Secrets to Sterile Processing Success

Two years ago, our orthopedic surgery center launched a comprehensive total joints program. We built two ORs and added 150 instrument trays, but couldn’t expand the footprint of the sterile processing department because every square foot of new real estate was allocated for clinical space. Last year, our surgeons performed more than 10,000 procedures, including 738 total joint replacements that require up to 10 instrument trays to complete. We’ve had to work smarter and harder to reprocess 150 additional instrument sets each week. The same factors that allowed us to run a lean and mean sterile processing department before our total joints program came online have helped us handle a 50% spike in reprocessing volume and offer a blueprint that any surgical facility can follow.

• Constant flow. Surgical technicians should deliver case carts full of soiled instruments to the decontamination area at the end of each case instead of waiting until several carts are ready to be transported. “Batching” case carts seems to make sense at first blush — techs make fewer trips to the SPD — but the sporadic arrival of carts leaves reprocessing techs alternating between dealing with downtime and scrambling to keep up. A lineup of carts leads to backups and delays while reprocessing techs prioritize the multiple instruments sets for reprocessing. Delays in decontamination also allow bioburden to dry on the surfaces of instruments, making them harder to properly clean and sterilize. A constant flow of incoming instruments ultimately helps the reprocessing process move along more smoothly.

You can help coordinate the responsibilities of the reprocessing techs through constant updates on the day’s case schedule, so they can allocate their resources to prioritizing the reprocessing of needed instruments sets and get them back into circulation as soon as possible.

Our two main autoclaves run full time, but we sometimes rely on the smaller units in our “sub-steriles,” which are rooms between our ORs. We can run full cycles in them in the event our larger autoclaves are temporarily out of commission. 

• Consolidated trays. If you audit each of your instrument trays, you’ll likely find tools that are rarely, if ever, used. Yet these unused tools must be reprocessed if they’re part of a set, so remove as many extraneous instruments as possible. It takes us about two-and-a-half hours to reprocess a single set, so every minute saved counts. Maintaining good working relationships with reps from our implant manufacturers, which supply the vendor trays, helps us compile instrument sets comprised only of necessary tools.

It’s best to standardize vendor sets, but that’s difficult to accomplish. We have two trays used in partial joint replacement procedures that are identical and used by all the doctors, but our instrument sets used for total joint replacements are configured based on the preferences of individual surgeons. Some vendors work with us to consolidate the number of backup instruments used in some procedures, so we’re able to fit them into one tray instead of two.

• Staggered shifts. Reprocessing techs should never sit idle, so schedule their shifts to coincide with the ebb and flow of instruments through the department. For example, our first-shift tech used to begin working at 6 a.m., but we changed the start time to 4 a.m. when the total joints program required an earlier start to our surgical schedule. The earlier start allows sufficient time for the tech to get the autoclaves started and tested, and prepare trays needed for the first procedure of the day, so the 6:45 a.m. case can start on time.

The second tech starts at 9 a.m. because that’s when the instruments from the first cases of the day arrive for reprocessing. We have a limited number of instrument trays for cases that fill our eight ORs, so the sets need to be turned around quickly for use later in the day. The third tech starts at 1 p.m. They reprocess instruments needed for the afternoon cases and get as many sets as possible ready for the next morning.

The techs meet briefly at shift changes. The tech who’s leaving discusses potential issues — such as a higher-than-usual number of knee cases, trays with missing instruments or problems with the reprocessing equipment — and the incoming tech writes down what needs to be done to address them.

Our reprocessing techs attend in-house training events run by staff or instrument reps and occasionally attend conferences to continue their education. We also maintain written explanations of proper instrument reprocessing practices, photos of instrument sets and checklists, and an instructions-for-use database. These references are much more effective than relying on word-of-mouth instructions on how to set up workstations, clean instruments and maintain the department’s reprocessing equipment.

We’re considering adding a fourth full-time tech and creating an additional fourth overnight shift if the three techs who currently work in the department are spread too thin by the workload. A surgical tech acts as a “sorter” who makes sure the trays that arrive from the ORs are organized and complete. This allows reprocessing techs to remain at their workstations to keep instruments moving.

• Outside help. Sterile processing doesn’t make a facility money, but it saves money by allowing revenue-generating surgeries to take place on time and in a safe manner. That’s why you should regularly inspect the quality of your instrument sets and consider working with an outside instrument repair service. The firm we’ve partnered with comes to our facility once a month in a large truck that houses a mobile instrument lab. The company’s reps sharpen instruments, remove burrs, tighten screws and replace damaged instruments. They take instruments apart and thoroughly clean them. The regular servicing extends the life of the instruments, which is a money-saver, and reduces the headache of having to deal with frustrated surgeons when damaged instruments wind up in ORs.

Instruments undergo preventative maintenance every two, four or six months, depending on the wear and tear they endure. This reduces the frequency of how often we have a tray down for repair, so we don’t have to scramble to compensate. It also reduces how often we use flash sterilization as a last resort, which increases patient safety.

• Clear communication. As the manager of the ORs and SPD, I’m always calling, texting or emailing colleagues, surgeons, staff and the product reps who supply the instrument trays. You can’t be successful without being in constant contact with all of them. Your communication must be consistent and effective, and you always have to find new ways to improve it.

If your vendor-supplied instrument trays are constantly cycling into and out of the facility, a tag system can keep their statuses straight. Apply a green tag to a tray if its contents are ready to be washed and sterilized. Apply a red tag if the tray isn’t ready for reprocessing because items are missing, or it’s been cleaned but not sterilized because a vendor rep will soon transport it to another facility. Keep a marker next to the trays, so techs and vendor reps can communicate with each other about the contents with notes written on the tags.

It’s nearly impossible to grasp the enormity and intricacy of SPD operations.

Create a binder that contains photos of the contents of each tray that enters and leaves your facility. Organize the photos by instrument manufacturer and require your techs to compare all incoming trays with the photos to make sure all components are present. You never want surgeons to discover mid-surgery that an item they need for the procedure is missing. With so many trays going into and out of our facility on a daily basis, with 20 to 40 items in each tray, the photos have been invaluable in keeping instrument sets complete and organized.

If your surgeons perform procedures at other facilities and sometimes borrow items from a set, track every tool they take out — and make sure they bring them back. It’s also a good idea to ask the implant manufacturers that supply your instruments to keep two complete sets on site. We’ve gotten a few companies to agree to this arrangement, which has helped decrease the constant reprocessing flow. The extra instrument sets also come in handy because we can borrow tools from them whenever one is missing from another tray.