Trust the Reprocessing Process

The proper cleaning and sterilization of microsurgical instruments is an essential part of safe patient care, but its importance can be overlooked by busy surgeons and frontline staff. That’s somewhat understandable. Many members of the surgical team don’t understand the numerous protocols that must be followed to make sure the tools are sterilized according to regulatory standards. “The gap that we tend to run into is caused by unrealistic expectations,” says Farris Williams, AS, BSHA, MHA, CRCST, CSPDM, manager of the sterile processing department at UC Health Yampa Valley Medical Center in Steamboat Springs, Colo. “There’s often a misunderstanding of what we actually do on a daily basis.”

Reemphasizing the key steps in proper instrument care for everyone involved in the process will help to clear up the confusion and ensure the job is done right.

• Ample time. The entire reprocessing cycle can take hours to complete, from washing debris off instruments at the point of use to sterilizing trays and reassembling sets for use in their next case. Standardized workflows are an essential part of streamlining the steps and improving instrument care, according to Mr. Williams, who uses checklists to make sure staff follow all the necessary steps, every time. “Checklists are helpful for everyone involved in the process, from veteran techs to new hires,” he says. “They’re a visual reference of all the steps you need to follow so you can complete them the same way.”

It’s important that reprocessing techs don’t feel pressured to keep up with unrealistic demands caused by a busy surgical schedule. “There’s a lot that goes into instrument reprocessing and one of the keys to making sure it’s done properly is to give staff enough time to complete the process,” says Luci Perri, MSN, MPH, RN, CIC, FAPIC, CSPDT, CEO of Infection Control Results, a consulting firm based in Charlotte, N.C.

• Meticulous cleaning. Members of the surgical team must make sure used instruments are prepared correctly before sending them to the sterile processing department for thorough manual decontamination. Ms. Perri says they should treat instruments with an enzymatic spray, keep them moist and clean visible debris off surfaces.

To make sure instruments are properly cleaned and free of organic matter, facilities can invest in an adenosine triphosphate (ATP) monitoring system that detects the presence of organic material. This test identifies instruments that need to be recleaned before sterilization, an extra step that decreases the risk of infection and improves patient safety.

• Highly trained staff. Widespread staffing shortages can cause facilities to take shortcuts in instrument care, including assigning the task to a surgical tech who has time to tackle it. However, many surgical techs haven’t gone through the rigorous training required to understand the important details of proper instrument care. She believes staff who reprocess instruments should be certified sterile processing technicians who focus solely on the task.

As surgical facilities continue to experience high numbers of vacancies among surgical staff members and offer incentives to get frontline roles filled, it could be wise to consider similar moves to bolster the sterile processing team. It’s also important to invest in the continuing education of reprocessing techs. “Protocols change, so staying abreast of best practices is critical,” says Mr. Williams. Sterile processing teams should remain current with the ANSI/AAMI ST79 sterilization guidelines. Four new amendments were recently added that address the cleaning of sterilization equipment, instrument and technological inspections and recordkeeping, and recommendations for maintaining the general cleanliness of the sterilization area.

• Constructive communication. There must be strong collaboration among surgeons, surgical techs and the sterile processing department to ensure proper instrument care remains top of mind. Relationship building is crucial, says Mr. Williams. That way, if either side needs help with something related to instrument care, it’s more likely to be addressed quickly because they have an existing rapport with one other.

To highlight the importance of these relationships, says Ms. Perri, it’s smart to form a committee comprised of staff members from the OR and sterile processing. The committee could work together to identify obstacles that impede instrument reprocessing or OR workflow and come up with solutions to benefit all parties. “Sterile processing is not always viewed as a priority because it’s not a revenue-generating department,” says Ms. Perri. “However, the OR can’t make money without sterile processing. I wish that was more widely seen.”

Mr. Williams suggests facilities go the extra mile to make sure surgical staff and reprocessing techs fully understand each other’s roles, responsibilities and time crunches. “Everyone in the facility should have some kind of awareness of what goes on in sterile processing,” he says. Discussions should focus on what your sterile processing team needs to do their jobs better and faster, so procedures can take place as scheduled without delays caused by missing, broken or soiled instruments.

Ms. Perri emphasizes the importance of letting sterile processing know in advance what the priority cases are for the day. If your facility has only one set of a certain type of microsurgical instrument and there are multiple procedures scheduled that require the set, give sterile processing a heads up. That way, you can work in concert to ensure demand for the set doesn’t disrupt the surgical schedule. “It’s important to talk to the manager or supervisor of the sterile processing department to find out what their challenges are, then work together to remove those obstacles,” says Ms. Perri.
Every member of the patient care team should team up to ensure surgery’s most delicate instruments return to ORs in pristine shape. “It helps to have a supportive group in place that’s aware of what goes into the sterilization process and understands its importance,” says Mr. Williams. OSM

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