THIS WEEK'S ARTICLES
Tips for Running a Successful Sterile Processing Department
Pay special attention to workflow, ergonomics and efficiencies.
Mount Sinai West in New York City recently wrapped up a $24 million expansion that grew its sterile processing department (SPD) from 2,000 square feet to 7,000 square feet. Bill DeLuca, CRCST, CHL, CIS, the SPD's associate director, shares these tips on keeping departments like his running smoothly and efficiently:
Process flow and ease of use. The space should allow staff to easily access and operate all of the critical equipment, such as sterilizers, autoclaves and decontamination workstations. “Staff members who are moving instrument trays from a sink to the instrument washer shouldn’t have to walk a long distance,” notes Mr. DeLuca.
Equipment repair. Low-temperature sterilizers and steam autoclaves can each cost around $80,000. If either goes offline, your vendor must return your service call in a timely manner. Mr. DeLuca also recommends buying in bulk. Instead of paying $130,000 for one low-temperature sterilizer, his facility purchased four, only paying $80,000 for each.
Ergonomics. Focus on making things less strenuous for your SPD staff by providing adjustable-height decontamination workstations and sinks. "At a minimum, you need workstations that can move up and down to accommodate the height of your staff," says Mr. DeLuca. Also pay attention to sink depth and width. "A sink basin that is 30 inches long, 17 inches wide and 10 inches deep should fit any type of tray," he says.
Engaged staff. If you are building or renovating your SPD, engage and involve someone from the department from start to finish. "Take their suggestions for design improvements seriously and capitalize on your chance to design the department exactly the way they want it," says Mr. DeLuca.
SPD staff are the unsung heroes at many facilities. By following tips like these, you can make their jobs easier and potentially less painful, while enhancing patient safety and infection prevention in the process.
The Importance of Point-of-Use Instrument Care
OR staff should prep tools before they arrive in sterile processing.
Scrub techs should keep instruments clean between uses throughout surgery and moist when they’re no longer needed for the case because dried blood coats instrument surfaces and can cause the joints of certain tools to stick.
It sounds so straightforward, but point-of-use instrument care remains an area for improvement at many facilities. Lack of compliance means bioburden can dry on surfaces and in the crevices of instruments, making it more difficult for reprocessing techs to remove it in the sterile processing department. That can lead to instruments not being properly sterilized.
Infection prevention consultant Linda Spaulding, RN, CIC, BC, CHEC, CHOP, suggests keeping soiled instruments moist by spraying them with an enzyme product, soaking them in an enzyme solution or water, or placing a moist towel over them until they're ready to be transported to the decontamination area. "It's best to begin cleaning instruments within 15 minutes to one hour after a procedure,” says Ms. Spaulding, who notes that prolonged delays can negatively affect the instrumentation. “Over time, dried blood and bodily fluids can cause instruments to stain, pit, rust or become dull," she says.
June Van Hoose, RN, CNOR, a manager of quality and safety at Parkland Health & Hospital System in Dallas, says a lack of uniformity in how surgical techs set up back tables can impact how well and how efficiently instruments are handled during and after procedures. Her solution is a standardized set-up that ensures instruments are organized the same way during every case. "A tray of basic instruments — the tools needed most often during a case — is lined up along the table's left edge, an open workspace is established next to the tray and a basin of sterile water is positioned at the top of the workspace," she explains.
Ms. Van Hoose notes that the standardized set-up decreases the number of times procedures need to be paused due to missing instruments. It improves overall case efficiencies and lets the team focus more on workflow and patient care. It ensures tools are accessible and easily cleaned, regardless of which staff member is working the case.
"Keeping instruments organized helps to ensure the tools are cared for properly before being sent to sterile processing," she says.
Saving Valuable Time in Sterile Processing
Making paper recordkeeping a thing of the past at this medical center helped streamline workflow, standardize processes and eliminate chances for errors.
CTracing a heritage back over 119 years to Sioux Falls Hospital, Sanford Health has become an institution known for its stability and health care excellence.1 In recent years, its facilities have experienced unprecedented growth – and with that growth came increased demands on its staff and physicians, especially in reprocessing and sterilization work, pushing its current perioperative staff to their limits.
To find relief from sterilization and associated administrative tasks, Sanford Medical Center Bismarck (Sanford) turned to the ASP Ecosystem, consisting of STERRAD® Systems with ALLClear® Technology, the STERRAD VELOCITY® BI System, and ASP ACCESS® Technology, as a source of leverage to streamline their low temperature sterilization operation through its powerful workflow automation.
Perioperative Services Management at the Sanford Bismarck Sterile Processing Department (SPD) began a committed, concerted effort to remove steps, tasks and processes that had the potential for productivity-draining errors. The genesis of this concrete effort was a decision to institute an instrument tracking system that enabled the standardization of instrument reprocessing recordkeeping. By scanning of barcodes or marks through a terminal or mobile interface, a substantial source of errors was eliminated.
The instrument tracking system, however, only eliminated some of the opportunities for manual entry errors. With the automation available through Sanford’s installation of the ASP Ecosystem, manual recordkeeping for its low temperature sterilizers was eliminated.
Prior to the availability of the ASP Ecosystem, Sanford depended on thermal paper-based printed records from their low temperature sterilizer systems or manual data logging to computer-based databases to maintain records of their instrument and device sterilization. This paper-based recordkeeping was an outdated process, which increased opportunities for error. Brandi Everding, SPD Manager for Sanford, recounts the now-retired process of manually recording low temperature sterilizer loads. "When your load was complete, you took printouts and scanned them and then attached [the image] to that specific load", said Ms. Everding.
Ms. Everding noted that this process always held the potential for error: "When you pulled a printout into a load, [it was possible] you might scan the printout into the wrong load."
Now that the hospital has implemented the complete the ASP Ecosystem, it has made manual recordkeeping for compliance an automated activity, resulting in measurable workflow efficiencies.
Missing Data and Manual Recordkeeping: It Happens to Everyone
Before the arrival of the ASP Ecosystem at Sanford, manual logging activity was frequently noted to have mixed results. Ms. Everding recounts the logging activities and their challenges: "I can tell you that, before the ASP Ecosystem was in place, I noticed not all the logging information was entered. It was missing one thing or the other, whether that be the lot number, the load number, the start time of the BI, or something else. That definitely caused some frustration, and it was something we constantly had to bring up with our staff. And [with the ASP Ecosystem], that has improved 100 percent."
With a busy low temperature sterilization schedule, Ms. Everding says, "We run a lot of low temp loads, for a facility our size. We moved a number of scopes out of HLD and into sterilization." This change resulted in the department running an average of 25 low temperature sterilization loads per day.
Since the department includes a BI with every sterilizer load, 25 BIs have to be run each day as well. This generated as many as 50 low-temperature sterilization load logging tasks each day, representing 50 interruptions, 50 opportunities for error and 150.6 minutes of lost productivity.
Perhaps more frustrating than missing log information was the non-stop requirement for logging tasks such as the completion of a low-temperature sterilizer load or a BI read. These logging tasks at Sanford may have been the cause of distractions and interruptions, on average one every 10 minutes or less per 8-hour day shift that can cause problems of their own.
Ironically, while manual recordkeeping tasks were meant to document compliance through mandated logging after each sterilizer run, logging activities at Sanford became new opportunities for errors. Regardless of whether a technician gathered the load print outs and recorded a load when it was complete or performed the logging tasks at the end of the day, recordkeeping required time that can now be better spent on tasks at Sanford.
Standardizing Recordkeeping: Automated is the New Standard
In addition to decreasing distractions and interruptions associated with manual recordkeeping, Sanford had another big intention for the ASP Ecosystem: standardization of its recordkeeping through automation.
Sanford began by interconnecting all of their instrument reprocessing systems with their instrument tracking system, CensiTrac™. This ensured that one logging method was used for reprocessing activities, netting significant savings in time and potential errors. Having their STERRAD VELOCITY® Readers connected as part of the ASP Ecosystem has been beneficial to the institution as well. Initiating a new BI is straightforward; the STERRAD VELOCITY® Reader allows the operator to scan a code on the vial and instantly checks to ensure the correct BI type is being used, the BI is not expired and that the BI has never been incubated before.
The results of all BI reads are reported to the operator as "Pass" or "Fail", all complete with pictures, to reduce the opportunity for misunderstandings or errors. Ms. Everding notes, "The STERRAD VELOCITY® Reader literally walks you through, so that’s something that’s a huge advantage when you look at having travelers or new technicians. Again, it really takes away chances for error."
Finally, ASP ACCESS® Technology provides all of the STERRAD® Sterilizer with ALLClear® Technology and STERRAD VELOCITY® Reader records in report form. While some of the information is also available in their instrument tracking system, ASP ACCESS® Technology also offers notifications if any system becomes disconnected from the network through its web application. "It even sent me an email when I had unplugged the old [system] and was getting the new ones set up… it's definitely working to its potential," says Ms. Everding.
Note: For more information, please go to www.asp.com.
1. Renshaw, Eric (2012) Forgotten Sioux Falls. Charleston, South Carolina, Arcadia Pub, pp. 26.
Rethink How You Reprocess Endoscopes
FDA warning prompts another opportunity to improve your practices.
The FDA's spring announcement was troubling: The federal agency was investigating 450 Medical Device Reports (MDRs) it had received since 2017 about post-procedure contamination and infections involving urological endoscopes.
While worrisome, the advisory is also an opportunity for sterile processing departments to revisit the soundness of their practices in caring for these notoriously difficult-to-clean instruments. Refocusing on the following four basic steps is a good start, suggests Alison Sonstelie, BS, CRCST, CIS, CHL, sterile processing lead coordinator at Sanford Health in Fargo, N.D., and president of NoCoast Consulting:
Risk assessment. Audit your facility's reprocessing steps from start to finish and ask for feedback from frontline team members about the process. Observe how bedside cleaning, manual cleaning and disinfection/sterilization practices are being conducted, and compare them to your standard operating procedures and competencies. "It's imperative to create a robust, multidisciplinary team to perform the risk assessment," says Ms. Sonstelie. "A formal process, education plan, visual guides, checklists, points of contact and a monitoring plan should be implemented to ensure all steps of pre-treatment and reprocessing are properly performed."
Leak testing. One of the MDRs the FDA is investigating involved a cystoscope that did not pass a leak test. Leak testing — one of the most misunderstood and frequently missed steps in endoscope reprocessing — is an important role in infection prevention because it can detect damage to the scope that may lead to fluid invasion, which can increase the risk of cross-contamination. There are two leak-testing methods: dry and wet. "Both require attention to detail and human interpretation," says Ms. Sonstelie, who notes that in addition to lowering the risk of cross-contamination, the practice can reduce endoscope repair costs.
Confirmation. Adenosine triphosphate protein (ATP) testing helps to verify the effectiveness of the endoscope cleaning process. ATP is an organic chemical that provides energy for cellular processes. Its presence in a "clean" endoscope is an indicator that potentially pathogenic material remains. "Whenever you implement an enhanced testing or verification program, it's a good idea to have a backup inventory of scopes available in the event still-dirty scopes need to be removed from service," says Ms. Sonstelie.
Eternal vigilance. Understand the standards, guidelines and best practices, and implement enhanced cleaning and disinfecting processes as needed. The most effective way to prevent endoscope-related infections and ensure safe patient care is to always be ready to adapt to new recommendations and technology.
Endoscopes have always been challenging to reprocess. The key to keeping patients safe from infections is to constantly revisit and reassess your protocols while staying on top of the latest evidence-based science.
Solar-Powered Sterile Processing?
New system could sterilize instruments in remote areas without electricity and fuel.
A team of researchers from MIT and the Indian Institute of Technology have devised a solar-powered method of sterilizing medical instruments in developing areas of the world where electricity and fuel-powered boilers are not reliable, unavailable or cost prohibitive.
The system devised by the research team requires only a two-square-meter solar collector to power an autoclave, which requires a steady supply of pressurized steam at a temperature of 120ºC. A prototype was tested in Mumbai, India, at a small medical clinic, where it successfully provided enough power to sterilize equipment so patients could receive safe care.
The system, featured in the journal Joule and in an article in MIT News, employs optically transparent aerogel, a material developed by MIT professor Evelyn Wang and others. This lightweight foam, made of silica, is a very effective thermal insulator that prevents heat loss from the solar collection device. Using this transparent insulating material, the researchers transformed a system that can generally produce only solar hot water into one that generates high-temperature steam.
Ms. Wang says the project is important because so many parts of the world have limited access to reliable electricity and affordable fuel. "We saw this as an opportunity to think about how we can potentially create a low-cost, passive, solar-driven system to generate steam at the conditions that are necessary for autoclaving or for medical sterilization," she says.
Production of devices like this will ultimately depend on acquiring the aerogel, which isn't yet available for commercial use. Once it is, however, the rest of the system is made of materials widely available throughout the developing world, and would cost only $140 to build.