The sterile processing department (SPD) is one of the most important parts of any operating room (OR). SPD maintains safety and compliance by preventing the contamination of medical equipment when the stakes are high, and even minimal errors can cause significant setbacks, delays in surgery, and even patient infections. In fact, the American Journal of Managed Care estimates that even one minute of downtime in the OR can cost over $100.
Every SPD needs to operate at constant peak performance because there is no room for error. Here we’ll identify the most common sterile processing department deficiencies to help your organization maximize efficiency and avoid costly pitfalls.
Insufficient Sterilization of Instruments
Instrument sterilization is the cornerstone of every SPD, so it may be no surprise that one of the more crucial mistakes staff can make is failing to perform this duty. The U.S. spends an estimated $9.8 billion per year treating the five most costly hospital-associated infections (HAIs), one-third of which are surgical site infections (SSIs).
Contaminated tools are a major cause of SSIs, leading to poor patient outcomes and leaving the organization vulnerable to lawsuits. All SPD staff needs to recognize the leading causes of improper sterilization:
- The more complex a tool is, the more likely it is to be improperly sterilized
- Unthorough cleaning of tools before sterilization
- Using the wrong cleaning chemicals
- Lack of staff training
To mitigate improper cleaning and sterilization, ensure instruments are always double-checked after cleaning and before sterilization — particularly when it comes to those with a higher risk for infection (e.g., orthopedic and neuro instruments.) Additionally, it is wise to utilize clean trace chemicals, which change color to indicate whether or not a tool is thoroughly disinfected.
Immediate-Use Steam Sterilization (IUSS)
IUSS, previously known as flash sterilization or flashing, is when instruments are sterilized by steam. Theoretically, this saves time, effort, and money; however, it has actually proven to be less effective — it increases the risk of infection, thus leading to increased costs. IUSS has long been a point of debate; and while some advocate for its use as a shortcut method, even the Centers for Disease Control and Prevention (CDC) warns against it:
“Historically, it is not recommended as a routine sterilization method because of the lack of timely biological indicators to monitor performance, absence of protective packaging following sterilization, possibility for contamination of processed items during transportation to the operating rooms, and the sterilization cycle parameters (i.e., time, temperature, pressure) are minimal.”
Additionally, guidelines set forth by the Association for the Advancement of Medical Instrumentation (AAMI) note that IUSS may have its place in the sterilization process. Still, the requirements for its efficacy are so stringent, that the practice is often minimized.
Turnover and Lack of Proper Training
An organization is only as strong as its staff; if the sterile processing employees are under-trained or constantly turning over, the probability of errors increases. Over the years, instrumentation and sanitization protocols have become more complex, scrutiny of SPD has intensified, and education and certification requirements have expanded. AAMI ST79 states that SPD staff should be certified within two years of employment and maintain their certification for the duration of their career.
This is in no small part due to the fact that technological advancements in equipment have increased the demand for individuals with specialized training, which hospitals have trouble finding. The Bureau of Labor Statistics estimates that there are around 60,000 medical equipment preparers in the US, so the labor pool isn’t as vast as it stands.
Couple this with the fact that SPDs generally have relatively high turnover rates and one quickly realizes that the cost of hiring and training employees can become a significant drain on a hospital. This constant cycle also leaves more room for error during the training and certification processes, particularly if the organization doesn’t have any experienced SPD veterans to oversee such protocol.
Incorrect Instrument Assembly
With such a vast array of instruments processed in an SPD, it may be no surprise that one of the more common errors is incorrect assembly (due to lack of training or ignoring manufacturer’s guidelines) and placing tools in incorrect trays. Such errors result in surgery delays while nurses and techs retrieve the correct instrument or locate a suitable alternative. Once again, considering the fact that one minute of downtime in an OR can cost upwards of $100, there is no room for such avoidable errors.
Because the industry is ever-evolving and manufacturers are constantly tweaking existing tools, it is of utmost importance to train staff to recognize any physical changes or use- cases in these devices. Additionally, most manufacturers have the most up-to-date instructions on their websites, which typically includes best practices for SPDs.
Decrease Sterile Processing Department Deficiencies
Surgical instruments come in all shapes and sizes, making them increasingly difficult to disinfect and sanitize properly. It is a joint effort to improve SPD practices—taking both OR and SPD actions to control and prevent hospital-associated infections.