Author: Megan Pietura

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

Justifying an Educator Role in Your Department

Posted on by Megan Pietura

In March 2024, Pure Processing’s Voice of the Customer (VOC) Committee met to discuss a topic on the minds of many in reprocessing departments: educators. Educators are essential in reprocessing departments, but not all departments have or can support a dedicated educator position.

Bill Filipponi, Director of Sterile Processing at North Kansas City Hospital, and longtime member of the VOC Committee, dove in deeper with Pure Processing into how departments can make the case internally to justify a permanent educator position.

Error Rates

Error rates are an effective indicator when gauging whether a team possesses the knowledge necessary to properly reprocess instrumentation. Filipponi explained that an increase in error rates should signal to managers that their team likely needs additional training focused on the source of the errors.

However, this is not always a straightforward process. Managers can identify the need for additional training, but they can’t always diagnose which specific training is necessary or how to effectively deliver it to those who need it.

Educators have the expertise to quickly identify training gaps and adjust their teaching methods to meet the needs of each SPD technician. This ensures teams spend appropriate amounts of time together and reduces error rates.

 

Complexity of instrumentation
Tip of a robotic arm.

The growing complexity of instruments requires departments to obtain and retain important information associated with reprocessing them. Managers and supervisors often fall into this role in lieu of an on-staff educator but aren’t always the best equipped to serve in that capacity.

As Filipponi pointed out, some scope IFUs require 80-90 steps to achieve compliance, and errors mean reprocessing a second time, effectively doubling the time spent reprocessing that scope. Dedicated educators can not only stay on top of these complex IFUs but keep teams up to speed and leverage their educational background to convey the why behind critical steps contained in IFUs.

“A ten-minute shortcut could lead to a week-long stay for a patient”, Filipponi explained. An educators’ ability to explain the importance behind certain steps helps teams to understand the impact of taking shortcuts or cutting corners, ultimately helping them do what’s right in the interest of patient safety.

 

Turnover rates 

Turnover and staffing problems have plagued reprocessing departments for years. A notable contributing factor to these high turnover rates is the difficulty of the work in departments and a steep learning curve. It might be easier for frustrated staff members to leave the industry in favor of one that’s less demanding, physically, and mentally.

As Filipponi elaborated, “It’s really money or time. You can perpetually hire, but that’s expensive and inefficient. You can offer overtime to cover the technicians you’re missing, but that’s also expensive. When you’ve got a smaller team than you need, it’s money or time that can make up the work, and it’s tough to get more time.”

Educators enhance the onboarding experience, helping to assess new hires’ current competencies and providing the education and training needed to bridge competency gaps. These first weeks can be critical for a new technician. The training provided can be the difference between them burning out in the first six months or climbing the ladder and leading a department in the future.

The bottom line: educators can contribute to lower turnover rates and more effective teammates.

 

Managers’ Time 

Most probably agree: it’s difficult to find a department that functions perfectly or rarely needs additional training or education. When, inevitably, a department without an educator needs to obtain additional training and educational resources, it will likely fall on the department’s manager to source and deliver.

Some view this as a necessary part of a manager’s role; work that they should be doing. Filipponi, however, explained that while managers can fill in in an educator capacity, it’s what they’re not doing during that time that has a bigger impact on the department.

“When managers are acting as educators, there are a lot of other things they aren’t doing. One-on-one meetings are the first thing to take a hit. They’re communicating with their team less; less able to implement leadership strategies. Overtime, they become less of a leader.”

When managers are unable to spend time developing their team, they begin to lose sight of team dynamics. The person that might have made a great supervisor doesn’t get the opportunity to grow because the manager can’t focus on evolving the team. Furthermore, they can’t focus on becoming a better, more effective for their leader.

Filipponi adds: “They can’t focus on culture, and retention is typically where you take the hit. People start leaving.”

Dedicated educators allow managers to continue serving in their capacity as a leader and improving their skills in that role. This allows teams to continue to evolve and grow, offering career ladders for those looking for one, and helping managers serve their team better.

 

Conclusion 

Educators may be viewed as a ‘nicety’ as opposed to a necessity. Sure, in some small departments it may be difficult to justify another headcount. This justification is more within reach than you may realize.

Filipponi explained that justification for anything comes down to dollars and cents. The benefits that educators offer departments translate easily into that language:

  • Reduced error rates mean less time doing double work. Consider the average hourly wage of a team member and what higher accuracy would mean for the bottom line.
  • Reduced turnover rates and staffing concerns mean less time spent conducting interviews, onboarding, and training new hires. How much time and money are being spent on these activities?
  • More effective leadership by managers means a more effective team overall. As the needs of your facility evolve, a dedicated team led by a manager that understands their team and how to help them achieve success means the department runs like a well-oiled machine, helping the facility achieve its’ long-term goals.

 

Interested in exploring more of what the Voice of the Customer Committee discussed in our more recent meeting? Check out these blog posts:

When Do Departments Need an Educator?

The Many Roles Educators Play in Reprocessing Departments 

About: Voice of the Customer Committee

The Voice of the Customer Committee is a panel of healthcare and instrument reprocessing professionals who have graciously donated their time to share their expertise and guidance on current challenges faced by the instrument reprocessing community. Through sharing their insights, experiences, and best practices, we have been given the opportunity to share these findings with our readership. We’d like to thank our VOC members for their outstanding input and insights, as well as their time! Thank you for your continued partnership, and all you do.

When Do Departments Need Educators?

Posted on by Megan Pietura

In March 2024, Pure Processing’s Voice of the Customer (VOC) Committee met to discuss a topic on the minds of many in reprocessing Steven Adams, Central Sterile Manager at Sinai Hospital Lifebridge Healthdepartments: educators. They play a pivotal role in reprocessing departments, but not all departments have, or are able to have, a dedicated educator role.

Steven Adams, Central Sterile Manager at Sinai Hospital Lifebridge Health, and longtime member of the VOC Committee, helped Pure Processing dig into how to determine when a department needs to fufill that role following the March call.

 

Determine who’s currently serving in an educator capacity

 Adams explained that the first step is determining who is currently providing the services of an educator. “Is it a nurse or peri-op educator filling in here and there? Is it the department’s manager? Is the person providing educational services to your department someone that is qualified to being so?”

Nurses or peri-op educators often step in as educators for sterile processing departments when needed. However, Adams suggests checking the periop educator’s SPD knowledge and expertise to ensure they are qualified to teach current practices to SPD staff.

Nurses and periop educators may have the right educational background to provide services. However, they are less likely to spend the time needed to learn about new instruments, processes, and IFUs specific to sterile processing departments.

Managers are the other common stopgap when a full-time educator isn’t part of the team. Adams explained: “A good manager is not necessarily a good educator. In fact, managers serving in an educator role may create a conflict of interest.”

Managers are tasked with holding their teams accountable, while educators are tasked with accommodating training and educational needs and helping teammates achieve competencies. When a manager takes on an educational role, their team may feel uncomfortable acknowledging deficiencies or skill gaps.

Over time, the lack of self-reporting can create a team that needs more training but has no way to request it. This can lead to compliance issues and increased burnout as technicians become frustrated and leave the department.

SPD teams need to feel comfortable asking for help and identifying ways to bridge knowledge gaps. “’We have no issues’ is never true!” Adams exclaimed.

 

Error reports and quality events

Quality events being caught by the OR is another signal that a department may be in need of a dedicated educator. Adams explained: “If it’s getting to the OR, that means it’s getting out of the department. That means there’s an issue with a team’s knowledge.”

Adams provided a few examples:

  • Bioburden getting left in nooks and crannies within devices demonstrates that a team might not have the intimate understanding of the devices that an educator could be providing. “You don’t know what you don’t know!”
  • Holes in wrap could be the result of lack of training associated with wrap inspection.
  • Incorrect or broken items making it into a tray could be because of a lack of instrument or assembly knowledge.
  • Missing items from trays may indicate that modifications to count sheets are misunderstood or not communicated to the team, causing ongoing frustration in the OR.

If a department is seeing increased error reports, quality events, and complaints from the OR, there may be an education or training related need that isn’t being met.

 

Internal auditing and day-to-day activities

“Someone other than the manager needs to conduct internal audits of a department on an ongoing basis.” Adams asserted.

Internal auditing can catch quality concerns before they become quality issues. Educators’ in-depth knowledge of standards, guidelines, and IFU requirements allows them to address concerns in real time, while a manager may not always have the time for these tasks. If regular, internal auditing isn’t occurring within a department, it may be worth considering the introduction of an educator role or a Quality Assurance Specialist.

Expanding on this, Adams went on to give his thoughts on safety reports: “If you’re seeing the same problem come up in safety huddles each week, there is something missing in your department.”

Another key consideration is how frequently your team receives in-services from vendors. Adams advises they occur regularly to ensure your team has the opportunity to ask specific questions about instruments and equipment used in a department. If in-services are happening infrequently, it may be a sign that there isn’t enough emphasis on training & education within the department.

 

Conclusion

If you’re not sure whether your department needs an educator, Adams has provided a number of questions you can ask to help you out:

  • Who is currently addressing my department’s training & educational needs?
  • Are there a realistic number of requests coming from my team regarding their training needs?
  • Are we seeing an above-average number of quality events occurring?
  • Is there a higher number of complaints from the OR than normal?
  • Are the same issues recurring in safety huddles?
  • Does the department receive an adequate amount of internal auditing?
  • Is the team receiving enough in-services to feel comfortable with what their tasked with?

While an educator is not always the solution to each of these problems, they do have the ability to positively impact them.

 

Does it seem like your department may need a full-time educator, but you’re unsure of how to get it approved? Check out this VOC blog post:

Justifying an Educator Role in Your Department

 

About: Voice of the Customer Committee

The Voice of the Customer Committee is a panel of healthcare and instrument reprocessing professionals who have graciously donated their time to share their expertise and guidance on current challenges faced by the instrument reprocessing community. Through sharing their insights, experiences, and best practices, we have been given the opportunity to share these findings with our readership. We’d like to thank our VOC members for their outstanding input and insights, as well as their time! Thank you for your continued partnership, and all you do.

The Many Roles of Educators

Posted on by Megan Pietura

In March 2024, Pure Processing’s Voice of the Customer (VOC) Committee met to discuss a topic on the minds of many in reprocessing departments: educators. Educators play many critical roles in reprocessing departments, some of which may go overlooked or underappreciated.

Gene Ricupito CRCST, CIS, CHL, CFER, PMP, Sr. Project Manager at UCSF Health, and longtime member of the VOC Committee, discussed the many roles educators play in sterile processing more in-depth following the March call.

 

“If you don’t have an educator, it’s what doesn’t happen that’s the biggest deal.”

– Gene Ricupito

 

Hiring and keeping great teams

Educators are in a unique position to not only help managers assess competencies but determine what a potential new hire will need in terms of training in the event they join the team, as well as how long that might take. “When you have an educator on the team, it makes a lot of sense to set up panel interviews and include them. This allows educators to weigh in on applicants and help managers make better hiring decisions.”

Beyond the initial hire, educators can streamline the onboarding process, helping new team members get on their feet quickly. With strong ability to assess existing competencies, educators are able to leverage their educational background and training experience to create and deliver training regimen during onboarding that focuses on the individual.

It doesn’t stop there, though! Educators play a significant role in retention as well. Spending time throughout the day allows them to interact with the team in a way that managers might not be able to, and on a more regular basis. Ricupito elaborated:

“Educators have more opportunity to deliver on-the-job training. Because they’re more of a peer to the team than a manager, they can take advantage of ‘teachable moments’ when they see them. It doesn’t need to be formal training; they can take corrective action and teach in the middle of a shift.”

Receiving regular training and input on how to achieve tasks can contribute to reduced burnout within departments, as team members feel more confident in their abilities and less frustrated with difficult tasks. Ricupito continued, “Educators maintain engagement. When people know how to do their job, it leads to competence and confidence.”

 

Quality

“Quality and education go hand in hand. If you’ve got quality issues, your best bet is to get an educator.” Ricupito stated. Many sterile processing departments don’t have dedicated quality managers. This can make quality events more likely, or alternatively, put strain on managers trying to put on one more hat. Ricupito explained that educators help to ensure quality within departments. “Quality is often driven by educators.”

This is another instance where teachable moments come into play. When an educator sees an action or practice that could result in quality issues, they’re able to step in and deliver the ‘why’ behind doing things a certain way. Over time, teams develop a firmer grasp on the processes that help ensure the department has as few quality events as possible.

Further, educators are in the best position to spot problems early and correct them effectively, helping departments avoid developing bad habits from the get-go, rather than perpetually trying to correct them.

 

Research

Adding to their ability to drive better quality outcomes throughout a department, many educators are deployed in a research capacity. This includes activities such as attending trade shows, reading industry articles, identifyingand investigating new tools and technology, and networking to share ideas and bringing them back to their department.

These activities keep educators on the cutting edge of new developments in the reprocessing space and put them in a position to solve longstanding problems in new ways as they take in new information. Examples could include ways to optimize tracking systems, more effectively inspect instruments, alternative methods of training, and how to achieve compliance with new, complex instrumentation the department becomes responsible for.

 

Vendor relationships

“Frequency and complexity of change is drastically different than it was 20-30 years ago,” Ricupito stated. “In many instances educators need to be a point of contact with vendors. They need to be creating strong relationships, because that’s how departments get the high-quality support they need from vendors as these changes occur.”

The role educators play has evolved in many ways, but building and maintaining vendor relationships is one that Ricupito believes will be increasingly important. Strong educator/vendor relationships help educators schedule regular in-services for their teams, as well get their questions answered more quickly by being able to contact their vendor representatives more directly.

“When a department has been supplied with an inadequate or insufficient product for their needs, the educator is likely to be the first one that realizes it.” Ricupito explained. Educators’ relationships with vendors enables them to quickly begin reaching out and identifying alternative solutions to get departments what they need to achieve their goals effectively and compliantly.

 

Justifying investments

Because of their depth of industry, departmental, and vendor knowledge, educators are frequently leaned on as subject matter experts when managers or supervisors are seeking to justify investment into new tools and equipment for their department. Their ability to merge what compliance standards dictate, the needs of their department, and what potential inaction can mean for patients puts them in a strong position to help make the case for new investments within their department.

 

Conclusion

Educators play many roles within departments, and all of them have a big impact. From the first time an applicant is looking to join the team, to jumping in on the job and creating teachable moments, to networking, to helping make the case for new equipment and technology, educators are critical to the departments they’re a part of.

 

Wondering if your department needs an educator, or looking to help justify hiring one? Check out these additional Voice of the Customer blog posts on educators:

When Do Departments Need Educators?

Justifying an Educator Role in Your Department

 

About: Voice of the Customer Committee

The Voice of the Customer Committee is a panel of healthcare and instrument reprocessing professionals who have graciously donated their time to share their expertise and guidance on current challenges faced by the instrument reprocessing community. Through sharing their insights, experiences, and best practices, we have been given the opportunity to share these findings with our readership. We’d like to thank our VOC members for their outstanding input and insights, as well as their time! Thank you for your continued partnership, and all you do.

The Cost of Cutting Corners

Posted on by Megan Pietura

“One bad apple spoils the whole barrel.” It is the age-old adage that reminds us of influence and its effect on outcomes. What if we took this same ideology and applied it to our reprocessing department? The repercussions of even one corner being cut can impact the integrity of the rest of the intricately connected process.

What is a cut corner?https://pure-processing.com/wp-content/uploads/2019/02/pp-t-712x400.png

A cut corner can happen at any point in the process and may not be intentional or even immediately realized. However, the impact can be all the same; it can hinder our professionals’ abilities to wholly comply with the standards.

It might be a shortened soak time, or a skipped visual inspection step. Sometimes it’s caused by the absence of a required tool or a full court press for time. Whether it occurs as a shortened step in decontamination or a rapid removal from SPD before adequate cooling before use, those instruments now face the unprecedented question: can SPD verify its sterility?

Cut corners can also be gaps in a process that leads to workarounds, missed steps, or broken transition from one process to the next in medical device reprocessing. A gap could be the missed suction that goes through the washer never flushed and result in a contaminated set on the clean side. Any time we lose a smooth transition from dirty to clean to storage, we are experiencing the repercussion of a cut corner.

 

What’s the cost to cutting corners?

Each step proceeding the last can be impacted by a lapse in process. We get further adage of “If it’s not clean, it can’t be sterile”, which further defines the impact of skipped steps.

Best case scenario is that the missed step is identified before the instruments are stored or make their way into patient care, but it must be reprocessed. This can lead to additional labor, and increased workloads.

In an analysis completed by BMJ Quality Safety, their findings revealed that more than 55% of tray errors occurred at the prep & pack phase of the process. (Catchpole, et al. 2021) Some of the documented consequences of these errors can include surgery delays and insufficient instrument inventory.

Cut corners can result in contaminated or damaged equipment that can also result in high repair or replacement cost. Just another reason that leaves the facility with a lack of sufficient treatment supplies.

Aside from the financial cost, there is also the cost of your team. Their morale, engagement and possibly even their reputation. Can your customer guarantee quality, just-in-time product? There is a rippling effect to corners cut that not only impacts the medical device, it touches our department, our colleagues and ultimately the patient.

 

How do we prevent or close present gaps in reprocessing?

What are some practical steps sterile processing or GI professionals can take to prevent the development of these sharp-edged corners during instrument reprocessing?

 

Know the standards and instructions for use (IFU)

Routinely review IFU’s against your current practice. Does an IFU have a specific PSI pressure for flushing, or specific soak time? What about the IFU that doesn’t provide validated steps for immediate use steam sterilizations (IUSS)?

When looking at the standards, understand the recommendations and steps provided. This could be the required length of an endoscope leak test, or information required to be documented as part of your recordkeeping. Once you have those questions answered, it may be time to review your policies and procedures to ensure your teams know the steps required to perform the job according to your hospital’s requirements.

 

Collaborate & Plan

Having a strategic plan in place for improving existing policies and preparing for the future can help prevent gaps or missed steps. Planning for peak volumes and keeping accountable to your policies and procedures can support your team with what it needs to succeed and provide comprehensive care to the medical devices they process. You can’t do this without having a team of stakeholders working together to make this happen. This could include infection prevention, operating room leadership and others who can advocate for the need for fully comprehensive processes.

 

Education

Often going hand in hand with policies and procedures is the importance of educating our teams. Making your education interactive and engaging or by introducing hands-on exercises can help your team understand and adjust their work patterns to employ safe and proper practices.

 

Quality Assurance

Routine audits can reveal inconsistencies in processes early on and can even aid in providing insight to patterns and impact. When doing audits, cut corners and gaps may not be easily spotted. Watching for those earlier mentioned workarounds, and technical inconveniences that negatively impact your team and their workflows, can often lead you to the root cause of the issue.

By increasing your collaboration, understanding the standards and IFU requirements and how they influence the process can alleviate the temptation to shorten the process and empower our teams to advocate for the need for time, resources, and support.

Every step in the reprocessing department has a corner and with that corner comes a cost, both the cut corner and the fully finished edge. It’s how we choose to invest in our departments, the process and our teams that  leaves a lasting impression on the medical devices, our teams, and the patient we serve.

 

References:

Alfred M, Catchpole K, Huffer E, Fredendall L, Taaffe KM. Work systems analysis of sterile processing: assembly. BMJ Qual Saf. 2021 Apr;30(4):271-282. doi: 10.1136/bmjqs-2019-010740. Epub 2020 Oct 19. PMID: 33077512; PMCID: PMC7979531. https://pubmed.ncbi.nlm.nih.gov/33077512/

https://www.ormanager.com/the-role-of-infection-prevention-when-auditing-spd/

 

 

The Various Types of Ergonomics to Consider in Reprocessing Departments

Posted on by Megan Pietura

In a recent Reprocessing Report post, we discussed opportune times to consider ergonomic improvements and updates. Now, we’ll discuss various types of ergonomic features to consider.

Ergonomics is defined as the science of fitting the job to the worker with a goal to increase safety and efficiency.

Many times, when we talk about ergonomics, our mind immediately goes to height-adjustability or working range of motion (all tasks are performed between shoulder and hip level). However, ergonomics and its application goes much deeper than that; it doesn’t always equate to costly projects.

Here are a few examples of ergonomics that aren’t always top of mind, but play a role in worker safety, comfort, and efficiency.

Lighting

Both ANSI/AAMI ST79 & ST91 provide luminosity recommendations specific to both job function and age of employees. Poor lighting can lead to both eye fatigue and strain. Lighting is a twofold safety measure for both the patients we serve and the teams conducting the work.

Magnification

Magnification is used to inspect small areas and details not easily seen by the naked eye. Magnification lens help alleviate eye strain, and can be purchased with lights attached to improve inspection capabilities. ANSI/AAMI ST91: 2021 recommends a minimum 5X magnification for flexible endoscope inspection with 10X magnification for duodenoscopes.  Just like lighting, magnification safety measures are twofold for both the patient and the worker.

Micro-ergonomics

These can be the finer details of ergonomics that aren’t always given the spotlight, but provide comfort in huge ways. Things like anti-fatigue mats, monitor tilts for computer screens, footrests, or chemistry dispensers all provide ergonomic relief to our sterile processing and endoscope reprocessing departments.

Aesthetics & Visual Cues

When talking about aesthetics in ergonomics, it isn’t just about décor or color schemes, but rather organization and functionality. Ergonomics is rooted in efficiency and safety. How workers interact with their workspace can directly impact their ergonomic experience and the efficiency of the department.  Having a clear, concise, easily understood layout will not only prevent injury due to clutter or poor configurations but will also give the worker visual cues as to the task to be performed, how to complete it and the resources available to do the job wholly and compliantly.

Posters, signage, and images can all provide quick reminders that can assist in efficiency. Having visual cues available for quick reference reduces foot traffic and body mechanics, such as extra bending and twisting to access policy binders or hard copy resources typically outside of their workstations. Strategically placed visual cues provide immediate information regarding policies and procedures.

 

Tracking Systems

Tracking systems contribute to ergonomics in a unique way by supporting productivity and contributing to efficiency through data collection and reporting. Additionally, tracking systems allow us to include relevant information to our teams based on the job they are completing, which aids in compliance and productivity. Integrating tracking systems at workstations enables technicians to obtain information regarding instrumentation, trays, process requirements, and IFUs without having to leave their workstations. Positioning these technologies at workstations also allows technicians to access this data in a comfortable position at working height, as opposed to hunching over a desk or table.

 

Conclusion

Ergonomics plays a role in all aspects of a technician’s job.  How they interact with the job to their ability to comply with current standards and regulations can all be influenced by the ergonomic technology available to them. As a continuous improvement plan, ergonomics allows your department to grow with the industry and can encourage positive outcomes for both the department and the patients they serve.

 

References:

ANSI/AAMI ST91

ANSI/AAMI ST79

When to Consider Ergonomic Updates

Posted on by Megan Pietura

The Occupational Safety and Health Administration (OSHA) requires that industry tasks be “designed to limit ergonomic risk exposure.”

In an industry where technology is improving and standards & regulations are becoming increasingly comprehensive, ergonomics has its place in continuous development. Continuous development at its core is an ever-evolving practice; a cycle that never ends. When considering ergonomic changes and requirements, we can see it necessitates constant review and consideration.

Ergonomics should promote both safety and efficiency, according to Merriam Webster’s dictionary.

When should you be giving consideration to ergonomics in your department? The National Library of Medicine connects ergonomics to its effects on productivity. It also looks at how workers interact with their jobs.

Anytime and place where an employee interacts with their work and department in a manual capacity provides an opportunity to improve ergonomics. In this post, we will categorize our opportunities as proactive and reactive instances. Neither one is right nor wrong. Both, however, do position you to plan for future growth.

 

Proactive:

New construction

When a new construction project is planned, it is a chance to review foot traffic and equipment upgrades. It also allows for the consideration of new technology and layout changes. All these factors can help improve ergonomics for a department.

New construction gives you a fresh start. You can plan ahead to avoid the challenges you face today. It also helps you think about future needs.

Approved renovations

Renovations may not offer a “blank canvas” like new construction, but they are a great time to think about ergonomics. Depending on the project, this could include new equipment such as decontamination sinks, better tracking systems, or upgraded reprocessing technology. These improvements help staff interact and move around their space more easily. This could also be the time to consider rearranging to match compliance requirements in your workflows.

Upgraded equipment

When new equipment is brought into a sterile processing department, it is certain that workflows and processes will be affected. Making smart capital purchasing decisions with ergonomics in mind can greatly affect technician comfort. This includes optimizing workflows to reduce strain and choosing ergonomic features like height adjustability. The way we implement our new equipment and the training we provide can affect how well the equipment is used in workflows.

Updates standards & guidelines

We have seen several updates to standards and regulations recently. This is especially true for endoscope reprocessing. Because of this, we need to rethink how we handle reprocessing, storage, and record-keeping.

Some things cited as ergonomic and safety recommendations include sink basin depths at a recommended 8-10” to ensure an average height comfort, anti-fatigue mats, PPE requirements, and air exchange requirements all play a role in the safety and efficiency of employees in the workplace.

Reactive Planning:

Increase in staff accident reports

Do you see a trend in accident reporting? Consider the location of the injury event within your department, the type of injury being reported, and its frequency. This can clue you into a possible lapse in the task or work around that is causing an ergonomic strain or risk.

Quality Assurance (QA) Failures

Quality failures aren’t always attributed to lack of education. There could be a missing process or lack of supply to complete the job? Is there a supply on back order, requiring a substitute that yourteam is unfamiliar with?

Routine non-compliance

Educational intervention isn’t always the answer to non-compliance events. There may be gaps in a process that requires workarounds.  For example, is there a cross in your process where you “back track” that could be causing confusion in the next process step? Or a bottle neck at certain points in the day or department that may be linked to skipped steps.

Tiredness, physical strain, and repetitive tasks can cause mistakes when following instructions. For example, flushing syringes by hand is a repetitive task. These human factors can affect performance. This can affect the quality of results.

As technicians’ hands become fatigued throughout a shift, the risk to compliance and quality increases. Crisscrossed workflows can create confusion. This confusion can hurt productivity and safety. Visual cues can get missed, or the process may need backtracking.

Reactive planning entails a bit more site-specific information and insight. Leaders should be aware of these metrics. Reviewing them through the lens of ergonomics may give you the vantage point you need to make a lasting change.

Interested in exploring how to make sure you’re collecting the right data in your department? Check out this blog post about setting up scorecards.

Risk Analysis

When considering a project or change, it’s important to do a risk analysis. This applies to new opportunities as well as improving your current setup.

A risk analysis can help you make better decisions. It shows clear cause and effect, giving your plan direction and a goal. It also can aid in providing you with the ability to measure its risk level and prioritize accordingly.

A good way to start assessing risk is to look at what different standards say about ergonomics. This includes lifting, twisting, carrying, and repetitive motion. Consider how these factors apply to the equipment, process, or workflow you are analyzing.

Conclusion

Whether big or small, the solutions to your ergonomic risk factors play a huge part in employee engagement, comfort, safety, organizational production, and long-term return on investment. Employees are our greatest asset, and the job they do requires adaptability to change and new challenges. Prioritizing ergonomics in our process improvement plan keeps the human factor of our work at the forefront of initiatives and progress and helps us mitigate ergonomic concerns well in advance.

Not sure where to start when it comes to identifying opportunities to improve ergonomics? Check out these blog posts to learn more:

How to Identify Ergonomic Concerns in Your Reprocessing Department

Solutions for the Top Ergonomic Issues in Reprocessing Departments

Ergonomic Guidance for SPD Injury Prevention

Integrating Ergonomic Tools to Reduce Injury and Strain in Packaging and Assembly

 

 

 

References:

https://www.osha.gov/ergonomics/control-hazards

https://www.ncbi.nlm.nih.gov/books/NBK580551/

ANSI/AAMIST79

ANSI/AAMI ST91

Copper’s Role in Infection Prevention Strategies

Posted on by Megan Pietura

Copper has played a significant role in human history, dating back to antiquity. Over the past 11,000 years, copper has become the third most used metal by man, by weight. From ceramics to jewelry to warfare, copper has been used by people for almost every purpose imaginable.

Copper has many unique properties which has allowed its use to flourish1:

  • Corrosion-resistant: Copper is commonly used in outdoor, marine, and manufacturing applications due to its ability to withstand moisture, salt, and sulfur.
  • Thermal conductivity: Copper allows heat to pass quickly through the metal; consider its popularity in uses like saucepans and boilers!
  • Tough & recyclable: Copper can be repurposed because of its highly malleable, ductile properties. Over 80% of the copper mined is still in use today because of its recyclable properties.
  • Anti-microbial: Copper has self-sanitizing properties. Our ancestors recognized this when choosing to carry water in copperware, where the water would naturally grow less algae and biofilm.
  • Biostatic2: Bacteria and other life forms cannot grow on copper surfaces.

It’s no surprise then that copper is found in our everyday lives; it’s extremely multi-purpose. Where copper’s strength is newly being realized is in our hospital systems.

 

The Oligodynamic Effect

The Oligodynamic effect3 is a fascinating reaction in science, wherein certain metals have a lethal effect on bacterial cells. Science is still determining how this effect exactly works, but it is believed that metal ions denature the proteins of their target cell membranes by binding to reactive groups, resulting in their inactivation.

Copper is essentially shown to ‘interfere’ with a cell’s normal functions and cause the cell’s rapid death. This reaction is extremely interesting for healthcare applications, where high-touch surfaces come in contact with millions of various pathogens every hour, every day.

Medical Benefits

Because of the denaturing ability of copper, it has been actively studied for use in our hospital systems.

The potential benefits of copper in healthcare settings are far-reaching:

  • The anti-microbial properties of copper are intrinsic; it’s an active, continuous process. Human behaviors & processes (washing hands, disinfecting processes, maintaining contact time, etc.) are balanced by copper’s natural, constant ability to denature cells, and thereby dangerous pathogens.
  • It’s cost-effective: while some hardware and fixtures need to be custom made, other pre-made copper fixtures, like faucets, drains and door handles, are readily available. The costs associated with switching material are found to be recovered within 2 months. MUSC discovered it could reduce the cost of HAI’s occurring in the patient room by investing in copper patient beds, saving potentially over $200,000 in incurred HAI costs.4
  • Installation requires little downtime or training: copper doesn’t need IFU, just polishing and cleaning. It will continue to kill pathogens so long as it’s present on high-touch areas.
  • Copper is long-lasting: some copper solutions require replacements, but usually to a lesser degree than non-permanent, consumable anti-microbial solutions.

 

But Does it Work?

It’s been shown that copper is effective in medical applications: copper has a 99.99% reduction in live bacteria during laboratory testing, and an 83% reduction in bacteria in clinical trials4. That same trial demonstrated a 58% reduction in healthcare associated infection, indicating that hospitals may benefit from evaluating copper-based items to reduce healthcare-associated infection rates, and the costs that come with them.

For more on that study, read our in-depth blog reviewing copper efficacy in clinical settings, here.

Use in Healthcare

Copper has found its way into many hospital applications. You may find it in:

  • Faucets: micro-organisms can easily survive in droplets. Copper faucets therefore make great sense for reducing microorganism growth.
  • Pipes: some cities and states have mandated the use of copper piping for its anti-bacterial, durable, and thermal properties.
  • Patient beds
  • IV poles
  • Door handles

Copper as a Supplementary Infection Prevention Strategy

Copper is not a replacement for hand washing, regular surface disinfection, instrument reprocessing, and other important infection control practices. It can, however, supplement existing policies and practices that aid in reducing HAI’s. It’s a metal that has proven its worth over centuries of use and testing. Copper’s track record in laboratory and clinical studies also suggest its ability to perform work for us in our hospital systems.

Looking for solutions that integrate copper into instrument reprocessing? Learn about our PureSteel™ Healthcare Reprocessing Sinks to explore the antimicrobial benefit for your department!

 

Works Cited

  1. Copper | Uses, Properties, & Facts | Britannica. The Editors of Encyclopaedia Britannica. (2024, March 4). Copper | Uses, Properties, & Facts. Encyclopedia Britannica. https://www.britannica.com/science/copper
  2. https://pubs.acs.org/doi/10.1021/cm0505244. Copper Nanoparticle/Polymer Composites with Antifungal and Bacteriostatic Properties
  3. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6504865/. Streptophyta and Acetic Acid Bacteria Succession Promoted by Brass in Slow Sand Filter System Schmutzdeckes
  4. A medical breakthrough 4,000 years in the making | MUSC
  5. https://pubmed.ncbi.nlm.nih.gov/26163568/. From Laboratory Research to a Clinical Trial: Copper Alloy Surfaces Kill Bacteria and Reduce Hospital-Acquired Infections