Author: Megan Pietura

3 Reasons Your Assembly Tables are Failing You

Posted on by Megan Pietura

Assembly teams carry a huge responsibility: they ensure instrumentation is functional, packs are accurately assembled, and everything is neat and orderly for their operating room staff.

The humble prep and pack table may be easily forgotten in this mission. At best, it does an adequate enough job as a place to assemble trays and packs. At worst, a prep and pack table actively reduces the quality and quantity of work an SPD can provide.

There are three common reasons assembly tables may be failing your team, your department’s objectives, and reducing your department’s potential.

 

1: Your sterile processing workstations are reducing your productivity

Every sterile processing department is heavily scrutinized for the quality and quantity of its work. The prep and pack table is not always considered crucial to this equation; a table is a table, after all. But, as one SPD Manager describes it:

 

“Why am I expected to deliver high end outcomes for my Patients and Hospital, but being asked to do this with low-end, mediocre technology for my Staff?”

A good starting point to assess current tables is to evaluate their actual workspace. As trays and instrumentation becomes larger, the tools required to assemble increase, and volume doubles or triples, every inch of workspace is valuable.

Actively cluttered and disorganized tables can cause mistakes; picking the wrong tool or instrument, missing a screw to assemble a device, or placing the wrong label on a tray can be a mistake that makes it way into the OR. An already scrutinized department can’t afford these avoidable mistakes.

As tables are left cluttered, the disorganization spreads elsewhere. As another SPD Manager describes their current workflow:

 

“The design of my current table hinders productive space, forcing our Techs to work in cramped spacing,

 and to zig-zag through the department to complete a single tray. Without high-end lighting, and high-end production tools, it places at risk of QC assessments, and therefore, the Patient.”

 

SP technicians already lack the time they need to do their job. Further wasting minutes and hours leaving an assembly table to find tools or space to assemble is avoidable lost time.

At a high-level, consider even a conservative loss of time when technicians leave their assembly table for 2 minutes for every tray assembled:

Hourly Wage for a Technician $25/hour
Minute Wages for Same Tech $0.42
Time/Motion Lost per Tray (leaving an assembly table to finish a Tray) 2 minutes lost
Trays Process on Avg per Day 300
# of Working Days Processing, per Year 240
Potential Lost Worker Time / Year $60,480.00

If staff were observed to lose 5 minutes per tray because of productivity inefficiencies, the potential outcome is even more worrying:

Hourly Wage for a Technician $25/hour
Minute Wages for Same Tech $0.42
Time/Motion Lost per Tray (leaving an assembly table to finish a Tray) 5 minutes lost
Trays Process on Avg per Day 300
# of Working Days Processing, per Year 240
Potential Lost Worker Time / Year $151,200.00

Well-designed assembly tables can reduce, even conservatively, 2 minutes of time to access lights, heat sealers, scales, and other tools, saving departments thousands of worker dollars.

Finally, consider if your table vendor provides everything for a well-rounded assembly table. From common needs like task lights to integrated computers to often forgotten electrical support, a great table may fail the test without passing scores in other key areas.

Productivity is the first and often most important metric that decision makers will evaluate from sterile processing: consider if your prep and pack table is failing you in this area.

 

2: Your sterile processing workstations aren’t truly “ergonomic”

Ergonomics is more than comfort. A lack of poor ergonomics can lead to mistakes, costs, and at worst, non-compliance. Poor considerations of lighting at an assembly table can lead to missed mistakes, and compromised patient safety. A recent update to the AORN Guideline for Manual High-level Disinfection directly addresses ergonomics as a key factor to improving patient outcomes1:

“Staff discomfort can lead to mistakes and non-adherence to processing guidelines. AORN recommends the sterile processing area have ergonomic features to reduce staff discomfort. Ergonomic features can include work surfaces and sinks at a comfortable height. Also, there should be space to perform cleaning with sufficient lighting.”

 

From the tiniest ergonomic details like footrests and the storage of heavy items, to more significant factors like adequate lighting as described in ST79 and ST91, lack of ergonomic considerations leads to mistakes and non-compliance.

Some might argue that their prep and pack tables are height-adjustable, but are they really? Hand-cranked height-adjustable tables cover up one deficiency with another. And, if the table set-up cannot also raise and lower with the workspace, then the prep and pack table doesn’t consider the entire worker’s space. Staff may find themselves excessively bending, hunching, reaching, or straining to use tools and computers.

Beyond these factors, poor ergonomics plainly leads to an increased risk of worker’s compensation claims:

“We’ve had 2400 lost worker hours this year due to various injuries, and a turnover of (8) employees, of whom (4) were assigned to our Clean Side due to poor ergonomics, and cramped working conditions.”

3: Your sterile processing workstations aren’t lasting

When your SPD is finally bestowed resources to upgrade and enhance, the opportunity cannot be wasted on poor investments. Prep and pack table projects can be costly; replacing up to 10, 12 or more stations is a major investment of both time and cost.

If an assembly table cannot be readily serviced or is frequently experiencing issues, it may be failing you. Even tables can come with unforeseen costs, as one Manager describes:

 

“My current Tables have lasted 8 Years, complete with service issues. They are not enabling my Team to be more productive, while protecting them.”

An investment into tables comes with a commitment; they may be in place for over 10 years. Plan for the future. If the assembly table cannot grow with the needs of your team or the direction of your hospital and system, it may not be the right choice. A glance at your current tables might reveal a patchwork of band-aid solutions meant to make a static investment grow with your needs.

Sterile processing bears a lot of demands. Patients cannot afford any mistakes in reprocessing. Administration cannot afford lost worker hours, workers compensation costs, and poor investments. As a department leader, you cannot afford to fight with your equipment. Careful evaluation of even the humblest piece of equipment, the prep and pack table, might reveal hidden failures affecting all of these areas. With these failures identified, they can now reveal focuses for future projects.

 

Exploring options to replace your existing prep and pack tables? Continue reading on to identify the qualities in a table that enable productivity, boost ergonomics, and deliver long-term ROI!

 

Works Cited

  1. Article | AORN

Productivity, Ergonomics and Quality Investments: 3 Factors for Picking the Perfect Prep and Pack Table

Posted on by Megan Pietura

Your sterile processing workstation might be failing you. Every piece of equipment in sterile processing is asked to deliver all the features and benefits they promised; they often fall short. Assembly tables are no exception.

In a previous post, we explored how current sterile processing workstation might be reducing productivity, increasing non-compliance and staff injuries through poor ergonomic design, and costing departments in the long-run with service costs and lost investments.

What, then, qualifies a ‘great’ prep and pack table? Here are some ways to screen out these concerns and find the ‘diamond in the rough’:

1: The best sterile processing workstations help staff feel productive

sterile processing workstations must provide clean, neat and organized workspaces. That directly mirrors the outcomes and quality of the assembly work.

Great sterile processing workstations will acknowledge that assembly tasks require a lot of tools and workspace. Effectively designed tables will clear workspace for instrumentation and trays, and keep accessories and tools organized up and away. These tables will also ensure there’s enough space for everything: from the big heat sealer shelves to the small sterilization indicators.

Sterile processing is not only assembling but inspecting instrumentation. Quality assurance needs are rising as well. Borescopes, ATP

testing, protein tests, and other assurance steps are further adding demands to sterile processing workstations. Tables that consider these factors in their utilization of space can help deliver better productivity outcomes.

Every minute counts in sterile processing. When staff zig-zag across their department to complete one task, something isn’t working. A well-designed prep and pack table will consolidate activities and tools to one station, enhancing the power of every, productive minute.

 

2: The best sterile processing workstations help staff feel comfortable & ensure compliance

A safe, comfortable and ergonomic work environment can drive quality outcomes. Staff don’t make avoidable mistakes, and more attention can be paid to quality outcomes.

Assembly tables that consider multiple ergonomic factors are in a better position to deliver these outcomes:

  • Vertical storage: Height-adjustable tables that help mount tools and accessories above their working space account for OSHA recommendations to reduce straining, reaching, and bending throughout the day.
  • Lighting: Effective lighting reduces eye strain and helps catch poorly cleaned or damaged instrumentation from making its way to the operating room. Effective illumination is also a compliance requirement, as stipulated by both ANSI/AAMI ST79 and ST91.
  • “Quality of Life” Ergonomics: Finer ergonomic needs are more than just aesthetics. They might include the ability to tilt monitors, affect screen brightness, be accessible for those with disabilities, and more.

To explore more elements of effective ergonomics and earn 1 free CE, take our Ergonomics: Its Place in Strategic Planning CE program.

Ergonomics can be an important, decisive factor in delivering compliant and consistent outcomes!

 

3: The best sterile processing workstations help departments get long-term returns on their investment

Assembly table projects are expensive in both time and price. Leaders have a responsibility to both manage these costs, and double-down on these investments.

sterile processing workstations do not belong on a list of equipment that sterile processing needs to service and repair. Thoughtful, simple design and innovation can make a big difference in preventing downtime and repair costs in assembly. Evaluate this component in your next prep and pack table investment. Designs should be sturdy for regular use, but not so complicated that items cannot be serviced, replaced, or easily taken care of.

light table

The needs of a department change often. The operating room’s technologies might change even faster. Ensuring tables are ‘future-proofed’

for changing technologies can ensure tables outlive trends. Consider if tables can ‘grow and flex’ with the needs of its department and administration.

Many sterile processing leaders would say that getting more meaningful work out of every minute, providing a compliant and comfortable work environment, and demonstrating an ability to deliver returns on investments are priorities. Assembly tables, when carefully selected, can do all these things.

Carefully consider and ask lots of questions of prep and pack table vendors, and if the going gets tough, consider these three factors when you need to fight for your decision. These selling features might help your department get the equipment it deserves.

 

Evaluating new sterile processing workstations? Explore why PureSteel™ Ergonomic WorkStations are in some of the highest performing hospitals across the country, and how they’re delivering against these three, critical promises!

 

Resolving Small Problems in SPD and GI

Posted on by Megan Pietura

In a previous post, Small Problems with a Big Impact on Patient Safety, we discussed how seemingly insignificant concerns seen in SPD & GI departments can have considerable impacts on processes and quality outcomes, ultimately resulting in risks to patient safety. With those issues and their ramifications identified, it’s logical to wonder, “okay, now what?”

Let’s dive into some of the simple solutions that departments can deploy to combat these small problems.

 

Adhesives

Many departments use adhesives in applications such as water line markers and temporary temperature strips, resulting in a risk of residual bioburden. Stainless steel volume indicator plates can quickly eliminate the use of water line stickers. With a relatively simple installation, these plates not only deliver a reliable visual to indicate how much water is in the basin, but their stainless steel construction allows them to be put through a cart washer for deep and easier cleaning. This means the days of maintaining and replacing temporary water line stickers are gone, with assurances that the plate is always ready for use after a trip through the cart washer.

Temporary, adhesive temperature stripes can also be eliminated through sink design. Integrated thermometers within sink basins ensure accurate, reliable temperature measurements via high-visibility LED gauges built into pegboards. This takes gauging temperature to the next level, ensuring that the team can easily determine whether water temperatures are outside of optimal ranges.

 

Bioburden

Residual or undetected bioburden can have wide-ranging consequences for patients. Every SPD and GI professional strives to eliminate all bioburden on and within the devices they reprocess. Even with the best of intentions, the human eye can only achieve so much; it’s challenging to know what you missed if you can’t actually see it.

Borescopes are being implemented in departments across the country. With advances in catheter diameter and visualization technology, their importance is growing each day. Implementing borescopes for visual inspection can help teams get their eyes into places they previously couldn’t, illuminating bioburden that may have been otherwise missed. With compact computers and varying monitor options able to be mounted to pegboards or dedicated visualization stations, visual inspection via borescopes is more feasible than ever.

For external inspection, magnified task lights provide the necessary illumination and up-close perspective needed to spot bioburden and damage before the instrument moves on. Some task light options even offer the ability to swap out lenses with varying magnifications, enabling teams to tailor the tool to their need. Consider task lights with at least 4x magnification, which meet a range of IFU and are better at inspecting complex devices.

 

Leak Testing

The critical nature of leak testing means that success (or lack thereof) has a big impact on departments and patients alike. Visualization plays a significant role, with most staff relying on the naked eye to visualize leaks. This means that adequate lighting is the key to helping technicians and nurses do this job well.

Hood lights mounted above the sink are an excellent first step towards providing the illumination required for the job. While the benefits of these lights extend well beyond the basin, their role in leak testing is notable.

Taking it a step further, sink design can take in-basin lighting to the next level in form of integrated LED basin lights. In-basin lighting eliminates the risk of shadows impeding visibility while conducting leak tests, as well as helping teams pinpoint the source of bubbles and, ultimately, the location of damage within devices such as endoscopes.

 

Sinks Equipped with Electrical Capabilities

Many sinks aren’t designed with the power requirements for end-users’ tools and accessories. This results in an inability to justify the purchase of these products, or abandonment of them after purchase, not only wasting money, but depriving teams (and patients) of the benefits these tools provide.

Considering the current and future power requirements that will be needed at decontamination sinks in the design phase can ensure that sinks have ample power supply and an ability to accommodate your department’s need now and later, when guideline and IFU changes may fuel new needs.

 

There are countless small problems that pop up in SPD and GI departments that can seem insignificant on their face but have the ability to create significant problems for patients if not resolved. Vendors see these and take them seriously, with many options developed to tackle these kinds of problems head-on. Whether it’s something as simple as volume indicator plates, or something that requires a little more planning in the design phase of equipment like sinks, there are ways to tackle these problems, help protect patients and providing your team with effective tools in the process.

 

Interested in learning about other challenges seen at decontamination sinks? Check out our blog: Common Problems at Sinks in Reprocessing Departments today!

Small Problems with a Big Impact on Patient Safety

Posted on by Megan Pietura

As reprocessing professionals, whether technician or leaders, there are common problems everyone can attest to. Ergonomic challenges, workflow issues, and process updates to name a few. Improving these can lead to a substantial return on investment, better engagement and a boost in compliance. However, there are sometimes unnoticed challenges within a department that may seem small or inconsequential that can contribute in big ways to patient safety.

In decontamination at the sink, there are several process tools that aid in both the cleaning and the monitoring process that we can often take for granted or may not get a second look in the hustle and bustle of daily volumes and throughput. With a closer look we can see that these quick fixes truly have a negative impact on the quality of care for the medical device and, ultimately, the patient.

 

Stickers

Adhesive temperature gauges and sink fill markers can provide a quick nod to compliance but frequently result in more harm than good in the long run. Adhesives used on stickers and tape require routine maintenance and replacement to ensure effectiveness and minimize its impact on microbial growth. Adhesive doesn’t hold up well during constant contact with water and can be found to peel and deteriorate overtime. As the stickers peel away the sticky residual is left behind acting as a bonding agent for bacteria, bioburden, and chemistry residuals present during the manual cleaning process. This can lead to biofilm formation within our sinks, or residual transference to our manual cleaned instrumentation.

 

Undetected Bioburden

If it isn’t clean, it isn’t sterile. Missed and undetected bioburden can be the source of a failed process. Visual inspection continues to gain traction as studies point to its benefits and the data highlights the repercussions of left-behind bioburden. This leads to a broken-down process posing contamination risks to the patient, and inevitably instrument damage.

Some bioburden is detectable with the human eye; missed staples and/or bone fragments might be examples. When departments lack adequate lighting, however, even this bioburden can be missed without adequate lighting.

Bioburden goes beyond what the human eye alone can detect and without the right equipment, including lighting and visual enhancement tools, undetected bioburden can make its way through the cleaning process and beyond, leaving risk, corrosion and potential infection in its wake.

 

Leak Testing

Leak testing is a critical step in the manual reprocessing of flexible endoscopes. This test is the early indicator of scope damage and can also clue into the potential location of the damage. Leaks can occur at various points of the scope and can often be hard to identify or detect without proper visual accessories and minimum leak testing time requirements can lead to misinterpretation of leaktest results.

A misinterpreted leak test whether, a missed fail or false fail, can impact patient safety in various ways including the risk of using a damaged scope, or eliminating inventory due to falsely identified issue that now results in insufficient procedural supply for patient volume.

Lighting is a critical factor to proper leak testing results. Ensure your department is equipped with proper overhead and possible in-basin lighting to assist in this QC step.

 

Water Temperature & Chemistry Dosing

Water temperature is another important consideration in the manual cleaning process. Temperature ranges aren’t just for optimal enzymatic performance but also for the prevention of blood coagulation. It is understood that blood can begin to coagulate at temperatures at or exceeding 113* F. Additionally, enzymes are activated, and their effectiveness can be based on optimal water temperatures. Too cool and the enzyme activation can be slow and “sluggish”, while too hot the enzymes can be extirpated altogether.

In addition, too little or too much cleaning chemistry can also have a negative impact on the cleaning process. Too little and organic soil isn’t effectively broken down. Too much and we have high foaming concentration in our cleaning solutions.

Without consistent, easy to read temperature and chemistry dosing monitors, the risk of inconsistency resulting in varied levels of cleanliness and cleaning effectiveness increases.

 

Electric requirements and power considerations

Powered equipment, such as height adjustable lifters, automated flushing, dosing pumps, and leak testers all have one thing in common; they require a power supply.  This can cause challenges when implementing upgrades and updating workflows, as current electrical outlet locations may be sparse or non-existent in work areas, especially within decontamination.

Attempting to remedy electrical needs with power strips can be an accident waiting to happen. Shorted fuses or overdrawn power strips can be a fire hazard or electrical shock risk to staff. Long-term fixes are a necessity when electrical or power is being discussed.

 

Small issues often seem like a low priority, until we look at the risks associated with their quick fixes. Knowing the repercussions when work environments are not fully functional can aid in guiding how and what gets addressed as departments continuously improve their operations.  Attention to detail is a prominent characteristic in the world of reprocessing, and when it’s applied to both our instruments and our processing tools staff and patients benefit from it.

Resources:
https://www.hpnonline.com/sterile-processing/article/13001537/keeping-murphys-law-out-of-the-spd

 

Are you looking for ideas to improve your department, and need a free CE? Check out our Ergonomics: Its Place in Strategic Planning Program today for other key areas to consider upgrading in your department.

Bioburden Bible: Identifying and Reprocessing Human Bioburden in Instrument Reprocessing

Posted on by Megan Pietura

This program is approved for .5 CE credits through HSPA. To receive your credits, you must earn an 80% passing score on the quiz at the bottom of this Report.

Objectives:

  • Define the types of bioburden SPD and GI departments are responsible for removing from medical devices.
  • Explain how enzymes interact with bioburden to aid in the denaturing of organic compounds to facilitate cleaning.
  • Analyze the types of enzymes used in medical device reprocessing

Sterile processing and gastroenterology professionals are asked to move mountains daily. From manually cleaning thousands of instruments to hauling heavy trays of devices, and quality checking every step along the way, they go through great means to ensure safe and clean devices for their patients.

Sterile processing and GI however are often reduced to the hospital ‘dishwashers’; cleaning, brushing, loading and processing thousands of devices a day to keep operations running. Such an oversimplified description fails to capture all the nuances of effective instrument reprocessing.

One such area is that human ‘bioburden’ is uniquely different from other forms of ‘dirt’ and ‘debris’. Its unique characteristics require sterile processing and GI to adapt cleaning processes and tools to tackle these forms. Let’s evaluate these unique bioburden categories, and how they might impact how and why instrument reprocessing is unique.

 

Bioburden

Bioburden is defined as “the number of contaminated organisms found in a given amount of material before undergoing a sterilizing

procedure” by the Patient Safety Authority1. For the purposes of this overview, two major categories of bioburden are dis

cussed. Each of these two groups have unique properties which may require unique cleaning practices:

  1. Protein-based bioburdens
  2. Fat-based bioburdens

Protein-based bioburden

Proteins are complex, highly structured molecules which provide the body with a variety of critical functions. We rely on proteins to keep us alive3. Blood is a common

protein-based bioburden cleaned in sterile processing and GI. Collagen is also a protein, which makes up the body’s skin, tones, tendons, and ligaments. Protein is a major structural component in the body made up of folded chains of amino acids and make up our cells and tissues, as well as many enzymes and hormones.

Denaturation, which modifies the structure of the protein to break up its bonds, causes them to have a looser structure and sometimes insoluble quality. High alkaline or acidic properties, heat, or certain detergents can all cause denaturation, making cleaning protein-based bioburden more difficult. For protein-based bioburdens, such as blood, this often results in coagulation and the formation of biofilm.

Fat-based bioburden

Lipids are a diverse group of organic compounds that include oils, fats, hormones, and certain compounds of membranes that group together because of their aversion with water4. Lipids help the body store energy, absorb nutrients, and create hormones. Lipids may be discovered on orthopedic devices for their prevalence around joints5  as well as plastic surgery devices that routinely come in contact with skin, oils and fats during grafting and reconstruction. Fat ‘pads’ many parts of the body to protect and insulate.

Lipids are notoriously hydrophobic, avoiding interactions with water, and often stick together as insoluble masses. That quality can make reprocessing particularly tricky.

 

Carbohydrates, such as glycogen, act as a storage compound in the liver and muscles6. The human body has little structural carbohydrates, and therefore, isn’t included in this overview as a unique category.

 

Other types of bioburdens

The human body is composed of many chemicals, minerals, and organic compounds. These chemicals come together to configure unique forms of human bioburden we see in instrument reprocessing, and are usually a combination of proteins, fats, minerals, and other organic compounds. Some of these might include:

  • Bone is made of protein, collagen and minerals such as calcium, so while not its own type of organic bioburden, is prevalent after some medical procedures.
  • Feces, while also prevalent in lumens found on some GI flexible endoscopes, is also not a unique form of organic bioburden, but mostly made up of indigestible matter like cellulose, cholesterol, fats, water, and dead bacteria.

 

Sterile processing and gastroenterology professionals should be cognizant of what forms of human bioburdens they may encounter in reprocessing. That knowledge can help implement cleaning tools and technologies to tackle these bioburdens.

 

The Role of Cleaning Chemistries

Enzymes are biological kick-starters. They already exist in the human body and help facilitate chemical reactions by binding to substrates to lower the threshold necessary to create a reaction. Enzymes are at work in the stomach, breaking down complex molecules into simpler forms to help digestion, or in the liver breaking down toxins in the body.

Enzymes are also found in enzymatic detergents, and are often categorized into groups:PureChannel Flush 0212162

  • Protease, which targets protein-based bioburdens such as blood and feces.
  • Lipase, which targets lipids and fats. Lipase can help counter the hydrophobic properties of lipid compounds and make them easier to break down and clean.
  • Amylase, which targets starches.

Enzymatic chemistries play a critical role in manual and automated cleaning efficacy both in SPD and GI reprocessing. Though some enzymatic detergents have single enzyme properties, there are multi-enzyme chemistries on the market. It is crucial to follow manufacture IFU on water/solution temperatures to ensure proper activation of the enzymes to aid in the cleaning process.

 

The Role of Technology & Processes

Technology is evolving at a rapid clip, most certainly in endoscopy and sterile processing. It’s both fun and fascinating to watch the investments in new washer-disinfector, ultrasonic, manual cleaning, quality assurance (ie cleaning verification & visual inspection), and sterilization technologies being developed.

SPD and GI departments have responsibilities to constantly re-evaluate their technological arsenal. As surgical devices become more

difficult to clean, so then must the technology evolve to clean them.

If new technology isn’t attainable, process updates can alleviate some of the challenges. This can include reviewing chemistry, equipment and instrument IFUs for improved or updated steps such as soak times, water temperature, brushing techniques or flushing requirements . Evaluate what processes are being conducted in a department and evaluate which have failed to change over the past 2-5 years. Manual cleaning, quality assurance, and sometimes visual inspection are areas which require new methods and practices.

 

Importance of Point-of-Use Cleaning

All medical device reprocessing begins immediately after the surgical procedure. Point-of-use cleaning is incredibly effective and important in the immediate breakdown of debris and bioburdens. Doing so immediately prevents the formation of biofilms. Collaboration with the operation room starts the foundation for effective point-of-use practices.

 

“Biofilm consists of an accumulated biomass of bacteria and extracellular material that is tightly adhered to a surface and cannot be removed easily. Biofilm has the effect of protecting microorganisms from attempts to remove them by ordinary cleaning methods used in the sterile processing area and of preventing antimicrobial agents, such as sterilants, disinfectants, and antibiotics, from reaching the microbial cells.”

  • ANSI/AAMI ST79:2017 3.1 – Handling of instruments during surgical procedure

 

Central sterile and endoscopy professionals are tasked with many challenges, some of which include processing of human bioburden and organic compounds. These bioburdens are far different than other bioburdens that are cleaned or reprocessed in other areas. One in that their make-up and characteristics require unique cleaning practices. Secondly, in their ability to harbor dangerous microorganisms which can cause harm to both medical staff and patients.

Endoscopy and sterile processing professionals can evaluate these four factors to ensure they’re equipped with the arsenal to tackle these unique bioburden challenges.

Looking for ways to improve your sterile processing or gastroenterology cleaning processes? Learn more about how the FlexiPump™ Independent Flushing System helps departments tackle their toughest instrumentation & cases!

 

Works Cited

  1. Authority, P. P. S. (n.d.). Bioburden on Surgical Instruments | Advisory. Pennsylvania Patient Safety Authority. https://patientsafety.pa.gov/ADVISORIES/Pages/200603_20.aspx
  2. FS14/FS077: Basic elements of equipment cleaning and sanitizing in food processing and handling operations. (n.d.). Ask IFAS – Powered by EDIS. https://edis.ifas.ufl.edu/publication/FS077
  3. National Human Genome Research Institute. (n.d.). Protein. Genome.gov. https://www.genome.gov/genetics-glossary/Protein
  4. Encyclopædia Britannica, inc. (2024, March 27). Lipid. Encyclopædia Britannica. https://www.britannica.com/science/lipid
  5. Daigle, P. (2022, November 4). Your guide to enzymatic cleaners. Outpatient Surgery Magazine. https://www.aorn.org/outpatient-surgery/article/2016-January-your-guide-to-enzymatic-cleaners
  6. The Editors of Encyclopaedia Britannica. (2024, May 16). Human body | Organs, Systems, Structure, Diagram, & Facts. Encyclopedia Britannica. https://www.britannica.com/science/human-body

Time and Motion Improvements through Assembly Table Designs

Posted on by Megan Pietura

In the demanding world of sterile processing, time and motion efficiency directly impact on SPD’s ability to serve its patients. Sterile processing technicians play a pivotal role in ensuring throughput but are often hindered by outdated equipment and inefficient workflows. By evaluating some of the reasons technicians lose valuable minutes during packaging, design considerations can be identified and integrated into assembly tables.

There are millions of reasons why technicians lose time during assembly. Here are three common reasons where the sterile processing workstation may be a culprit for lost time during assembly activities.

 

Reason 1: Inadequate Storage & Organization

A lack of easily accessible storage can lead to constant disruptions during the assembly and packaging process. Technicians often leave their tables to refill containers with indicators, stickers, tape, and other essential tools, which interrupts their workflow and slows down the entire packaging process.

Design Consideration: To tackle this challenge, consider assembly tables with integrated storage. Backwall pegboards can be especially useful, providing ample organizational space that can be arranged to suit any system. By having everything in one place and within easy reach, technicians can work more efficiently, and reduce their steps across departments.

Vendors that provide pegboards or backwalls should also provide the features to organize these tools. Bins, peel pouch organization, or lighted shelving complete vertical storage solutions.

 

Reason 2: Wrapping & Streamlining Packaging Materials

With some departments reducing their use of blue wrap, it no longer makes sense to keep wrapping materials at every table. This can waste space and result in overordering supplies. Similarly, bulky heat sealers often occupy excessive table space, while switching between pre-cut and roll packaging requires organized storage for both.

Design Consideration:  Departments may choose to re-evaluate their whole workflow, opting to streamline certain packaging processes to specific tables.

A great example are peel pouches. Some table options available are specially built to be peel packing stations and organize those tasks into one location. SMS wrapping stations may also garner time & motion savings when integrating both wrap storage, inspection and wrapping into one convenient location.

When departments don’t have the real estate for a dedicated table, consider design elements that store heat sealers off of countertops, integrate wrap and vertical storage, to free up valuable working space for other assembly tasks. Vertical storage goes for the space used above the table, and below it! Consider the full design capabilities of your vendor.

The same idea can be applied for quality verification processes, such as protein testing, ATP, or borescope inspection. Dedicating physical locations for these activities can give a technician everything they need to do in one location and stay focused on the task at hand.

 

Reason 3: Weighing Trays

ANSI/AAMI ST77:2013 recommends that the combined weight of trays never exceeds 25 lbs. for sterility assurance and protecting worker safety:

“The loaned instrumentation policy should include processes to:

 e) determine responsibility for ensuring that sets weigh no more than 25 pounds”

– ANSI/AAMI ST79 5.2.3.2 Loaned instrumentation policy

 

As sterile processing technicians assemble their trays, the need to periodically assess weight might require technicians to leave their table.  Carrying around trays to weight stations doubles-down on the strain and fatigue. Minutes are lost catching overweight trays or leaving the assembly table.

Vendor trays are a primary culprit for overweight issues. Before accepting overweight trays, sterile processing technicians need the tools to check the weight. Vendor check-in stations therefore need to be designed with this need in mind.

Design Consideration:  Developing assembly tables w/built-in scales to periodically weigh trays can help reduce the amount of time technicians spend leaving and returning to tables. As well, mobile scale carts located at vendor check-in areas help prevent overweight trays from entering workflows and causing overweight issues.

Identify vendors who integrate this concern into their assembly table designs, or those who offer scale solutions. Integrating scales or weight-management technologies can save back aches for staff, and improve sterility outcomes for patients.

 

Partnering with vendors who understand and address these key factors in sterile processing workstation designs is essential for achieving time and motion goals. The right table configurations can streamline technician workflows, reducing unnecessary use of time. These designs also support compliance with crucial standards, providing peace of mind for technicians and patients.

 

Looking to partner with a vendor who can help you save technician time during packaging, and optimize assembly outcomes? Contact us today to learn about the newest in assembly table technologies!

Hidden Potential: Lost Time and Productivity Inefficiencies in Fragmented Assembly Processes

Posted on by Megan Pietura

Have you ever sat down at the end of the day, tired, but feeling like you didn’t accomplish a lot? Wondering what it was that made you exhausted by the end of it? You may look back on your day and recall a handful of accomplishments; a few things knocked off the to do list. However, upon further evaluation you recall the ten plus trips up and down the stairs you took putting items away, or the repeat trips to the car to unload the groceries. This all took up time, that while necessary to complete the job, stole time away from your ability to complete additional tasks or achieve a couple extra goals.

This same concept applies to our workdays and how we manage our tasks and the physical steps required to complete them. Workflow mapping and time-motion studies are formal methods to measure and evaluate how much movement is required to efficiently complete a task. These studies have not only helped efficiency but also budget planning and providing metrics for staff performance evaluations (Kalne et al, 2022).

There are several factors sterile processing departments can evaluate to determine their reprocessing efficiencies.

Supply Location

Are supplies easily and readily available to the team as they go about their work? Are their work areas stocked with the most often used items so that they are not repeatedly leaving their station or pausing a reprocessing step to gather their supplies? This could include brushes, flushing devices and inspections tools in decontamination. At prep and pack areas, it could be demagnetizers, indicators, container locks and instrument testing material.

Each step of the process requires some consumable or tool. It is important to keep supplies centralized and quickly accessible to decrease foot traffic and allow for more time to be dedicated to quality and compliance.

Manual and Automated Processes

Automation is quickly finding its way into sterile processing, beyond the integration of washer disinfectors and conveyor systems. There are flushing systems, and instrument recognition software. We now have the capabilities of artificial intelligence (AI) and software interfacing at our fingertips to improve not only efficiency, but also standardization and consistency. When considering automated processes, consider how it will improve and support your department. Poorly integrated automation can also have a negative consequence of decreasing productivity and compliance. Careful implementation of AI is key to prevent unwanted outcomes.

Too Much Purview

Staffing shortages, unexpected absences and increased work volumes continue to be commonplace in our healthcare facilities. Bandwidth is limited and team members are doing double and sometimes triple duty. This can directly relate to reduce productivity as they juggle being in multiple places and assignments throughout the day, sometimes in the same moment.
Do you have a technician who may be assigned to prep & pack, but it also responsible to unloading the washers and covering sterilizers while a peer is at lunch? Appropriately and strategically filling voids in the operational plan can make immediate improvements to your process times and productivity levels.

 

Resources

Resources and references are an important component of consistency and compliance. How we store, communicate and maintain availability of resources can impact the amount of time a sterile processing technician is away from their work area.
Are resources kept on a shelf or in the cabinet in the department? Are there opportunities to upload procedures, instructions for use (IFU) and reminders to your tracking system, or even create posters and visual cues they can reference without having to walk across the department or leave their work area?

Routines

Inventory, referencing resources and even stepping away from our stations to perform specific job functions comes with being a GI or sterile processing tech.
Instilling thoughtful and consolidated routines into our technicians’ and nurses’ daily processes eases the labor their bodies must contend with and can help reduce unnecessary repetition throughout their day.

There can be a large return on investment (ROI) in conducting and implementing changes identified through a time-motion study. Kalen, et al found that time-motion studies can “regulate expenses, enhance working conditions, inspire staff, and boost productivity by developing a “standard” job technique.” (2022) Knowing and understanding the impact of the department’s layout, the operational strategies, and the routines the teams develops informs us on the overall production of the department, and enhances our abilities to troubleshoot, prioritize and improve how we complete our daily tasks.

 

References

Kalne, P. S., & Mehendale, A. M. (2022). The Purpose of Time-Motion Studies (TMSs) in Healthcare: A Literature Review. Cureus, 14(10), e29869. https://doi.org/10.7759/cureus.29869
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9629289/

The “Why” Behind Endoscope Sink Design

Posted on by Megan Pietura

One of the most important places in an endoscopy suite or clinic is the decontamination sink. Undervaluing the impact that a well-designed endoscopy reprocessing sink has jeopardizes all proceeding steps in the process. The sink is the center for leak testing, manual cleaning, and visual inspection procedures. A poorly designed or suited endoscopy sink can increase cross-contamination risks, damage delicate endoscope inventory, cause bottlenecks, or create confusion and cause lapses in reprocessing.

Standards have clarified what elements are required for a properly designed endoscopy sink. What are some of these design elements, and how do they positively impact endoscope reprocessing outcomes?

Flushing an endoscope in an endoscopy sink

Separation & Workflow

Separation between clean and dirty has long been a challenge for endoscopy reprocessing departments because of space. Space is a non-negotiable factor for creating separated clean versus dirty areas. Space also impacts workflow; without it, nurses and technicians double-back on each other, potentially cross-contaminating cases and scopes.

When one-way workflow cannot be enforced in an endoscope processing room, high-volume and backlogs create confusion. It’s easy to lose sight of proper workflow when scopes are piling up and the clock is ticking.

Sink design can have a positive impact. A properly designed endoscopy sink should consider the full decontamination space. Is my sink installed where doors don’t impede one-way workflow? If there’s only one room, can I maintain at least 4 foot of space between clean and dirty (ANSI/AAMIST 91:2021)?

Limited space does not have to limit solutions. If space is of concern, how can my sink vendor provide partitions and design elements that reinforce proper workflow, and separation between clean dirty? These are valid considerations for sink design.

 

“Adequate space shall be provided to allow for the manual cleaning and rinsing of devices during decontamination. It is optimal that the manual cleaning area is physically separated by walls or partitions in a two-room configuration to control contaminants generated during manual cleaning. Doors that open in the direction of the one-way workflow and closeable pass-through windows separating the decontamination area from the adjoining disinfection/sterilization area should remain closed when not in active use. An endoscopy processing room with a one-room design should provide a minimum of 4 feet between the decontamination area and the clean work area and either a separating wall or a barrier that extends a minimum of 4 feet above the sink rim to separate soiled work areas from clean work areas (FGI, 2018 [146]; AORN, 2018e [39]).”

ANSI/AAMI ST91 4.2.2 Physical Separation

 

Basins

Most flexible endoscopes have at least two characteristics in common: they are delicate, and intricately designed. These qualities demand careful handling and specialized care during cleaning.

While basins should be deep enough to allow for full submersion of the endoscope, excessively deep basins can lead to ergonomic challenges for staff, risking discomfort and potential injury from prolonged bending. However, striking the right balance is important, as appropriately deep basins help to mitigate aerosols during cleaning.

Basins should also be a certain size: over-coiling is a common risk for larger scopes. Over-coiling also reduces leak testing outcomes, masking potential leaks.

“Use decontamination sinks that are deep enough to allow complete submersion of the endoscope and large enough to allow the endoscope to be positioned in the sink without tight coiling”

AORN Guidelines for Perioperative Practice 1.9.1

“Use decontamination sinks that are deep enough to allow complete submersion of the endoscope and large enough to allow the endoscope to be positioned in the sink without tight coiling”

AORN Guidelines for Perioperative Practice 1.9.1

 

Having at least 2 sink basins, optimally 3, prevents cross-contamination between scopes. Sinks should also be height-adjustable, when available, to reduce ergonomic discomfort for staff. Improper ergonomics can have severe, negative consequences for worker safety and retention. In the 2024 GI Nurse and Technician State of the Industry report, 189 anonymous endoscopy participants ranked the ergonomics in their department at a 6.3/10 score. This is a current challenge, and can ‘leak’ into the cleaning process through mistakes, and shortcuts.

“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. 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 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; foot stools should be readily available to accommodate shorter personnel.

At a minimum, two sinks or one sink with two separate basins should be used. Consideration should be given for additional space for delayed processing protocol. One sink or sink basin should be designated for leak testing and manual cleaning and the other only for rinsing. Optimally, three sinks or one sink with three separate basins should be used, with each function in a separate sink or basin.”

ANSI/AAMI ST91 4.3.2 Sinks and accessories

 

Staging Space

The staging space serves multiple crucial functions in endoscopy processing areas. Firstly, it ensures that each endoscope is treated as an individual case, preventing any risk of cross-contamination or damage that may occur from stacking them. This is essential for maintaining the integrity of the endoscope and the safety of patients.

Secondly, the staging area provides an optimal environment for inspection and leak testing, allowing technicians to thoroughly examine each endoscope for any potential issues before use.

Additionally, the staging area can facilitate visual inspection procedures, enabling staff to assess the cleanliness and condition of the endoscope before proceeding with processing.

Reprocessing professionals and their vendor partners should consider where and how staging space is integrated into the sink design.

Sinks should have attached solid counters or adjacent work surfaces on which to place the endoscope while attaching it to the leak tester, detach and separate removable components, and to inspect the endoscope for physical damage and cleaning effectiveness.”

ANSI/AAMI ST91 4.3.2 Sinks and accessories

 

Lighting

Fine detailed cleaning is routine with endoscopes. Per ANSI/AAMI ST91: 2021, wet leak testing should now be conducted for 60 seconds to help find fine bubbles, tricky in poor lighting conditions. Multiple ports and channels mean more areas for cleaning, and more areas to miss. Lighting is critical to ensure proper visual inspection procedures. Magnifiers further adjunct lighting for proper inspection.

“Lighting of the recommended illuminance should be placed above the sink and counter area so that personnel can adequately perform inspection activities as the endoscope is processed (see 4.3.8 and Table 1). A lighted magnifier should be available for inspection.”

ANSI/AAMI ST91 4.3.2 Sinks and accessories

 

Gastroenterology clinics and sterile processing departments struggle with many challenges, most of which aren’t going away. A practical solution to these challenges can be equipment design, and understanding why standards make certain recommendations.

Endoscopy and sterile processing professionals should carefully consider which vendors they partner with to fulfill these design needs. Pure Processing intimately understands and studies endoscope reprocessing standards and departments, to help provide custom endoscope sink solutions. Contact us to learn more about our process, and if we’re the right fit for your project!

 

Looking for a checklist to start your endoscope sink evaluation? Download our free, Endoscope Reprocessing Checklist, and ensure your next GI sink meets these 16 key considerations!

Impact of Rising Colon Cancer Screening on GI

Posted on by Megan Pietura

Preventive screenings play a vital role in public health, contributing to overall better health outcomes. Among these screenings, colon cancer screenings (colonoscopies) stand out for their early detection capabilities.

Typically recommended for individuals aged 45 to 50, depending on their risk factors, these screenings are essential for spotting signs of bowel cancer in its early stages. Despite the short duration of the procedure, lasting only 15 to 20 minutes, its impact is significant, especially within the domains of public health and gastroenterology.A doctor sitting next to a patient, discussing colon health.

For gastroenterology and sterile processing departments, it’s crucial to consider the broader implications of colonoscopy procedures. As public health initiatives advocate for increased screenings and improved access to affordable healthcare, both the GI industry and SPD are confronted with significant changes and challenges.

 

Looking at the screening population

When considering colon cancer screening, understanding its importance becomes imperative because of the escalating diagnosis rates. From 1989-1990 to 2012-2013, rectal cancer rates in adults aged 50 to 54 increased to match those in adults aged 55 to 59 (Siegel). With these increasing rates, the United States Preventive Services Task Force lowered the recommended colon cancer screening age to 45 in May 2021, down from the previous age of 50 (Colorectal).

While there are several positive aspects to this change, such as earlier detection and intervention, the expanding population within this new age range translates to a higher caseload for those in the GI and sterile processing space.

 

Population Before Recommended Screening Lowered to 45

55-64 Years Old 43,408,408
65-74 Years Old 33,111,965
Total 76,520,373

 

Population After Recommended Screening Lowered to 45:

45-54 Years Old 40,868,806
55-64 Years Old 43,408,408
65-74 Years Old 33,111,965
Total 117,389,179

 

Percentage of Increase: 53.4%

Lowering the screening age broadens the pool of individuals eligible for colon cancer screenings, directly impacting demand on endoscopy professionals. Managing potentially double the caseload amidst existing challenges such as high turnover, inadequate compensation, and limited resources, presents significant hurdles. Despite their expertise, professionals in the GI space must execute meticulous work that supports optimal patient outcomes.

 

Exploring the 2024 GI Nurses and Technician Survey 

The 2024 GI State of the Industry Survey, collected and presented by Pure Processing, is designed to provide a comprehensive overview of the current landscape within the GI field. Through the survey, emerging trends, key challenges, and positive developments are identified. Importantly, the survey serves as a platform for gastroenterology nurses to anonymously share their perspectives, allowing them to voice their appreciation for the industry and bring attention to areas in need of improvement.

 

“Keeping up with demand, particularly turnover, while maintaining compliance,” succinctly encapsulates the challenges prevalent in the industry, as one survey participant commented. The available screening population exacerbates deficiencies within the GI field.

The survey shed light on the major shortcomings in four key areas: financial resources, staffing levels, compliance requirements, and support systems. Balancing an increased caseload with spatial constraints and regulatory demands proves challenging, even for seasoned practitioners. Despite the rising population, many nurses and technicians identify inadequate compensation and support as primary issues in their departments.

 

Another survey participants confirms how rising demands impacts work: “Too many procedures for the number of scopes available. Understand and respect the time to properly process a scope. They should all take the same amount of time if the technician is following the instructions.”

 

As cases increase, standards and guidelines also evolve and become more complex. 30 percent of survey participants cite compliance as the foremost issue in their department. GI nurses face overwhelming caseloads while also managing scope reprocessing, requiring not just skill and patience but also significant time and resources.

Nurses often feel unsupported as caseloads rise while resources remain stagnant. As caseloads surge, hospital revenue increases, underscoring the vital role nurses play in conducting procedures. There’s a pressing need for increased resources such as space, staffing, and support to ensure compliance and provide optimal patient care.

 

Conclusion

Despite its challenges, the collaborative spirit among nurses, nurse managers, and technicians is palpable. With over 100 mentions of “teamwork” in response to the question “What do you enjoy about being a GI Nurse, Nurse Manager, or Technician?”, it’s clear that teamwork is integral to achieving optimal patient outcomes.

In an industry where mutual support and encouragement are paramount, nurses find solace and strength in their peers. This connection and compassion for one another are crucial components of a positive industry experience, especially as the industry constantly evolves and workloads increase.

 

Nurses in the field are not only hardworking but also compassionate, serving as the driving force behind public health principles. The advancement of public health is propelled by the dedication and commitment of those within the GI industry. This experience has expanded my understanding of public health beyond the confines of the classroom.

I’ve learned that successful outcomes rely not only on patients’ decisions to get screened but also on the collective efforts of the industry, which steadfastly tackle challenges head-on. Despite these challenges, the unwavering teamwork within the GI profession demonstrates a commitment to providing the best care for our patients.

 

Written by Adriana Pierropoulos | Inside Sales Account Manager 

Author Profile

As an Inside Sales Account Manager at Pure Processing, I leverage my public health background to educate our clients on ergonomic and advanced reprocessing solutions. Graduating from Purdue University with a BS in Public Health, I aim to empower and support our customers in optimizing their departments and processes. At Pure Processing, my primary goal is to raise awareness about our innovative solutions and advocate for our clients’ and patient’s needs. Through my dedication and passion, I strive to ensure that our customers receive the education and support necessary to create the best possible environments for their teams.

References

  • Bureau, U. S. C. (n.d.). Age and sex composition: 2020.
  • Colorectal cancer: Screening. (2021, May 18). US Preventive Services Taskforce. https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/colorectal-cancer-screening
  • Siegel, R. L., Fedewa, S. A., Anderson, W. F., Miller, K. D., Ma, J., Rosenberg, P. S., & Jemal, A. (2017). Colorectal cancer incidence patterns in the United States, 1974–2013. JNCI: Journal of the National Cancer Institute, 109(8). https://doi.org/10.1093/jnci/djw322