Reprocessing Department Leadership: How Can You Mobilize Your Teams for Success?

All companies, organizations, sports teams, sterile processing departments and GI labs that strive for greatness have one thing in common: effective leaders.

 

Effective leaders deploy three common strategy tactics that mobilize their teams around their mission. Those tactics get their teams rowing in the same direction, so to speak. I’ve outlined them here to share a roadmap for achieving such success.

 

Develop and communicate vision 

1. Successful sterile processing department (SPD) managers must have a vision. Leaders that can step away from day-to-day tasks to share their vision tend to be the ones with the most effective and productive processing departments.

 

Managers get sucked back into the day-to-day operations of their departments due to limited resources and labor now more than ever. But the managers able to step away and prioritize developing and communicating their vision for the department are the ones that become highly accomplished leaders.

 

Set aside the time to establish your vision if you haven’t done so, and make it mission critical to share it with the team on a frequent basis.

 

Create a shared set of core values 

2. Good sterile processing department leaders create a winning and accountable culture. Steve Jobs coined it first as “Culture wins over strategy.” Managers must task themselves with creating and improving their department’s culture. A foundational component of department culture is establishing core values.

 

Creating a great culture that is honest, open, and accountable starts with a shared set of core values to which everyone is held accountable. Core values speak to the mission of the team and the desired behaviors that will help them navigate their responsibilities. Values are what every team is hired, fired, and coached to. Those core values must be integrated into everyday life including team huddles, department meetings, 1-on-1 meetings, and reviews.

 

Managers become effective leaders when they develop, reinforce, and hold their teams accountable to a shared set of core values.

 

Set personal and team goals 

3. Good sterile processing department managers have personal and team goals. Winning managers have set such goals that move the team toward the overall vision.

 

Sinai Reprocessing TeamLet’s try a football analogy.  The vision aspect could be winning the big rivalry game. The goals are small, achievable accomplishments toward the win. First downs, or a deep punt that puts the offense on its heels, and of course touchdowns and extra points, are important goals toward winning that rivalry game.

 

But let’s not forget running successful practice plans also helps accomplish game time goals and is equally important. A great example for sterile processing or GI labs that many of you dream of is updating, rehabbing, or building out a new department. Goals may start with data collection, time studies, gathering technician feedback, identifying, and documenting current safety challenges, and departmental inefficiencies.  All of this is important information to help you build a financial justification.

 

Yes, there is much more to it than that. But these are the three tactics that stood out the most to me in my 26 years’ experience working with sterile processing services (SPS).

 

It all begins with having a vision and making time to communicate that mission, establishing a shared set of core values to hold teams accountable, and setting personal and team goals.

 

Passion for Processing: An Exercise in Loving our Professions

Looking back on past companies and organizations, it’s the culture you worked in that you probably remember most. Whether people said good morning to each other, how your manager gave you feedback, or maybe it was the unique traditions you shared with an office friend. All these examples are rooted in the Core Values that lived in that workplace culture.

One of our Pure Processing Core Values that defines our culture is Passion for Processing. It’s about being a lifelong learner, being dedicated to our customers one at a time, and fundamentally, about being engaged with our work and its impact on patient safety.

We want to take a moment to say thank you to those who dedicate their lives and ground their professions in this Core Value. Sterile processing is a hard job. It’s dangerous, and sometimes it’s ignored or just all together forgotten.

During this very special International Sterile Processing Week of celebration, recognition, and saying thank you, we must also remember to love our mission. Without sterile processing, we could never take care of each other. We help those in our community heal, grow, and live their lives as they were meant to be lived. Sterile processing is fundamentally rooted in kindness and care.

This sterile processing week, take a moment to remember why we love our profession, and maybe reconnect with your own reason to have Passion for Processing (or if you struggle to find that passion in the first place).

Here are five simple things to try this week to stoke (or light) your Passion for Processing:

  1. Find the thing you like the most and focus on that first. Is it the satisfaction of knowing you finished an instrument tray perfectly? Maybe it’s that one coworker you can always rely on during tough times. Or sometimes it’s bigger than ourselves. It’s knowing that your commitment to your craft is what ultimately protects patients and helps them heal. It can be powerful to remember these things when work gets tough.

 

  1. Challenge yourself. Find something about your job you can’t do well and commit to mastering it. Small or big, embracing change helps us see our professions as bigger than our day-to-day responsibilities. Being a lifelong learner opens you up to a new world around you!

 

  1. Expand your network. Attend a local chapter show. Join an online group where your peers can share and post their thoughts and where you can share your own stories (like our LuvDecon community, here). You may find subsets of the instrument reprocessing world which speak to you, and you can engage with a community who shares in those interests and passions.

 

  1. Recognize your achievements (and mistakes). Think about what you’ve accomplished since last year’s Sterile Processing Week. Maybe you earned that certification you were studying so hard for. Or maybe you made a mistake but learned a new skill (or newfound faith in your own abilities). All those experiences are fundamental to our own personal growth. You are a new person because of your experiences in sterile processing.

 

  1. Give yourself a new job title. On the days when you’re struggling, remember that your title cannot define all you do and are. Isn’t it true that inspecting each individual instrument allows someone to go home healthy to their family? Remind yourself that your job is bigger than what your title says.

 

Happy Sterile Processing Week! Without the commitment, dedication, and support of the those within the sterile processing community, our patients and hospitals would cease to function. We are grateful for all you do, and hope you enjoy this week. Thank you!

 

Don’t forget to also have some fun during Sterile Processing Week! Pure Processing is offering free posters and pins (limited supplies available) to any sterile processing department. Request your free Mission Possible: Making HAI’s Impossible items here, and share a photo or video of your SP Week celebrations! A department will be chosen as a winner for a prize giveaway at the end of SP Week.

There is no IFU for Establishing a ‘Patient-First’ Culture in Reprocessing Departments

There are instructions for use (IFU)s for just about everything in sterile processing departments (SPD), and for good reason. SPD is responsible for cleaning some of the most vital and potentially risky equipment in the hospital: Surgical instruments.

 

ANSI/AAMI ST79: 2017 requires departments to follow IFUs to ensure effective decontamination and sterilization. Those IFUs are geared toward patient safety by reducing the incidence and possibility of infection. Infection prevention is at the core of everything we do. Yet we often miss the mark when it comes to prioritizing the patient as we perform our reprocessing.

 

And there is no IFU provided to leadership on how to create a patient-first culture in their departments.

 

There are no instructions that tell us how to instill a group mindset of patient-first focus, or how to ensure the end user, as it were, sits at the top of every technician’s mind in the department. That their efforts aren’t just to reprocess, but to improve, and even save, someone’s life.

 

When there is no roadmap to follow, departments must put their own plan into place.

 

Let’s talk about culture

 

patient first cultureCreating a patient-first culture which incorporates employee psychological safety is important for teams to achieve success.

 

Two questions need to be addressed during all reprocessing tasks:

 

  1. Does the team have a patient-first focus? Or are they simply following a protocol?
  2. If they feel something is not meeting IFUs for patient safety, do they feel comfortable speaking up?

 

It’s important to establish a patient-first culture to identify where infection prevention improvements are needed, and also to encourage team members to be at ease with bringing to attention to something that needs a change.

 

One example could be syringe flushing. Do team members recognize that syringes create inconsistent flushing pressure? Are they encouraged to always prioritize patient safety to the point where they are comfortable suggesting a different way of doing things? Can they trust that their suggestions will be received in a positive manner?

 

Creating a patient-first mentality along with providing team members with the trust and support to identify issues can elevate your department, as well as bolster confidence for team members.

 

Where are the IFU police?

 

There are no IFU police looking over every shoulder in the department. And sometimes it seems as if none are needed. When patient safety numbers are doing well, it can be all too easy to believe there is no problem.

 

It’s easy to dismiss the idea of potential IFU issues when there are no negative patient outcomes. But believing there is no problem should be a red flag to leadership and educators. A false sense of security can prevail when a problem isn’t evident. It can spread throughout the team. And that is anathema to sterile processing department efforts to prioritize patient safety as a critical, daily effort.

 

Implementing a patient-first mentality combined with encouraging trust and autonomy within your team will create a crew that will become their own IFU monitors. They will become more vigilant and work together to identify solutions before a potential issue becomes a real problem.

 

We’re all in this together

 

There is no manual to tell us how to instill a patient-first culture in our SPD. But we can make our own IFU by outlining clear ways to communicate with our teams, encouraging teammate participation for improved ways to meet best practices, and by wrapping it into a core culture.

 

These efforts will strengthen team bonds, elevate best practices, and improve SPD outcomes. After all, those patients are counting on us.

 

 

 

Join LuvDeconAre you looking for a sterile processing community where you can connect, learn, and grow? Join LuvDecon, a digital community specifically created for SPD professionals. LuvDecon is here to help you become DECONfident! Share the ways you reinforce and create a Patient-First culture in your department with our LuvDecon members; you may pick-up some ideas yourself!

Planning for Patient Safety in the Sterile Processing Department

“Think of this tray as being YOUR patient.”

 

The wise sterile processing director knows the importance of placing the patient front and center for SPD technicians. Technicians may not physically interact with the patient, but their work and diligence on medical instrumentation will.

 

Providing clean, working, sterile instrumentation for patient procedures is one of the most critical functions of the sterile processing department. It is evident that proper processing reduces or even eliminates hospital-acquired infections (HAIs) and contributes to safety and success of patient recovery.

 

A patient promise

 

Sterile processing leadership understands that patients should leave the hospital in better condition than when they arrived. They do their best to impart this message to their teams. It is a serious vow. A negative domino effect impacting patients and their recovery can occur without ideal processes and adherence to best practices in central sterile.

 

The negative domino effect is a perilous risk that is all too easy to trigger. The promise to send a patient home in better condition can be broken. Let’s look at ways patient safety efforts might be undermined, and review ways you can overcome them.

 

Where SPD patient safety efforts can break down

 

Here are three ways patient safety efforts might be interrupted:

 

SPD staffing skill issues

In today’s environment, maintaining skilled staff and hiring new staff has become a near impossible task thanks to so many alternatives to better pay and less hazardous conditions.   Instrumentation issues (complexity of instruments and sets, loaners, IFU’s, less inventory) add to the difficulty for current staff.

 

Answers to these questions, followed by the right action plan, can help to address staffing skill issues:

  • Are you preparing staff prior to new specialties or ramped up surgical procedures?
  • Are new staff in place before those events occur?
  • Do staff have access to continuing education?

 

Placing quantity over quality in sterile processing

quality over quantity

This happens often when production demand shoots up, and especially with low numbers of skilled staff. It is too easy to fall into the trap of the “good enough” mentality. This happens when teams select quantity over quality on number of trays done per shift. In reality, the priority should be on number of trays processed properly (the quality) per shift.

 

Bottlenecks in productivity

Ever just throw more people at a problem? Most SPDs are forced to do so to overcome industry and hospital changes. Some of these bottlenecks can be minimized by listening to staff’s continuous improvement ideas, and standing in the middle of the problem, and just observing.  Likely, the core of the issue is a 20-year-old design that hasn’t accounted for growth through additional space, effective workflows, and newer technology that enables staff productivity and safety. Identifying and planning that core change to remove bottlenecks is a good strategy for your staff and your department.

 

How can you deliver on the sterile processing patient promise?

 

How can you overcome the three issues above to deliver on the promise to send a patient home in better condition than when they arrived? Here are three ways to help you do so.

 

Make the investment in SPD equipment

It’s worth it to invest in technology that enables staff safety, and helps technicians be more productive. Throwing more people hours (without enough skilled people) at the problems can be counter-productive and lead to sickness, injuries, and possible staff turnover. Making technology investments in your current valued staff demonstrates your concern for their safety and wellbeing, enables their productivity, and lifts morale.

 

Quality enhancer

Having your OR 100% on board with point-of-use instrument care prior to coming to SPD will create incredible efficiencies for staff-starved SPD. If that’s not a reality in your facility, then focusing on pre-cleaning and cleaning processes of your instrumentation in decontamination will have greatest impact to patients.  “If it’s not clean, it can’t get sterile” never changes. Cleaning with purpose and diligence will enable and enhance all quality assurances through processes to patient.

 

Space

Plan, justify, and fight for more space now, to correct what hasn’t happened, but to also account for what will happen in the next 5-10 years. As surgical procedures ramp, new specialties are added, instrumentation becomes more complex, and new staff is added, it will become more difficult to predict those future needs. You can never catch up to future production without the space, which allows added technology, and proper workflows for your team to perform. Without it, we go back to throwing people hours at the problem (see SPD staffing skill issues above).

 

Keeping the patient promise

 

Planning for patient safety and instilling a patient promise culture is valuable in every sterile processing department. Roadblocks will happen, staffing issues will occur. The best way to keep that patient promise is to shore up your department with well-trained staff, to anticipate future surgical load, provide the equipment necessary for ideal technician productivity, and avoid the temptation to “throw more people” at a problem.

 

Invest in your department with the right updates. Remember that quality should take precedence over quantity. Anticipate, plan, justify, and fight for the space requirements of your growing department before it becomes an emergency.

 

Patients rely on the promise of going home in better condition than when they arrived at the hospital. Let’s keep that promise for them.

 

 

Prepare for your departmental renovation or update with the best sterile processing partners in the business. Contact us today to speak with a specialist who can guide you through the process!

Pre-cleaning Complex Instruments and Its Impact on Patient Safety

Inadequate cleaning before sterilization accounts for 34% of surgical site infections.1 Patient safety is a top priority for every hospital across the country and sterile processing departments play a vital role in maintaining the integrity of patient safety during surgical procedures.

The advancements in healthcare technology have birthed innovative surgical instruments that often have complex designs. Sterile processing departments are faced with the new challenge of properly cleaning those complex instruments in a fast paced and high-pressure environment.

We’ve outlined three essential steps in pre-cleaning complex instruments to ensure it’s done correctly and without compromising patient safety.

1. Always follow the instructions for use (IFU)

Each instrument comes with Instructions for Use. The term “instructions for use” refers to the information provided by the manufacturer to inform the user of a device’s intended purpose and proper use and of any precautions to be taken.2

A portion of each IFU details how to properly clean the instrument prior to use in surgery. The IFU will outline what steps need to be taken during cleaning, what cleaning technologies should be utilized and under what conditions. It is always critical to become familiar with the instrument’s IFU and follow it step-by-step. Omitting any of the cleaning steps in the reprocessing protocol can lead to deadly infections.1

2. Utilize pre-cleaning technologies

Sterile processing departments rely on modern technologies every day to aid in instrument reprocessing. Instrument IFUs often require the use of these technologies to clean complex instruments effectively. Many complex instruments have small channels, moving parts and little nooks and crannies. Lumened or cannulated instruments account for 35% of cases where inadequate cleaning before sterilization was identified.1

flushing robotics 004The use of automated flushing systems assures copious flushing of internal device channels and lumens during pre-cleaning. Unlike traditional methods of flushing, automated flushing will ensure departments stay compliant with industry guidelines and IFUs by consistently flushing the same volume and pressure each time.

The use of cavitation will also improve the quality of your pre-cleaning process tremendously. Cavitation creates bubbles induced by high frequency pressure (sound) waves to agitate a liquid. The agitation produces high forces on contaminants adhering to substrates like metals, plastics, glass, rubber, and ceramics.3 Ultra-sonic cleaners in sterile processing departments utilize the process of cavitation and help clean complex instruments’ hard-to-reach places.

3. Support from direct leadership and supporting departments

Cleaning and preparing each instrument for an entire hospital’s surgical procedures is no easy task. Sterile processing departments are under immense pressure to ensure each instrument is cleaned thoroughly and in a timely manner in preparation for the next surgery. It’s important for the organization’s leadership to ensure the SPD staff has the proper equipment and workflow to meet these high expectations.

Pre-cleaning complex instruments often involves multiple steps that require time and attention-to-detail. SPD leadership must take this into consideration for their staff to be compliant and get the job done correctly. The support from surgeons that work in conjunction with SPD will also help this process tremendously. Their understanding of the pre-cleaning process will prevent productivity pressures from forcing staff to deviate from the cleaning instructions for the instruments at hand.

These three essential steps ensure correct processes and patient safety. You can elevate your department’s influence on the reduction of surgical infections by following IFUs, taking advantage of pre-cleaning technologies, and ensuring support from direct leadership. Implementing such recommendations takes a commitment to action and follow through but are well worth the effort.

 

Learn more about the Pure Processing FlexiPump Independent Flushing System which helps assure copious flushing of internal device channels and lumens during pre-cleaning, and can flush up to three instruments at once.

References

  1. ECRI (2017). If it’s not clean, it’s not sterile: Reprocessing contaminated instruments. Event Reporting and Analysis Alerts. Accessed online August 27, 2021. https://www.ecri.org/components/PSOCore/Pages/e-lert041117.aspx
  2. Schuh, M. (2020). MDR: requirements for instructions for use for medical devices. Reusch Law website. Accessed online August 27, 2021. https://www.reuschlaw.de/en/news/mdr-requirements-for-instructions-for-use-for-medical-devices/
  3. Todd, bert H., Allen, ll K., & Alting, O. (1994). Manufacturing processes reference guide. Industrial press

 

 

 

 

 

Reprocessing Considerations for 5 of the Most Difficult-to-Clean Surgical Instruments

As surgical procedures advance, the design of surgical instrumentation that central sterile processing staff and nurses are asked to reprocess also becomes more complex.

Many instructions for use (IFU) that were once short and easy to understand are now rigorous, time intensive, and difficult to measure. This increase in complexity in IFUs, tied with other environmental challenges such as staffing shortages, changing guidelines, and lack of control over the operating room’s pre-cleaning quality, makes staying compliant with IFUs more difficult than ever.

Certain surgical instrumentation is more challenging to reprocess than others. Here are five types of surgical instruments that may require additional planning and consideration by staff to ensure IFUs are being met.

1. Robotic instrumentation

soaking roboticsRobotic devices continue to be a difficulty for sterile processing staff because robotic instrumentation cannot be disassembled.  The instrument’s design includes many intricate nooks and crannies.

A 2016 Infection Control & Hospital Epidemiology study conducted on cleaning robotic instruments concluded that it is virtually impossible to fully remove contamination from their arms.

“These instruments are wonderful tools that allow surgeons to operate with care; but completely decontaminating them has been a challenge for hospitals,” said Yuhei Saito, RN, PHN, MS, lead author of the study and assistant professor at the University of Tokyo Hospital.1

Sterile processing departments may also face another challenge: Robotic arms that are too long for many of their existing sink basins. Pre-existing stations become outdated more quickly as instruments become larger, longer, and heavier, and difficult to scale up as the OR evolves.

Ask the following questions about your own processes if you are reprocessing robotic devices, or plan to implement a robotic system:

  • Do my sink basins fit robotic arms for proper soaking?
  • Can I sacrifice a sink basin for a full, 30-minute soaking period, per IFU requirements?
  • Am I really flushing robotic channels for their full IFU every time, and can I ensure I meet pressure requirements?
  • Do I have the automated cleaning systems in place to meet robotic IFUs?

2. Flexible endoscopes

Scope Flushing 072921Flexible endoscopes are notoriously difficult to reprocess due to their complex designs. Some of these design elements might include:

  • Long, dark, and often narrow channels, which favor bioburden and biofilm development, especially if channels are left wet and/or improperly cleaned
  • Elevators
  • Rough or pitted surfaces
  • Heat and chemical sensitive construction
  • Right angle bends, and complex ports

Reprocessing departments responsible for cleaning flexible endoscopes may consider supplementing their existing standards of practice by requiring certification to staff cleaning flexible endoscopes, enhancing training, or re-writing procedures for worst case scenarios. All of these areas can help draw extra attention to a scope’s complex design, which may prevent errors.

3. Ocular and ophthalmic instruments

flushing ocularAny ocular surgery where the anterior segment is exposed is at risk of a potential Toxic Anterior Segment Syndrome (TASS) infection. These procedures not only include cataract cases, but also eye trauma and macular degeneration procedures. Facilities reprocessing instrumentation which supports these cases should pay special attention to ANSI/AAMI ST79:2017 “Comprehensive guide to steam sterilization and sterility assurance in health care facilities” guidance.

Ocular instruments might be best processed in dedicated areas of the department solely for eye instrumentation. Eye instrumentation IFUs may, for example, restrict the use of enzymatic detergents. When residual enzymatic gets in a patient’s eye during a procedure, it can lead to blindness or other severe, negative outcomes. You may also find your ocular IFU now includes single-use brushes only, or specific water quality requirements.

4. Flexible reamers

In a 2018 study by the Healthcare Infection Society, “Soil and/or biofilms were evident on complex-design [flexible reamers] following 20 cycles of contamination and reprocessing, even using the reference standard method of cleaning… although the depth gauges could be disassembled, biological residues and biofilm accumulated in its lumen.” 2   Flexible, exterior channels are prime locations for bioburden and biofilm development and require special attention during cleaning.

This study points to a key issue: Even under best practices and total compliance to IFUs, complex designs may sometimes prevent even the most well-trained reprocessing staff from completely decontaminating instrumentation. Instrument design may be purposeful in the operation room, but it can be a roadblock for those reprocessing said instrumentation.

Departments should consider if the manual cleaning methods they’ve implemented are meeting or exceeding IFU requirements consistently, even in worst-case scenarios.

5. Loaner instrumentation

Loaner instrumentation poses a unique challenge for reprocessing departments. Many staff members may be asked to clean instrumentation for the first time without adequate training and preparation. A lack of communication from vendors on IFUs and proper cleaning protocols could further complicate the cleaning process. Even if the instrumentation is not complex in its design, these outside factors make reprocessing loaner instrumentation more difficult for even seasoned staff.

Having a robust loaner instrumentation program, including strict IFU reporting by vendors, a thorough decontamination process for instruments arriving at your facility for the first time, and giving teams proper time to clean pre- and post-procedure can help reduce manual cleaning errors. 3

For any department that is reprocessing any of these complex instrument designs, proper training and processes become foundational to ensuring your patients’ wellbeing and safety.

 

For more information about enhancing your manual cleaning procedures for robotic, endoscope, ocular, orthopedic, or loaner instrumentation, watch our free, 1 CE educational program, A Royal Flush: Your Winning  Hand for Pre-Cleaning Protocol.

 

References

  1. Yuhei Saito, Hiroshi Yasuhara, Satoshi Murakoshi, Takami Komatsu, Kazuhiko Fukatsu, Yushi Uetera. Challenging Residual Contamination of Instruments for Robotic Surgery in Japan. Infection Control & Hospital Epidemiology, 2016; 1 DOI: 10.1017/ice.2016.249
  2. Lopes LKO, Costa DM, Tipple AFV, Watanabe E, Castillo RB, Hu H, Deva AK, Vickery K. Complex design of surgical instruments as barrier for cleaning effectiveness, favouring biofilm formation. J Hosp Infect. 2019 Sep;103(1):e53-e60. doi: 10.1016/j.jhin.2018.11.001. Epub 2018 Nov 10. PMID: 30423413.
  3. Sadler, D. (2016, November 15). Cover story: The challenges associated with loaner instrumentation. OR Today. https://ortoday.com/cover-story-the-challenges-associated-with-loaner-instrumentation/.

Top 5 Ways to Improve Sterile Processing Productivity

Productivity for sterile processing professionals is a priority topic these days. Reasons for this are varied, but we can all agree on its importance. Sterile processing departments must operate, as all areas of the hospital must, with efficiency, adherence to best practices, and with the highest-quality patient safety outcomes in mind. These all combine to form the basis for determining departmental productivity capabilities.

 

Many resources discuss how central sterile productivity can be measured in terms of output, surgical volume, or even surgery minutes. How fast can the central sterile processing department (SPD) turnover case carts? A critical consideration exists, however, that must be taken into account: equipment.

 

The right equipment is necessary for SPD technicians to achieve instructions for use (IFUs), reprocess devices in a consistent manner, and to avoid injury as they do so. It is also necessary to ultimately achieve productivity goals.

 

Here are 5 ways to improve sterile processing productivity with the right equipment.

 

1. Sterile processing sinks

 

Decontamination sinks are where a majority of SPD technicians spend the day working. Disassembling, soaking, flushing, and manual cleaning all take up quite a bit of time. Now, imagine if you had to walk all over the department just to get tools and accessories. Or if the sinks were at awkward heights and did not match the user’s physical needs. Imagine having to stop and reposition repeatedly to accomplish tasks. That would all contribute to a rapidly diminishing productivity outcome. One that can be further reduced when technicians are in pain from working in unaccommodating conditions.

 

Your sink equipment should include the following to tackle such issues and overcome productivity roadblocks:

 

  • Adjustable heights to accommodate different technicians
  • Accessories easily within reach on back walls or shelves
  • Ergonomic wrist rests to avoid injury
  • Integrated temperature, enzymatic, and tracking monitors where appropriate
  • Integrated and organized electrical capabilities for powered accessories
  • Added lighting to assist with visual inspection in dimly departments

 

2. Space considerations for ideal SPD equipment

 

Full scale renovations may not be something your department can do this year. But productivity can take a hit when space becomes a constraint. The way to get around productivity drain is to utilize equipment specifically created to meet the physical needs of a location.

 

Look for equipment designed to do more with less space if your available square footage has limitations. One example is the PureSteel Xi Reprocessing Sink. The Xi Sink has a small footprint while also offering a surprising ability to accommodate larger surgical and robotic instruments with a basin maximized for such instrumentation.

 

3. Transport carts

 

PureSteel™ XL Transport Container Tiered Cart 2Carts are often a necessity for central sterile departments. Their use for soaking and transport may seem to be rather simple, but don’t let that fool you.

 

Those trusty tools can support your productivity efforts in several ways by making use of what you have available to you in terms of space and storage, increasing ease of movement, and by turning a small area into a multi-tasking space. A few examples:

 

  • Soak instruments, rather than tie up existing sink basins necessary for rinsing and flushing
  • Provide up to four levels for soaking soiled devices with just one cart
  • Utilize an organizational back wall to install flushing systems and soaking timers and create all-in-one reprocessing stations

 

4. Soaking stations

 

Mobile Soaking StationPeak reprocessing hours can create a bottleneck for productivity.  And we all know the last thing we want to do is hold up the operating room or our decontamination techs. Creating and maintaining flexible workstations can solve the bottleneck and help your team accomplish more with less.

 

Mobile soaking stations can expand your department’s functionality while being small enough to take up minimal space. They offer many advantages:

 

  • Create extra reprocessing sink spaces during peak reprocessing hours
  • Accommodate robotic and larger orthopedic sets if your existing basins can’t fit longer instrumentation
  • Rolling casters allow mobility throughout the department
  • Pegboards offer installation options
  • Installation without tapping existing plumbing keeps installation OSHPD-friendly

 

5. Flushing more than one instrument at a time

 

flexipump independent flushing system laparoscopicFlushing is a huge productivity block. Flushing one instrument at a time is something more and more departments are moving away from, thanks to new technologies that allow for multiple instruments to be flushed at the same time. That saves technicians time, enables them to perform additional tasks, and ensures IFU compliance.

 

Equipment like the FlexiPump Independent Flushing System automatically flushes internal instrument channels and handles multiple devices at once without constantly pulling and plunging syringes for just one lumen.

 

Flushing productivity can also be enhanced when integrated with sink inserts, dedicated eye sinks for channeled ocular surgical devices, and automated enzymatic chemistry dispensers. These all contribute to the reduction of unnecessarily repeated tasks, the ability to perform multiple tasks at once, and creates a more ergonomically designed environment that supports your productivity goals.

 

It’s time to increase productivity

 

Measuring output and surgical volume is important for understanding SPD productivity efforts. The question is, how can you make a change? How can you increase output and support surgical volume? Training is always a good place to start. But your team also needs the right equipment and tools to diversify, perform multiple tasks to standards, and avoid injury.

 

Look closely at your current equipment and take stock of where it creates backlogs. Notice where technicians get stuck and why. Pay attention to how much time is lost. And then evaluate how certain changes could improve output.

 

Have a question about improving your department’s productivity? Contact our specialists for answers!

 

 

 

Pure Processing solutions are designed to accommodate any facility’s pre-cleaning footprint, from tiny pre-cleaning corners in an endoscopy lab to a full SPD “dirty side.” Systems and accessories can be selected to optimize the tasks and achieve the workflow volume of each specific department. We also offer continuing education, training and in-service, and valuable resources for SPD staff.

 

 

 

 

Syringe flushing variability impact to surgical instrument manual cleaning: What’s the risk?

The manual cleaning of reusable and cannulated instruments requires specific steps to meet IFUs, and adequately flushing them before the sterilization process is one of the most critical of these steps.

 

Syringe flushing 081921Many reprocessing departments continue to flush instruments with syringes for manual cleaning. For departments still using this method for flushing, it’s important to fully understand how your prescribed methods for meeting IFUs can positively or negatively impact outcomes. Syringes, for example, have a hidden weakness beyond the control of your staff: variability of outcomes.

 

We can all agree variability is something to be avoided at all costs in any reprocessing department. Consistent flushing and cleaning must occur on instruments with channels where bioburden can lodge and escape the cleaning process. That same bioburden can later break free with potential to infect the next patient if it is not completely removed prior to sterilization. That means standards were not met, and a patient’s outcomes could be negatively impacted. No department wants that.

 

Some may argue that syringes are just easier to use when flushing. Syringes may appear to shorten flushing time, and they don’t come with own set of IFUs. At first glance they truly do seem like a viable option. So, what exactly makes them so risky?

 

Technicians and nurses cannot flush the same each time

 

Technicians and nurses are human beings who may plan to perform consistently. But they are not robots calibrated to operate in exactly the same way during set tasks. Some days may be busier than others and technicians feel rushed to keep up. Or there may be other distractions in the department or from the OR. And sometimes people are simply preoccupied with the demands of their day. There is simply no way a technician can perform the exact same flushing process day to day. Steps can be skipped or inadvertently forgotten.

 

The bottom line is that no technician or nurse will flush a device with the same pressure and volume every single time. That means variability becomes a factor with each processed instrument.

 

Syringes are not calibrated for performance

 

While every technician or nurse strives to meet standards and IFUs, it’s a fact that no two people will flush an instrument the same way with syringes. That’s because syringes cannot be calibrated to consistently perform for the user. They are a manual tool without presets for pressure or volume, and that leads to inconsistency. Syringes cannot indicate when manual cleaning and flushing steps are complete or thorough.

 

Syringes risk repeated performance variability without functions to guide a user or to confirm IFU flushing steps are complete.

 

Syringes can cause long-term strain and injury

 

The physical work involved for sterile processing technicians can be difficult. Handling multiple devices per day, lifting heavy instruments and trays, pushing carts and more already make it a physically demanding role. Add to that the repetition of these tasks day over day, and the risk for potential, long-term injury becomes compounded.

 

Those deceptive syringes mask an insidious impact to the technicians themselves. It may seem simple to draw and push a syringe multiple times to flush a surgical instrument. But try it for days. Weeks. Months and years. All that strain over time can contribute to ergonomic injuries to wrists and hands. Ergonomic injuries to sterile processing staff can have far reaching impacts, starting with employee injury, workman’s compensation, reduced department turnaround time and productivity, and even staff satisfaction. Are those simple, “easy-to-use” syringes worth it?

 

It’s time to eliminate the risk of SPD flushing variability

 

Lessen the risk of variability in your sterile processing department with one simple change: Swap out the syringes. Your department is a key participant in patient safety and outcomes. There would be no clean surgical instruments without you. To that end, all your practices, processes, and trained staff must be at their best. Investigate syringe flushing alternatives that can best support all of your initiatives and take care of your team.

 

 

Learn more about the FlexiPump Independent Flushing System to automatically flush internal instrument channels, free up technician time to perform additional tasks, and avoid the repetitive motion pain and injury associated with syringe flushing.

 

You can also access a free, 1 CE credit by watching our related Royal Flush: Your Winning Hand for Pre-Cleaning Protocol CE program, where we expand on this topic in more detail, and provide you with tools to make changes in your department.

Ergonomic guidance for SPD injury prevention and productivity

Incorporating ergonomics into your central sterile processing or GI department is essential to increasing employee efficiency, satisfaction, and safety. It may be difficult to pinpoint every ergonomic issue in your department, but several organizations have developed guidelines which can help you identify potential areas for improvement and how to implement enhancements for your staff members.

1. Occupational Safety and Health Administration (OSHA)

OSHA offers a possible solution for consistent bending by “placing an object such as a plastic basin in the bottom of the sink to raise the surface up while washing items in the sink.” Technicians often find themselves reaching into deep sink basins to properly clean instruments in decontamination. While deep sinks may be required for heavy soaking or larger trays, they are not conducive for most manual cleaning tasks. Prolonged bending can lead to lower back, shoulder, and neck pain over time, creating more serious issues in the future. Incorporating a PureStation™ Sink Insert into a deep sink basin to raise the working level and lessen bending can save your technicians from unnecessary pain and meet the necessary safety guidelines.

OSHA also suggests using “height-adjustable work surfaces or lift tables to minimize head tilt.” Expecting all employees of varying heights to use the same worktables and reprocessing sinks positioned at the same height can create an ergonomic hazard in departments. The use of height-adjustable workstations and reprocessing sinks can reduce the risk of back injuries in technicians and nurses by allowing the user to adjust the height to their most optimal level.

When evaluating height-adjustable equipment, it is also important to assess another OSHA requirement, “Redesigning workstations so packaging and equipment can be reached while maintaining the elbows close to the body.” Reprocessing sinks and assembly tables often come with many accessories and mounted items such as monitors, shelves, or powered equipment. These accessories, used often and throughout reprocessing tasks, should be positioned on equipment to reduce reaching over shoulder height, and avoid flexion pain for employees. Height-adjustable equipment that allows the entire station, including their many accessories, to adjust to the user’s most optimal height should be considered when designing tables and sinks.

PureSteel™ Reprocessing Sinks and Ergonomic WorkStations are all height-adjustable so users can vertically adjust their stations to adapt to their ideal working height. PureSteel™ stations also feature back wall organizational pegboards which also adjust with the unit, ensuring the entire station is positioned properly for the user.

View a complete list of OSHA recommended solutions for more details.

2. IAHCSMM 

IAHCSMM identifies several ergonomic concerns that any department could be facing. One of the identified stressors is frequent repetition. Syringe flushing cannulated items requires a lot of force and repetition, leading to carpal tunnel syndrome and other musculoskeletal disorders. Training employees to recognize the signs and symptoms of injuries, report potential problems, and recognize tasks that can cause ergonomic stressors can help identify corrective actions to address issues.

The FlexiPump™ Independent Flushing System can provide hands-free, ergonomic-friendly lumen flushing that is safe for technicians and nurses, enhances manual cleaning of cannulated devices, and meets ANSI/AAMI ST79:2017 and instructions for use (IFU) requirements. Users can attach up to three lumened devices at once to each FlexiPump system to meet the copious flushing IFUs for each device without the frequent repetition and force of a syringe or spray gun.

3. ANSI/AAMI ST91:2015

ANSI/AAMI 3.2.1 guidelines suggest “Anti-fatigue mats should be used in areas where prolonged standing is required. Anti-fatigue mats should be constructed of materials capable of withstanding frequent cleaning.”

Technicians can endure hours of prolonged standing at sink basins and prep and pack tables. The use of anti-fatigue mats increases employee comfort and removes unnecessary fatigue and discomfort from standing on hard department floors.

When determining which anti-fatigue mats to use in your department, consider:

  • Whether the mat provides anti-fatigue benefits. Many mats reduce the risk of slipping, but don’t actually relieve pain or make standing more comfortable.
  • The ability for the mats to withstand robust and heavy cleaning.
  • Sizes of mats appropriate for the space in which they will be worked.
  • Mats which can be used in both decontamination and assembly areas, which makes cleaning and reordering easier and more consistent.

GelPro™ Eco-Pro Anti-Fatigue Mats are a cart-washer safe mat choice for reprocessing departments. They are a one-piece construction made from renewable, plant-based material, making them an environmentally friendly, sustainable choice for departments that replace mats often or on routine schedules.

By understanding these ergonomic guidelines, managers and staff members can help make immediate improvements in their departments or begin planning for larger scale enhancements in the design of their equipment.

 

For more solutions to ergonomic issues in sterile processing, endoscopy, or operating rooms, check out our newly updated product catalog.

 

The Importance of Best Flushing Practices When Reprocessing Flexible and Rigid Scopes

Properly reprocessing flexible and rigid endoscopes is a critical element of the healthcare infection control process. Scott R. Lucas, PhD, PE, program manager, engineering, of ECRI Institute’s AFI Group says, “Hospitals should be diligent in addressing risks related to endoscope reprocessing before a contamination—or even worse, a patient infection—occurs.” The ECRI Institute in 2010 identified cross contamination from flexible endoscopes as number one in the top ten medical technology hazards.

 

Flexible endoscopy, while common, is subject to high infection control risk. Infection can occur in three ways:1

  • Patient to patient
  • Environment to patient
  • Organisms within the patient’s body

 

Clinical studies have found reusable endoscope infection risk to be linked to micro-organisms clinging to endoscope biomaterial surfaces. Biofilms are then formed, which often remain wet after processing, and lead to contamination risk. “The formation of endoscopic biofilm during clinical practice can be related to reuse of detergent, manual cleaning, and incomplete drying of processed endoscopes. Developed biofilms protect the micro-organisms from exposure to detergents and germicides, which increase the likelihood of survival through a decontamination process.”2

 

Diligence to guidelines and manufacturer’s instructions for use (IFU) during scope pre-cleaning will remove the bulk of bioburden after endoscope use. But thorough flushing and brushing before any disinfection procedure is required to complete the job. It’s a task that your reprocessing department performs often, considering that a single scope averages 300 to 1,200 uses per year.

 

Many departments have slightly different manual cleaning protocols for flushing due to the differences in flexible and rigid scopes. It is, however, one of the most critical steps to ensure complete removal of bioburden prior to high level disinfection. It’s helpful if your department has one manual cleaning tool that can meet IFUs for your full scope inventory.

 

Reducing infection risks with proper scope cleaning protocols

Rigid and flexible endoscopes should be wiped down immediately after use and kept moist. Then the scopes are placed in an enzymatic detergent solution. All channels should be brushed and aspirated during manual cleaning. The channels should then be flushed with detergent. These steps should be performed even on channels not used during the endoscopic procedure. Removable parts are cleaned separately.

 

Manual cleaning should include brushing and flushing channels and ports according to the manufacturer’s IFU. Using warm tap water for deep cleaning and a disinfectant-detergent solution is standard. Be sure to flush away all disinfectants after cleaning, as they can cause deterioration to delicate instrumentation over time. These areas can become susceptible to hidden microorganisms and pathogens that can infect the next patient. It is important for staff to handle endoscopes with care to avoid excessive coiling or twisting, stacking, or buckling.

 

Cleaning will require multiple steps and use up to two sinks (preferably three):

 

  • Sink 1: Soak in cleaning solution
  • Sink 2: Rinse
  • Sink 3: Treated water rinse

 

Determining the best endoscope flushing solution for your department

Staff must be as efficient as possible to process a high volume of endoscopes. Staff must also be meticulous in performing scope processing tasks to ensure compliance to cleaning protocols. That’s when having one solution to manually clean different types of scopes and meets compliance, makes a difference. The manual cleaning steps prior to high level disinfection must be thorough and meet IFU and guidelines.

 

If you don’t already have an ideal single endoscope flushing device solution in your department, you’ll want to look for the following:

 

  • Works with flexible and rigid scopes
  • Has the proper adapters for flexible and rigid scopes
  • Reduces exposure to chemicals
  • Reduces ergonomic impacts to technicians
  • Offers an automatic flushing option to run independently
  • A pressure relief valve to protect delicate scope channels is compatible with multiple scope channel diameters and sizes
  • Can flush cleaning and rinse solutions

 

Identifying a solution to best fit your department needs, follow IFU, and protect staff from injury is ideal. A proper manual cleaning flushing device should do all of the above and can enable your team to manage a high volume of endoscope processing while achieving staff and, ultimately, patient safety.

 

 

 

Learn more about the FlexiPump’s endoscopic cleaning capabilities, how it can improve staff ergonomics, and automate manual flushing.

 

 

References:

  1. Crowson, Carol (2000). Cleaning and disinfecting flexible endoscopes. Nursing Times.
    Vol: 96, issue: 38.
  2. Omidbakhsh, N. et al (2021). Flexible gastrointestinal endoscope processing challenges, current issues and future perspectives. The Journal of Hospital Infection. Volume 110, P133-138, April 01, 2021.