By Tony Thurmond, CRCST, CIS, CHL
Virtually every discipline with the health care environment has its share of “sacred cows” and myths – and many of those have been passed down year after year to employees. Those myths eventually are then viewed as acceptable practice because they convey “the way things have always been done in the departments.” Many myths abound in the sterile processing department (SPD) and their lingering presence creates confusion that can erode interdisciplinary relationships and, worse, lead to errors and misjudgment that impact patient safety and customer service.
Many health care professionals can recall certain practices that originated as a myth and eventually were deemed as a “truth” that continued to be followed in the days, weeks, months and years that followed. Often, many employees blindly ascribe to those myths without giving deeper pause as to why. In some cases, we may be so busy that we simply don’t challenge those practices (or we simply trust that certain practices are acceptable because others haven’t challenged them). But it’s critical that we understand how myths can be detrimental to safety and success inside and outside the SPD – and we must work to dispel them.
Daily, sterile processing professionals have an opportunity to instruct and guide their teammates and customers toward a better understanding and drive proper practice in the name of safe patient safety. It’s a responsibility that must be acted upon. It won’t always be easy, especially because SPD’s customers may have also grown accustomed to the myths as well – but it’s essential that sterile processing professionals stand their ground through any resistance and stay committed to separating fact from fiction.
What follows are some issues that I believe present an opportunity for deeper exploration and better understanding:
Sterile processing staff should be “all knowing.” Many sterile processing professionals have faced the situation where they pulled every item on a physician’s preference card, but then the operating room (OR) reports everything was not there. Perhaps sterile processing professionals have been told something like this: “Dr. Smith uses [such and such] item for every case, and you should know this.” Or perhaps the SPD receives a call and is told, “I need one of those blue gadgets that attaches to the instrument I opened.” It’s always a challenge when those in the SPD receive a call for an instrument, but the device in need isn’t referred to by its proper name.
SPD lost our instruments. The myth that the SPD loses instrumentation has been going on for more than my 36 years of working in the surgical/sterile processing realm. My favorite thing to hear from OR staff is, “I know that when I put everything in the basin after the case, it was there. We don’t lose instruments.” Items mysteriously disappear daily along the trail from the OR to the SPD. At a former facility, we ordered replacement Allis clamps/forceps at a rate of about 80-100 per month. We addressed this issue during the OR huddle and heard comments like, “we never lose instruments,” even though a scrub technician stated they used clamps frequently to hold tubing and cords onto the drapes (and then admitted the clamps were probably being thrown out with the drapes).
Missing instruments also frequently arise from careless instrument handling and rapid surgical suite turnover. Along with rapid turnover, it’s rarely taken into consideration the time needed to properly gather the used instruments, perform point-of-use cleaning and organize instruments in a way so they are not lost or damaged.
It does not take that long to process that instrument. It’s not uncommon for sterile processing professionals to receive a call from the OR stating an instrument or tray they just used for a previous case is needed for the next case (and “by the way, the patient is in the room, so I need it now.”) This type of rushed request occurs more frequently than it should. But it’s essential that sterile processing professionals never rush any processing steps because doing so not only goes against standards, guidelines, policies, procedures and best practices, it sets patients up for infection risks or other harm. Instrument processing (and diligent inspection to ensure no bioburden remains on devices and/or devices function properly) takes time. Shortcuts or “rush jobs” must never be considered an option, and it’s essential that SPD customers (the OR and other procedure areas) understand what’s required and never allow (or request) processes to be rushed for the sake of time.
What follows are some of the most effective ways I’ve found for dispelling myths and incorrect beliefs:
- Emphasize education. Education is always the first step is combatting misconceptions and false assumptions. Sterile processing professionals know they must follow Association for the Advancement of Medical Instrumentation standards and they know that the Association of periOperative Registered Nurses standards give guidance for the OR nurse. They also know that surgical technologists are guided by the Association of Surgical Technologists and the National Board of Surgical Technology and Surgical Assistants. All these organizations give guidance for each critical team member and if they are studied and reviewed closely, all three speak of the proper care and handling of instrumentation, point-of-use instrument care and the proper design of preference cards in order to meet the needs of the surgeon and the patient. They also address proper sterilization methods and requirements. Knowing the correct process and knowing more about one another’s processes will be help solidify better working relationships and dispel myths.
- Commit to proper practice. Proper practice requires a disciplined approach to our work each day, and for every case and every instrument. This is an expectation we should have for ourselves, our teammates and our customers every day. Studying SPD customers’ guidelines will prepare sterile processing technicians for situations that may arise. It will also help them address and correct processes and then share that knowledge with the customer. I inform my customers that I reviewed their organization’s guidelines and then I share with them the location in those guidelines to support my reasoning and share knowledge. It’s helpful to also share how their guidelines and practices interact with sterile processing and its own guidelines.
- Work together: Creating a stronger bond with those in the OR is a best practice that can be achieved more easily than one might expect because both departments have a great deal in common. Many of us are entrenched in our practices because it’s simply the way we were taught; however, many of the veteran teachers developed practices and habits that weren’t always based on guidelines and standards. Guidelines are ever-changing. We must reach out to our customers and build an understanding of one another’s needs, requirements and standards. It’s good practice for the SPD to invite their customers to the department to show them their challenges (and use that as an opportunity to explain why we cannot meet the quick turnover demands because they conflict with IFU, policies, procedures, standards and best practices). And those in the SPD will also benefit by meeting with their OR teammates to better understand their needs and challenges.
Lingering myths in the workplace can jeopardize patient safety and erode trust and teamwork. Reviewing and understanding guidelines that impact both the SPD and OR – and then engaging in interdisciplinary education – will help dispel myths, set more realistic expectations, promote standards-based best practices and deliver better outcomes for the patient.
Tony Thurmond, CRCST, CIS, CHL, serves as Central Service Manager at Dayton Children’s Hospital. He is also Past-President of the International Association of Healthcare Central Service Materiel Management.