OR WAIT null SECS
By Ryan Rozinka
Sterile processing department (SPD) technicians play a crucial role in ensuring all instruments that pass through their department are properly processed and ready for use. The operating room (OR) depends on the SPD to turn over instruments quickly to keep cases on schedule, and the patients expect that the instruments they come in contact with will be properly sterilized. So, while SPD technicians don’t directly interact with patients, the work they do directly impacts patient experience and safety. Therefore, it only makes sense that infection preventionists (IPs) work closely with the SPD to understand their practices in an effort to improve workflow and reduce a facility’s surgical site infection (SSI) rate.
The main role of the SPD is to decontaminate, clean and sterilize instruments following manufacturer’s instructions for use. However, assuring instruments are sterilized effectively for every case while keeping pace with OR scheduling demands is no small feat. While biological indicators (BIs), the load monitoring tool that challenges microbial lethality, are available to ensure equipment has effectively met sterilization conditions, many facilities do not use them in every load because they historically have taken hours or even days to provide a readout result. This has caused instruments to be released for use before SPD technicians have verified that the load has been effectively sterilized – potentially putting patients at risk.
The good news is that there have been rapid advancements in the sterilization assurance technology space over the recent years, namely in decreasing readout times for BIs to as quick as 30 minutes or less. This innovation has reduced the historic conflict between speed and quality, making every-load monitoring a feasible reality. Monitoring every load not only could help reduce risk, but it also streamlines SPD workflow while raising the overall standard of care a facility provides.
With decreased incubation time on BIs, every-load monitoring is a possible reality for facilities. Let’s look at four reasons you should implement every load monitoring at your facility.
1. Avoid recalls
Instrument recalls are incredibly serious occurrences, and the facilities that have gone through one previously don’t want to again. By implementing every-load monitoring, facilities can provide the utmost level of assurance that instruments are safe before they come into contact with a patient. This puts another assurance process in place to minimize risk to patients. If a BI happens to be positive and staff must recall instruments, SPD technicians only need to locate one load, as opposed to multiple, if they are monitoring every load. It’s much easier to recover one rack of sterilized instruments, rather than going on what feels like a wild goose hunt to find the others that have already been put away or, even worse, placed in surgery. And often with every load monitoring, instruments haven’t even left the SPD yet, as they haven’t been deemed safe, making locating and reprocessing them much easier.
2. Enhance patient safety
Patient safety is always on the forefront of any facility. SPDs that implement every-load monitoring can help ensure every patient is receiving the same standard of care. By monitoring every load, OR staff and patients can have confidence that every instrument has met sterilization parameters prior to use.
3. Improve processes
Sterilization processes are complicated. Not only are multiple steps involved, but they require rigorous attention. Some of the most common errors that can occur include improper loading and organizing of packs within the sterilizer chamber, overloading the chamber, using incompatible materials, over filling rigid containers and using the wrong type of packaging. While many facilities have specific initiatives in place to help decrease risk of human error, every-load monitoring isn’t always built-in. The reality is that shorter readout times not only make every-load monitoring possible, but can also increase process efficiency. In the event a BI comes back positive, facilities are forced to retest the sterilizer, quarantine or retrieve any affected loads. Additionally, all sterilizers, as well as the department and systems, are looked at to determine and correct the cause of the failure. While a positive BI could be negative to patient safety, monitoring every load can provide a good check and balance to ensure the SPD is following all necessary department standards and best practices.
4. Cost savings
One common hurdle to incorporating every load monitoring is cost. The cost of purchasing the appropriate amount of BIs to monitor every load can seem daunting. However, take a step back and look at the bigger picture if instruments aren’t properly sterilized – this can increase risk. It can cost a facility roughly 1.43 times more to treat a patient with an SSI compared to one without, according to a study published in the Journal of the American Medical Association. Facilities should aim to reduce risk in every area they have control, and that includes ensuring instruments are properly sterilized and safe for patient use.
While the innovation is available and the benefits are clear, it can be difficult for the SPD, as a non-revenue driving department, to get management buy-in to implement new technologies. SPD technicians and IPs can work together to evaluate new technologies and the impact it can have on reducing risk at their facility. The IP’s perspective is invaluable, particularly when bringing in new products. They can evaluate how implementing every load monitoring and faster BIs can ultimately have an impact on improving patient care. Together, the SPD and IPs can share this insight and make the push to senior leadership about the benefits of every load monitoring versus the standard weekly or daily monitoring, to help increase the standard of care at the facility.
Monitoring every load is the gold standard of care when it comes to providing medical instruments that are safe for patient use. Not only does it help the SPD streamline workflow, but it can support infection control practices. While the work primarily happens in the SPD, it doesn’t come down to the efforts of one department. To be successful, there must be a cross-functional approach and dedication to raising the standard of care the facility strives to provide.
Ryan Rozinka, CRCST, CHL, has more than 18 years of experience in sterile processing. He has held the role of sterile processing manager and business operations/sterile processing manager where he was involved with processing improvement (PI) initiatives, overall budget for surgical services, employee contract negotiations, and day to day department operations. He currently works as a technical service specialist with 3M’s Medical Solutions Division’s Sterilization Assurance group in St. Paul, Minn.