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“I Got It!”​: Why Initiative Makes the Sterile Processing World Go Round

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One of the most annoying sounds I’ve ever heard was the buzzer on the cart washer in my first hospital. Man, that thing sounded like a cricket the size of Godzilla was scratching its legs together—again, and again, and again. But as loud and annoying as the sound was, the buzzer also served as the impetus for one of my first experiences on the importance of sterile processing initiative that I had in my young career.

What it meant for me

For technicians working in the clean assembly area, we knew what that buzzer sound meant. One of us had to stop what we were doing, walk all the way over to the cart washer, unload steaming hot carts, close the door, and walk all the way back to our table before trying to pick up where we left off. Because of the layout of prep and pack tables in the department, we knew certain people would be closer to the cart washer than others, so some of us made decisions about where we worked based on the unspoken expectation of who would probably be unloading the cart washer for the night.

All of this thinking was very me-centered. We knew that buzzer would interrupt what we wanted to do. It would slow us down from completing our trays or make us lose our place in checking off a count sheet. It might even interrupt a conversation we were having with our teammates. The buzzer did not care what we were doing, and we did not really have an option to ignore it, so we had to deal with it even if we were not happy about it.

What it meant for them

That was the perspective from the clean side. But for the technicians in the decontamination area, it was a completely different story. Every time the buzzer went off on the cart washer, it was a sign of coming relief from the overwhelming press of empty case carts waiting to be loaded into it for cleaning and thermal disinfection. Many times these technicians could hardly walk around their sinks due to the number of case carts being staged for washing.

Each time the buzzer sounded and carts were unloaded on the clean side meant a little more breathing room (and walking room!) for the team on the dirty side. With more space to maneuver, it was easier for these technicians to safely transfer trays from manual cleaning sinks into ultrasonic machines, and from ultrasonics into washer-disinfector equipment.

What it meant for us

Each buzzing cart washer signaled that more clean case carts would soon be ready for building by our case-picking team who were preparing the surgical cases for the following morning. There were many occasions when we did not have enough clean case carts available to keep up with the speed at which this team was picking surgical trays and disposable supplies. They could fill the carts quicker than our machine could wash them.

Until all the cases were pulled, these technicians could not begin working on the missing instrument list for the evening or transition back into the assembly area to assist in completing trays. The efficiency of their night rested heavily on the efficiency of that case cart cleaning process.

What it meant for the patient

Ultimately, all the implications of that annoyingly loud buzzer ended with a patient. At the end of the day, it wasn’t about any of us on the clean side, it wasn’t about any of them on the dirty side, or even about how efficient the rest of our team could be with our department duties. That buzzer forced us to make a decision about how much we valued Mr. Johnson’s total hip procedure on Thursday. It required us to be truthful about the real level of care we had for Mrs. Thompson’s open heart procedure at 7:00 a.m. tomorrow. It was more than the sound of clean carts; it was the sound of conscience, and each of us had to answer it.

Why initiative makes the world go round

What does all this have to do with initiative? It’s simple really. This little slice of the sterile processing experience, something as mundane as an alarming buzzer on a cart washer, has a way of separating the can-do and will-do personalities from the can’t-, won’t-, or won’t-do-it-with-a-smile-on-my-face members of our team. We learn a lot about the inner drive of the SPD technician who is the first to yell, “I got it!” when that buzzer goes off for the tenth time of the night. And we learn just as much about the technician who pretends to be too busy, too focused, or selectively deaf to the inconvenience that initiative calls them to take part in.

Who would you want on your team? Who would you want processing surgical trays for your child, spouse, or loved ones? A sterile processing professional who comes to work every day understanding the call to sacrifice her comfort, preference, and expectations for the good of the team and safety of the patient, or a technician who is always hoping someone else will step up to take care of the issue? If you want to cultivate excellence in your own career as a frontline technician or department leader, it will be impossible without first developing an addiction to initiative. If you want a department full of go-getters and team players, highlight, reward, and set expectations for nonstop initiative across your staff.

It won’t take long until you start to see the results from the dirty room to the OR and every alarm, buzzer, and beep in between.

Who’s got it?


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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