3 areas to improve during the manual cleaning phase of medical device reprocessing

Flushing, visual inspection/cleaning verification, and soaking are three of the most vital processes in medical device reprocessing in reducing healthcare acquired infections (HAIs) and ensuring patient safety. When these processes are not performed against standards and guidelines, bioburden can easily be left on an instrument for the next patient.

3 areas that need improvement

Soaking

Items should be pretreated with an initial cold water rinse with running tap water or an initial soak in cool water and/or a clinical-soil-dissolving pretreatment product (e.g., an enzymatic cleaner or pH neutral detergent). –ANSI/AAMI ST79:2017, 7.6.1

It is well known that the speed in which processes are performed and completed, impact the patient care environment. When robotic instruments and scopes require long soaking times per manufacturer’s instructions for use (IFU) or from delayed reprocessing, maintaining surgical schedules can become jeopardized.

As a result, larger instruments such as robotic devices or flexible scopes, that have IFU soaking requirements, utilize lots of basin space, reducing the amount of space sterile processing departments have to perform other, necessary pre-cleaning functions. The ability for technicians to multitask while instruments are soaking becomes impossible when basin space is not available. And ultimately, without proper soaking, gross soils are not properly broken down, making it difficult to remove bioburden during the cleaning process.

 

Flushing

Thoroughly flushing lumens helps ensure complete surface contact with the solution. If a brush is too large, it will not fit into the lumen; if it is too small, it will not have complete contact with the lumen walls and, consequently, will not clean them thoroughly. –ANSI/AAMI ST79:2017, 7.6.2

syringe flushing of scope While syringes provide a simple, as well as disposable option when flushing, they aren’t entirely effective at removing bioburden. Using a syringe to pull liquid and plunge it into instruments multiple times is not productive. Furthermore, no two techs flush exactly the same way with syringes or spray guns, leading to inconsistent flushing practices.  As a result, “copious flushing” is variable.

Flushing instruments with spray guns is another inefficient cleaning method. Technicians are not able to clean more than one instrument channel at a time, which affects a central sterile processing department’s throughput. Compromised productivity isn’t the only disadvantage when it comes to flushing with spray guns. Spray guns create aerosols, making contaminated liquids even more dangerous when they are converted to vapors, coating staff members in fluids and hard-to-reach areas, putting staff and patients at risk.

 

Visual inspection/cleaning verification

Instruments should be carefully inspected for flaws, damage, debris, detergent residue, and completeness… –ANSI/AAMI ST79:2017, 7.4.1

endoscope interior channel

Endoscope interior

The importance of visual inspection cannot be overstated. The naked eye is unable to detect microscopic bioburden, minute cracks or damage in instruments, even lint inside of lumened channels. If bioburden is left in the channel, the chance of the next patient developing a HAI increases. In 2015, 687,000 patients developed HAIs in the U.S. Of that number, 72,000 of those patients died.1

Visual inspection can be a costly investment. The alternative leaves sterile processing and endoscopy departments to visually inspection instruments and scopes with the naked eye and/or magnification lenses. Unfortunately, eyes and magnification lenses can only visualize easy-to-reach areas in channels. In those hard-to-reach areas of channels, a lot of patient safety risks lurk.

 

3 Ways to Improve Pre-Cleaning Processes

mobile soaking station blog1. Create dedicated soaking spaces

Renovating a decontamination area is costly and not always necessary. Soaking robotic arms, scopes and other larger instruments that demand precious sink basin space also hamper efficiency and the bottom line. Utilizing tools such as smaller mobile sinks, and soaking containers, departments can improve turnover times while meeting compliance.

For example, smaller mobile options, such as the PureSteel Mobile Soaking Station, feature a soaking basin that is wide enough to accommodate soaking requirements for robotics and larger instruments. Its easy-to-drain options also do not require plumbing and can be outfitted with numerous accessories.

Mobile carts that feature vertical storage for multiple soaking containers are built specifically with soaking in mind. By utilizing vertical soaking space, numerous devices can be soaked in containers that are designed to fit the device, as well as easily transport and drain the containers in the smallest overall footprint available.

Flushing robotics in MSS2. Automate flushing

By utilizing an automated flushing pump, precleaning compliance is achieved through friction, fluidics and contact time with detergents. Automated flushing systems such as the FlexiPump Independent Flushing System, achieve these three objectives through pressurized, copious flushing for specified periods of time. The adaptability of automated flushing systems to connect to virtually any lumened device, allows for a tight connection and a complete flush each time.

Automated flushing also streamlines processes by allowing technicians to multitask. Automated flushing systems can connect and flush multiple devices or ports at once, freeing up technicians to brush complex pieces on devices, clean the surrounding work areas, or start prepping the next tray for reprocessing.

3. Implement visual inspection technology

The best visual inspection intentions are not going to ensure 100% verification of cleaning practices without the flexibility that inspectionPureClear™ Visualization Station borescopes offer. Visual inspection borescopes come in many different lengths and diameters that can provide visualization in areas that are hard-to-reach. Inspection scopes are available in fiber-optic and digital models for various resolution needs.to inspect channels, connection ports, distal tips and spaces behind elevator channels. Inspection borescopes can be easily manipulated to identify debris, bio-burden, damage and irregularities that the naked eye and magnification lighting cannot achieve.

To aid technicians in visual inspection, borescopes can also be attached to a monitor so that the borescopes camera can be displayed in larger resolutions to get an even more detailed analysis of cleaning verification, exceeding visual inspection compliance.

 

By implementing these processes, departments can improve compliance, reduce the risk of HAIs, and become more efficient. Analysis of current departmental practices, manufacturer IFUs, and standards and guidelines, can help create a best practices protocol improve staff and patient safety.

To learn how to create protocols and to earn 0.5 CEU, watch A Royal Flush: Your Winning Hand for Pre-Cleaning Protocol.

 

References

  1. https://www.cdc.gov/hai/data/portal/index.html#:~:text=From%20the%20HAI%20Hospital%20Prevalence,survey%20to%20have%20an%20HAI.

 

 

 

 

 

 

 

 

 

Solutions for Easily Boosting Capacity in Backlogged Sterile Processing Departments

backlogged departmentIt is a scene that is all too familiar in sterile processing departments: case carts pilling up in decontamination, while scheduled surgeries are delayed or postponed due to backlogs in reprocessing. Those backlogs are often created by bottlenecks that can easily be adjusted or eliminated with a few uncomplicated solutions.

 

Sterile processing backlog area 1: Soaking

The most common sterile processing bottlenecks occur during the soaking and manual cleaning processes.

Soaking and manual cleaning is critical for patient safety. ANSI/AAMI ST79: 2017, 7.5.1 states “presoaking instruments moistens and loosens the soil, thus making the cleaning step more effective and efficient.”1 Additionally, device instructions for use (IFU), such as robotics, can require soak times of up to 30 minutes. Flexible and rigid scopes can be even more demanding when delayed reprocessing occurs, requiring a minimum of one hour of soaking, and up to ten hours for some gastrointestinal scopes.²

Many reprocessing departments do not have enough sink basins to dedicate tor instruments with extended soak times. Additionally, many sink basins are not wide enough to accommodate soaking larger instruments or trays, leading to more reprocessing delays.

Robotic instruments and scopes are inherently difficult to clean. Properly soaking the instrument loosens and removes gross bioburden to make the cleaning and rinsing process more effective. If proper protocols are not followed during the manual cleaning process, that can add additional delays to an already bottlenecked process. So how do departments prioritize basin space and while meeting standards and guidelines?

Options to accommodate medical device soaking requirements

Mobile carts are a quick fix for departments that do not have extra space or resources for a renovation. Departments can create a dedicated soaking space during peak processing times by incorporating a sink insert into a mobile cart or integrating a mobile sink basin. Sink inserts and mobile carts are available in a variety of sizes to accommodate robotics, rigid and flexible scopes, as well as separate areas for ocular instrument reprocessing.

Mobile carts are available in multi-tier options so that departments can soak multiple sets of instruments at once within a small footprint. The mobility of the carts also makes it easy to store the cart and sink inserts when not in use or utilize it for vertical storage options as a place to store soaking containers when not in use.

 

Sterile processing backlog area 2: Flushing

Properly flushing instruments during the manual cleaning process can create backlogs when volume of lumened instruments and processes for flushing are considered.

Lumens must be flushed with highly efficient practices, so time-saving measures can be difficult to implement without the expense of quality. Contact, friction, and fluidics are necessary to properly remove bioburden from lumened instruments and scopes.

  • Specific contact times are required by detergent IFUs to effectively dissolve and loosen bioburden deposits such as blood, fat, and tissue
  • Friction, by brushing or flushing, facilitates the separation of bioburden from its points of attachment on internal device surfaces
  • Often, brushing or flushing alone does not remove hard, stuck-on bioburden. By integrating fluidics, or a high volume of fluid under pressure, those volumes ensure that detergents and residues are completely flushed from interior channels and lumens

Traditional tools to flush lumened devices such as syringes and spray guns may be a simple, cost-effective option. However, cost-effectiveness should be balanced with efficiency and effectiveness.

Syringes may be a simple, traditional solution. But pulling liquid and plunging it into each instrument for a specified number of times is a time-consuming process. And no two technicians’ flush instruments in the same way, every time. That can lead to practice discrepancies from shift to shift.

Similar to syringes, spray guns cannot clean more than one channel at a time, and require technicians to use both hands, which decreases the ability for technicians to multi-task.

Alternatives to flushing with syringes and spray guns

Flushing robotics blog 4Automated flushing systems effectively address the issue of throughput by enabling simultaneous flushing for multiple channeled items or ports with much less connection or disconnection time. One automated system can allow technicians to flush up to 5 items at a time. Output can be doubled or even tripled when multiple systems are installed at sinks.

By automating the flushing process, departments can also ensure that devices are consistently flushing at the proper volumes per instrument IFU and ANSI/AAMI ST79:2017 flushing and rinsing standards. Automated systems provide options for flushing for specific amounts of time at specific volumes so that contact time IFUs are met. Additionally, treated and untreated water and cleaning solutions can be integrated into the system to aid in loosening bioburden and assuring pre-cleaning protocols are met.

Automated systems are adaptable to a wide variety of instruments:

  • Orthopedic
  • Endoscopic
  • Robotic
  • Ocular
  • Laparoscopic devices
  • Suction tips
  • And more

These flushing systems ensure automated, consistent flushing for your full channeled instrument inventory.

 

Reducing reprocessing bottlenecks NOW

When departments are already challenged with time constraints, fast, affordable solutions are the easiest way to increase capacity. Large-scale renovations are not always necessary. Instead, simple tools such as mobile carts, sink inserts, and automated flushing systems can be easily installed and implemented to alleviate backlogs and reduce processing times. More care can be taken to deliver safer outcomes for staff, instruments, and patients when departments do not feel rushed to provide instrumentation quickly.

Explore mobile cart, sink insert, and automated flushing system options to increase your sterile processing capacity!

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Looking for more blog topics like this? Read 3 Ways Height Adjustable Sinks and Tables Improve Sterile Processing Workflow

 

References:

  1. ANSI/AAMI ST79:2017 – Comprehensive guide to steam sterilization and sterility assurance in health care facilities. webstore.ansi.org. Accessed November 17, 2020. https://webstore.ansi.org/Standards/AAMI/ANSIAAMIST792017?gclid=Cj0KCQiAhs79BRD0ARIsAC6XpaWiXjfqTZozgNVWCjY53KHU_bD9gvHr7wsoeypRrbhjCxnrk7kqeR0aAnVkEALw_wcB
  2. Benedict M. Delays in Endoscope Reprocessing … and the Biofilms Within. Accessed November 18, 2020. https://medical.olympusamerica.com/sites/default/files/us/files/pdf/Whitepaper—Delays-in-Endoscope-Reprocessing-FINAL-APPROVED-single-page-version.pdf

 

 

 

 

 

 

 

 

3 Ways Height Adjustable Sinks & Tables Improve Sterile Processing Workflow

According to the Occupational Safety and Health Administration (OSHA), “Ergonomics is the practice of designing equipment and work tasks to conform to the capability of the worker.” The ultimate purpose of this practice is to prevent injuries to staff while they are performing their tasks.

Preventable injuries create a host of negative consequences to workers and their employers, including:

  • Pain and an inability to perform tasks
  • Healthcare and worker’s compensation costs
  • Temporary staffing costs
  • Possible turnover and retraining costs
  • Lost productivity and morale
  • Lost revenue

OSHA’s Occupational Safety and Health Act of 1970 mandates that employers provide workplaces that are “free from recognized hazards that are causing or are likely to cause death or serious physical harm” to employees.

 

Sterile processing worker and workflow hazards

OSHA says hospitals are among the most hazardous places to work. During the 12 months of 2014, the Bureau of Labor Statistics recorded 294,000 nonfatal work-related illnesses and injuries in U.S. hospitals.

Ergonomic hazards in sterile processing departments (SPDs) are typically musculoskeletal disorders (MSD) associated with bending, reaching and repetitive motion tasks. Specifically, when working in sinks, technicians must sort, take apart, inspect and manually clean medical devices and instruments prior to assembly and sterilization or disinfection.”

These tasks are performed hundreds of times a week, and have typically been done while standing at static, deep sinks designed for the restaurant industry. Workers spend hours on their feet each day inspecting instruments and trays and wrapping each tray for sterilization. These tasks are often performed at a non-adjustable workstation that is not designed with staff safety in mind.

 

Focus on sterile processing ergonomics

Whether they are performed in the GI department or the sterile processing department, reprocessing tasks are rife with potentially uncomfortable activities. These range from prolonged standing in one place, to awkward postures and repeated extreme bending, or performing repetitive wrist and arm movements that can cause pain and numbness. Some ergonomic solutions were designed to be added to existing department equipment. However, when a department is ready to remodel, or a new facility is being built, an opportunity is created to identify ergonomic hazards and address them more thoroughly through better designed manual cleaning workflows and permanently installed injury-prevention solutions.

OSHA has provided specific “possible solutions” to help address ergonomic injuries in the SPD (also known as Central Supply). They are intended to be applied to other similar work areas in the hospital. Among other suggestions, they include:

  • Redesign workstations so packaging and equipment can be reached while maintaining elbows close to the body
  • Use height-adjustable work surfaces
  • Minimize prolonged overhead activity (to avoid reaching over shoulder height)

In addition, the American National Standards Institute (ANSI) and the Association for the Advancement of Medical Instrumentation (AAMI) issued a joint document, the ANSI/AAMI ST79: 2017, 3.3.6.1.3,  which offers more detailed recommendations for setting up a decontamination area:  “Ergonomic factors affecting worker safety and comfort should be considered when designing work spaces in the decontamination area, including: a) adjustable counters, sinks, and work surfaces positioned at heights that take into account the average height of the employees and the tasks to be performed at each location.”

The standard also states:

“Designing the area to facilitate efficient work flow and to provide adequate space for necessary equipment can reduce the potential for cross-contamination and enhance efficiency. Considering ergonomic factors during the design phase can help prevent worker injury.”

 

All utility sinks are not healthcare reprocessing sinks!

Every effort should be made to make the sink workstation as ergonomic as possible since it is the primary pre-cleaning work site. In the past, healthcare facilities had few options for sinks that could be used to reprocess devices. Their stainless steel sinks, not designed for healthcare functions, were unnecessarily deep. When used for healthcare instrument reprocessing activities, they have been a source of MSD of the hip, back, shoulder, and arm.

 

All prep and pack tables are not equal

Workstations in the assembly area of sterile processing are one of the most critical pieces of equipment required to properly inspect and package instruments prior to sterilization. Workstations without ergonomic considerations are a culprit in back, hip, shoulder, arm, and eye strain.

Incorporating a height-adjustable countertop as well as an attached pegboard allows users to raise or lower the workstation to meet their height while also allowing supplies and tools to be within easy reach. Attached task lights also move with the height-adjustability of the workstation, aiding in reducing eye and neck strain during inspection tasks.

Healthcare manufacturers identified the need to supply more ergonomic equipment and are developing better tools for these critical functions.

 

Workflow is essential to productivity

It is important to understand the flow of tasks and activities, the challenges and bottlenecks, the specific items being processed, and which specific processes are being used. In addition, the workflow requirements of all reprocessing stakeholders must be considered: Technicians, facility management, and the infection control department. Everyone should express their objectives and challenges in order to design the best solution for all. Planning for inventory growth and turnover is also a consideration for this area.

 

Three ways height-adjustable sinks and workstations improve workflow

1.  Height-adjustable sinks and workstation allow for less strain and minimize overhead activity

A height-adjustable sink or workstation allows fully customizable placement of the tools for individual technicians and brings items closer to the user. A height-adjustable pegboard and other movable hanging storage systems bring tools to users’ fingertips. Height adjustment on sinks and workstations enable the optimal ergonomic working height setting and head tilt for virtually any user, to help avoid strain and injury.

2.  Ability to rotate workers through repetitive tasks

The ability to instantly customize the height and reach of a sink or workstation electronically with the push of a button, makes it fast and easy to rotate staff members with different ergonomic needs and capabilities at the sink and workstation.

3.  Reducing the Clutter Factor

There is a strong indirect correlation between clutter and productivity in any workplace. Cluttered workstations add to workers’ time and effort, add to personal stress and morale, and can eventually affect the quality of work. In healthcare reprocessing areas, poor job quality can have a much more serious consequence: It can affect worker and patient health and safety.

Reprocessing areas are typically complex environments, with numerous cleaning tools, instructions, jugs of chemistries, device parts, packaging and assembly supplies in and around the work areas. Clutter and disorganization are very common conditions in these work areas because of the inherent nature of the work. A messy workspace requires more reaching, untangling and other musculoskeletal activity, which adds to the ergonomic stressors already in play. Additionally, heavily cluttered areas also carry the risk of becoming a breeding ground for organisms that can contaminate surfaces, tools and devices.

 

Improve your sterile processing workflow with the right tools

Before selecting a sink or workstation intended to be used as a medical device reprocessing tool, hospital decision-makers must consider this: Are they using a local fabricator or supplier with general sink design experience, or consulting a healthcare specialty manufacturer with extensive research and observation-based knowledge of the reprocessing function and its related requirements?

OSHA has made it clear that attention to proper ergonomics helps reduce injuries and discomfort that can affect a worker’s ability to function, and that identifying and addressing ergonomic issues should be a mandatory practice for all industries. Providing an ergonomic workplace can also help employers reduce healthcare and other costs related to avoidable injuries, so it is in their best interest to do so.

By installing and using a powered, auto-height adjustable healthcare reprocessing sink or prep and pack workstation, and providing ergonomic storage to organize the immediate workspace, sterile processing management can eliminate unnecessary pain and costs while developing a safe, efficient and highly productive workflow to better support clinical areas of their hospital. These industry-specific tools provide a simple and valuable solution for healthcare providers.

 

Learn more about Pure Processing height-adjustable prep and pack tables and reprocessing sinks, which feature adjustable pegboard and shelving accessories to meet your workflow and workplace goals.

 

References

  1. U.S. Bureau of Labor Statistics (2016). Hospital workers suffered 294,000 nonfatal workplace injuries and illnesses in 2014. TED: The Economics Daily. Accessed online 10/27/20. https://www.bls.gov/opub/ted/2016/hospital-workers-suffered-294000-nonfatal-workplace-injuries-and-illnesses-in-2014.htm
  2. United States Department of Labor. Healthcare wide hazards. Occupational Health and Safety Administration. Accessed online 10/26/20. https://www.osha.gov/SLTC/etools/hospital/hazards/ergo/ergo.html
  3. The Joint Commission (2014). OSHA worker safety in hospitals program launched online. Environment of Care News, April 2014, Volume 17, Issue 4. Accessed online 10/27/20. http://www.jcrinc.com/assets/1/7/EC-News-Apr-2014-1.pdf
  4. Centers for Disease Control and Prevention. Healthcare workers. The National Institute for Occupational Safety and Health (NIOSH). Accessed online 10/26/20. http://www.cdc.gov/niosh/topics/healthcare/default.html
  5. United States Department of Labor. Central supply. Occupational Safety and Health Administration. Accessed online 10/26/20. https://www.osha.gov/SLTC/etools/hospital/central/central.html
  6. United States Department of Labor. Occupational Safety and Health Administration. Accessed online 10/26/20. https://www.oshatrain.org/courses/pdf/OSHAErgonomics.pdf
  7. Dawson, Lawrence (2008). 6 reasons to clean out the clutter. Industrial Safety and Hygiene News. Accessed online 10/26/20. http://www.ishn.com/articles/87360-6-reasons-to-clean-out-the-clutter
  8. Association for the Advancement of Medical Instrumentation (2017). ANSI/AAMI ST79:2017, Comprehensive guide to steam sterilization and sterility assurance in healthcare facilities. Accessed online 10/26/20.

Central sterile education & training are key to reducing HAIs

education CE blog

For decades, reusable medical devices have been the culprit of healthcare-associated infections (HAIs).  Each day, approximately 1 in 31 U.S. patients has at least one infection in association with his or her hospital care,1 underscoring the need for improvements in patient care practices in U.S. healthcare facilities.

Sterile processing departments play a crucial role in patient safety outcomes. The risk of infection and death increases dramatically if instruments are not thoroughly cleaned and sterilized. In addition to understanding the patient safety element of sterile processing, technicians are also required to understand every inch of a surgical instrument to thoroughly clean and sterilize the device for use on the next patient.

Properly trained sterile processing technicians are critical

Better patient care begins with properly trained sterile processing technicians. Technicians require the most up-to-date information to properly do their jobs.

As medical procedures evolve, so do technology and instrumentation. Keeping up to date with reusable medical devices advancements requires continuous knowledge. Risks increase without the latest industry standards and manufacturer instructions for use (IFU). The safety risk to staff and patients cannot be understated.

According to the United States Bureau of Labor Statistics, there are 50,550 instrument specialist technicians, with job growth expected to increase 20% by 2022.2 That means there are 50,550 different ways an instrument could be cleaned. Inconsistent cleaning practices can be avoided, and patient outcomes can be improved by providing training and education on best practices, national standards, and manufacturer IFU. These must become a mandatory part of every sterile processing department’s quality protocols.

Consistent sterile processing training improves outcomes

Departmental best practices can be improved by consistently providing training and in-service opportunities to staff. This helps avoid medical device reprocessing issues such as dirty instruments that can lead to HAIs.

Sterile processing products such as sterilizers, automated flushing pumps, inspection technology and more are constantly evolving to improve processes and effectively clean and sterilize instruments. Best practices are followed more consistently, and technicians are more confident in the ability to perform their duties when they are properly trained.

Providing ongoing education and certification opportunities to all staff is another way a department can improve not only patient safety but staff safety as well. Educational offerings come in a variety of options, but we will focus on two of the most common: Continuing Education and Certification.

Sterile processing continuing education

Continuing Education (CE) programs offered by facilities, associations, and vendors provide departments with the opportunity to keep up to date with:

  • The latest industry trends
  • Standards and regulations
  • Recommended practices
  • Manufacturer IFU

Vendors and industry associations are a great resource when it comes to obtaining CE credits. This year has also seen an increase in virtual opportunities to easily receive CEs. Social media platforms like Facebook and LinkedIn have many sterile processing professional groups where CE resources are shared. Vendors and industry associations such as HSPA, ASTAORNSGNA and others also have resources on their website in which to find CE opportunities.

Sterile processing certification

Professional certification requires technicians and staff to take educational courses and exams to assure they have met competency-based standards to perform their jobs. Certification opportunities abound through HSPA, CBSPD, community and junior colleges, and other outlets.

Several states understand the importance of the critical tasks that sterile processing technicians are faced with and now require sterile processing technicians to become certified. To become a sterile processing technician in Connecticut, New Jersey, New York and Tennessee, you must be certified. Certification requires technicians to take courses in order to pass a certification exam.  Certification ensures departments are performing their duties through high standards.

CBSPD offers the following certifications:
  • Certified Sterile Processing and Distribution Technician (CSPDT)
  • Certified Ambulatory Surgery Sterile Processing Technician (CASSPT)
  • Management in Sterile Processing (CSPM)
  • Flexible Endoscope Reprocessors (CFER)
  • Certified Surgical Instrument Specialist (CSIS)
HSPA offers the following certifications:
  • CRCST – Certified Registered Central Service Technician
  • CIS – Certified Instrument Specialist
  • CER – Certified Endoscope Reprocessor
  • CHL – Certified Healthcare Leader
  • CCSVP – Certified Central Service Vendor Partner

In addition to enhancing patient and staff safety, sterile processing training, education, and certification opportunities provide an outlet to network with other professionals to learn from each other.

Establish a continuous sterile processing training methodology in your department for future growth and adherence to best practices. Now is the time to support your technicians with additional learning opportunities to strengthen the team and improve patient outcomes. Those are the keys to reducing HAIs!

 

Earn CE credits and certification through Pure Processing! Visit our Educational Resources page for more details. Follow us on Facebook and LinkedIn for more educational content.

 

References:

  1. Centers for Disease Control and Prevention (2018). 2018 national and state healthcare-associated infections progress report. Accessed on October 12, 2020. https://www.cdc.gov/hai/data/portal/progress-report.html
  2. Gooch, K (2015). 15 facts, statistics on central sterile departments and technicians. Beckers Hospital Review. Accessed on October 12, 2020. https://www.beckershospitalreview.com/hr/15-facts-and-statistics-on-central-sterile-departments-and-technicians.html