CS CONNECTION
Association of periOperative Registered Nurses’ (AORN) guidelines on proper use of surgical N95 respirators in the periopera- tive setting,” Gorog continued. “Hospitals were tasked with developing new protocols that outlined steps to reprocess single use N95s that met the criteria of the FDA, mask manufacturer and sterilization manufac- turer authorization.” “As a result of the pandemic, the U.S. Centers for Disease Control and Preven- tion (CDC) and AORN have developed optimization strategies that provide predic- tive analytic tools that facilities can use to anticipate their potential supply demands with the evolving pandemic and readily respond to ensure that they can protect both their staff and patients,” Gorog added.
Biological indicators
Regarding best practices for quality and sterility assurance, Gorog says one of the most important practices to implement within the CS/SPD is to monitor every load with a biological indicator (BI). She points to a number of industry guidelines in support of this practice. For example, the CDC states in its Steriliz- ing Practices chapter, “Biological Indicators are the only process indicators that directly monitor the lethality of a given steriliza- tion process.”1 on Sterilization2
The AORN 2020 Guidelines and Association for the
Advancement of Medical Instrumentation (AAMI) ST 583
recommend sterilier effi-
cacy monitoring, preferably with each load. “By monitoring every sterilization load,
the SPD can ensure sterilization conditions were achieved prior to releasing surgical instruments for use on patients and reduces the recall time needed to identify and recall instrumentation in the event of a positive BI,” said Gorog. “As part of a quality man- agement strategy with sterilization moni- toring, every load monitoring can identify facility process failures earlier compared to daily monitoring practice.”
The human factor
“The number one root cause of errors in SPD is related to the technician(s) who pro- cessed the instrument(s),” said Agoston. “Factors such as amount of time, compe- tency, standard work, distractions, motiva- tion, work environment, complexity of the instrument, etc. all enter into the equation and impact the quality of the work. Staff shortages and limited experience exacer- bate the problem. In most hospitals 30 to 50 percent of the SPD staff have less than one year experience.”
“Automated washers and sterilizers do fail periodically but there are automated verifications and indicators to warn of a
problem,” Agoston added. “Instruments wear out and fail, and the well trained SPD technician can, through inspection, weed out these before they threaten the patient. But the biggest issue in every OR is quality errors either caused or not discovered by the technicians who processed the instru- ment. These errors are recorded as a missing instrument, broken instrument, improper packaging and contamination due to a dirty instrument or contaminate in the package.” According to Agoston, staff members working in decontamination play a critical role as they can examine instruments for missing parts and perform quality assur- ance checks, such as leak testing a exible endoscope. When a quality issue is discov- ered, he says it is the technician’s obliga- tion to report this information to the OR. The physician should be notified when a flexible endoscope is found to leak post use. This knowledge can help the physician effectively monitor or treat the patient to reduce the risk of infection,” said Agoston. “Unfortunately, the current practice in most hospitals is to focus on the cleaning process so that the endoscope is not ooded and then to return it for repair. What is lost is the fact that there is a potential that the endoscope was in use when the leak developed. No competent SPD professional would allow it to be used on a patient because a leaking endoscope cannot be effectively sterilized or high level disinfected (HLD).” Agoston points out that when the CS/ SPD does not have adequate quality assur- ance/quality control (QA/QC) processes in place, the quality burden falls on the OR. “It is never a good idea to have your nurses and surgeons be your QA person,” said Agoston. “This wastes time in the OR and potentially places patients at risk if the errors are not found or if the error is found during use. Having the nurse or surgeon be the QA person is equivalent to a manufacturer of a product having the customer evaluate it for form, fit and function. Many customers would be lost if this was the industry’s accepted practice. The QA/ QC process must take place in SPD to prevent wasting time in the OR and increasing risks to patients.”
Gaining support for quality/ sterility assurance investments While CS/SPD professionals want to improve the quality of their processes in order to enhance patient care and safety, many face challenges in securing leader- ship support for resource allocation to the department. How do you convince the C-suite to make investments in the CS/SPD?
36 January 2021 • HEALTHCARE PURCHASING NEWS •
hpnonline.com The power of data
“With data,” said Eddie Conklin, CRCST, CHL, Central Processing Manager, Penin- sula Regional Medical Center, Salisbury, MD. “For requests of full-time employees (FTE), new processes, new equipment and materials, you must provide your data.” He offers the following examples: • FTEs: “A FTE request starts with understanding customer service lev- els: Is the expectation that everything is processed the same day, 24/7/365? Then calculate your demand takt time, resources and workflow.”
• Additional instruments: “Measure your flips (EZ Passes) and calculate the waste from the OR and central sterile processing (CSP). If you need new containers for ridged scopes, then gather your repair data.”
“To queue up your future requests and to gain momentum, show the results to the senior staff again using data,” Conk- lin added. “For example, make the case for new workbenches by explaining to senior staff that this will help reduce cycle times in assembly and enable the movement of third-shift employees to peak times, which in turn provides additional benefits, such as the ability to provide immediate missing instrument information to the OR. I’m sure there are hundreds of examples. By providing data to your senior staff you are providing them a choice and direction to improve and hopefully elevating CSP to become their priority.”
Conklin’s team at Peninsula Regional earned Healthcare Purchasing News’ 2013 SPD Department of the Year award.
Communication is critical Kevin Anderson BSN, RN, CNOR, CSSM, CRCST, CHL, CIS, CER, Clinical Educa- tion Coordinator, Healthmark, agrees that using the right data to support resource requests is key to securing leadership buy-in for them. He adds that communi- cation is also critical, stating: “If you are not getting what you need, then chances are you have to find a bet- ter way to communicate. Data certainly speaks to most administrators, but it could also be a story of a near miss that could have been avoided. So the short and simple answer is to communicate whatever is necessary to get what you need, albeit while being ethical and not making things up to manipulate the situ- ation. Hopefully, that part goes without saying.” HPN
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https://hpnonline.com/21165383 for references.
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