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.

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.