By David Taylor III, MSN, RN, CNOR, and Rebecca Taylor Alvino, MS, RN, CNS, CIC, CNOR, CRCST, NEA-BC, FAPIC
Surgical instruments and other reusable devices must be effectively reprocessed so they are safe and functional for patient use. Meticulous attention to detail and adequate time and resources are essential to ensure sterile processing (SP) professionals can meet that critical goal. Unfortunately, sterile processing departments (SPDs) across the country are being pushed to produce more with less, often facing unreasonable expectations for faster-than-acceptable turnaround times to keep pace with procedural volumes.
SPDs, like other healthcare departments, are highly regulated, and the technical work performed in the department is physically intensive, requiring specialized knowledge and attention to detail, as well as adequate resources to produce clean, sterile, well-functioning and on-time instruments for patient use. While SPDs should be well-controlled environments, they can feel chaotic, overwhelming and, at times, impossible to manage. The high-stress work environment can create physical, operational and logistical challenges while raising stress levels for technicians and leaders.
- Common reasons for a chaotic SPD include:
- Lack of qualified, experienced staff
- Inadequate space to handle the volume of work
- Old, outdated or malfunctioning processing equipment that cannot meet procedural and processing demands
- Insufficient instrument inventories, resulting in reprocessing urgencies to meet clinical throughput
- Ineffective, outdated or broken processes
- Excessive procedural volume that creates unreasonable daily processing volume and pressure
- Antiquated or inaccurate pick lists or surgeon preference cards that contribute to duplicate or frequently unused instruments in sets, process waste and increased handling events for sterile items
- Lack of interdepartmental relationships between the operating room (OR) and other procedural areas
HIGH COST OF LOW SUPPORT
High-level disinfection (HLD) and sterilization, when performed improperly, can jeopardize a healthcare organization’s accreditation or licensure. The Joint Commission identified IC 02.02.01 EP 2 (high-level disinfection and sterilization) as one of the most frequently cited standards across ambulatory care, critical access hospitals, hospitals and office-based surgery in 2023. Note: In July 2024, The Joint Commission updated its Infection Control standards. Several studies have demonstrated that established, scientifically based guidelines are not always followed, placing millions of people at risk annually.1,2
Still, when it comes to device reprocessing, healthcare organizations often fail to adequately address the issues that impede their efforts to improve processes and achieve financial solvency. Reliance on benchmarking data to inform SPD resource needs can be detrimental if the units of service are calculated inaccurately within the SPD or across comparable facilities, or if the benchmark does not accurately reflect the complexity and volume of SPD work. There may be self-imposed obstacles that get in the way, leading to questions about why the work is not getting done with the staff they have on hand and the time they budgeted. That risk is costing health organizations billions. In the U.S. alone, hospital-associated infections (HAIs) cause thousands of deaths and cost organizations as much as $45 billion annually. Many such infections can be avoided through evidence-based infection prevention (IP) processes and by appropriately following recommended guidelines.3
When soiled instruments are not identified before their intended use, this creates issues not only for the OR and SPD but also for patients. Procedural delays can extend the time a patient spends under anesthesia, which can adversely affect patient outcomes. Additionally, delays or complications can increase patient anxiety and reduce their overall satisfaction with the care they receive. Furthermore, disruptions caused by procedure delays can contribute to surgical site infections (SSIs)4 or other significant complications from improperly processed instruments. Even if such negative outcomes do not occur, it has been estimated that one minute of downtime in the operating room (OR) can cost over $100.5 All of this can damage an organization’s or a surgeon’s reputation, trigger reviews by accrediting agencies, result in citations and fines from regulatory bodies, and even lead to lawsuits. Since June 2023, at least six U.S. healthcare facilities have made headlines after reports from st
aff and surgeons about sterilization issues and subpar instrument quality.
The role of senior administrators in managing infections and other negative patient outcomes – as well as lawsuits – is to minimize the impact on their organization’s reputation and bottom line and take essential steps to prevent future occurrences. Unfortunately, too many executives do not know how to manage SPDs effectively to prevent such incidents.7 They may struggle to identify where accountability ends and ownership begins, leading to confusion, inefficiencies and missed opportunities. It becomes essential to ask: Did this process gap always exist? Could it have been prevented if the right leadership had been in place, adequate staffing had been provided or if clearer communication channels had been established?
CONCLUSION
Today’s SP leaders must be highly technical, business-savvy and flexible in meeting daily challenges effectively and efficiently. They must effectively manage everything from staff productivity, regulatory requirements, accreditation standards, evolving standards, manufacturers’ instructions for use (IFU), employee competencies, overruns and more. Given the SPD’s essential role, executive leaders must provide adequate support and resources to ensure SP leaders and technicians can meet or exceed service expectations and contribute to infection prevention and other positive outcomes. Failure to do so will come at the organization’s peril – putting the institution and patients at risk.
– David Taylor III, MSN, RN, CNOR, is an independent hospital and ambulatory surgery center consultant and the principal of Resolute Advisory Group LLC, in San Antonio, Texas. He has served as an HSPA contributing author since 2019.
– Rebecca Taylor Alvino is a nurse leader whose 21-year career spans perioperative nursing, infection prevention, and sterile processing leadership. She is a nurse epidemiologist and system director of hospital epidemiology and infection prevention in Northern California.
References
1. https://www.infectioncontrolresults.com/asc-sterile-processing
2. https://www.cdc.gov/infectioncontrol/guidelines/disinfection/introduction.html
3. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9949640/
4. https://www.hopkinsmedicine.org/health/conditions-and-diseases/surgical-site-infections
5. What Are the Implications of the Costs of Operating Room Time? (ajmc.com)
6. Assessing the magnitude and costs of intraoperative inefficiencies attributable to surgical instrument trays – PubMed (nih.gov)
7. https://www.durangoherald.com/articles/patients-file-lawsuit-against-mercy-hospital-over-infections/
