Author: Megan Pietura

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.

Elevate Your SPD Workspace

Posted on by Megan Pietura

As we highlighted in a previous post, Workstation Disorganization: Problems and Opportunities, a myriad of problems can stem from a disorganized workstation. While it may seem like there isn’t enough space to organize your workstations adequately, there is a way: elevate your workstation.

 

Free up table space

When analyzing a workstation and improving its configuration, one glaring problem is likely to come up before anything else: there isn’t enough space on the table surface for everything I need. It’s time to go above the tabletop and start utilizing vertical space.

The space above the back of most tables is generally under-utilized, if not entirely ignored. This vertical space is valuable real estate that can serve a multitude of purposes, including:

  • Affixing storage bins for various consumables
  • Mounting equipment, such as magnifiers
  • Organizing computer and tracking systems
  • Adding shelf space
  • Add storage for blue wrap

 

Storage bins for consumables

Many consumables and materials are required in an SPD department. Making sure that they’re all available and easily accessible at a workstation is a key to success for technicians.

Mounted storage bins enable custom configurations to allow for organization that facilitates streamlined workflows and faster packaging and assembly.

 

Mounted equipment

The tools used in SPD are critical to departmental success and, more importantly, patient safety. All too often tools, such as magnifiers, are kept somewhere other than workstations, or deliberately moved from workstations because they inhibit technicians when not in use.

Mounting these tools are a game changer, and deliver three notable advantages:

  1. Tools can be maneuvered into technician’s area of activity when needed and shifted away when usage is complete. Mounted equipment is at the ready, but out of the way.
  2. Because the equipment is securely mounted to the back panel of the table, the risk of damage from falling or being knocked off of the table is mitigated.
  3. Mounted equipment doesn’t take up any valuable real estate on the surface of the workspace. What’s more, any power or data cords can be run behind the unit, reducing clutter and freeing up more working space.

As new SPD-focused technology and equipment come out, a pegboard-style back wall will guarantee that your technicians have the space to make sure whatever they need is right at their fingertips.

 

Racks for blue wrap

All too often, departments centralize blue wrap where space allows. Its also common that the central location isn’t located where wrapping takes place.

By relocating disposable blue wrap to its point-of-use, technicians spend noticeably less time preparing their tables for use.

Beyond the organizational benefits, having material elevated off of the workstation means that tools, such as built-in tabletop lighting, can be better utilized, ensuring that every wrap is suitable for the sterilization process.

 

 

Elevate (and adjust) your Workspace!

Getting equipment and materials ‘elevated’ to vertical space along a back wall is tremendously beneficial in terms of organization, effectiveness, and efficiency. But there’s another variety of elevation that can have a big impact on the work done at a workstation: ergonomics!

The ability to elevate – and lower – a workstation’s height can improve the comfort and efficiency for technicians. A fixed-height workstation might be good for one team member’s ergonomic ‘Goldilocks’ zone, but for all others, that table is less compliant. A couple benefits of height-adjustable tables include:

  1. Effective use of the table’s organization and layout. When mounted accessories can also change height with the table, the entire station is optimized for ergonomic benefit.
  2. When technicians need to reach or stoop at their workstation, it can cause strain or injury over time. By offering an ergonomic solution at each workstation, instances of strain and injury can be substantially reduced.

 

Have a problem or challenge you’d like to tackle? Let us know!

Workstation Disorganization: Problems and Opportunities

Posted on by Megan Pietura

We have all seen it: an assembly table or workstation disorganized and in disarray. Many departments operate this way every day, but what problems arise from that disorganization, and what opportunities are there for a department to improve?

Lack of space

A typical sterile processing workstation requires many tools and materials. While they’re all necessary, A sterile processing workstation with no space on the counter and a lack of storage bins.they can get in the way if they are not given a deliberate, permanent home. Assembling a rigid container becomes difficult with a keyboard in the way. Inspecting an instrument is also challenging when a monitor blocks the magnifier.

These tools suddenly become hindrances, similar to enabling fans to watch a basketball game from the center of the court. Setting up a workstation or table in a way that allows easy accessibility to tools and materials – while also keeping them neatly out of the way when not in use – enables technicians the space necessary to do their job without leaving their workspace.

Lack of focus

A cluttered prep & pack workstation. Inspecting and packaging requires immense attention to detail; not only does everything need to be executed flawlessly to ensure patient safety, but the correct materials and equipment need be employed based on the types of instruments and the sterilization processes they require. A variety of small issues can arise.

Consider the scenario where you aim to impress your spouse with a homemade dinner. You would probably get all of your ingredients together, organize them, and use them in the order necessary to create a fantastic meal. Now imagine every ingredient you own was strewn about the kitchen. It’d be tough to know where to start, right?

The same sense of chaos can stem from an unorganized table or workstation. A methodical, focused approach is important for determining where each item should go. If not, technicians waste time focusing on what to grab next from where, and less on the task at hand.

 

Spending more time without a process

Needing to search for the equipment a GI or sterile processing technician needs can do moreOld photo of an automobile than just divert their focus; it can slow them down considerably. A good process produces good results, and good processes require organization. After all, it was an industrial level of organization that made Henry Ford’s production line so successful.

By organizing the factory and its’ resources in a way that guaranteed one step was easily completed before the next, Ford was able to produce cars faster than ever while maintaining a consistent level of quality.

Tables and workstations can benefit from the same level of organization. Configuring a workstation to allow for a streamlined, predictable workflow – with all components readily available – enables a technician to not only produce high-quality results but do it more efficiently and consistently.

 

Centralization

A prep & pack workstation with surgical instruments on topLet us briefly revisit the meal you are preparing to impress your spouse. The first thing you would probably do is gather your ingredients. You head to the fridge for a protein and vegetables, then to the pantry for some pasta, and finally grab a few spices from the cabinet.

Next, you will need your pots and pans, which you retrieve from another cabinet. After a few minutes in the kitchen, you are prepared to begin cooking.

Now imagine the fridge is in the bathroom, the pasta is in the garage, the spices are in the basement, and the pots and pans are in a shed in the backyard. Preparing dinner has just become a nightmare, and distractions will likely arise along the way.

Just like it makes sense to have everything you need to make dinner in the kitchen, it makes sense to put everything a technician needs at their prep and pack table. Each time they are required to go and get something, they are breaking their focus, wasting time, and opening the door to potential distractions.

 

F.A.N.

Functional, accurate, neat; we are all familiar with the FAN principle. To create an ideal workstation for a technician in SPD, apply the FAN principle:

Functional – Workstations are organized in a way that technicians have the tools and the space needed to perform every function of their role.

Accurate – The materials needed to prep various instruments for sterilization are readily available at the workstation.

Neat – The workstation is organized to facilitate a streamlined, easy-to-use process that allows technicians to consistently produce high-quality results.

 

“I don’t have the space…”

Most departments lack adequate space, due to sterile processing services being an afterthought in the hospital design process, and an increase in complexity and throughput requirements for sterile processing.

For reprocessing professionals struggling with this issue, not to worry. Check out Elevate Your Workspace to find out how your department can get on the path to more organized, efficient, and ergonomic workstation setups. If you’re interested in getting an outside perspective to help solve an organizational problem you department is facing, we’d love help out!

Two Departments, One Sink: A Discussion of How Design Impacts Reprocessing Outcomes

Posted on by Megan Pietura

Meet Imani and David.

Both Imani and David have been managing their respective sterile processing departments. Both worked their way up from technicians into management, they attend their local chapter meetings, and periodically get together to collaborate on common issues. It’s ideal that both are also in need of decontamination renovations at the same and can collaborate. With the plan to add robotic procedures at both their facilities, some serious changes would need to be made to accommodate the new devices and their IFU.

On top of new ultrasonics and cleaning implements, Imani and David have sourced a potential sink which can meet many of their initial needs. The sink is height-adjustable, it has three basins, and includes some space for organization.

While David and Imani share many things in common, their situations are quite different. Good design is not necessarily universal. Its most basic definition is to, “plan and make decisions for a specific use or purpose”. While David and Imani’s sink choice is well-designed, it is not done so around their specific use or purpose. Their design choice may lead to both intentional and unintentional impacts.

Let’s examine how this one sink design impacts their project outcomes.

 

Height-adjustability & ergonomics

Recommendation:

Consider looking beyond height-adjustability to achieve ergonomic benefits. For example, many sink models also include organization that adjusts up and down with the sink, to keep all accessories at a user’s most ergonomic height.

Look for customizable features, like basin space and length, to fit height-adjustable units into smaller footprints. Vendors should be aware of basin requirements for instrument specialties like orthopedic and robotic.

 

Accessories & integrations

Recommendation:

Organization is unique to every department. David might consider if his sink choice will help him create all-in-one sink stations that can both store and organize cleaning supplies. By mapping out a potential workstation, including required electrical, water and air supplies, David could identify other elements to add to his sink.

Imani may have found the right basin sink, but what about features to meet flushing requirements? Or visual inspection protocol? Sinks can be more than just triple-basin stations; the right sink vendor can integrate all the necessary tools for IFU compliance.

 

Utilities & facilities requirements

Recommendation:

A well-designed sink goes beyond showy features. Sinks must be connected to plumbing, plugged into walls, and fit into unique spaces. Consider a sink that can have pre-plumbing work done, like telescoping drain systems, to make plumbing installation easier and cheaper.

Some sink options also include built-in electrical outlets, adding capacity to departments with little to none.

Lighting is also critical. See if your sink choice has built-in options, or accessories which can increase visibility at the cleaning station.

 

While it’s clear David and Imani have a lot in common and can collaborate with each other, their shared sink choice may not have the right design for either of them.

For managers considering a new reprocessing sink, locating a provider who can collaborate, design and engineer a solution for their unique, current needs, and potential future plans, may be a critical piece of the puzzle.

 

Pure Processing partners with managers, project planners, architects, and reprocessing professionals to build a sink solution that works for them and their objectives. Contact us to learn more about our consultation process and our reprocessing sink solutions.

What to know about: Ocular Reprocessing

Posted on by Megan Pietura

Nearly everyone agrees that proper cleaning and sterilization of any kind of procedural instrument is vital within a surgical setting to ensure the best patient outcomes. However, it’s easier said than done when the instruments are more complex, and guidelines also become tedious and require instrument-specific reprocessing steps.

Ocular devices are an example of devices fitting the complexity criteria. Departments must be prepared to have a detailed discussion on how to reprocess these devices correctly to reduce potential infections and aid in a safe surgical experience.

There are many reasons why ophthalmic devices are tricky to clean. In this post we are going to cover three (3) questions to consider when assessing ocular reprocessing practices.

  1. What are the potential consequences of improper ocular instrument cleaning?
  2. How should care and cleaning instructions be modified?
  3. How do IFU inform reprocessing decisions?

 

What are the potential consequences of improper reprocessing?

Mainly associated with cataract surgeries, any ocular surgery where the anterior segment is exposed presents the risk of a Toxic Anterior Segment Syndrome (TASS) infection, an acute inflammatory response to foreign material inside the anterior chamber of the eye that can lead to severe vision impairment.

Incomplete cleaning processes that leave residual cleaning chemistries, mineral deposits from steam sterilizers, and/or powder from sterile gloves have contributed to cases of TASS outbreaks.

TASS has often been linked to the failure to follow the processing procedures recommended by the manufacturer or by guidelines such as ANSI/AAMI ST79, AORN 2010a, CDC 2003b, HSPA.

Other notable transmitted diseases have included HIV, hepatitis C Virus and prions such as Creutzfeldt-Jakob disease (CJD). (TJC, 2019)

For these reasons, care and cleaning instructions are often modified for ocular devices.

 

How is care & cleaning impacted?

Pre-cleaning in the OR

Flushing ophthalmic lumens should be initiated in the OR and completed in the decontamination area. When sterile water baths are used for cleaning or soaking soiled instruments in the OR, they should be separated from the sterile field and instruments still in use. When flushing is used as part of a cleaning technique, the effluent should be discharged into a sink or separate basin while minimizing splash and aerosolization, so that contaminated fluid is not spread.

Dedicated processing areas

Many guidelines recommend that ocular instruments are best processed in dedicated areas of the department solely for eye instrumentation. Ophthalmic device 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.

Water quality

The volume and type of water for cleaning and rinsing should follow the manufacturer’s IFU. The IFU for many intraocular instruments recommend or require critical water (sterile distilled, reverse osmosis, or deionized) for most cleaning steps and for final rinsing. Use of tap water for rinsing and for removal of detergent should be used only if in compliance with the manufacturer’s IFU for the detergent and for the equipment. Because tap water can contain heat-stable endotoxins from gram-negative bacteria found in a municipal water supply, critical water is recommended for the final instrument rinse.

Enzymatic detergents

Cleaning with enzymatic detergent may be warranted in certain situations. If enzyme detergents are used for any reason, instructions for proper dilution and disposal of cleaning solutions should be followed. The cleaning solution should be mixed with measured amounts of water according to the detergent’s IFU. The instruments should be thoroughly rinsed to ensure removal of all cleaning agents as well as all debris loosened during the cleaning process.

Review your ocular instruments manufacture instruction for use (IFU) for information on recommended cleaning chemistries and compatibility.

Ultrasonic systems

Ultrasonic cleaning poses another risk of TASS infection, according to the TASS Task Force surveys. If an ultrasonic cleaner is used, the technician should remove all visible soil before placing instruments in the ultrasonic cleaner.

 

How do IFU’s inform reprocessing decisions?

In years past as a result of IFU revisions, ocular devices were required to have their own dedicated ultrasonic cleaners. Many are now discussing the potential for two dedicated ultrasonic systems. One dedicated for static soaking and ultrasonic cleaning, while the second for providing critical water for ultrasonic rinsing.

Ocular reprocessing IFU may also soon include a restriction to singe-use brushes for cleaning. Inventory that is a mix of single-use and multiple-use brushes  would need to be separated, so single-use items are not accidently reprocessed or re-used.

When it comes to automated cleaning, IFUs can include specifics regarding washer cycles and parameters. Ocular instruments are delicate and may require a gentler cycle parameters.
Reaching out to your local washer/disinfector rep will help you determine cycle capabilities and what adjustments can be made to comply with ocular reprocessing IFUs.

These potential changes to IFU demonstrate why regular review of guidelines and IFU is crucial to maintaining compliance. Changes can be implemented and easily slip by. It may also be recommended to partner with other departments who reprocess similar specialties, and rely on each other for updates, news, and changes to guidelines and IFU.

Understanding potential consequences, completing step-by-step cleaning according to guidelines, and making a continuous effort to review IFU and guidelines will lead to a cleaner and safer surgical experience for both patients and reprocessing staff. Ocular reprocessing may pose a challenge, but it certainly can be managed.

Pure Processing provides a portfolio of solutions for departments responsible for ophthalmic reprocessing. Contact us to see how we can help create automated flushing systems, dedicated reprocessing areas, and enhance your compliance and efficiency.

Sources Cited

https://www.aao.org/clinical-statement/guidelines-cleaning-sterilization-intraocular

https://cdn.hpnonline.com/files/base/ebm/hpn/document/2021/02/2103_CEU.602bd67277ea1.pdf

https://apicmt.org/images/meeting/041119/best_practices_for_processing_ophthalmic_instruments_2019.pdf

https://www.jointcommission.org/-/media/tjc/documents/resources/hai/quick_safety_disinfection_of_tonometers_final.pdf

Are you “Robotics-Ready”? Preparing your department for robotic IFU requirements

Posted on by Megan Pietura

With advancements in technology and better patient outcomes, robotic surgery has become one of the most rapidly growing specialties in the United States. From 2012 to 2018, robotic surgery cases increased from 1.8% to 15.1% (1). If these devices are not in your department yet, they may be soon.

If your department is preparing to start robotic device reprocessing for the first time, or looking to improve existing practices, it can be confusing to pick a place to start. One of the best places to begin is with instructions for use (IFU). Following device IFUs is essential for two main reasons:

  1. For the patient’s safety. Contaminated devices can lead to hospital associated infections and surgical site infections for patients. It is sterile processing’s duty to ensure that their medical devices are cleaned properly to reduce these infection risks.
  2. For your staff’s safety. When cleaning medical devices, sterile processing staff can be exposed to harmful chemicals and be at risk of injury. By following device IFUs, the risk to central sterile staff can be reduced.

However, even with IFU guidance, many departments struggle with shared reprocessing challenges. Common issues that departments run into might be:

  1. Sink basins which are too small or short to accommodate robotic arm length
  2. Sink basins being used to accommodate the 30-minute soak time, creating bottlenecks at the sink
  3. Trouble cleaning difficult-to-reach areas on robotic arms, as arms cannot be taken apart for thorough cleaning
  4. Ensuring arms are not being reprocessed after their maximum use
  5. Poor manual cleaning practices, and/or over-reliance on ultrasonic cleaning to perform manual cleaning
  6. Drying and assembly or robotic instruments, which require up to 4x magnification

Let’s examine some of these challenges in more detail, and potential areas to start improvements or implement efficiencies.

 

Manual Cleaning & Flushing

Many technicians make the mistake of assuming that ultrasonics can replace manual cleaning for robotic instruments. However, there are several steps that need to happen prior to using an ultrasonic cleaner.

An ultrasonic cleaner’s IFU typically requires manual removal of bio-burden before its use. Soaking a robotic instrument takes 30 minutes alone, however, it then needs to be flushed, sprayed, brushed and rinsed all prior to being placed into an ultrasonic cleaner.

It’s also easy to make mistakes during flushing, as arms have two ports, and for its laborious, time-consuming process. Flushing with a syringe is inefficient, and a spray gun does not ensure the pressure being flushed through the lumen (robotic devices have a pressure requirement during manual flushing of 30 psi).

Consider implementing improvements in manual flushing to improve throughput and efficiency.

 

Soaking

Many departments face challenges with soaking. Either their basins are too small to properly orient and fit robotic arms, or the sink basins which can fit their arms require the sink to be tied up for the 30-minute period, causing bottlenecks for other instruments to get processed.

For situations like this, it may be time to think of implementing a 30-inch basin, minimally, or cart to your department. Ensuring that the device can fit inside the sink basin can minimize the risk of damage to the device as well as ensure proper soaking and flushing. Mobile carts also offer the advantage of freeing up precious sink basin space.

Whether it’s a new sink or a mobile cart, a dedicated soaking space will allow your workflow to continue while ensuring robotic IFUs are being met.

 

Visual Inspection

While cleaning robotics properly is essential to patient safety, these instruments also need to be inspected after cleaning. The best way to inspect any instrument is to utilize a task light at the decontamination sink. Doing this at the reprocessing sink allows technicians to catch contaminated devices before they are sent to the clean side.

Robotic arms should also be visually inspected on the assembly side of the department. To properly inspect these devices, ensure it is entirely dry and inspect it for soil and damage. Cracked and damage housing, residual debris, bent or broken jaw tips, or damaged cables are all points of focus when inspecting robotic arms. Magnifiers with at least 4x magnification are often recommended. Check your IFU for guidance on the power required to inspect hard-to-see areas.

Whether you already reprocessing robotic arms or are in the process of implementing a robotic program, addressing these common challenges can better ready you for their arrival to your department.

 

You may also consider the following questions:

  1. Is my staff trained and up-to-date on robotic IFU? Do they understand the inherent challenges, and are confident in reprocessing these devices?
  2. Is my decontamination department outfitted to address flushing, soaking, ultrasonic, and visual inspection considerations?
  3. Can I meet robotic IFU requirement at every station, and by every technician?

For any department reprocessing robotic devices or planning to reprocess them in the future, it is important you stay up to date on current IFUs and ensure all steps are being met properly.

Whether it’s tackling flushing multi-port robotic arms, or implementing sinks with can accommodate the length of robotic devices, Pure Processing is prepared to discuss your robotic reprocessing challenges, and ensure you are robotics-ready!

 

Additional Sources

[1] M. D. Kyle H. Sheetz, “Trends in the adoption of robotic surgery for common surgical procedures,” JAMA Network Open, 10-Jan-2020. [Online]. Available: https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2758472#:~:text=The%20use%20of%20robotic%20surgery%20increased%20from%201.8%25%20in%202012,CI%2C%201.9%25%2D2.3%25). [Accessed: 04-Feb-2022].

Quality Over Quantity in Sterile Processing Part 2 – How to begin the Quality Journey

Posted on by Megan Pietura

Thank you to our wonderful partner and contributor, a sterile processing manager from Southeastern Pennsylvania, for writing these blogs with us. We are so grateful your time, insight, and dedication to your profession! We couldn’t do it without you.

Our recent Quality over Quantity blog focused on priorities to keep in mind when making the shift from a quantity to quality mindset in sterile processing. Those priorities included integrating new IFU processes, importance of reference and catalog numbers, IFU complexities, and several others. Now, in part two of this series, I’d like to recommend processes we’ve utilized at our own facility to help others solve the priorities listed in that post.

Involvement of next level leadership to “team up” with the problem

Get your teammates involved: Next level leadership, infection control, educator (SPD or OR), and a facility Joint Commission readiness team allows your team to holistically engage on behalf of patients, and able to see a 360-degree engaged team view for solving quality problems. Teammates can be of great assistance in training, audits, and keeping SPD updated with regulatory requirements.

Start small with any team changes: Set brief timelines to implement (1-2 weeks maximum to train and implement), gain momentum, change small behaviors accretive to goals, and audit, audit, audit until corrected. Gain team buy-in to a long term process with immediate aligned wins. You and the leadership team must be visibly involved in the short-term processes, stack the small improvements as successes, and continue to improve.

Where to start in renewing quality processes

Start with an IFU: Update a group or category of instruments (power, stringer, lumens, non-submersible), or a specific vendor (sports med “no name,” scopes-cameras “no name”) to cover multiple items for the staff. Go back to basics, where we usually find even most seasoned technicians have forgotten why they do what they do. Box locks need to be inspected for, a magnifier must be used to check the tips of A, B, F, H and W… you get the idea.

Get specific with standardizing uniform steps: That includes what brush for what purpose! It needs to be very clear, or staff will go off label or use what’s most convenient in front of them. Technicians can’t be expected to memorize IFU data, so ensure the automated electronic asset management system is utilized to its fullest. Deploy a small subset of teammates to help with end-user verbiage to keep it all short, simple, and executable. Lengthy explanations are for resource books and in-services, not for immediate visual aids.

One set at a time: Take a basic, frequently used set, and verify you have all the reference numbers. Standardize the products in these sets and then move on to the next. Use your primary instrument vendor for data and on-site assistance. Utilize their services for maintaining stock, most-used items, and assisting with pegboard creation and maintenance.

PM’s for your instruments are a MUST! On-site mobile sharpening trucks, etc. are a must to maintain your instrumentation and customer (surgeon) satisfaction. Maintained instruments result in better performance, reviews, and OR/SPD relationships. These partners can assist with inventory reporting assisting in case/turnover needs and assuring clarity in advance for budgeting needs.

In the 12 months since having a truck onsite twice a month, we have:

  • Eliminated scissor sharpness complaints from daily to twice a year
  • Seen “sharp” declines in complaints, and productivity
  • Our customer satisfaction and relationships have thrived

Test it…. Yourself

Basic Time Studies: Take two members of your team and have them “mock-through” one of your updated process recommendations. Better yet, you should be one of those audit members! Start with a current IFU and complete the necessary steps while timing. But no rushing. You can use this as a baseline for these types of steps, and how they equate to multiple other processes. Example-time the basic processes of filling the sink, or loading/unloading an ultrasonic, or washer. Or, time one of your more involved processes such as robotics, or flexible endoscope processing.

These are the types of unrecognized units of people hours that can greatly assist in bench-marking quality and productivity performance, while also providing great ammunition for additional staff  and  technology to assure quality trumps quantity in your department.

Consistent quality is a journey

In my first “Quality Over Quantity” blog, I outlined some of the deterrents of a quality first mindset and provided some awareness and simple quality fix ideas. In this Quality Over Quantity part two post, I advocated for the process of HOW to begin. Consistent quality is a journey with an ever-moving destination, with the how and the why as your guideposts.

Read Part I, here: https://pure-processing.com/quantity-over-quality-in-sterile-processing-part-1-cause-and-effects/

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.

Quantity Over Quality in Sterile Processing Part 1: Cause and Effects

Posted on by Megan Pietura

Thank you to our wonderful partner and contributor, a sterile processing manager from Southeastern Pennsylvania, for writing these blogs with us. We are so grateful your time, insight, and dedication to your profession! We couldn’t do it without you.

Do you remember the time when your sterile processing department was overrun with high volume, or had reduced staff? Or perhaps it was both at once! It’s times like those when reprocessing instrument quantity becomes the focus over quality. And ultimately patient safety is the sacrifice. That’s a tradeoff no one wants.

Such a scenario is almost a given when production demand shoots up, and especially during times with low numbers of skilled staff. It is too easy to fall into the trap of the “good enough” mentality. That happens when teams select quantity over quality on number of trays processed per shift. In reality, the priority should be on number of trays processed properly (the quality) per shift. Keeping a focus on proper processing aligns with your goals for patient safety.

The following are priorities to keep in mind when making the shift from a quantity to quality mindset.

Integrating new IFU processes

Instrumentation IFUs do have updates. Unfortunately, they can be easy to overlook during times of high production demand and experienced staff shortages. But placing those updates on a backburner hinders your staff from being efficient, meeting IFUs, and ultimately preventing patient infection.

An added block to integrating new IFU processes are those traditional reprocessing steps from the past. One example is the visual inspection for blood being the main priority. That has led to experienced staff never fully integrating new instrument inspection IFU processes. Other similar considerations are box locks, pitting, alignment, cracks, and sharpness.

Overcome IFU update obstacles with a clear focus on continuing education, routine team IFU updates, and by scheduling in-service training sessions with instrument manufacturers.

The importance of reference and catalog numbers

Many hospitals have continued to process disposable instruments and/or instruments made prior to the concept of having a reference or catalogue number on the actual instrument. That can make it difficult to update reprocessing practices for specific devices.

Without a product number, it can be difficult to convey updates about what is no longer safe or acceptable. Adding to the difficulty is the fact that the instrument cannot be researched, leading to a gap in proper handling and processing practices.

One solution is to identify all instruments without products numbers currently in rotation throughout your department. Regulate their use, replace them with numbered products if you can, and establish a method to identify their updates on a regular basis.

Instrument IFUs increase in complexity

IFUs have increased in variety and specifications. It’s inevitable, really, as patient safety processes evolve and progress. A few notable examples include specific brushes, validating processing equipment, extensive hand wash processes, and enhanced visual inspection. And many more IFUs now recommend the best practice of a final rinse with critical water.

Acknowledging these complexities can help your team stay ahead of the curve. Add this focus to your routine IFU education and manufacturer training plans.

Lack of inventory leads to high caseload

Your department has probably experienced the terminal turnover of sets to get through a caseload. The reason this happens is a lack of inventory, and the sterile processing department bears the brunt of the impact. A lack of inventory can be attributed to a few causes: Budgets, and real-time inventory assessments. Budgets rarely capture the necessary funds to replace or restock instruments or containers, as they are usually part of the OR Budget, and OR staff rarely have a true pulse of instrument usage rates, damage/loss rates, and tend to be always chasing in arrears.

The importance of time studies to IFUs

SPD leaders can show industry recommendations to gain additional full time staff support. Time studies regarding the actual safe handling and inspection of instruments with reference to the IFU need to be published to back that need up. Without that information, a question arises: If we could do it with three people before, why do we need six? The fact is, no one wants to admit that processes have not been done correctly, completely, or safely in the past. Quality product was often more a result of luck than best practice or MFC adherence. Most departments don’t have the time, people power, or wherewithal to perform their own holistic time and motion studies to validate. Time and again we return to “what we have been doing is good enough.” Only recently has the “people factor” in the work environment been brought to light on our most important assets, thanks to the AAMI focus on maintaining safe body temperatures, more frequent breaks, and hydration necessities.

Say goodbye to the quantity over quality mentality

Quality offers a more effective solution to patient safety than quantity. Even though departments struggle with large caseloads and limited staff, they must follow IFUs to prevent healthcare associated infections. The best way to do that is with consistent education, learning opportunities, and creating a culture around updating processes as IFUs change.

Avoid the “good enough” mentality and shift to a “quality over quantity” mentality to develop your department and your team into an effective sterile processing department for the long term. That will ensure following best reprocessing practices while ultimately improving patient outcomes for your facility

 

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.