Healthcare Facilities' sterile processing departments (SPD) handle thousands of reusable surgical instruments daily that have become more technical and difficult to clean and process. If these items are not processed properly we put our patients at risk of getting infections from dirty instruments used on them. This could also result in unnecessary extended stays of patients and possible death as well as putting the reputation of the facility and surgeons at risk of citations from governing bodies. Patient safety is dependent upon SPD personnel performing functions competently.
Decontamination is the most important step in the sterilization process beginning with point of use cleaning in the operating room. Items must be cleaned according to the manufacturer’s instructions for use (IFU’s). These must be followed for each item processed. Failure to properly clean a device will prevent sterilization from occurring. There are several factors that contribute to having a properly functioning decontamination area:  there must be proper dilution of detergents or damage to instruments will occur to include rusting and discoloration,  lumens are a big issue so there must be an assortment of brushes with varying lengths and diameters to thoroughly clean inside lumened instruments,  SPD staff need to be competent in the use of all processing equipment,  monthly in-service should be recurring and completed by the manufacturer’s representative,  efficacy testing of the equipment should be completed and documented ensuring equipment is functioning as intended.
Assembling and processing of the trays is another integral part of the process. There are still hospitals around the country that do not have an instrument tracking system, although there are several out there to choose from. A tracking system is a great tool for productivity and facilitates an organization becoming a paperless department. One of the best aspects of one of these systems is that trays can be tracked to the patients they were used on. When assembling trays there are many checks prior to sending the completed tray to sterilization.
A great assembly area will have magnifying glasses, materials for checking sharpness of scissors, a unit to insulated laparoscopic instrument for damage, an adjustable work station and a computer. Instruments must also be function tested, lumens checked for bio burden and selecting the proper wrapper or container for the tray that is being assembled. All these must be accomplished and prepared according to IFU’s. In the past, most of the instruments were very easy to clean and process. Now, there are several different sterilization and high level disinfection processes to choose from and we must know the correct method otherwise the instruments may not be ready for use.
There are factors that can inhibit items from being packaged and properly assembled for sterilization. If items are not loaded properly or overloaded this will not allow for proper sterilization of the trays. Items should be loaded to assure adequate contact from the steam or sterilant depending on the sterilization process being used. All sterilizers’ cycles must be monitored to ensure all sterilization parameters were met. This includes required biological testing and interpreting and signing off on the sterilizer printout. Also, be diligent to not allow vendors and OR staff to remove items for the sterilization cart until they are properly cooled as they could possibly contaminate them.
SPD has a major impact on infection prevention and safety. All items processed in SPD must be sterile and safe for patient use. Staff must be knowledgeable in all aspects of SPD to ensure the safety of our patients. Personnel need to be trained and educated in correct processing methods and have the tools to perform their job. What I described above is just some of the processes that are required for SPD staff to accomplish to get this right for every patient every time. I always end a daily huddle with “clean and assemble a tray as if you knew that tray was going to be used on you or a family member”.
If your organization is interested in improving your Central Sterile Department and would like some guidance from our experts, be sure to check out our new Central Sterile Improvement Program: Central Sterile Processing Improvement Program
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