OR and SP Riding the Wave in the Perfect Storm

Sterile processing (SP) and operating room (OR) staff once “lived” in separate worlds, rarely working or communicating. They were on two different islands. However, there is a tidal wave of issues causing “the perfect storm” that is requiring these two departments to work closer together than ever before.

The national emphasis on reducing healthcare-acquired infections (HAIs), in particularly surgical site infections (SSIs); the authoritarian muscle flexing on sterilization guideline updates from regulatory agencies, such as the Joint Commission and the Centers for Medicare and Medicaid Services (CMS); sterilization equipment warning letters from the Food and Drug Administration (FDA); the technology explosion; and the fact that most healthcare facilities are operating on a razor thin margin, are some of the issues creating this perfect storm. Now more than ever, OR and SP must work together to combat the tidal waves of change.

Partners in Patient Safety

The Association of periOperative Registered Nurses (AORN)’s mission is “To promote safety and optimal outcomes for patients undergoing operative and other invasive procedures by providing practice support and professional development opportunities to perioperative nurses. AORN will collaborate with professional and regulatory organizations, industry leaders, and other healthcare partners who support their mission.”¹

SP professionals are healthcare partners who support the AORN mission. As with the perioperative professional association, the OR and SP personnel within each facility should collaborate for safe patient care. SP is considered part of the surgical team. Even though SP staff are not physically present at the OR table, the products that they manufacture certainly are and that can make a big difference in the patient’s outcome.

Standards and Recommended Practices

It is imperative that SP and OR professionals follow the most current published standards and recommended practices relating to reprocessing of surgical instruments and other devices. The three primary sources for recommendations are AORN’s Perioperative Standards and Recommended Practices, AAMI’s ST79 Comprehensive Guide to Steam Sterilization and Sterility Assurance in Healthcare Facilities, and the Centers for Disease Control and Prevention’s (CDC), Guideline for Disinfection and Sterilization in Healthcare Facilities, 2008.^1-3

Astute SP professionals consider AAMI’s ST79 their bible. This is a true comprehensive user’s guide. Included in these standards are:²

• Functional and physical design criteria

• Staff qualifications

• Processing procedures

• Installation, care and maintenance of steam sterilizers

• Quality control

• Quality process improvement

The OR usually carries more clout and can add support to the SP efforts to follow standards and recommended practices.

Personnel Considerations

According to the Association for the Advancement of Medical Instrumentation (AAMI), “The responsibility for sterile processing should be assigned to qualified individuals who have demonstrated competence in all aspects of sterile processing: decontamination, preparation, packaging, sterilization, sterile storage and distribution of sterile medical devices.”²

AAMI recommends that all preparation and sterilization activities be supervised by competent, qualified personnel. Employees responsible for supervisory functions should be prepared for this responsibility by education, training, and related experience.

Certification in Sterile Processing

AAMI emphasizes that all personnel responsible for SP activities should be certified, at a minimum, within two years of employment. They also propose personnel assigned to supervisory functions in SP complete a SP management certification examination and maintain that certification throughout their tenure.²

Currently, New Jersey is the only state that has mandatory certification for SP employees. As the profession continues to develop and additional critical thinking skills are required, more states are seeking mandatory certification for this vital role in healthcare and especially in the efforts to reduce HAIs and surgical site infections (SSIs).

Certification helps develop the basic level of understanding and knowledge or SP functions, assures consistencies and standardization, develops a professional element to the department, and builds self-esteem, confidence and authority. However, the most important part of certification is that it can help protect the patient because of the increased knowledge, understanding, and commitment by the staff.

There are two professional organizations that offer internationally recognized certification in sterile processing, the Certification Board for Sterile Processing and Distribution (CBSPD) and the International Association of Central Service Materiel Management (IAHCSMM). Both of these entities offer various levels of certification. For instance, one can get certified as a technician, supervisor, manager or educator. Specialty certifications such as instrument technician, ambulatory surgery SP technician, flexible GI endoscope reprocessor, and vendor certifications are offered. 

Educational Materials

There are many educational resources available to help train and educate personnel in preparation and sterilization activities. Both CBSPD and IAHCSMM have educational materials that are helpful in orientating to SP as well as studying for the certification tests.

For many SP professionals learning surgical instrumentation can be challenging. There are many publications on surgical instrumentation available. One that I found very helpful for my staff was “Instrumentation for the Operating Room: a Photographic Manual“ by Shirley M. Tighe. This book is current and follows a logical path from basic instruments to advanced instrumentation. The chapters are assembled by surgical procedures according to the body systems involved. The photos are very clear and usually have more than one view of each instrument.⁴

The “Instrument Course Workbook” by Natalie Lind, IAHCSMM educational director, is another great publication exclusively written on surgical instruments. This resource guide is a fundamental guide to what is involved in instrumentation today and includes specialty instrument information on topics such as microsurgery, laser instruments, robotics, endoscopes and much more.⁴

Various instrument manufacturers’ instrument order catalogs are yet another tool available to learn surgical instrumentation. These are generally given to the facility at no cost. Many are available online which help staff to stay current and can be easily available to multiple staff.⁴

AORN Specialty Assembly

AORN established a Specialty Assembly (SA) devoted to SP and Materials Management (MM). The SA is dedicated to building bridges between OR nurses, SP personnel and materials management employees; providing and promoting a dynamic network; serving as a forum for communication; identifying and exploring patient care issues; and addressing current issues related to SP or materials management.

This SA is open to all AORN members. Non-nurse healthcare professionals who support the mission of AORN may join AORN as associate members and then choose to become a member of the SP/MM SA. To find out more, log onto:

http://www.aorn.org/Community/SpecialtyAssemblies/SpecialtyAssemblyGroups/SPMMSA/

Conclusion

Both OR and SP have a significant role in patient safety. The need to reduce HAIs and SSIs, the growing complexity of surgical instruments, the increased regulatory requirements, and the streamlined healthcare budgets are placing more demands on these two departments. Following current published recommended practices, obtaining available resources and collaboration between these two departments will help healthcare faculties ride the wave in this perfect storm.

Rose Seavey, RN, BS, MBA, CNOR, CRCST, CSPDT, is the president/CEO of Seavey Healthcare Consulting, Inc, and formerly the director of the sterile processing department at the Children’s Hospital of Denver. Seavey was elected to the AORN board of directors for 2008-2010. She was honored with AORN’s award for Outstanding Achievement in Clinical Nurse Education in 2001. She served as the president of the American Society of Healthcare Central Service Professionals (ASHCSP) in 2003 and is the 2002 recipient of the ASHCSP National Educator of the Year award. She also was selected as one of the Who’s Who in Infection Prevention in 2006 by Infection Control Today. Seavey is a member of several AAMI working group committees that are developing recommended practices and is currently a co-chair for the ANSI/AAMI Working Group for Hospital Steam Sterilizers performance standards. In addition she has lectured and authored many articles on various topics relating to perioperative services and sterile processing, locally, nationally and internationally.