Author: Megan Pietura

Appreciation – The Key to Retention

Posted on by Megan Pietura

Retaining great talent is pivotal to any sterile processing department’s success; the work technicians do is critical to patient safety. Given this importance, a department really feels it when a good technician makes the decision to leave. So, why do technicians decide to leave?

That was one of the questions we asked in our recent 2022 Technician Survey: Why do technicians leave departments, aside from compensation?

Here’s how our respondents answered.

Bar graph depicting reasons sterile processing technicians leave departments. Lack of appreciation 36.89%, management style 21.31%, Painful/repetitive movement 15.57%, lac of upward mobility 13.11%, nature of work 6.56%, something else 6.56%

 

Lack of appreciation

One response blew the rest out of the water: lack of appreciation.

And why wouldn’t it? A basic human desire is to be appreciated for what you do, and in the case of sterile processing technicians, that’s a lot! Despite an instinctual urge to associate appreciation with compensation and benefits, there are plenty of other ways to show your team that what they do is appreciated.

  • Verbal appreciation – Seemingly obvious, verbal affirmations can be easily overlooked, especially when this skill may not come naturally to every manager. Sometimes a simple verbal affirmation, or a “job well-done”, can show a teammate that you see and appreciate their efforts.

 

  • ‘Monthly’s’ – Creating an informal program that recognizes team members on a regular cadence is a great way to improve departmental morale and publicly recognize individuals. This can come in the form of something as simple as “Technician of the Month”, to something a bit more fun, like “Patient Safety Warrior”, of the month!

 

  • Events – Sometimes just getting the team together for a free lunch and some bonding time in the name of appreciation demonstrates that management is paying attention and wants to reward their team for all they do. Events offer a venue to get know each other and decompress with people who recognize the realities of working in central sterile.

 

Another key to retention? Leadership and management styles. Check out our blog post on reprocessing leadership to learn more: Reprocessing Department Leadership: How Can You Mobilize Your Teams for Success?

All About: The Joint Commission – The Fundamentals of Preparing Your Department

Posted on by Megan Pietura

Most medical facilities in the U.S. will face an accreditation survey at one point by the Joint Commission (TJC); about 88% hospitals are certified by the TJC. This accreditation process provides structure and guidelines for healthcare systems, and provides measured ways to improve patient care, and reduce healthcare associated infections (HAI’s), particularly surgical site infections (SSI’s). But in 2006, the shift to making surveys unannounced surveys began, encouraging healthcare facilities to be continuously prepared, and focus on a consistent process of improving and bettering outcomes.

This surprise visit can create a sense of chaos or unease in the minds of some sterile processing and GI managers. Even a single observation can lead to a request for improvement (RFI). But by understanding some core fundamentals, any healthcare facility can be prepared for their next visit.

Understand your accreditation body

Not all medical facilities will face accreditation by TJC. For ambulatory centers, they may face accreditation through the American Association for Accreditation of Ambulatory Surgery Facilities (AAAASF), or Accreditation Association for Ambulatory Health Care (AAAHC), and all states have healthcare licensing programs. Verify your accreditation body, so the appropriate regulations and considerations are kept in mind.

 

Re-read the essentials

The TJC will want assurance that facilities are following relevant regulations, standards and guidelines pertaining to instrument reprocessing. ANSI/AAMI ST79 and ANSI/AAMI ST91 provide guidance on workflow and department organization and are worth a re-read often, by all staff members. The Centers for Disease Control (CDC), Association of Operating Room Nurses (AORN), Society of Gastroenterology Nurses and Associates (SGNA) are also very relevant to name a few. This may also be an appropriate time to ensure departments have the most updated copies of these relevant guidelines.

Instrument instructions for use (IFU) are also important, and should be updated.

The Sterile Processing in Healthcare Facilities: Preparing for Accreditation Surveys guideline is another helpful tool, especially for newer management or staff members.

 

Routinely dust off competencies

Sterile processing is the subject matter of all things related to instrument reprocessing. Surveys want assurance that staff are fully competent (and confident) in their core cleaning responsibilities. They may also assess certifications, and involvement with professional associations. Ensuring job responsibilities accurately reflect work, and yearly assessments of responsibilities are performed are important.

Ensure that current policies and procedures at the facility are reviewed and reflect current regulatory guidance. Staff must be able to demonstrate knowledge and adherence to the hospitals policies.

 

Mock surveys

Mock surveys, and implementing tracer methodology, can help create a living exercise of the real thing. Getting away from a desk, table or sink and conducting a tracer and secondary tracer exercise can bring out real gaps in compliance, training, or areas for improvement. It can also be crucial to include infection control, the OR, or others to lessen the ‘tunnel vision’ effect.

 

Takeaways

Accreditation is not to be feared. The accreditation and survey process helps provide frameworks for healthcare facilities to ensure an ongoing commitment and dedication to patient care. But a proper understanding of the process and requirements involved can greatly reduce stress and anxiety when a surprise survey is announced.

 

Now that you’ve got the fundamentals down, check out: How to Ace a Visit from the Joint Commission

Six Takeaways from the ANSI/AAMI ST91:2021 Update

Posted on by Megan Pietura

Starting your department on the road to ST91 compliance

 

Some of the most common minimally invasive procedures in the U.S. are endoscopy procedures, making endoscope reprocessing crucial to patient safety (ProMedica.org). Although common, these procedures do not come without risk; endoscopes are extremely intricate and advanced medical instruments, making them hard to clean by nature. “Contaminated endoscopes are the medical devices frequently associated with outbreaks of health care-associated infections” (NCBI.gov).

Patient safety, research, and process advancement continue to be a top priority for gastroenterology and sterile processing departments across the country. On March 3, 2022, AAMI released the updated ANSI/AAMI ST91:2021 Flexible and semi-rigid endoscope processing in health care facilities (AAMI.org). These guidelines were presented to help GI and central sterile departments create processes and procedures that reflect the latest research and advancement in endoscope reprocessing.

Amid nationwide staff shortages, leaders in gastroenterology and sterile processing department’s are more overwhelmed than ever. Implementing the latest ST91 updates into your department may seem like a daunting task that could include significant time, effort, or renovation costs, but getting started is easier than it looks.

Here are just 6 impactful improvements to help your department begin the journey towards ST91 compliance.

 

1. Implement height-adjustable equipment

Staff ergonomics continues to be an important factor in creating compliant departments that also reduce unnecessary costs and pain, like in workers compensation claims or days away from work. Consider making investments towards more ergonomic equipment when possible.

“Sinks, counters, and work surfaces should be:

  • height-adjustable or positioned at heights that accommodate the average height of employees and the tasks to be performed at each location; and
  • sufficient to accommodate the endoscope length”

Section 4.2.1 – General Considerations; ANSI/AAMIST91:2021

 

“Sinks should be height-adjustable so that personnel do not have to bend over to clean endoscopes. An ideal decontamination sink is height-adjustable, approximately 36 inches (91 centimeters [cm]) from the floor.”

Section 4.3.2 – Sinks and accessories; ANSI/AAMIST91:2021

2. Change the way you think about sink design

Sink design is more than height-adjustment. A properly designed sink that meets both compliance standards and department restrictions can also reduce device damage or repair costs. Basin sizes are one design element that can impact scope reprocessing, such as in total immersion in detergents or tight coiling.

“Sinks should be deep enough to allow complete immersion of the endoscope to minimize aerosolization. The size of the sink should be adequate (i.e., a minimum of 16 inches x 30 inches) to ensure that the endoscope can be positioned without tight coiling and 8 to 10 inches (20 to 25 cm) deep, enabling a person of average size to work comfortably without undue strain on the back.”

Section 4.3.2 – Sinks and Accessories; ANSI/AAMIST91:2021

It may be prudent to invest in a custom sink design, or partner with a vendor who can provide consultations of challenging decontamination areas.

 

3. Implement a borescope to inspect high-risk endoscopes

If your department reprocesses high-risk endoscopes, now might be the time to evaluate a borescope program. While borescope programs can be complicated or expensive to implement, it may identify other areas of improvement for a department, like a lapse in manual cleaning or damages that occur during transport.

“High-risk endoscopes (e.g., duodenoscopes, linear ultrasound (EUS) endoscopes, bronchoscopes, endobronchial ultrasound (EBUS) endoscopes, ureteroscopes, cystoscopes, and as determined by the facility) shall be evaluated with cleaning verification tests after each use.”

Section 7.8.4 Cleaning Verification; ANSI/AAMIST91:2021

 

“Visual inspection alone is not able to determine if the reduction in clinical soil is sufficient for an effective cleaning result but is critical to determine any defects or potential damage to the endoscope.”

 

“Visual inspection can include the use of borescopes to inspect the inner channels/lumens present in many flexible endoscopes.”

Section 13.5.1 General Considerations; ANSI/AAMIST91:2021

 

Looking to implement a borescope program? Download our free checklist to ensure you’re considering all relevant areas impacted by integrating this technology into your department.

 

4. Implement lighted magnification for inspection

As important as internal inspection, having the proper illumination throughout a department can aid in assessing all endoscope varieties. Elevator channels and distal tips need particular attention for gross soil or other bodily substances.

“Lighted magnification should be used to inspect endoscopes and accessories for external cleanliness and damage.”

“According to the FDA/CDC, it is recommended that areas of the endoscope at the distal end be inspected using at least 5x magnification, 10x magnification for duodenoscopes.”

Section 7.8.2 Visual Inspection; ANSI/AAMIST91:2021

 

5. Enhance manual cleaning procedures

Manual cleaning is the foundation to effective high-level disinfection and sterilization outcomes. Any residual bodily fluids or debris can impact steps further along in endoscope reprocessing.

Automated flushing devices are one option to ensure endoscope channels are being flushed according to their manufacturer’s IFU while removing the variability of either manual methods, or between different practices among staff.

“Flush all channels according to the endoscope manufacturer’s written IFU.”

Section 7.6 Manual Cleaning Steps; ANSI/AAMIST91:2021

 

6. Better anti-fatigue mats

Keeping a clean work environment in endoscope reprocessing areas is critical. Ensure that high-touch items, such as anti-fatigue mats, are chosen that can be easily cleaned and maintained. Anti-fatigue mats also add further ergonomic benefits.

“Anti-fatigue mats should be:

  • used in areas where prolonged standing is required;
  • and constructed of materials capable of withstanding frequent cleaning”

Section 4.2.1 General Considerations; ANSI/AAMIST91:2021

 

Looking to implement any of these ideas or others for your endoscope reprocessing area? Pure Processing representatives are ready to learn about your space and provide guidance on potential reprocessing solutions. Contact us here to learn more.

 

 

Works Cited

ANSI/AAMI ST91:2021.

“Endoscopy.” ProMedica, https://www.promedica.org/services-and-conditions/endoscopy

Kovaleva, Julia, et al. “Transmission of Infection by Flexible Gastrointestinal Endoscopy and Bronchoscopy.” Clinical Microbiology Reviews, American Society for Microbiology, Apr. 2013, https://www.ncbi.nlm.nih.gov/pmc/articles/

“ST91: Endoscope Processing in Healthcare Facilities.” Default, https://www.aami.org/ST91.

The State of Sterile Processing: “The Industry is Coming Home to Roost”

Posted on by Megan Pietura

In early March of 2022, Pure Processing convened members of our Voice of the Customer committee to discuss staffing and retention. We learned a lot from the conversation with them, and if you haven’t seen our blog: Sterile Processing Staffing & Retention in 2022: A Conversation with VOC, be sure to check it out.

One concept that stuck out and led to deeper conversation was the idea that the sterile processing industry “is coming home to roost.” As we listened to the VOC members discuss and elaborate on this, it became clear that something’s going on under the surface in the sterile processing world.

 

Nowhere to grow

A core tenant of building a career is having the opportunity to grow, expand, and thrive as a professional in your field. In an exceptionally competitive labor market where organizations are trying to appeal to younger generations that have a focus on career progression, sterile processing seems to have fallen behind.

There has been pushback from upper management over the years as SPD Managers and Directors have attempted to implement a hierarchy for technicians to climb within their departments. Even in situations where there are opportunities to grow, from Tech I to Tech II, for example, there isn’t always an associated compensation change or increase in responsibility.

The problems derived from the lack of growth opportunities are twofold:

  1. Not seeing an opportunity to grow, current technicians are leaving organizations or the central sterile industry entirely.
  2. Potential newcomers are assessing the growth landscape in sterile processing departments and determining that they would rather not begin a career without clear pathways for upward mobility.

In order for sterile processing departments to continue doing their critical work of ensuring patient safety, they need to be able to offer current and potential technicians the ability to grow in SPD.

 

Lack of incentives for experience, certifications, and continued education

Another aspect touched on by our VOC committee was a notable lack of incentives associated with years of experience, education, and certifications. Many organizations are screening applicants without certain certifications, but not adjusting compensation for those that do hold them. As states throughout the country mandate certain certifications, organizations may be finding it easier to justify as a “ticket to ride.”

Current and prospective technicians, however, do not view it this way. Experience, continued education, and time/money spent obtaining certifications are investments that technicians have made in themselves. The lack of incentives or compensation for certifications, education, and experience may be regarded as a lack of appreciation to current SPD professionals, and could be causing prospective technicians to perceive them as a barrier to entry.

Compensating technicians for the knowledge they’re bringing to the table or maintaining in a department demonstrates appreciation, as well as ensures the department has the best talent possible to provide safety to patients.

 

Stagnant Wage Growth

Ask almost any technician or reprocessing professional what their biggest concerns or issues  regarding the industry are and  you’re bound to find at least one commonality: wages.

Pushback on wage growth over the last two decades has led to reprocessing positions being out-competed by many other industries. Among the consequences of this stagnancy is a reluctance in the labor market to take jobs in sterile processing, contributing to a notable personnel shortage in departments throughout the country.

Stagnant wages have also led to career technicians (often referred to as ‘lifers’) to consider exploring other opportunities for the first time. A true passion for the work they do is often the only lifeline keeping these experienced professionals from exiting the industry more readily.

 

“The industry is coming home to roost.”

One of our Voice of the Customer members put it best when discussing the overarching concerns the industry is facing: “The industry is coming home to roost.”

Without clear professional ladders to demonstrate career paths, incentives and appreciation for individual growth, certifications, and education, and competitive wages, sterile processing has become less appealing to potential employees, and departments are feeling it. The industry could be facing staffing challenges for years to come. As one VOC participant commented: the industry may need some “re-engineering.”

Many managers and directors are already taking on new initiatives to improve their departments. From persisting in their efforts to increase their teams’ wages, to collaborating with other departments in the hospital to improve communication and address longstanding problems, to creating new positions that don’t require certifications and serve as an entry point for newcomers, those in SPD management are approaching the problem head-on.

Are you looking for ways to improve your department? Culture is a great place to start! Check out our blog post on Creating and Maintaining a Great Culture in Sterile Processing!

Have a problem you need to solve? We’d love to help out!

Establishing & Maintaining a Great Culture in Sterile Processing

Posted on by Megan Pietura

As many have learned over the last few years and amid the Great Resignation, attracting and holding onto phenomenal talent has become more important, and difficult, than ever.

Some variables, such as compensation and benefits, can be out of a manager’s control, but there is a high-impact variable that SPD Managers can control without approval from their HR departments: Culture.

So, what steps can be taken to start building a great culture in your sterile processing department?

 

Demonstrate a willingness to help

Team members in sterile processing are in a perpetual state of multitasking with the accuracy and focus necessary to keep patients safe. Couple that level of activity and laser-focus with being short staffed, and you’re likely to end up with a frustrated team struggling to get everything done.

Jumping in to help your team when things get hectic demonstrates that you’ve got their back and that you’re willing to roll up your sleeves and do the same things they’re asked to do.

 

 

Recognize high performance

Sterile processing is a demanding job that requires not only a great deal of knowledge, but the ability to utilize that knowledge on the fly in a fast-paced environment. Often, the only feedback a technician might get is the disapproval from the OR when items are missing or lost, leading to a belief their work isn’t appreciated, or fully understood.

Taking the time to privately, or publicly, recognize technicians when they do a great job lets them know their effort is seen. It also helps to understand how each technician prefers to receive that feedback, such as in one-to-one or group meetings.

 

Make workstations work for techs

The work completed in sterile processing is taxing, to say the least. Whether it’s being hunched over a sink, stretching to reach materials, or having to make another trip across the department to grab something, little inconveniences can lead to irritations about coming to work, and can lower morale.

Seeking the input of your team and incorporating them into the decision-making process can help illuminate problems you weren’t aware of, as well as help get buy-in on new changes being made. Technicians can help identify ways to improve processes and configurations in your department to not only make their jobs easier, but also boost the productivity of your department.

 

Spend time together as a team

A lot of organizations and departments refer to themselves as a family, or a team, but rarely is it as true as it is for sterile processing departments. SPD shows up each day with an understanding that the work will be difficult and underappreciated. It’s important that everyone is on the same page, have each other’s backs, and will do everything they can to ensure patient safety. It’s a stressful job that requires passion and teamwork.

It’s important for sterile processing departments to spend time outside of the high-pressure environment they operate in together. This allows them to get to know each other better, discuss the stresses and achievements that only their coworkers will truly understand, and ultimately improve communication and team performance.

 

Focus on leadership styles that emphasize growth and understanding

Leadership can take a great team and make it terrible, or it can turn an average team into all-stars. Developing and fostering effective leadership styles for your department can make all the difference; your leadership style is the beating heart of the culture you want to create for your department.

Leadership styles that help technicians grow through coaching and learning from mistakes, allow flexibility where possible, and demonstrate an understanding of individual problems and considerations, show your department that you’re not just there to manage them, but to support them as people.

 

More Than Staffing & Retention

A great culture can transform a department, and the benefits go well beyond staffing and retention. It makes a workplace more enjoyable to be a part of and generates enthusiasm among staff, while also facilitating growth and development.

Make your department a place that a newcomer would be impressed by – a place people want to be a part of. Investing time in your workplace culture is an investment in your people.

 

We thank our Voice of the Customer panel for their time and insights. If you missed our previous blog post discussing takeaways from our March Voice of the Customer meeting about staffing & retention, check it out!

 Have a unique challenge or problem you want help solving? We’d love to give you a hand!

Time: How Instrument Reprocessing Professionals are Fighting the Clock

Posted on by Megan Pietura

Instrument reprocessing professionals are spending more time than ever reprocessing instrumentation. As devices have become more complex, an increase in manual and mechanical cleaning time has inevitably followed suit. Tasked with ensuring IFU compliance and meeting the dynamic demands of the operating room and heightening procedures (OR), technicians and nurses are in a perpetual battle with the clock.

For example, consider the cleaning instructions for Zimmer orthopedic manual surgical devices (for hips, knees, trauma and extremities)1. The instructions list three separate options for cleaning and disinfection, ranging from rigorous manual to completely automated. While rigorous manual cleaning can take up to 45-50 minutes as prescribed by the IFU, sterile processing technicians only save about 10 minutes using a completely automated method using an automated washer and disinfector cycle.

Average times only increase when considering visual inspection, assembly, sterilization, and cooling time. Adhering to device cooling best practices can add up to two hours to a tray’s reprocessing time.

 

Zimmer Orthopedic Reusable Device Reprocessing Instructions*
Function Time Comments
Decontamination & manual cleaning 45 minutes, minimally Assuming a Combination method of both manual cleaning and automated washing using a washer/disinfector cycle
Assembly & visual inspection TBD Dependent on the condition of the devices, staffing, workflow, experience of staff, and other variables
Moist heat/steam Sterilization 30-45 minutes, minimally Dependent on the sterilizer cycle, model, and load size
Cooling time after sterilization 2 hours, preferred AORN Guidelines for Perioperative Practice: Sterilization2 recommend minimally 30 minutes, but preferrable 2 hours
TOTAL 3.5 – 4 hours, minimally  

 

*Reference the full Zimmer IFU for details here. This chart is referential only to provide a general sense of minimally prescribed reprocessing time.

 

Extensive reprocessing times for surgical devices are not limited to specific specialties or manufacturers. Robotic devices are another great example of lengthy IFU, especially in decontamination.

Xi EndoWrist and Single-Site Instruments*
Function Time Comments
Prime & soak 30 minutes, minimally
Flushing & spraying (while submerged) 5 min per arm, minimally
Ultrasonic 15 min Dependent on the sterilizer cycle, model, and load size
Post-ultrasonic flushing & spraying (while submerged) 5 min per arm, minimally
Thermal disinfection 5 min Optional step
Inspection, assembly TBD Dependent on the condition of the devices, staffing, workflow, experience of staff, and other variables
Sterilization 30 min, usually Dependent on the sterilizer cycle, model, and load size
Cooling time after sterilization 2 hours, preferred AORN Guidelines for Perioperative Practice: Sterilization2 recommend minimally 30 minutes, but preferrable 2 hours
TOTAL 3.5 hours, minimally  

*Reference the full and most up to date da Vinci IFU here. This chart is referential only to provide a general sense of minimally prescribed reprocessing time.

 

Staffing and retention, and impact on turnover time

As people leave sterile processing for positions in other industries, departments are trying to do more than ever with fewer people. The exodus of labor is severely straining many SPD’s ability to keep up with the demand of the OR. This issue is being compounded by the growing reprocessing times that more and more IFUs are requiring for complex devices.

While staffing concerns cannot be resolved overnight, departments should study its impact on reprocessing throughput, and begin identifying solutions now. Read more about the recent impacts to staffing retention with our latest blog, here.

 

Making better time

There are a myriad of tools, strategies, and methods departments can implement to improve reprocessing times, but cutting corners is not one of them. Adjustments to reprocessing activities utilizing a non-standardized practice that could result in lapses in compliance with IFU and regulatory guidelines should never made. Patient outcomes must always be kept top of mind when adjustment processes or workflows.

 

Strategies that support better use of time include:

  • Increase training for technicians and nurses: while this will require time and effort on the part of management, highly trained staff will not only reprocess their devices more effectively, but with greater adherence to department practices, and with more personal confidence
  • Increase device inventory, when possible: investments in instrument sets are often returned quickly, and sets can provide long-lasting returns in the form of durability
  • Improve reprocessing functions with better equipment: outdated devices and equipment may not only run slower than newer technology but added downtime can further hinder processes
  • Enhance workflows: Validate workflow issues with spaghetti maps. Spaghetti maps can provide compelling insights into how time is spent by workers hopping around departments hunting for tools and materials. Consolidating equipment and materials at workstations and sinks allows for quicker execution of tasks.
  • Communicate: Changes in a department are often met with skepticism and subsequent reluctance to conform. Conveying and demonstrating the value associated with efforts to better utilize limited time can help get buy-in and make sure the entire team is operating in the most time-efficient way.

Virtually every department will be faced with the growing dilemma of lengthening reprocessing time. Additions to the reprocessing cycle, like borescope inspections, also complicate turnaround time. But all departments have resources and tools to face these challenges. Consider how a deep dive of your department can reveal hidden time bottlenecks and highlight the areas where your limited time can be spent for the greatest ROI.

 

Do you have (or need) some ideas to improve your department’s turnaround time? Contact a Pure Processing representative to determine how you can shave time off tasks and start winning the battle against the clock.

 

Works Cited

  1. Reusable device reprocessing instructions. Reusable Device Reprocessing Instructions | Zimmer Biomet. (n.d.). Retrieved April 22, 2022, from https://www.zimmerbiomet.com/en/support/reusable-device-reprocessing-instructions.html
  2. Association of Operating Room Nurses. (2018). Guidelines for Perioperative Practice: Sterilization.

Sterile Processing Staffing & Retention in 2022: Insights from Central Sterile Managers

Posted on by Megan Pietura

At Pure Processing, our Passion for Processing runs deeps (it’s one of our Core Values, after all). It was also one of the catalysts for the creation of our Voice of the Customer (VOC) committee in May of 2020; who better to help shape the improvements and future of sterile processing than its own managers and leaders?

We were fortunate enough to convene many of our VOC members in March of this year to discuss a topic that organizations throughout the country are grappling with in 2022: Staffing & retention.

Each VOC member shared their experiences with their staffing challenges, but also some of the ways that they addressed them. From city center hospitals to rural medical centers, here are some of the ways that our committee addressed the staffing and retention challenges they faced:

 

Take note of errors, but don’t publicly shame.

Sterile processing departments need to be able to catch and record errors in order to improve, but calling out technicians publicly and shaming them in front of their peers can lead to burnout and high turnover.

 

Provide a professional ladder for members of SPD to climb.

Everyone wants to be able to grow in their profession, and sterile processing technicians are no different. Having a clear and attainable ladder for team members to climb allows them to continue growing right where they are.

 

Put a buffer between the rest of the hospital and SPD technicians.

Sterile processing departments can be chaotic and tense all on their own; technicians don’t need staff from other areas of the hospital coming into their place of the work to give them a piece of their mind. Ensuring that input and feedback from other departments flows through management channels allows everyone to be heard without causing undue stress.

 

People working in SPD don’t want to find a new job in fast food, even it pays more.

SPD professionals are passionate about what they do and understand the impact they have on patient safety. Despite the wage growth in industries like fast food and retail, members of our VOC panel indicated that people working in SPD don’t necessarily want to jump ship strictly based on pay, because they take pride in their work. That being said…

 

Make sure compensation is competitive for your region.

Compensation is an ongoing point of contention in many industries, and sterile processing is no exception. Making sure that the compensation offered by your department is comparable to other SPD positions in your immediate geographic region helps to guarantee an apples-to-apples comparison when competing for and retaining talent.

 

Create a work environment that people don’t want to leave.

SPD Managers can improve retention rates by striving to create a work environment that technicians want to continue working in. Demonstrating a willingness to jump in and help, making workstations more functional, and recognizing high performance were some of the examples given to create a desirable department to work in.

 

Include your team.

Members of your team can provide insight on how to improve the department. Getting them involved in projects from the start can help avoid pitfalls in terms of practicality and implementation. Asking for their input and incorporating them in the decision-making process is a great way to give team members a voice and get them invested in the department.

 

Keep morale high.

From showing appreciation, setting aside time to spend together as a team, to focusing on leadership styles that emphasize growth and understanding, many of our VOC members commented on the importance of maintaining high morale and the approaches they take to doing so.

 

Let HR know what to look for.

Some sterile processing departments aren’t as involved as they would like to be in the recruiting and hiring process. Letting HR departments know what kind of previous experience is valuable is a critical step to identifying great talent for your department.

 

Partner up with local schools.

While not all of our VOC participants had central sterile programs at their local colleges or institutions, all of those that did had a relationship with them and were actively engaging them. Even attending high school job fairs or speaking engagements made an impact. Letting students know about the nature of SPD and generating awareness can help bring in more applicants and create interest in the field.

 

A common theme: Culture

We really enjoyed our conversation with our VOC participants (and we really appreciate you taking the time – thank you!).

The conversation spanned a wide range of different ideas and thoughts on how to best retain and attract talent, but one theme seemed to weave throughout: creating a great culture.

Interested in what we learned about creating a great culture in sterile processing? Keep an eye out for our upcoming blog post: Establishing and Maintaining a Great Culture in Sterile Processing.

 

Have a challenge you’d like help with? Let us know!

The Science of ‘Space’: How to make your reprocessing space work for you

Posted on by Megan Pietura

One thing most SPD professionals can relate to is a lack of space within their departments. Most central sterile departments were built into hospital plans before the innovations of the OR took place, locking departments into layouts that cannot be expanded or easily increased.

As instrument complexity and sizes grow, and as new reprocessing technologies emerge, real estate in central sterile departments will be at even more of a premium than it is today.

So, what are some strategies to get more out of limited space?

(Click the image)

Identify underutilized space

Making time to analyze and assess unused space throughout your department can illuminate many opportunities. Freeing up valuable space that’s currently utilized inefficiently, or incorporating innovative organization and storage ideas, can add efficiencies and have quite an impact.

An often low-hanging fruit is to look at the vertical space near sinks and assembly tables. While some sinks and prep and pack tables allow racked shelving to be attached to their back wall for basic storage of small materials, many departments don’t utilize this space at all. Check out our blog post on elevating your workspace for a deeper dive on vertical space usage at workstations.

 

Find ways to free up space

Various tools and equipment are used throughout sterile processing or an endoscopy’s reprocessing area. From computers, to borescopes, to magnifiers, there’s no shortage of tools required to help technicians or nurses do their job.

While these tools are immensely helpful and play a critical role in ensuring patient safety, they can take up a considerable amount of space. Finding alternative methods to store these tools is a worthy investment. A great example is getting computers off of surfaces by mounting above or to the side of the workstation. Some computer mounts allow for housing or handheld scanners, or laptop stands that easily fold away to reduce its overall footprint when not in use. Mounts can also help organize messy electrical and USB cords.

Areas below sinks and workstations tend to be underutilized as well. By adding open configuration shelving, you can begin storing enzymatics and chemicals that are required at that station. Integrating equipment built with this kind of storage is easier than retrofitting obsolete equipment, however.

 

Add functionality to existing space

Versatility is the name of the game. Being able to give space multipurpose functionality effectively doubles it. A few examples of adding functionality to an existing space include:

 

Get a fresh perspective

Sometimes working within a space can make it difficult to see new opportunities for improvement. Allowing an outside perspective to have a look and offer suggestions can expedite the process of solving space-related issues. Like the feeling of being stumped on a puzzle and having someone else walk over and immediately place a piece, sometimes you just need a second set of eyes on a problem to identify the best solution.

Interested in exploring ways you can improve your space usage? Download our newest ‘Study Guide for Space’ checklist!

 

 

AORN Guidelines for Perioperative Practice: Defining and Achieving ‘clean’

Posted on by Megan Pietura

Why do we need Guidelines?

Reprocessing a surgical instrument is a highly technical process. Guidance is needed for all the elements of reprocessing, from point of use pre-treatment to sterilization. If a nurse or technician fails to clean and sterilize instruments correctly, the outcome can be detrimental to patient safety. This is where AORN guidelines are critical.

 

AORN guidelines on ‘clean’

Determining if an instrument is ‘clean’ is more complicated than it seems. The AORN guidelines state that it can be difficult to ensure if an instrument is clean when it is more complex in construction and intended use..

“Reusable surgical instruments with complex designs (eg, powered devices, robotic instruments, instruments with narrow lumens) can present challenges to decontamination processes, and cleaning verification may be useful to evaluate cleaning effectiveness in these devices”

AORN eGuidelines+:2020 10.1

 

Staging for success: the impact of a department’s workflow on achieving ‘clean’

AORN recommends the department be set up to optimize unidirectional workflow. The sterile processing department should be set up like a one-way street, where instruments flow from point A to point B in a linear fashion. This guidance helps prevent cross-contamination and maintain ‘clean’ when it is achieved. Departments will also find recommendations for where clean vs. dirty items are handled:

“Perform cleaning and decontamination in an area separate from locations where clean items are handled”

AORN eGuidelines+:2020 2.2

 

As manual cleaning is foundational to achieving sterility, ensuring the decontamination sink can enable cleaning outcomes is critical.

“The decontamination area should be equipped with multiple sinks that are designated for soaking and cleaning, intermediate rinse, and final rinse; large enough to accommodate instrument trays; at an ergonomically correct height; and marked at the water level needed for cleaning solution measurement;”  

AORN eGuidelines+:2020 2.5

Looking for a new reprocessing sink? Consider these 5 ways to identify the best sink for your department.

 

Manual Cleaning

Manual cleaning is the most important step for ensuring a device is clean, and if it is not performed properly, can compromise the device’s sterility. AORN states that cleaning can be done through manual or mechanical processes and that the device’s IFU should be consulted for best practice.

“Manual cleaning is often recommended for devices that cannot tolerate the action of mechanical cleaning or cannot be immersed (eg, power drills, delicate microsurgical instruments, flexible endoscopes, cameras).”

AORN eGuidelines+:2020 9.5

 

Specifically, for lumened devices, AORN states:

” Flush lumens with cleaning solution and brush them with a brush of the length, diameter, type, and material specified in the device manufacturer’s IFU.”

AORN eGuidelines+:2020 9.4.5

 

 

Visual Inspection

While the AORN guidelines do not have a concrete outline to determine if an instrument is clean, they do state what can be done to ensure some definition of clean is achieved.

“Currently, there is no single standard of clean, nor is there a standard test for soil for surgical instruments.  Efficacy of cleaning has traditionally been evaluated through visual inspection.”

AORN eGuidelines+:2020 10.1

 

Although subjective, visual inspection is one method reprocessing professionals have to determine quality of clean. Visual inspection with the naked eye is typically not sufficient. To address this issue, the AORN guidelines recommend lighted magnification is used to inspect.

“An instrument that appears clean to the naked eye may harbor debris that cannot be seen without magnification.”

 

AORN eGuidelines+:2020 10.2  ”

 

With magnification, technicians and nurses can help visualize the things our eyes alone cannot. Furthermore, lumened devices, and devices with narrow lumens especially, can pose a problem for assuring cleanliness. For this issue, AORN guidelines recommend a borescope or endoscopic camera be used.

“An endoscopic camera or borescope can facilitate identification of retained soil. Clinical soil retained after cleaning can impede subsequent disinfection and sterilization.”

AORN eGuidelines+:2020 10.3.4

 

One specific instrument was called upon by the guidelines to be connected to SSI’s (Surgical Site Infections) even after extenuating decontamination and sterilization processes had been performed: the Arthroscopic Shaver. The guidelines highly recommend using a borescope or endoscopic camera to inspect this device.

“In a 2007 case-control study, Tosh et al 102 reported on an outbreak of Pseudomonas aeruginosa SSI in seven patients on whom the same arthroscopic shaver was used. During investigation, the researchers found debris in a lumen of the shaver although the shaver had undergone repeated decontamination and sterilization procedures. The researchers concluded that the retained surgical debris allowed the bacteria to survive the sterilization process, and the subsequent use of the shaver was likely related to the SSI outbreak.”

AORN eGuidelines+:2020 10.3.3

 

Patient safety is the number one goal for any SPD or GI department. The processes technicians and nurses perform are imperative to upholding this sacred vow, but they are also mired with grey areas that leave much to interpretation by the departments. Consulting guidelines, such as AORN and consulting manufacturer’s IFU help departments to ensure they can achieve their number one goal, patient safety.

Looking for more information on how to ensure all devices are being properly cleaned and decontaminated? Read The Three Pillars of Effective Lumened Cleaning to learn what tasks support highly effective manual cleaning outcomes.

 

Works Cited
AORN, the Association of Perioperative Registered Nurses, published a set of guidelines pertaining to reprocessing surgical instruments and associated best practices. For the full guidelines and full details, please visit: AORN eGuidelines+ (aornguidelines.org) References“AORN EGuidelines+ Guidelines for Perioperative Practice: Instrument Cleaning.” Aornguidelines.org, Oct. 2020, www.aornguidelines.org/guidelines/content?sectionid=173736661&view=book&expand=true.