Partners in Clean
ES and SPD Staff Collaborate to Keep the SPD Spotless
By Kris Ellis
Each facilitys sterile processing department (SPD) is an indispensable component of the effort to provide excellent patient care. In order to be successful in their mission of providing clean and sterile instrumentation to the operating room (OR), SPD staff must have an organized and sanitary area in which to work. Imperfect housekeeping in this area may increase the potential for contamination and hinder the departments efficiency.
The American Society for Healthcare Central Service Professionals (ASHCSP) offers several basic guidelines that apply to cleaning the SPD, including:
- Cleaning should begin in the sterile holding area and progress to the dirtiest part of the area
- The sterile storage area must be as clean as possible and free from dust and insects
- Floors should be damp-mopped or wet-vacuumed each day
- All work surfaces should be cleaned using a germicidal solution
- Walls, ceilings, vents and ceiling fixtures should routinely be inspected for dust and other debris, and should be damp-dusted at least monthly, or as needed
- Carts and containers should be cleaned regularly using detergent and a disinfecting agent
- Records should be kept of all cleaning activities.1
The SPD presents a unique challenge for environmental services (ES) departments in several respects. I think its a unique area in the fact that theres so much activity happening in that area, so you try to do your job around whats going on in there, says Brett Higgins, manager of environmental services and grounds at Davenport, Iowabased Genesis Medical Center. Its just a very busy place weve got some very busy ORs, and to be able to get in there and co-exist while theyre doing all the equipment and do what it is that we do is a challenge in itself.
Thomas J. Fitzgerald III, CHESP, chief of environmental management service at VA Palo Alto Healthcare System, and president of the American Society for Healthcare Environmental Services (ASHES), points out that cooperation between SPD and ES staff is the basis for successfully coordinating the cleaning. We have a commitment from them, and theres a commitment from us also, and thats the thing you have to work with youve got to have a team commitment in the SPD, because theyre always busy, he says. But the bottom line is its non-negotiable on cleanliness, because a mistake we make could cost somebody their life. We have to get in there, and thats the bottom line. If theres an emergency, we might have to stop momentarily, but the fact is that the work must go on it cannot wait until tomorrow.
Establishing and maintaining a regular, workable schedule can also be tricky. The challenge lies in consistency having it cleaned routinely, says Rose Seavey, RN, MBA, CNOR, ACSP, past president of ASHCSP, and director of the SPD at the Childrens Hospital in Denver. There are various reasons for that; one of them is that its hard to get in there because were a 24/7 operation, so you need to coordinate with the ES department when they can get in and when they cant get in. Sometimes its dependent on the staffing in the ES department; do they have enough people? Mainly I think there needs to be a routine time that its done. Here what we do is we team up with them and we tell them that if they give us the time then we will make sure that we have people to help them move things.
Scheduling conflicts inevitably arise in some situations, but Seavey maintains that they must be taken in stride and worked around. Then you have to negotiate a better time for them to come back, because were in that environment we work with the OR emergencies that come in, depending on what the OR schedule is like. They have to be sensitive to our needs, and we have to be sensitive to theirs and negotiate what works best.
Seavey also suggests that team-building activities can be beneficial. What weve done here is weve tried to make them, especially those who work directly with us, feel like part of our team, so we know them we might invite them to potlucks or into the lounge to have coffee with us; we try to make them feel like theyre part of our team. Due to longer OR hours, Higgins says finding a mutually convenient time for cleaning is more difficult than ever. We do it on second shift, and that has less activity, but second shift is almost equal in activity anymore, until you get right down to the very end of the shift, he says. Twenty years ago, second shift was a ghost town around here because surgeries werent happening like they are today; ORs werent scheduled from four in the morning until 10 at night.
For Higgins, this aspect of the cleaning process can be particularly demanding. Thats why I say its the most challenging piece we dont have a third shift, and because of that we moved our second shift back to 12:30, we started an hour later, and then we have a small gap in between service, and we leave one person here to handle things. The real challenge is coexisting in that space and doing what we both do at the same time.
Its complete cleaning daily, but its a shared responsibility, Higgins continues. As far as floors, walls, any high dusting or the high items, those are done by ES. The walls are done on a monthly basis, just like the OR.
Fitzgerald notes that dust and dirt are the perfect vehicles for hospital-acquired infections, and thus must not be allowed to flourish in the SPD. Since surgical instruments are prepared for use in the SPD, the area is held to the same cleaning standards as the OR. In the SPD, we really clean it like we would a surgical suite, because a lot of the instruments and supplies end up in the OR, and they also end up in areas where patients have open wounds, and cancer units, so we have to make sure that we have a dust-free environment and an aseptic environment at all times, he says. We have to do detailed cleaning in there seven days a week.
Variation in size and composition of a facility dictates the time and resources that must be dedicated to this area. We have a big SPD we have more than 913 beds here, so were one of the largest healthcare systems in the United States, and second largest in VA (Veterans Affairs), Fitzgerald says. Our SPD is probably not the norm, but we do have someone assigned there about six hours per day. We are also on call if they have some kind of emergency, like an air vent blows out or a filter falls and theres dust coming out, then well send someone in whos trained.
Maintaining a baseline level of cleanliness is in everyones best interest, as Seavey explains. As with any area, if you dont keep it up its going to be harder, she says. The other thing is that theres so much equipment that needs to be moved, and thats another issue or concern, because we cant just do surface or just spot cleaning; you need to do the entire thing, because contamination can happen just about anywhere, so the whole floor has to be done.
In terms of specific areas of the SPD that require particular effort and attention, the decontamination areas are often mentioned. Theyre so busy in there, so sometimes, logistically, its hard to get in there, but you need to have some kind of schedule in place where regardless of what theyre doing, unless its an emergency, they have to let you in there so that you can do the things that you need to do to make sure that area stays clean and sterile, Fitzgerald says. The decontamination area is very critical, and the prep area is also extremely important.
From Seaveys perspective, the decontamination area is not the only area that presents a significant challenge in maintaining cleanliness. Everybodys going to say decontam because thats where the majority of the microorganisms are; we put a lot of emphasis into that because of the nature of what goes on in there, but for me, I think its the processing areas and the sterile storage areas, she offers.
The processing areas contain delicate equipment and different kinds of sterilizers that may need to be treated differently. Some of the sterilizers can be moved, and they need to be moved in order to get back there and get the dust bunnies and things like that, Seavey continues. If you think about it, thats probably the cleanest area because youre preparing things at that time to be sterilized, so it has to be a very clean environment. Also, thats positive air flow, so you need to be cognizant of that.
Talking about the sterile storage area, you have to limit traffic in there. Thats where all your sterile stuff is stored, so you really need to follow the guidelines as far as how things are stored and mounted on floors, because that area needs to be cleaned daily. You cant have dust floating around in that area.
Christina Ragan, CRCST, supervisor of sterile processing at Genesis Medical Center, points out that the potential for exposure always exists, and SPD staff must do their part. We have to have things done as soon as possible because of that, and you never know whats on an instrument, so you treat everything equally, and you have to stay on top of it, she says. Thats continual; the counters, the case carts we take care of those types of things.
Higgins notes that ES staff must have special training for dealing with the SPD. The training is that of critical care areas as far as how we do the scheduled walls and floors and rolling equipment through a disinfectant, regardless of where that may be whether its in a cath lab, an OR, an SPD, Higgins says. And you can kind of almost relate those things just as far as the requirements, even from a physical standpoint; they kind of follow hand-in-hand with each other.
Fitzgerald says that established guidelines and standards should serve as the basis for effective cleaning. We use Association for Professionals in Infection Control and Epidemiology (APIC) guidelines for cleanliness and we also use recommendations from the Centers for Disease Control and Prevention (CDC), says Fitzgerald. We also have our own protocol for surgical areas, and we follow really the same protocol that we use for the surgical suite. The difference versus a regular area is that every day we do the same thing over and over detailed cleaning every day. In regular areas you dont have to detail every day, but in there you must pay special attention to all surfaces.
1. ASHCSP Training Manual for Health Care Central Service Technicians, fourth edition.
ASHES to Launch Initiative to Assist Environmental Services in Optimizing Operations
Responding to its members and other environmental services (ES) managers challenged by inadequate industry guidelines for day-to-day operations to guide performance to ensure a clean and safe healthcare environment, the American Society for Healthcare Environmental Services (ASHES) is taking the leadership role in an industry-wide effort to establish best practices.
The National Environmental Services Performance Indicators (NESPI) project ranks among the most comprehensive undertakings ASHES has embarked upon in its entire 20-year history. NESPI will compile, analyze, and report performance indicators for ES disciplines for areas such as staffing, waste management and compensation.
In the coming weeks, all environmental services professionals will be asked to participate in this unprecedented national data collection effort. The survey tool will be accessible via the Internet utilizing state-of-the-art information technology to assure the complete confidentiality of respondents. The goal of this effort is to provide, in aggregate, realistic and viable performance indicators to help the profession reduce costs, improve productivity, and achieve optimal outcomes in all areas of responsibility. Technology-based reporting capabilities will facilitate the participants ability to establish meaningful benchmarks based on these customized reports.
ASHES leadership, board, committees and staff will be calling on all ES managers nationwide - members and nonmembers alike - to respond to this national survey. Watch for additional details and information on how to participate at www.ashes.org