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Cover Story: The Clean Team

The Clean Team: Central Sterile Processing works with the OR to provide optimal care

by Don Sadler

OR Today Magazine | Cover Story | The Clean Team


The role of CSP is multi-faceted.

“It starts with instrument decontamination, followed by instrument cleaning and preparation for packaging, organizing into sets, sterilization and then transport to the OR on trays, ready for use,” says Byron L. Burlingame, MS, RN, CNOR, a perioperative nursing specialist with the Association of periOperative Registered Nurses (AORN).

Given the importance of clean, sterilized instruments in positive patient outcomes, it follows that the relationships between the OR and CSP staff members are equally important.

“Depending on the size and protocol of the hospital, there can be a lot of interaction and communication back and forth between OR and CSP staff,” adds Burlingame. “Nurses order specific instruments and trays from CSP and share information (like manufacturer’s instructions) with them that’s critical for cleaning, sterilizing and labeling instruments. And CSP staff will notify nurses if instruments are broken or need to go out for routine maintenance. There are quality control checks back and forth between the OR and CSP.”

OR Today Magazine | Cover Story | The Clean Team

“Improving communication between the OR and CSP helps optimize workflow, throughput and efficiency in the OR,” adds Sabina Chadha, executive vice president of sales and marketing for Haldor Advanced Technologies. “This enables hospitals to improve the quality of care, while at the same time reduce costs and increase revenue.”

Burlingame says he has experienced ideal and less-than-ideal OR-CSP relationships at hospitals where he has worked.

“At one hospital, there was total communication back and forth and OR and CSP staff valued each other as equal team members,” Burlingame says. “Once I was working as the OR circulator on a critical case in the middle of the night, with new surgeons and staff. I needed help from CSP to find the instruments we needed and they were very responsive to our needs.

“But at another hospital, an instrument was missing and OR and CSP staff kept going back and forth over what had happened to it,” he adds. “The instrument was eventually found — it wasn’t where it was supposed to be, nor was it labeled properly — but the teamwork aspect was missing in this instance.”

Chadha notes that OR-CSP staff interactions often consist of urgent requests from nurses for missing instruments, or for replacements for broken instruments.

“The OR is a very fast-paced environment, and sometimes there can be communication breakdown and finger-pointing, which results in decreased productivity,” Chadha says. “Creating a streamlined process for the transport of instruments back and forth helps optimize the workflow and ensures that the OR has the right instruments for the right procedures and patients, at the right time.”


The specific processes for transporting instruments back and forth between the OR and CSP differ somewhat from one hospital to the next. This depends in large part on the size of the facility.

“In one large hospital where I worked, there were two floors of separation between the OR and CSP,” Burlingame says. “We usually used the elevator or a dumb waiter to transport instruments — clean instrument carts would always go up one elevator and dirty instrument carts down the other.

“In another smaller hospital, the OR and CSP looked like one big department, with CSP right across the hall,” he says. Not surprisingly, transport is usually more efficient in smaller facilities.”

One of the best ways to improve communication and teamwork between the OR and CSP is for staff to spend time on each other’s turf. At Winthrop-University Hospital, Dybec says there is a weekly in-service with CSP during which time OR and CSP staff share essential information with each other.

“New OR staff must spend a certain amount of time in CSP to see first-hand how they function and what their role is,” Dybec explains. “And CSP personnel are routinely sent to the OR so they can watch procedures and see for themselves how the instruments are used, which helps them see how important their role is in each surgery.”

Burlingame says understanding the process is vital.

“We used to have CSP personnel spend time in the OR to watch procedures, and I used to spend time in CSP to see the flow of instruments and the work that goes into cleaning and sterilizing them,” Burlingame says. “So I understood why it took 20 minutes to get a sterilized instrument back — 18 minutes in the sterilizer and another two minutes to wash it. It really helps for everyone to see things from each others’ perspectives.”


OR Today Magazine | Cover Story | The Clean TeamDybec notes that surgical devices and instruments have changed drastically and become much more intricate during the three decades that he has been working in the OR.

“This is especially true when it comes to robotic surgery devices,” Dybec says. “They require specialty cleaning and processing in order to work properly, so it’s important that CSP personnel keep up with changes in instrument technology and how these impact cleaning and sterilization.”

More advanced tools call for time-consuming procedures.

“The intricacy of today’s advanced surgical instruments makes instrument cleaning, decontaminating and sterilization more complex, and more crucial, than ever,” says Burlingame. “Robotic instruments and articulating arms, for example, require far more advanced cleaning and sterilizing than a pair of scissors.”

The use by OR nurses of instrument transport humectant pre-cleaners like Prepzyme® Forever Wet spray from Ruhoff can help prevent the adhesion of bio-film and bio-burden on surgical instruments, says Dybec.

“It gently coats instruments to maintain moisture, making it an ideal pre-cleaner for soiled instruments during transport, or when instruments sit for an extended period of time before processing by CSP,” he explains. “Spraying this on soiled instruments in the OR starts the breakdown process before instruments get to CSP, making their job a little easier, since instruments with dried blood can be very hard to clean.”

Haldor’s ORLocate® system, the leading RFID-enabled surgical instrument management solution, is another technological innovation that can help improve the relationship between the OR and CSP.

“This system provides real-time visibility to both the OR and CSP on the location, status and condition of individual surgical instruments, thereby improving communication and optimizing workflow between the two departments,” says Chadha. “It helps improve patient safety, reduce capital costs, increase staff efficiency and enhance patient care.”

The solution also addresses hospitals’ needs to reduce the loss of surgical instruments; optimize instrument reprocessing, repair and maintenance schedules; and prevent retained surgical item (RSI) events. It also enables hospitals to associate specific instruments with specific patients to improve infection control.

Chadha is also encouraged by new legislation that recently passed in New York and New Jersey requiring CSP technicians to be certified.

“CSP performs a crucial function in the hospital when it comes to improving infection control, so this legislation is critical,” she says. “I believe this kind of legislation will soon be passed nationwide, which is a big step in the right direction.”



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