day.

"That drives how much equipment and space you need," says surgeon Joseph Lelli, MD, the director of Children's Hospital.

The size of your SPD has a lot to do with the services your facility will offer as well as the number of ORs it will run, says Mark Voigt, BS, director of central processing at CentraCare Health in St. Cloud, Minn., a 24-OR hospital with an 18,000-square-foot SPD.

2. Add the right equipment

Every SPD needs an autoclave, which can cost up to $200,000, but make sure yours is large enough to accommodate the tools you plan to reprocess and the services you plan to offer over the next 15 years. That's how long an autoclave is expected to last and how long it needs to handle your instrument load, says Mr. Voigt.

Barcoded instrument tracking software lets you monitor instruments and track their locations as they move though the reprocessing system. It also tracks instrument usage, which helps with conducting regular maintenance and knowing when to replace instruments. It also measures how many items your reprocessing staff handles, which can help you allocate the correct manpower and resources within the department. Another added benefit: The software lets you link instrumentation to individual patients, so you can see what devices were used during specific cases. That detailed level of tracking can help you determine if contaminated instruments are to blame when you're drilling down to the cause of a surgical site infection.

3. Focus on the layout

While proximity to the OR, equipment and size are all important factors to consider when designing and constructing a SPD, you also need to design the layout to improve staff safety and efficiency.

Mr. Voigt says his department features individual workstations in the decontamination area. The work areas are clean, organized and stocked with needed cleaning supplies and tools. In order to cut down on unnecessary movement, which wastes valuable time, each workstation is within steps of the washing stations where techs place instruments after they've manually cleaned them.

His hospital also invested in pass-through washers and pass-through autoclaves so that the decontamination area is completely separate from where sterilized instrument sets are reassembled and stored. "That's important because it protects patients," says Mr. Voight. "It eliminates the risk of staff grabbing a tray that's prepped for sterilization, but not yet sterile." OSM