Teaming Up to Improve Instrument Care

Hardworking professionals in ORs and sterile processing departments should respect each other’s efforts, but consternation between the two groups is often more common than collaboration. Surgical team members don’t always understand the complex workflow of sterile processing departments, says Jon Kraft, BSN, RN, CNOR, central sterile leader for ENT and neurologic surgery at Vanderbilt Children’s Hospital in Nashville, Tenn. “If they need instruments or equipment, they want them now,” he says.

Reprocessing techs, meanwhile, often grow frustrated when their colleagues in the OR don’t treat soiled instruments with enzymatic cleaner to prevent bioburden from drying on the surfaces of the tools, an oversight that makes it much more difficult to remove before the items are sterilized.

Friction can form between both groups when either side doesn’t understand or appreciate the other’s roles and responsibilities, according to Mr. Kraft. “Communication gaps exist when staff members in each department think their roles in patient care are more important, when in fact they aren’t,” he explains.

There are ways to get both groups working in concert to ensure complete instrument sets are returned to ORs on time and ready for use.

• Smart scheduling. The Steamboat Surgery Center in Steamboat Springs, Colo., is a two-OR facility specializing in joint replacements and spine procedures, which require reprocessing techs to clean and sterilize up to 40 vendor trays filled with complex instrumentation each week.

Allison Thompson, RN, BSN, the center’s clinical director, emphasizes the impact batch scheduling has on the workflow and efficiencies of the sterile processing department. Stacking the same surgeries — shoulder replacements, for example — at the beginning and end of the day allows enough time in between the blocks for reprocessing the basic instruments used in the cases. 

The center’s surgical leaders huddle with the sterile processing manager to review the next day’s cases and specific instrumentation needs. “We discuss the instruments that will have to be reprocessed and the cases in which they’ll be used,” says Ms. Thompson. “A clear plan is in place before the day starts.”

• Shared experiences. Steamboat Surgery Center opened its doors with a low case volume and a skeleton crew, with each member taking a turn working in the sterile processing department out of necessity. “That was a great learning experience for us all, and one we took seriously,” says Ms. Thompson. “We hired a full-time sterile processing staff as case volumes began to increase, but that time spent reprocessing instruments has given the current surgical team an appreciation of the importance of proper instrument care.”

They particularly understand the importance of treating instruments at the point of use. “Because nurses and instrument techs worked in sterile processing, they take the time to wipe down instruments immediately after they’re used, treat them with enzymatic spray to ensure bioburden doesn’t have a chance to dry on surfaces and in articulating joints and cannulations, and organize them in case carts before sending them to decontamination — all to help reprocessing techs do their jobs more easily,” says Ms. Thompson. “They pay more attention to preparing instruments for sterilization because they’ve been on the other side of it. Surgical team members who know what happens on the back end of instrument care take the front end more seriously. They’re good co-workers and conscious of helping their colleagues clean instruments thoroughly and efficiently.”

Ms. Thompson requires all new clinical employees, regardless of their role, to maintain competencies in proper instrument care. “That cross-training creates a constant understanding between the ORs and sterile processing, and allows us to shift staff to cover instrument reprocessing during busy days,” she says. 

Surgical team members at Vanderbilt Children’s also spend time in the sterile processing department during orientation to watch reprocessing techs in action. “I didn’t have that experience when I was a circulating nurse, and I think it would have been beneficial for me to gain a greater appreciation for how much hard work it takes to turn around instrument trays,” says Mr. Kraft. “That’s something you can’t understand unless you see it in action.”

• Intermediary interventions. Nurses and techs have a lot on their plate during busy days in the OR and might not have the bandwidth to worry about preparing soiled instruments for cleaning and sterilization. “I’ve found it’s important to be actively involved in communicating with the surgical team about the needs of the sterile processing department, and keeping reprocessing techs informed about the instrument needs of the ORs,” says Mr. Kraft.

He relies on three staff members who serve as liaisons between the ORs and sterile processing to remain attuned to how well instruments are flowing through the facility. The liaisons are part of the sterile processing department, but spend their days embedded among the surgical team, helping them turn over rooms, track down needed instrumentation and prepare used sets for transport to the decontamination area.

“The staff members who fill the liaison roles have been working in the hospital for at least 15 years, so they have a great rapport with their colleagues,” says Mr. Kraft. “They’re knowledgeable about instrument care processes and are constantly visible in the ORs. They advocate for our department, but also keep reprocessing techs informed about what’s going on in the ORs.”

The liaisons are also readily available for Mr. Kraft to meet with briefly to review the surgical schedule and discuss specific trays that will need to be turned over quickly between cases. “The huddles create a closed communication loop that ensures the surgical team and reprocessing department remain on the same page as their needs inevitably shift throughout the day,” he says. “It’s one of the most important factors that helps to maintain a positive and productive working relationship.” OSM 

Note: This three-part article series is supported by Healthmark.