Rebooting Our Reprocessing Department

We asked our SPD staff to train OR nurses and surgical techs how to clean instruments in the OR. Most notably, SPD staff stressed the importance of and technique for removing gross debris from instruments with moist gauze and sterile water, and then spraying instruments with an enzymatic solution designed to facilitate breakdown of soils and finally wrapping instruments in a towel moistened with water for transport. The instruments must remain moist with a wet towel or enzymatic until proper decontamination begins. The instruments should be transferred in a closed system to the decontamination area from the operating room.

We also made it mandatory to wash all surgical instruments by hand, not just those with visible contamination. SPD staff also identified arthroscopic shavers as a decontamination challenge and demonstrated to OR staff how to disassemble removable parts and apply enzymatic cleaner to exposed surfaces in the OR.

2 Manual cleaning in the SPD. Once instruments arrive in the SPD, they are sorted, inspected and disassembled as required by the IFU. For certain delicate instruments, manual cleaning may be the only cleaning that occurs because they cannot withstand the mechanical washing process. Some facilities may not have mechanical washers and thus rely solely on manual cleaning. Manual cleaning generally begins with rinsing gross debris off the instruments, then immersing instruments in enzymatic detergent solutions adhering to the solution's IFU recommendations. All cannulated instruments and instruments with lumens must be flushed and brushed at the point of use and in the decontamination area. After manual washing is finished, we rinse the instruments to remove the enzymatic.

3 Each reprocessing tech must demonstrate the instrument cleaning process. It's one thing to think you know something. It's quite another to demonstrate that you actually do. The SPD leader personally evaluated each reprocessing tech throughout the entire decontamination process for a rotating selection of instruments every 3 months and provided additional training on areas identified as weaknesses. We called this mandatory competency evaluation and verification. SPD staff also provided one-on-one competency verification to OR nurses and surgical technicians on proper dirty instrument initial cleaning and preparation for transport.

4 Improved and standardized workflows. We added an additional sink to create a 3-sink system of soaking, cleaning and rinsing. This lets techs perform an initial rinse, followed by hand-washing, and then a final rinse. We improved workstations by organizing and stocking each station with uniform items needed for processing. In addition to prioritizing sets to be cleaned, we also reviewed and revised instrument sets — removing or adding instruments — to reduce unnecessary instrument reprocessing based on utilization data.

5 Safety checklists. What gets measured gets done, right? We developed checklists to document sterilization tracking and environmental safety in SPD. We created a competency checklist for all elements of the decontamination and sterilization process for soiled equipment. Staff complete the checklist with each set of instruments they process.

Removing instrument debris in the OR is the most important step of decontamination.

6 Staffing changes. We changed leadership in SPD, replacing a surgical tech with an RN to provide administrative support and to perform professional-level administrative duties. We restructured shifts to accommodate changes in workload and hired additional staff to support workload increases. We transferred the assistant director of the OR to SPD to oversee 1 month of comprehensive sterile processing process and procedures training for SPD staff who had previously not undergone formal training. The goal was to educate SPD staff on best practices based on AORN and AAMI guidelines.

7 Daily huddles. We hold daily huddles for SPD staff to ensure consistency in practice and process improvement by reviewing elements such as broken equipment needing replacement and receipt of new equipment inventory. The SPD leader reviews all equipment with the staff that is processed through SPD and needed for the next day's schedule to ensure items are sterile and available. We note how many items we processed using immediate-use steam sterilization. We also celebrate small victories, such as the number of days that have passed since SPD had a break in processing.