Your surgical volume is increasing. The all-star surgeons were successfully recruited from the competitors across town. Your facility earned Magnet status, recently made some kind of US News & World Report Best Hospital list, and you even passed your last accreditation survey.
Bravo.
All is well with the world, right?
Well, not so fast.
Chances are high that there may be unmet needs sitting in plain sight in your facility's CS/SPD department. Even if this team made it through your most recent infection control tracer or tri-annual survey, there may still be issues that need addressing, capital that needs investing, and collaboration that needs implementing. Because many CS problems occur out of sight of perioperative leaders and physically removed from frontline patient care, it can be easy for hospital administrators to underestimate the real scope of their challenges and the fundamental importance they play. Miss something here and the best sterile technique in the world, the most prestigious surgeon, the fastest turnover time in the country will mean nothing. The headline will read "Dirty Surgery," and that's all that will matter to patients in your city.
If you don't want this to happen to you or your facility, take note of these 10 common ways that hospitals can put their patients and Sterile Processing departments at risk -- and commit to fixing them today:
1) Poor Compensation Practices
One of the most ubiquitous challenges facing CS/SPD departments are poor compensation levels compared to the skill of the instrument technician position and the value given by these technicians to quality-based patient outcomes. If your hospital compensation can not compete for the highest quality of CS technicians in your market, you will end up with dangerously unskilled staff, high turnover, and constant quality issues related to this. As Stephen Kovach notes, "Quality doesn't cost, it pays."
2) Lack of Department Leadership/Oversight
Although CS leadership reporting often rolls up underneath perioperative or material management directors, successful leaders of Sterile Processing departments should have particular industry knowledge and regulatory expertise to ensure they can run their departments according to industry best practice. If your facility is large enough for multiple shifts in your CS/SPD, do not neglect creating and hiring the critically important positions that provide supervision to every shift and process managementto the entire team. If you are a health system with multiple CS departments, give strong consideration to creating a System Director role in CS to drive standardization and compliance across your facilities.
3) Nonexistent or Incomplete Data Management
If your CS department does not have a surgical inventory management software, stop reading this list now and start making some phone calls. Do they cost money? Yes they do. And so do lost, stolen, and poorly managed surgical instruments. Discover major surgical site infections on multiple pediatric patients over a two-week period? Which instrument sets were used? Without an inventory management software, your attorneys are going to have a difficult time proving you did your due diligence in protecting these defenseless patients against an insufficient instrument tracking process. Notified of a product recall on specific instrument SKUs? Good luck finding those. Beyond these scenarios, there are also savings in efficiency, optimization, and standardization that are made possible with these must-have CS asset tracking technologies.
4) No Industry Certification
Baseline industry knowledge is available to the Sterile Processing industry in a handful of great certification options through the IAHCSMM and CBSPD organizations. But as with any other patient-care career, facilities should require these baseline certifications as a condition of employment AND be prepared to incentivize and reward those technicians who go above and beyond in gaining additional certifications in instrument specialization, healthcare leadership, and endoscope reprocessing. If your hospital does not supply these study materials, reimburse for the exams, or give a measurable raise/bonus for this growth in expertise, do not be surprised if your best and brightest go somewhere else that does.
5) Insufficient Capital Equipment
Apart from the laboratory, few departments in your hospital are as "equipment-driven" as your Sterile Processing team. Unfortunately, CS departments are many times under-equipped to support the level or type of processing being thrust upon them by a hospital's surgical volume. Depending upon the type of instrumentation being processed, ultrasonic cleaning may be required for a majority of your entire inventory -- but how many of these units do you have? What is your plan if one goes down for repair? Are you containerizing large portions of your inventory to guard against holes in wrap? Did you consider the huge impact that will have in the number of loads through your 15-year old cart washer? These types of capital questions are often overlooked or ignored until there is a catastrophic breakdown in processing or infection control tracer. Don't let that be your story. Plan ahead and keep your team equipped.
6) Low-Quality Instrument Repair
I am still surprised by how many facilities do not give adequate budgetary support for and engagement with their surgical instrument repair partners. Hospitals may encounter subpar repairs or poor customer service for years until someone finally wakes up to the wreckage made of their surgical instrument fleet and yells "STOP!" On the other hand, the impact that a high-quality instrument repair program can have on physician satisfaction, operational/capital budget spend, lifespan of instruments, and patient safety is hard to overstate. True surgical instrument repair services go far beyond just grinding a few scissors. These vendors must be held to the highest standards of quality, communication, and proactive instrument management. A compromise here is just asking for cracked needle holder jaws and faulty laparoscopic insulation.
7) Inadequate Inspection Technologies
One of the most dangerous things that can happen to your patients is for your CS/SPD team not to be given the inspection technologies necessary to properly confirm instrument functionality and removal of residual bioburden prior to sterilization. In other words, if you are asking your CS/SPD department to sterilize what they cannot see, you are doing a disservice to every patient who walks through your door. If your hospital owns arthroscopic shavers, your CS team should have flexible inspection scopes to look inside them. If your hospital utilizes micro-instruments or any type of needle holder (that'd be everybody), your CS technicians should have access to lighted magnification technologiesand other similar tools (such as magnification visors).
8) No Temporary/Agency Staffing Support
Because of the current challenges inherent in poor compensation practices (#1) and non-mandatory/non-incentivized industry certification (#4), a great many CS/SPD departments around the country are critically dependent on temporary staffing (also known as agency staffing) to overcome a lack of adequate permanent staffing levels, consistent equipment downtime, and growing surgical volume. The trouble comes when hospital administrators fail to approve this staffing support when it is needed or wait too long to do so. I often say that CS professionals are "too good at their jobs." You can push them, and push them, and push them, and they will still get the job done. But that's not any way to care for those on the frontline of patient safety or guard against professional burnout and turnover. Temporary staffing support is a must-have in many seasons of CS life. Hospitals should understand and quickly support this when needed.
9) Unwillingness to Utilize Consultation
Many millions of consulting dollars have been poured into getting our nation's Operating Rooms running safely, efficiently, and with a sustainable vision for the future. But many times these consultations leave out a crucial step in the surgical service workflow -- the people, processes, and products of the Sterile Processing team. While this trend is starting to change, there is still abundant opportunity for improvement in many CS/SPD departments, particularly related to data management across perioperative systems (#3), leadership development, communication, and process improvement. Hospitals should not assume systemic Sterile Processing challenges can be overcome or major construction projects coordinated without occasional expert consultation.
10) Non-Compliant Storage Systems
As surgical procedures have grown more complex over the last few decades, the amount of instrumentation needed to support them has grown as well. But in many CS departments, the one area that has not grown is the sterile storage area. These rooms are sometimes overloaded, poorly designed, and non-compliant with manufacturer's recommended instructions for storing instrument trays (particularly with blue wrapped items). Traditional stainless steel wire shelving leads to poor stock rotation of slow moving trays and possible puncture risks for wrapped instrument trays. For the sake of eliminating waste and pursuing compliance, facilities should support their teams in upgrading to the next generation of sterile storage technologies.
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Risk is not a word that hospital administrators, patients, or the public want to hear about their hospital -- but it could not be a better description of what happens when health systems and facility leaders put the needs of their Sterile Processing department at the bottom of the list. With serious quality breakdowns of surgical instrument programs flooding the news on a regular basis, your hospital's CS/SPD team needs more than just recognition during the International Central Sterile Week , they need your help to win the war on microbes today.
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