STERILE PROCESSING Let’s talk about ANSI/AAMI ST91:2021
There was much excitement across the industry when the long-awaited updates to ANSI/ AAMI ST91:2021, Flexible and semi-rigid endoscope processing in health care facilities were released in March 2022. We asked CS/SPD professionals and suppliers for their thoughts on the impact of these changes to CS/SPD departments that reprocess a high volume of scopes, and advice on how to proceed with implementation.
Debra S. Burns, BS, CRCST, CIS, CHL, LBBP, Certified HSPA Instructor, Sterile Supply Consultant, Aesculap
“The updates to ST91 address new guidelines for cleaning, verification, drying, storing and patient safety and may require major process changes and possibly major purchases. A way to manage the change is to review the updates and evaluate the resources available to move toward compliance. “A good place to start in managing change in sterile processing is with a comprehensive
and quality training program. For example, the more challenging updates involve the high- risk scopes having different processing requirements, cleaning verification and sterilization. Enhancing the visual inspection can add quality to the current cleaning processes. As the guidelines state, endoscopes should be inspected with lighted magnification along with the cleaning verification testing. “A recommendation for implementing and managing the changes is to prioritize the changes high on the list. ST91 does not state how soon the changes need to be adopted, but it would be best practice to have an implementation plan to provide to the surveyor in the event a visit is conducted before the changes are made.”
Kenneth Campbell, Director of Sterile Processing, Berkshire Medical Center
“There is certainly a lot of controversy around the changes. You must admit that 10 minutes is a long time to be standing somewhere blowing out a scope. With regards to the guidance on using only two sinks now - one for cleaning, one for rinsing – today’s departments are not set up that way. As for sterilizing scopes versus high level disinfection, many hospitals are not in a position to send down scopes to be sterilized so what they you do? There is a lot of conversation going on around that right now. “The reality is that a department can’t do it all at once. Something I heard said at the 2022
HSPA Annual Conference has stuck with me, and I now say it to my team, ‘While we want a perfect department let’s start with a perfect day with no mistakes today and we will worry about tomorrow, tomorrow.’ By doing so, each day will get a little easier.”
Peter Hawryluk, Account Executive, MedVantage “Departments should develop guidelines and protocols with their staff to ensure that all
work adheres to the necessary requirements. Specifically, accurate dates for hang time should always be cross checked to make sure that the hospital standards are being met.”
Jeff Paquet, President & CEO, Mobile Medical International Corporation Solutions “Based on our review and understanding of the standard, CS/SPD are being pushed away
from manual processing, and toward high-level disinfection and sterilization of endoscopes. This means more use of low temperature sterilizers.”
Eric S. Smith, CFER, Infection Prevention & Control Specialist, Medical & Scientific Affairs, Olympus Corporation of the Americas
“For facilities that follow AAMI standards, the ST91 updates may add
time to the reprocessing procedure for leak testing, drying time and clean- ing verification depending on endoscope risk. Scopes that fall under the classification of delayed reprocessing will require additional steps before the normal processing cycle with which staff may not be accustomed. CS/SPD departments should make trial reprocessing runs based on the new standards to determine how the updates may impact their specific facilities. “CS/SPD departments will need to figure out whether existing equipment and processes are sufficient to meet the new standards. A facility, for instance, may need more drying equipment to incorporate the additional reprocessing time or new equipment to track reprocessing and storage steps. Facilities may need to schedule more time between procedures to account for the longer reprocessing requirements.”
44 July 2022 • HEALTHCARE PURCHASING NEWS •
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Measuring workflow improvements Tracking and measuring progress in CS/ SP workflow can help drie continuous improement. Showing how an initiatie deliered results in efficiency, uality and or safety can also help a SSP team gain leadership support for additional inestments in the department. imsey categories measurements into
three categories utcome easurements, Process easurements and aste easurements. He says all of these can be used to measure improements and create a continuous improement culture. utcome easurements are the easiest
and most common in that they measure the uality of the final product or serice, said imsey. For most SPs, this is the uality of the instruments sent to the andor the serice proided. hile customer facing ual- ity should always be measured, it is a reactie measurement that is often too late. It is much better to build in proactie measurements that help catch the issue before it reaches the ustomer. imsey describes Process easurements as
those that focus on the process steps and how well a SSP team performs and adheres to them. Eamples of Process easurements include compliance to standard work through audits and obserations, dirty instruments caught in assembly, instrument backlog in assembly, and missing instruments. he concept is that if you control and improe the internal process, the outcome or product produced will be better, imsey eplained. nother way to look at Process easurements is to measure how well the internal product is handed off between each step of the process. his includes how well the hands-off the dirty tray to SP and how well decontamination hands-off the tray to assembly. ccording to imsey, aste easurements
are the hardest and least used. hey focus on measuring what ean refers to as wasted actiity. his includes measuring rework, returned unused items, phone calls, special delieries, or anything that is not according to plan, said imsey. fun way to look at this is to enision the perfect SP and then measure whats happening that shouldnt HPN
References
1. Mattingly AS, Rose L, Eddington HS, et al. Trends in US Surgi- cal Procedures and Health Care System Response to Policies Curtailing Elective Surgical Operations During the COVID-19 Pan- demic. JAMA Netw Open.2021;4(12):e2138038. doi:10.1001/ jamanetworkopen.2021.38038
2. Position Statement on Patient Safety, AORN Journal, V115, 5, 454-457, 2022
3. Shahid, S., Thomas, S., “Situation, Background, Assessment, Recommendation (SBAR): Communication Toll for Handoff in Health Care – A Narrative Review.” Safety in Health, 4:7, 2018, Open Access
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