5 Tips for More Efficient Sterile Processing

Infection Prevention

By: Rachel Mandel

Published: 12/19/2019

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How one hospital turned its SPD into a shining example of excellence.


A large hospital had so many case carts full of trays backed up during the day they struggled to turn around instrument sets in less than 24 hours. Within 6 months, they cut their sterile processing turnaround time by 40%, reduced errors in half, dramatically increased nurse and surgeon satisfaction with the sterile processing department (SPD), and saved the hospital nearly $600,000. These 5 small and modest changes made big impacts.

1. Get to the root of the problem. When a respected surgeon complained about SPD delays, the staff kept the surgeon's instrument sets in a special location and paid special attention to them. Problem solved, right? Wrong. These kinds of workarounds didn't address the core problem. Perform a root cause analysis. Only a smooth and efficient sterile processing workflow will ensure that every surgeon in every OR has instrument sets delivered on time and in pristine condition.

2. Match schedules to work crunches. This hospital had more techs than they needed at 7:30 a.m. They were mostly idle until about 10 a.m., when the morning cases were finished, carts started coming in and they had to start turning things over quickly. They needed more people from 10 a.m. to 2 p.m. when they were busiest. So, some early-shift employees started coming in later and evening-shift workers started earlier. This shift in staffing to mirror the workload made huge improvements very quickly.

When do the case carts start backing up at your facility? Do you need more people first thing in the morning to take care of instruments used the day before, or do you need more during crunch times during the day? Adapt. Consider adding a runner during your busiest times, someone to make sure everyone has what they need when they need it. If your SPD staff has complained about having to leave their stations to retrieve something, a runner might be the solution.

3. Work toward one-piece flow. The hospital's 10 a.m.-to-2 p.m. crunch wasn't solely because that's when the first group of cases ended. As in many facilities, the OR staff was "batching" the instruments and carts, waiting until they had several used instrument trays before they took them to SPD. This seemingly made sense. They only had to make one trip instead of several when they could be doing other things. They also well-meaningly thought it would be easier for SPD to process more than one cart at one time.

SEE THE LIGHT A well-lit SPD is crucial for techs to perform quality work.

Nothing could be further from the truth. Batching generates waste. One-piece flow, although it may be counterintuitive, makes sterile processing more efficient. One-piece flow means that when the cart or instrument is ready for SPD, it goes to SPD and gets processed as it arrives. You might get some initial pushback from insisting that the OR staff make more trips, but once employees see that it works and the result is fewer case delays while waiting for sterile instruments, they'll get on board.

Think about it. With batching, SPD must scramble when the packed carts arrive and prioritize what sets are needed first. This is made worse if some instruments are complex and hard to clean. It also results in workers picking and choosing which instruments they'll clean. Some will only remove what they're comfortable cleaning from the carts. This can't happen when you institute one-piece flow processing. A tech must process an entire cart at the appropriate station before working on the next one in line. As part of the change from batching to one-piece flow, the hospital put colored tape on the floor that let staff know with a glance how many carts they had waiting, which cart was next and when additional staff was needed to assist when volume increased (see "Keep Your Case Carts in Line" here).

4. Declutter your SPD. A messy environment makes people tense — the last thing already harried SPD employees need. Remember, an SPD is a working laboratory, not a storage area. If there are items there that don't need to be there, get rid of them. This hospital had unused instruments, pediatric oxygen masks and wire baskets in SPD that did not belong there. There were policies and papers stored in closets that were outdated at best and obsolete at worst.

A well-maintained physical plant in SPD is also critical. Lighting in the ORs was excellent, but in SPD, not so much. We improved lighting for thorough instrument inspection. We also recommended that the facility ensure that its water and steam were in compliance with purity and chemical requirements specified by equipment manufacturers and regulations.

5. Standardize instructions. Don't rely on word of mouth when training new techs. There should be written explanations, photos and checklists that explain what they need to do, how to set up their workstations, how to clean instruments and how to maintain equipment. Checklists in the OR improve patient safety and outcomes. The same is true for SPD.

The waiting game

There is another waste that gets eliminated: Waiting. Nobody wants to be in an operating room, with a patient on the table under anesthesia, waiting for an instrument. Been there; done that; don't' like it. We aren't being patient safety-minded and can't call ourselves patient-centered care advocates if we allow this to happen to our patients due to an inefficient or broken process.

We all want the same thing, which is high-quality patient care. In SPD and the OR, this can be accomplished with processes that consistently provide the right instruments and equipment to the right place in the right condition at the right time.

I know it seems overwhelming, but the results this hospital realized can be achieved anywhere, and these 5 tips can help. As a first step, go to where the work is being done and encourage your staff to voice their concerns and challenges. Your staff already has the answers and solutions you seek. Listen to them and encourage experimentation and change. That is how you can create a culture of patient safety and continuous improvement in a high-reliability organization. OSM

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