CS CONNECTION
Assess and assure quality in every step of sterilization process
by Kara Nadeau
aintaining a high level of quality in a healthcare setting is always a challenge given the many factors that can disrupt standard processes and sometime require staff members to divert from established protocols. While nobody wants to admit it, an emergency case might require operating room (OR) and central sterile/sterile processing department (CS/ SPD) staff members to streamline processes in order to provide immediate care to the patient on the table. This has been especially true during the COVID-19 pandemic, where a sudden surge in SARS-CoV-2 virus cases and depletion of personal protective equipment (PPE) have forced healthcare staff members to engage in practices that would be considered taboo in times of “business as usual.” In the CS/ SPD, staff have found themselves using equipment normally intended for the repro- cessing of surgical instruments to reprocess disposable N95 respiratory masks for reuse. The pandemic is by no means over, but surgical cases have resumed out of neces- sity to care for non-virus patients. Health- care staff members have been challenged with maintaining high quality levels in care delivery during these unprecedented times. In the CS/SPD, some professionals have taken the opportunity to evaluate the processes they have in place for quality and sterility assurance and make improve- ments to increase effi cacy and safety. In many cases, quality/sterility assurance best practices can boost process effi ciency as well, enabling the CS/SPD to deliver safer and more effective instruments to customers faster.
M The big picture
While improvements to the processes of instrument delivery to the OR, use on the patient, delivery of instru- ments back to the CS/SPD, and reprocessing of those instruments can make a difference, Barbara Ann Harmer, MHA, BSN, RN, Vice President of Clinical Services, IST, urges health- care facilities to take a step
Barbara Ann Harmer
back, evaluate these processes as a whole and implement an overarching continuous quality improvement program. “A continuous quality improvement program takes into consideration the entire process pathway, which would include decontamination, cleaning, preparation, packaging, sterilization, quality control (monitors), storage and distribution,” said Harmer. “Your organization should be conducting an ongoing risk analysis for all aspects of your processing. The identification of any risk is integral to prevent any risk that could occur to staff or personnel. isk stratifi cation is integral to the identifi cation of risk areas, quantify- ing the risk and the identifi cation of any actions that could be taken to prevent or resolve the risk.” Harmer says education and training will assist staff in understanding how to identify a risk, provide a plan, prevent the risk or resolve the risk. Therefore, those conducting the risk assessment should communicate to staff members whether the risk has been prevented or resolved. “Typically, risk analysis is performed at least annually,” said Harmer. “With COVID-19, there was the necessity to look immediately at risks for the department’s processing activities. For example, supply chain management issues were overwhelm- ing for CS/SPD; to name a few, the lack of PPE, detergent solutions and wipes, processing supplies; with lockdowns, the inability for service representatives and sales representatives to offer maintenance and information onsite. taffi ng is a daily consideration in CS/SPD but inadequate staffi ng was evidenced by staff or a staff member’s family becoming positive and the staff member could not come to work.”
An ounce of prevention Addressing quality issues before they impact care is critical. That’s why CS/ SPD professionals should take the time to inspect instruments and perform preventa- tive maintenance to avoid issues down the road. But pressures from the OR to turn around sets faster for a growing number of procedures makes it extremely challenging
32 January 2021 • HEALTHCARE PURCHASING NEWS •
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for CPD staff to fi nd the time to perform these proactive tasks.
“Thorough inspection of instruments during tray assembly and careful docu- mentation of instrument set contents are essential for quality tray assembly,” said Lawrence Zelner, President, RST Automa- tion. “All too often technicians shortcut the inspection process because of time pressure due to labor shortages and large swings in workload. Missing instruments and incor- rect instruments are other problems that result from shortcutting the instrument verifi cation process required by contempo- rary computerized instrument management systems.”
“Increasing complexity of surgical instru- mentation, unclear, incomplete or missing instructions for use (IFU), overloaded surgi- cal sets and overburdened SPD staff are just some of the contributing factors that lead to inadequate cleaning and inspection of surgical instruments, resulting in increased bioburden risks,” said J Schrader, Market- ing Director, SPD Products and Services, Aesculap.
“The COVID-19 pandemic has made it more important than ever to carefully inspect instrumentation for bioburden,” Zelner added. “At some hospitals, the pressure of the pandemic has also led to increased labor shortages. Therefore, it is more important than ever before to imple- ment new processes that promote improved quality while assisting technicians to work more effi ciently.
“By proactively inspecting these vital tools, customers can greatly decrease their risk of broken/damaged instruments and potentially damaged containers that can lead to compromised sterility issues,” said Schrader. “It is imperative that the SPD department partner with a repair vendor who offers training, on-site service and a preventative maintenance plan that focuses on all sets, particularly the high-turn trays.” Manufacturers in the CS/SPD space have introduced new innovations to make it easier for department professionals to per- form proactive inspections and preventative maintenance. For example, Aesculap offers Surgical Asset Management programs,
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