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Dangerous Decontam: Is Your Department Design Hurting Your People?

Updated: May 5, 2023

You don’t have to spend more than five minutes in a sterile processing decontamination area to realize it’s a dangerous space. The entire concept of standard precautions causes some technicians to daydream about what horrible disease might be clinging to this orthopedic broach or buried inside that narrow liposuction cannula.

Even with all the microscopic fire-breathers present in that area, there may be other, more visible dangers lurking in plain sight. Those dangers can hurt your people just as easily as an unintentional sharps exposure. Here are five common department design considerations that could keep your decontamination technicians safer.

Take stock of the value of air exchanges Chemical fumes, aerosolization, and industry recommendations all provide ample reasons to ensure adequate air exchanges are happening in your department’s decontamination area. The dangerous truth here is that respiratory issues can often take substantial time to develop in technicians who are being overexposed to certain chemicals while on the job, so leaders may not know there is an issue until months or even years after it first began. Department leaders have a responsibility to monitor compliance in this area, even if other hospital staff are tasked with the mechanical and engineering portion of it.

Let there be light Many of us can’t even get from the bed to the bathroom without some kind of nightlight to guide the way, yet many decontamination areas were designed without the idea of adequate lighting in mind for safe transport, cleaning, and loading of surgical instrument trays. In particular, in areas of manual cleaning and testing, such as instrument sinks and scope basins, technicians need ample light to ensure they are safely handling and inspecting all instruments in their trays. Deep sinks, water discolored by detergent, and plastic PPE visors all make visibility difficult as it is, which can lead to any number of punctures, pinches, and scrapes if technicians are not able to see exactly what they are doing.

Keep feet on the ground (comfortably and safely) From head to toe, decontamination technicians know they must be protected from splash or exposure risks. For feet, liquid-resistant shoe covers are recommended anytime there is a “…potential for shoes becoming contaminated and/or soaked with blood or other bodily fluids” (AAMI ST79:2017 4.5.2.C). Although a technician’s feet may be dry, many decontamination areas still become extremely wet throughout the day, leading to serious slip hazards for technicians moving about in the workspace. Without proper drainage, safety mats, and floor texture, these areas can be a source of unnecessary risk for your teams. Even in a setting that is typically drier, considerations should still be given to the impact that hours of standing can have on your technicians’ feet, legs, and back. Antifatigue mats are a must-have for this area, but should be regularly cleaned to avoid mold or mildew.

Focus on back safety One size fits all is a decent mantra for adjustable baseball caps and leather belts, but definitely not for the height of sinks and other cleaning surfaces in your decontamination area. While adjustable, ergonomic sinks are still a luxury in many sterile processing departments, they can have a tremendous impact on a hospital’s ability to protect their personnel from needless injury caused by undue bending, twisting, and lifting. Although decontamination and cleaning is a manual job, facilities should still do all they can to reduce the physical impact of this repetitive and extended motion on the bodies of SPD technicians. If mechanical upgrades are impossible in your current space, there are products on the market that can insert into existing sinks to raise the working level to a more ergonomic height.

Ensure space for a safe space For many departments, one of the most dangerous design flaws in their decontamination area is a general lack of adequate safe space. When peak volume is combined with a number of fully PPE’d technicians, case carts entering and exiting, trays moving from sinks to sonics to washers, manifolds being loaded and unloaded, and staging of containers and instrument sets happening on every available surface, something as simple as safe movement becomes a serious challenge.

Apart from knocking down a few extra walls, two of the most important things you can do are map out a standard decontam workflow and prohibit technicians from building leaning towers of instrument Pisas. Even busy, cramped decontamination areas can still be safely organized to guard against trip hazards and sharps risks with intuitive, clearly marked workflow and staging areas. If policies ensure that neither containers nor instrument trays can be stacked multiple levels high, technicians can be protected against serious injury from contaminated equipment falling on top of them or their teammates.

Decontamination of surgical instrumentation will always have some level of danger associated with it. As long as microbes seek to do us harm, we will need brave and committed technicians to don their impervious armor and do battle with bioburden seen and unseen. But that does not mean that every danger is a necessary part of the job. Department leaders and hospital administrators owe it to their teams to do everything possible to allow SPD staff to focus on their primary task of reprocessing, and trust that the system around them is a safe one. Safe design is not only possible, it’s the true signal of the value we place on our frontline staff.

What signal is your department sending?


Hank Balch is the Founder and President of Beyond Clean, the global leader in Sterile Processing education & networking. You can follow him on Linkedin at Hank Balch and find his Fighting Dirty video series on YouTube. Hank is an international thought leader and has written over 200 other Sterile Processing articles and commentary, along with published articles in Becker's Hospital Review, Infection Control Today, AAMI News, AAMI BI&T Journal, Outpatient Surgery Magazine, and contributions to Healthcare Purchasing News. Hank's CS/SPD team in Louisville, KY was named the "2016 CS/SPD Department of the Year" by HPN. He has also served as the founding President of the South Texas Association of Sterile Processing Services and President of the Kentuckiana IAHCSMM Chapter, in additional to being nominated for the 2017 President-Elect & 2018 President-Elect of the International Association of Healthcare Central Service Materiel Management, now HSPA.


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