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Infection Prevention
Getting Along with Central Sterile Processing
Dan Mayworm
Publish Date: October 10, 2007   |  Tags:   Infection Prevention

Dan Mayworm As an OR manager, you want the right supplies, properly reprocessed and delivered in a timely fashion to the OR. But what about central sterile processing? Your CSP staff doesn't want to hold up cases, and they get equally upset if they fall behind. With a little help from the OR, they don't have to. Here are 10 things CSP needs from you to function best - and meet your needs.

Dan Mayworm\ 1. Communication
This is the first and most crucial step. Follow the three C's: civility, conciseness and consistency. Nothing is ever gained by shouting or being demeaning. Rational people will resolve issues in a way that ensures continued cooperation and openness.

For communication to be concise and consistent, use a common set of terms. Instructions like, "Send me that long, thin thing with the red cap on the end," will lead to mistakes, wasted time and loss of temper. CSP needs you to use the proper nomenclature for each piece of equipment, set and pack. In addition, you need to set out the exact contents required in each set or pack. This eliminates the guesswork for CSP, which goes a long way toward avoiding errors.

2. Support
CSP needs your support when it comes to dealing with other factions in your facility.

  • Physicians. Many surgeons want everything in one large single pack. But the larger and heavier the pack, the greater the chance for sterilization failure (and back injuries). Work with CSP to break the items into smaller packs that are easier to sterilize and carry. Many surgeons want items included that are never used. Help CSP identify and eliminate those items from the set. This saves time, material and money by extending items' usage life and keeping par levels down. If an item is needed in rare cases, CSP can package it separately.
  • Administration. Help CSP convince administration to give processing staff the equipment, space and manpower they need to work effectively; manpower means having enough people as well as certified managers and technicians. The CSP manager must be part of buying equipment, establishing space requirements, and determining the process flow through CSP and storage areas.
  • Environmental services. No one can provide safe, sterile items without the right steam quality, and CSP should not work without proper light, heat and air conditioning. Environmental services should set air to flow from clean to dirty in each work area.

3. Standardization
Mistakes happen when each surgeon wants his own glove or scope manufacturer. Because docs' supply preferences cause multiple inventories of the same items, they can increase the chances costly mistakes will occur. Therefore, your facility should make every effort to keep it simple and standardize equipment, sets and packs.

4. Willingness to change
What do you do if CSP suggests a change to your practices? For example, you've been covering used instruments with a wet towel before sending them to CSP. Some of your new instruments are more complicated and intricate, though, and CSP suggests that, to help ensure adequate cleaning and sterilizing, you disassemble the instrument and place it in an enzymatic cleaning solution as soon as possible after use. Your choice is not between keeping things the same or adding another task. It's this: Do you want to help ensure a sterile instrument by spending a little time up front, or do you want to risk the possibility blood and other debris will dry on the internal parts of the instrument, making it nearly impossible for CSP to adequately clean the item?

When there are problems, CSP would like to know that you're willing to discuss possible solutions, including changing your current processes.

5. Educational opportunities
Let your CSP staff know about educational opportunities and encourage their attendance at such programs. I've found the greatest benefit of these seminars is reaped when the CSP and OR managers attend together. Then the CS manager doesn't have to try to sell any new ideas the learning experience generates. The Certification Board for Central Sterile Processing and Distribution (www.sterileprocessing.org) and the International Association of Healthcare Central Service Materials Management (www.iahcsmm.com) have certification programs. Insist that anyone who delivers reprocessed items to the OR be certified. It's required in many hospitals, where CSP staffs are large and process a long list of complicated instruments. But it also applies to small hospitals and surgery centers that have enlightened management and want only qualified people in such important positions.

Dan Maywor\m 5. Scheduling
When you put the same procedures back-to-back-to-back, supplying sterile instruments is a nightmare for CSP. This is particularly troublesome if the procedure requires expensive instruments in short supply. But it makes sense for the surgeon to do the same procedures on one day. So how can you accomodate him and still be confident you'll have sterile instruments for each procedure?

You can have enough in inventory to have a fresh, sterile instrument for each case (which could be very expensive). Or you could have enough so that there's adequate time between cases to effectively sterilize. Say you have 12 cataract cases on one day. Each case takes 20 minutes. Proper decontamination, packaging and sterilization takes one hour. By my calculations, you need four of each instrument. You could clean and flash between cases (if instruments are flashable) and need only two, but I don't recommend it.

The point: CS needs to be involved in scheduling decisions. Effective scheduling can reduce inventory by allowing just-in-time sterilization. CSP can only accomplish this with accurate and timely information about the next day's schedule. Armed with this information, a CSP manager can ensure that, instead of sterilizing something simply because it has been used (then putting it on the shelf), the department will be sterilizing what's needed for the next day.

6. Single-use reuse
Don't ask CSP to reprocess single-use items without giving staff enough time to get manufacturers' directions for how to do this safely. If the manufacturer isn't forthcoming (few will be), give CSP enough time to validate processes.

7. Purchasing
Involve CSP when buying equipment it will use, and equipment and instruments it will reprocess. Ask for their input. You'll be glad you did.

8. Validation
Entrust the CSP manager with validating the safety and effectiveness of re-usable sterile product reprocessing. Don't require more validation than is necessary (such as the wasteful practice of putting an indicator in every pack). If the manager isn't capable of effectively validating the department's work, you need a new manager.

9. Respect
In my nearly 40 years of dealing with infection prevention issues, I've found most of the controversy regarding the on-time delivery of sterile supplies arises from a lack of respect and communication between CSP and the OR. The attitude that "anyone can wash dishes" is outdated and does no good. Everyone wants respect, including your CSP staff. Pay them respect, and you'll find everything else falls into place.