William DeLuca

When it comes to the culture of a hospital, nothing is as important as the employees who work for it and aim to provide excellent patient care. When it comes to a hospital's balance sheet, particularly the physical assets, nothing is as important as the actual hospital and other ancillary buildings.

Building a brand-new sterile processing department (SPD) is expensive, tedious, time consuming and in most cases, necessary. Central sterile processing departments are an essential piece of not only perioperative services, but the entire hospital. Most reasons for rebuilding or renovating an SPD is most likely because of an aging department, or the need to keep up with competitive market trends and to keep up with operating room (OR) demands. Most often, the reasons for expansion are to keep their facility modern and competitive, and to support a growth in OR case load. A lack of washer disinfectors, case cart washers, sterilizers and even prep and pack and storage locations can all become concerning areas for bottlenecking. SPD will not be able to meet OR demands if SPD does not have the equipment to match. This can possibly cause case delays and patient harm.


	Before hospitals can tackle a project as large as a new SPD, executives must know what capital and financing options that are available to them. Finding the capital is much harder than justifying the need for such a project. Market growth, healthcare insurance, and OR case load are often major factors when justifying capital needs. If OR case load has increased 10 percent over a 10-year span, and SPD hasn’t made any significant equipment or storage additions to its department, it might be time for a rebuild.


	When tackling a project of such a large magnitude, selecting a strong project team is essential. A vast array of healthcare professionals and their expertise are needed. Infection control, environmental services, perioperative services, engineering, architects and others all play a tremendous role in assuring a positive outcome. When creating a new SPD department, we should also be thinking of how we can improve operations and work-flow. A great way to start the PI process is to either hire a team of experienced healthcare professionals, preferably with a PI background. Or even better, create a team from the facility being rebuilt, including Sterile Processing techs, Surgical techs, Nurses, engineering staff, and environmental staff. Ideally, we want to be able to hear the opinions and perspectives of all different professions and departments, each department has a different and valuable outlook on operations.


	One of the more criticized aspects of building a new SPD comes in the form of a question. "How do we know you won't need to expand more in the future?" When planning for a new SPD, you don’t just plan for the short term - you plan for the long road ahead. This can be accomplished by using forecasting modeling and by analyzing the demand of the future with financial consultants and other stakeholders. For example, identifying growing specialties (such as orthopedics), the demographics and population of the area, and what the competition is doing. Planning for a new SPD means analyzing statistical data for future predictions of demand for every one of the hospital's provided services, ranging from the OR to the emergency department. This portion of the construction outline can be timely, but the project team must make sure what they are creating now will be relevant in no only the present, but in the future as well.


	Healthcare technology is ever-changing, so the need to stay up to date and current with SPD equipment is necessary. Instrument washer-disinfectors, automatic endoscope reprocessors (AERs), sterilizers, lighting, and assembly tables are all expensive and can vary in options. We need to give SPD staff the proper resources and tools to carry out their duties efficiently. Not only the OR, but the entire hospital relies on SPD to decontaminate, assemble, sterilize, store and deliver instruments and soft goods. Other areas need to be accommodated as well; the SPD is sometimes responsible for decontaminating and storing patient equipment, and restocking code carts and intubation boxes. This calls for even more storage and floor space. This all calls for proper planning and space. For example, a double-sided sterilizer and close-by storage areas are ideal ways of promoting an efficient work-flow. Sterilizers will be loaded from one end, and when the load is complete the other end of the sterilizer will open to the “cool-down” area, or storage area. This helps with decreasing foot traffic and minimizing exposure to dirty air. A one-way work flow from dirty to clean is an obvious must-have for a new SPD.


	The value of morale of staff in SPD is underestimated. When staff come to work in a brand-new facility with advanced technological equipment and machines, they feel better, they might even have an extra pep in their step. It’s a proud feeling that the people in the suits care and have an actual hand in our department. Quality of work can be directly correlated to staff morale and comradery.

There are always specific challenges in implementing a new central sterile processing department. The need for collaboration, coordination and communication involving all levels of stakeholders and is heavily stressed. Regular meetings amongst team members are important to keep the flow of communication and the schedule of completion as updated as possible. There is also a need for communication required so customers understand why a delay may occur.

There are two elements that are helpful to a project’s success.

The first point is that there be up to date references used, best practice standards, peers and experts who are experienced on the same process, and SPD employees including techs and management who know the ins and outs of the operation. Association for the Advancement of Medical Instrumentation (AAMI) ST79 and other standards/manuals from AAMI are designed to assist the design when building and planning. A new manual from AAMI can help healthcare facilities prepare for upcoming construction and renovation projects, as well as plan for equipment purchases, testing and implementation.

Secondly, there should be enough space available to accommodate the expansion of new equipment, which is one of the most important facets of the new construction. Space constraints are often a factor in new construction and is a frequent problem in remodeling projects. Before becoming fully operational, the new department must also pass department of health (DOH) inspections. These inspections can be tedious and long. Therefore, preparation and planning with the design teams are a crucial part of building a new SPD department. The last thing anyone wants is for the DOH inspection to come back with negative reports, or major revisions needed. The design team will most definitely miss some things, or maybe after the project is complete, wish they have done it another way, it won’t be perfect. There are too many moving parts and obstacles to create and build a perfect SPD, however we can sure get close. There are specific documents and forms that need to be submitted to the DOH before construction begins. A Certificate of Need preparation, Certification Letters, Plans Submittal and other documents are required prior to construction. Not only does the DOH visit after the project is complete, but they also visit when the project nears completion. This way, the DOH inspectors can become familiar with the project and become more acquainted with personnel. When the project is coming close to the final stages, a notification is sent to the DOH to request a DOH Sanitarian Inspection. This is to assure the project meets regulations and requirements, especially concerning work safety, but also including infection control, environmental codes and building codes.

When all is said and done, the main purpose for all renovations and rebuilds are to ensure the patients receive high quality care. OR staff and patients will also benefit from a new SPD. With new equipment, efficient storage and work flows, trays will be delivered to the OR faster, with fewer missing instruments and cleaner equipment -- all have positive impacts for patient care and safety. That of course is everyone’s main goal.

Quality over quantity for patient care, one tray at a time.

William DeLuca, CRCST, CHL, CIS, is associate director of the sterile processing department at Mount Sinai West.

William DeLuca

Articles

Challenges and Lessons in Building a New Central Sterile Processing Department