It is inevitable that there will come a time when each of us is a patient at the mercy of doctors, staff, and the protocols that they — not we — adhere to. As sterile processing department (SPD) professionals, we should step back from these experiences and reflect on what worked and what didn’t, how we felt as a patient during the entire treatment experience, and how we might take those lessons and apply them to our everyday interactions with our own patients and our colleagues at our facilities.
My recent experience as a patient led me to believe that patients likely observe so much more than we realize. While waiting for my procedure, I picked up on the interactions between my doctor and her support staff, the support staff and other departments, and the overall vibe of a facility whose chief purpose is to help people heal. I also observed the efficiency with which things ran, the cleanliness of procedure and recovery areas, and the team’s adherence to the latest safety and sanitizing protocols (something, I admit, that regular patients may not observe with such an exacting eye).
Above all, however, two things stood out: my connection with a competent and equipped physician who would be guiding me through my procedure and healing, and the quality of the hospital itself. Luckily, sterile processing can play an outsized role in positively affecting both, and SPD professionals can help other departments establish procedures that can lead to better outcomes for physician satisfaction and patient safety. Read on for how.
Physician satisfaction depends largely on whether a doctor feels that she or he has been able to provide the quality and quantity of care needed and desired by their patients, and a satisfied doctor is more likely to lead to more satisfied patients. But a doctor cannot do it alone, and support teams like sterile processing can make it easier for a doctor to deliver efficient and safe care. Sterile processing should take this notion to heart and shore up processes to increase efficiency and patient safety, rework procedures to ensure that trays will be delivered to the operating room (OR) in a complete and timely fashion, and solicit feedback from the physicians they serve to find other areas of improvement.
Hospital quality truly starts from the (below) ground up, as sterile processing departments are frequently located in the basement of a facility. While this under-ground location can lend itself to being overlooked, SPD administrators should visit their departments regularly to observe their teams in action and to identify areas of improvement before they become problematic. SPD techs should remember that their behind-the-scenes work is just as crucial as the operating team’s, and managers should establish a rigid continual quality improvement (CQI) process to weed out process shortcomings. After all, unsafe, missing or contaminated surgical instruments can spell disaster for the desired patient outcomes, the true measure of quality care.
Where the SPD Can Invest in Itself to Invest in Quality The SPD should do more to contribute to patient outcomes and quality than just help physicians’ days run smoothly; it must also invest in itself and its people, and limit mishaps in the areas under its control.
Human Factors That Can Affect Quality
The first step of investing in the SPD is establishing the high standards that the team should strive to meet, and then empowering the team to meet them. To empower our teams, we must invest in their education, core competencies, and skill sets by providing training and education. A commitment to education validates that your facility is committed to quality and adherence to protocol, reinforces industry best practices, and allows a team to build solid onboarding training processes.
Another crucial investment is the investment in the correct tools, equipment, and adequate space and time for an SPD to get the job done well. By arming your team with the right tools for the job and the training on how to use them, an SPD can reduce the human errors that can affect quality. Remember, gone are the days of purely manual cleaning tools; new technologies and advances in medical device manufacturing necessitate a whole new and ever-evolving skill set that we must impart to our teams.
Environmental Conditions That Can Affect Quality Environmental conditions that affect quality include temperature and humidity, type of water used for cleaning, an SPD’s layout, and more. While an SPD cannot control the weather, it can and should control the temperature and humidity in its department. Pay close attention to these variables and meet the specific standards in general work areas, decontamination stations, sterilization equipment access rooms, sterile storage, and personnel support areas as outlined by AAMI ST79 and The Joint Commission. Each room or area should have independent temperature and humidity monitors and the daily conditions should be recorded by personnel. This tracking allows personnel to detect unwanted changes in conditions that may affect process results. Generally speaking, work areas should be comfortable enough for workers but cool and dry enough to minimize bioburden.
Also consider the type of water used for cleaning and de-contamination as well as air flow in the facility. While tap water may be used for initial rinsing, final rinses should be performed according to the standards provided in the manufacturers’ instructions for use (IFU). The IFU may call for deionized, distilled, or reverse osmosis water depending on the instrument. Air flow must pass from the preparation and packaging area to the soiled and decontamination areas, and not the other way around, to prevent the spread of contaminants.
The ideal SPD layout should be designed to separate areas in which contaminated items are received and processed from the areas in which clean items are packaged, sterilized, and stored. Functional work areas should be physically separated by walls or partitions to control contaminants during the phases of reprocessing. The distance between related work areas should be minimized and the workflow should provide adequate space. Pedestrian traffic should be restricted to authorized staff, who should wear protective equipment when necessary.
Environmental factors also include exposure to ergonomic risk factors on the job that may lead to musculoskeletal disorders (MSDs) of the upper extremities, back, and lower extremities. Workstations should be ergonomically designed and specific to the work being performed. Stools should be available in the work area as standing in static positions for long periods of time can cause muscle fatigue and pooling of blood in the lower extremities, while hard floors can create trauma and pain for the feet. The work areas should be cleaned and free of clutter, carts, tables, mobile equipment, and instrument trays should be organized to ensure there is adequate space for the staff to maneuver, queue trays, or r access the sinks during peak workload times.
Processes That Can Affect Quality
When it comes to sterile processing, the ever-enduring rule of thumb is always to follow the manufacturers’ IFUs and ensure that there is enough time allotted to do so. As mentioned above, technological advances of surgical instruments have made cleaning and sterilization more complex than ever before, and the only true way to keep up is to follow IFUs. Also, attention to detail is key. Shortcuts and rapid turnovers lead to process failures and improperly cleaned and sterilized instrumentation. Collect daily statistics on items that are requested most often and use the data to support the purchase of additional instrumentation to limit tight turnarounds. Reprocessing without following the appropriate steps will most likely render an item unsafe for use on patients.
Equipment and Required Materials That Can Affect Quality
The use and function, recalibration, ongoing periodic cleaning and maintenance, and contractor servicing of any and all tools and equipment should be done according to manufacturers’ IFUs. Establish appropriate records and tracking methods to be sure everything is done in accordance with these instructions. Take part in the purchasing and acquisition of new instruments and equipment and provide feedback on what’s doable within your department’s current constraints.
In summary, while the nitty gritty of staff education, department environmental conditions, decontamination processes, and SPD equipment may happen out of patients’ sight, a commitment to all four more often than not yields the result we’re all looking for: a safe and quality medical treatment experience.
Reflect on these things the next time you’re part of a team that’s treating patients. Are you treating them the way you would want to be treated?
Original article printed in the Healthcare Hygiene Magazine, December 2020 issue.