STERILE PROCESSING


Proactive planning Redding cautions health systems to “look before they leap” into a change in reprocess- ing strategy and/or location, stating: “It is imperative for health systems to con- duct a detailed assessment of reprocessing operations to identify gaps, blind spots and risks for the organization. Too many times, we see health systems that can financially justify to centralize reprocessing services but lack the ability to operate like a system. Some of the factors to consider are: surgical volumes and geographic footprint, clinical expectations, organizational commitment and risk tolerance, instrument and tray inventory strategy, transportation infrastructure, work- force readiness, systems and work practices.” Frieze notes the importance of stakeholder engagement: “For facilities considering offsite processing, they should do a thorough risk analysis, and involve facilities management, SPD and infection prevention.”


Stuart sees health systems today “taking a pause” and looking beyond their immedi- ate CS/SPD needs to how they will address reprocessing for the next eight-to-10 years. In his experience, these are the health systems that have successfully centralized their sterile processing onsite or offsite.


“A big struggle in healthcare today is know- ing how to forecast,” said Stuart. “I have been in six new CS/SPD constructions and recent renovations that were five-year plans, and they are already struggling year two. I chal- lenge health systems to expand their horizons to the 12–15-year mark and plan accordingly.” “This isn’t something where you wake up one morning and decide to centralize,” Stuart added. “It requires six-to-12 months of preparation and due diligence about the process to determine if it is the right solution for your facility.”


As Crowe notes, a move to centralization provides the opportunity for the health system to evaluate and improve its CS/SPD processes and practices, including relation- ships between the CS/SPD department and clinical teams. “The best piece of advice would be to really evaluate where your health system is before jumping into a centralization decision,” she said. “Centralizing reprocessing can provide great benefits to the organization, but it can also work as an amplifier for any existing problems in your sterile processing depart- ment or in the relationship between the sterile processing department and surgical services without a good understanding of the preexisting realties of the departments and considered plans to make improvements as part of implementing the centralization.”


Staffing models


The switch from individual hospital CS/ SPD departments to centralized, offsite


reprocessing operations will likely require the health system to reconsider traditional staffing models.


“Facilities are forced to do more with less, which can translate to centralizing processes to decrease the number of staff needed,” said Elammari. “However, caution is necessary for these scenarios because this can cause burnout for the staff, which often translates to disengagement and quality issues.” Stuart says that, in his opinion, the “three- shift model” doesn’t always meet the needs of today’s onsite or offsite, centralized environment:


“I am starting to see more hospitals adopt stagger shift, but I am surprised at how many still have that three-shift model. There are benefits to looking at sterile processing from more of a manufacturing perspective and incorporating some of the tried-and-true technologies from manufacturing into the space. It’s time to do that type of integration.” “Healthcare organizations are focused on


patient care and the delivery of healthcare services, and are typically not experts in manufacturing,” he added. “The shift to offsite is a departure from anything they have been exposed to in the past, and it’s a huge investment from a financial perspective. Changes in the ability and speed to provide OR support should also be considered. Don’t be afraid to seek assistance from people who have knowledge in the space.”


Inventory management and storage Because instruments and devices are being processed offsite, added time must be fac- tored for transport to and from the facilities. In most cases, the health system must invest in additional inventory to help ensure clini- cians have items when they need them. David Phillips, Marketing Manager, Hänel Storage Systems, says health systems must also consider the risk for error when an offsite center delivers instruments for scheduled cases, and ways to minimize the risk, stating: “Without proper inven-


David Phillips


tory management, there is the risk of life- threatening errors, with the wrong surgical supplies potentially delivered to a hospital. If even one small item is incorrect, then the SPD is no longer located elsewhere in the same hospital but possibly across town. This problem can easily be solved by keeping a small supply of commonly used supplies and instruments onsite at all times, in case of mistakes.”


When centralizing sterile processing offsite, Phillips says it becomes even more critical to efficiently retrieve supplies and required instruments trays according to the surgical schedule, so an entire day’s worth of


30 June 2022 • HEALTHCARE PURCHASING NEWS • hpnonline.com


containers is transported to the correspond- ing hospital. At the end of the day, these materials are then returned for reprocessing. Phillips points to the Hänel Rotomat auto- mated sterile storage carousel as an excellent solution. The Rotomat protects against dust, dirt and potential contamination, and tracks supplies as they are stored and retrieved, with the extra benefit of saving valuable floor space.


Trusted transport


When reprocessing is moved offsite, a major consideration is how to transport instruments and devices efficiently and safely between facilities. Hendee’s CS/SPD department services multiple offsite locations, which has reduced practice variations greatly, but it has also created challenges in the form of transportation and delayed processing. “We did not think about the transporter,”


said Hendee. “We considered the bins for transport, the vehicles, the DOT regulations etc. However, we did not think the trans- porter themselves would need any special training. That was until they picked up a load of sterile items and badly mishandled them. When the load arrived at the clinic, there were sterile items placed inside the biohazard transport container and a rigid container had been held by one handle, causing the instru- ments inside to poke holes in the filter. Once we explained the process fully and what was expected these issues went away but the fact that we missed this needed piece of training could have caused serious issues.” As Stuart points out, health systems that have centralized supply distribution in place typically have an easier time transitioning to offsite reprocessing, stating:


“Among health systems seriously consid- ering a centralized, offsite model, about 70% have self-distribution in place. They already have trucks going to hospitals each day and courier services to serve clinics. That’s an important factor to consider - for these organizations, transportation is not a new cost when they shift to offsite reprocessing.”


When onsite makes sense While there is a growing trend toward cen- tralized and offsite reprocessing of reusable devices and instruments, there are some cases where onsite reprocessing is best for clinical care effectiveness, efficiency and safety. “There are numerous factors that can influ- ence where reprocessing is performed. Infection pre- vention, regulatory guid- ance, turnaround time, budgets, process efficiency, inventory management, and sustainability initiatives can all play a part,” said Richard Radford, CEO, Cenorin.


Richard Radford


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