Instrument Reprocessing Done Right

The first step to ensuring your facility’s instruments are properly cleaned and sterilized is grasping the importance of the tasks and appreciating the hardworking staff members who perform them. “Surgical leadership must support sterile processing professionals and give them the tools they need to provide ORs with safe instrumentation,” says Harry Mullen, CRCST, CIS, CHL, CER, chief executive officer and managing director at Central Sterilization Solutions, a trade school in Southern California. “I teach my students that they’re not just sterile processing technicians. They’re infection control professionals.”

He suggests conducting regular competencies to make sure staff follow sterile processing’s guiding principle: You can clean without sterilizing, but you can’t sterilize without cleaning. “It’s not simply a matter of fulfilling surgeons’ needs to have instrumentation,” says Mr. Mullen. “It’s a matter of doing the job correctly each time.”

Julie Jackson, a-IPC, CST, MEd, FAST, an independent infection prevention consultant based in Munith, Mich., emphasizes the importance of having a solid orientation and education program in place based on standardized workflows and processes for cleaning and sterilizing instruments. The repeatable actions will be easier for staff to learn and follow, according to Ms. Jackson. “Education is the foundation for everything that occurs in sterile processing,” she says. “Staff need to demonstrate competencies on a regular basis.”

Top-performing sterile processing departments are built on a well-trained staff, but other technologies and techniques can help them do their jobs more efficiently and effectively.

• Instrument tracking. Mr. Mullen is amazed at the number of surgical facilities that have not yet added instrument tracking technology, which lets the sterile processing team know in an instant where instruments are in the reprocessing cycle. Some platforms provide access to step-by-step instructions for cleaning and sterilizing individual instruments.

Ms. Jackson agrees that instrument tracking and the ability to call up care instructions for specific instruments are essential aids for reprocessing techs. “The technology should be standard in today’s sterile processing departments,” she says. “It’s no longer a luxury.”

• Spot checks. AAMI standards state the need to run biological tests on instrument trays on a weekly basis and with every load that includes implantable devices to confirm sterilizers are working properly. However, says Mr. Mullen, increasing numbers of facilities are placing biological indicators in every load because a positive test requires recalling all instruments that were reprocessed since the last negative reading.

Biological test packs cost about $5 per load, a relatively minor expense that can add up quickly in busy facilities. But Mr. Mullen points out that recalling several instrument loads could be more expensive in terms of supplies needed to resterilize the recalled sets — not to mention the potential for lost OR time if surgical teams are left without the instruments they need to perform surgery.

Testing for the presence of adenosine triphosphate (ATP), which measures cellular and molecular growth on surfaces, can be used to confirm that instruments have been properly cleaned before sterilization. ATP tests, which take minutes to complete, can also be repeated on the clean side of the department before trays are sent to the ORs. Other testing options, which test for the presence of proteins on surfaces, can be conducted more quickly.

“It’s not practical to conduct the tests on every load, but let reprocessing techs know that periodic spot checks will be conducted to make sure they’re performing quality work,” suggests Mr. Mullen. 

• Rounds and audits. Sterile processing managers often get so bogged down with meetings, completing reports and performing daily tasks that they fail to observe the performance of their team and conduct audits to ensure they’re completing instrument care steps properly. However, managers need to complete the feedback loop by answering questions techs have about the job they’re doing.

Ms. Jackson suggests pulling instrument sets that are waiting to be put in the automatic washer and documenting what you see during regular rounds of the sterile processing department. Are the instruments opened appropriately? Are they free of visible soil? She also recommends conducting audits in the pack-and-prep side of the department on randomly pulled instruments to ensure the sets are complete and in good working order. “Involve the reprocessing staffs in the audits,” suggests Ms. Jackson. “That way, they’ll start policing their own work.”

The check-ins should be productive, not punitive. “Tell the techs, ‘Talk to me about why you’re doing it this way,’” says Mr. Mullen. “You need to understand where your staff is coming from and why they’re doing things the way they are, which provides insights into their level of education.”

Share the results of the audits with the staff, and listen to their feedback. “They’re closest to what’s happening on a daily basis,” says Mr. Mullen. “Best practices in instrument care don’t necessarily come from manufacturers. Reprocessing techs can come up with great ideas that are simple to implement and maintain safe patient care.” 

• Morning meetings. Ms. Jackson recommends conducting daily morning huddles within the sterile processing department to confirm needed supplies — proper-sized cleaning brushes, for example — are on hand. Invite a member of the surgical team to the huddles and confer about their instrument needs, including cases that require special instrumentation, and sets that must be turned around in a set amount of time during the day.

• Standardized practices. Ms. Jackson says establishing a standardized workflow within the sterile processing department and capturing measurable metrics help you understand what’s being done well while also identifying areas of needed improvement. Doing so also lets you identify ways to improve instrument care efficiencies.

It’s also important to create a standardized supply inventory, suggests Ms. Jackson. “Determine how many items your team uses on a daily basis and allow enough ordering time to ensure the supplies are always available,” she says. “Staff shouldn’t waste time and energy looking for what they need to do their jobs correctly.”

• Specialized care. Every tech in the reprocessing department should have the fundamental skills to reprocess general instrument trays, but Ms. Jackson suggests creating teams of techs who specialize in cleaning, assembling, packing and prepping instruments needed for complex cases such as orthopedics. “They’ll become experts in handling the tools and much more efficient in doing so,” she says.

• New technologies. Ms. Jackson says borescopes can be used to visualize the insides of lumened instruments to ensure the surfaces have been properly cleaned. She also touts the need for ultrasonic washers, calling the equipment essential to instrument cleaning efforts, and says newer models can house large instruments such as robotic arm attachments in a single load.

By giving your team the training, tools and support they need, instruments will be properly reprocessed the right way and right on time, which will keep your facility firing on all cylinders. OSM

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