5 ways healthcare reprocessing sinks improve workflow and productivity

How healthcare reprocessing sinks are a better option than commercial stainless steel sinks

In central sterile processing departments, the decontamination area’s reprocessing sinks represent the most critical area in ensuring that instruments are being properly cleaned. While commercial stainless steel sinks are commonly used for reprocessing medical instruments, not all sinks are created equally.

Manual cleaning and disinfection of instruments requires that sinks have either two- or three-basin sections1 to soak, rinse and provide a final rinse with critical water. The American National Standards Institute (ANSI) and Association for the Advancement of Medical Instrument (AAMI) standard ST79:2017 also recommends that sinks have “attached solid counters or adjacent work surfaces on which to place soiled and clean items separately.”

To make the most of the space available in the limited confines of the decontamination area, sinks need to also serve as a workstation. Unlike commercial stainless steel sinks, healthcare reprocessing sinks are designed with the decontamination tasks and users in mind. As such, ergonomics and workflow standards and recommendations are met.

 

5 ways healthcare reprocessing sinks improve productivity and quality

  1. Ergonomics
    Height-adjustable healthcare reprocessing sinks meet Occupational Safety and Health Act (OSHA)2 compliance and reduce musculoskeletal disorders. Central sterile processing personnel heights and physical capabilities vary, making height adjustability a necessity to perform duties optimally. Height-adjustability also comes in varying options. While the overall sink can be height-adjustable, having an attached pegboard or shelf under the sink that moves with the sink, also helps alleviate staff pain from bending and reaching by keeping tools within easy reach.
  2. Protection from aerosolization
    While personal protective equipment (PPE) is a necessity, sinks can also provide another way to ensure the reduction of aerosolization. Aerosols can make contact with personnel from any direction and can transfer microorganisms to personnel. The incorporation of a sink basin splash guard allows for personnel to be able to manually clean instruments without being exposed to dangerous organisms.
  3. Workflow
    Incorporating tools that ensure proper workflow allows healthcare reprocessing sinks to become a training tool. Workflow plates that indicate whether a particular basin is to be used for soaking, rinsing, or a final critical water rinse can be used as a training tool to educate new hires. It also serves as a reminder to veteran personnel when redundant, repetitive tasks can lead to overlook protocols. Workflow plates are also removable for easy cleaning.
  4. Lighting
    ANSI/AAMIST:79 requires adequate lighting of work surfaces.” Ancillary lighting should be considered for areas where instruments are manually cleaned and inspected.” Task lights with magnifying lenses allow personnel to be able to visually verify the cleaning process. Magnifying task lights can be installed on a pegboard with an adjustable arm that meets the ergonomic needs of each staff member for less eye strain and greater inspection capabilities.
  5. Instrument protection
    Tools such as staging panels and sink liners protect the tips of delicate, expensive instruments when more space is needed. By adding a staging panel to an existing sink basin, the sink’s built in counter space is expanded to help stage instruments prior to sterilization. Sink liners in basins and on sink countertops provide a soft-landing area to prevent damage to instruments while they are staged.

 

 

Learn more about Pure Processing healthcare reprocessing sinks, which feature moveable pegboard and shelving accessories to meet your workflow and workplace environment goals.

Looking for more sterile processing articles? Read Central Sterile Processing Education and Training Are Key to Reducing HAIs.

 

References:

  1. United States Department of Labor. Central supply. Occupational Safety and Health Administration.. https://www.osha.gov/SLTC/etools/hospital/central/central.html
  2. Association for the Advancement of Medical Instrumentation (2017). ANSI/AAMI ST79:2017, Comprehensive guide to steam sterilization and sterility assurance in healthcare facilities.

 

 

 

 

 

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

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

How sterile processing and endoscopy/GI departments can improve flushing, inspection/cleaning verification and soaking practices

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

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

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

1. 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.

2. 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 inspection 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.

 

 

 

 

 

 

 

 

 

3 Ways Height Adjustable Sinks and 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, and manually pre-clean each device or instrument, and then prepare it for disinfection or sterilization processes.

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 pre-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 area station 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 tables and sinks, which feature moveable pegboard and shelving accessories to meet your workflow and workplace environment goals.

Looking for more sterile processing articles? Read Central Sterile Processing Education and Training Are Key to Reducing HAIs

 

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.