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Sterile Processing Tips for Restarting Elective Surgery Support

By: Natalie Lind

May 13, 2020

Many healthcare facilities that suspended elective surgeries during the first weeks of the pandemic are gearing up to resume those procedures. Obviously, there will be a backlog of cases and a push to catch up as soon as possible, which can put significant strain on the Sterile Processing department (SPD). Fortunately, there are some things that may make the ramp up go more smoothly. What follows are a few things to consider:

The Physical Work Area

Cleaning. Make certain the entire work area is clean and ready to go. Conduct rounds through the departmental work areas to identify any issues and resolve them as soon as possible.

Equipment Readiness. Check equipment and schedule any needed repairs. Make certain all reprocessing equipment is available to ensure timely turnaround of instruments.

Supplies

Outdates. Check any items with expiration dates to ensure that those supplies are within the expiration date and ready for use.

Inventory. Ensure all supply areas are stocked and adequate back-up stock is available. Work with the Materials Management department to attain current information and develop a plan.

  • Procedural supplies - Use surgery forecasts to determine whether the supply inventory is ready for increased caseload.
  • Operational supplies - Use anticipated case volume to determine whether current operational supply levels will be adequate.

Check for changes in inventory (substitutions due to shortages, etc.). If there have been changes, notify users and provide any education needed to SP staff.

Identify possible shortages. Identify any items on backorder and make alternate plans, if possible. Notify any impacted users.

Instruments

Repairs/Replacements. If instruments need repair or replacement, take the necessary steps to have them ready for the uptick in cases. A full and functional inventory of instruments enhances service to the Operating Room (OR) and may reduce turnarounds.

Endoscopes. Check endoscopes in storage to ensure they are within their processed shelf life. If they need reprocessing, complete that before the surge in cases begins.

Instrument tray readiness. Be sure all necessary instrument trays are set up and sterilized prior to cases starting.

Predict and plan. Use forecast schedules to help identify possible service issues, such as overlapping instrument needs and loaned instrument plans. Work with the OR and Endoscopy to develop a plan to address those issues before they become problems.

Staffing

Address status of loaned staff. If SP professionals have been loaned to other departments, notify those departments of the need to return SP staff to the SPD. Some departments may not want to return staff right away as their volumes may still be high. Be sure the departments are aware of the plan and know they will need to cover necessary services through employees loaned from other departments, overtime or travelers.

Address educational needs. If policies, processes or procedures have changed, ensure all staff members know about the changes and have been trained (if necessary). Remember, some staff members may be returning from furlough and may have missed the changes when they first occurred.

Focus on communication. Good communication will help prevent errors and frustration. Work on a formal plan to ensure that user departments and work areas within SP are aware of plans, situations and changes. Several short huddles throughout the shift may help. Also, designating facilitators in SP and the OR who can gather and disseminate information and work out issues may also be helpful during these busy times.

Stress a team approach. The busiest times require the strongest teams. Remember, everyone has been through a difficult experience and emotions are fragile. Stress the importance of supporting team members and set an example.

Discuss possible need for additional hours for SP staff as workload demands. Use the data provided by Surgery and the Endoscopy department to inform administration of the increase in workload. Compare anticipated need to normal staffing and develop a plan to handle increased workload.

Notify SP professionals that extra hours may be needed. Look for a way to notify staff of additional needed hours and develop a fair way to distribute those hours.

Prioritization

Hold nonemergent projects. If possible, consider putting a hold on nonemergent projects and use additional staff time to meet the additional workload demand. Set a tentative date for the resumption of projects.

Use facilitators between SP and user departments to help ensure that processes run smoothly. Set up people and processes to facilitate the sharing of information and ensure that needs are prioritized.

Reduce meeting times. If possible, reduce routine meeting times during peak workload. Provide staff with routine information through employee email or posted notices.

Reduce management meeting times. Communication between managers and other departments is critical; however, consider postponing noncritical agenda items and addressing only current needs to enable managers to dedicate more time to their departments/employees.

Please note: These suggestions were written assuming that a department has been running in some capacity.

Additional considerations if equipment has been shut down or idled

If the department has been closed and water has been sitting in the water lines, the lines should be run to remove the old/stagnant water from the system.

If the sterilizers and automatic washers have been shut down or left to idle for a long period of time, contact the sterilizer or washer manufacturer for advice. Sterilizer performance may be affected by a shutdown.

Check with the Facilities Maintenance department regarding steam quality. An interruption in the steam supply system, which can be caused by a shutdown or disruption of continued use, may adversely affect the steam quality. There could also be a build-up of residual water in the steam lines that could flush through the system on restart. For more information, please refer to ANSI/AAMI ST79:2017, Section 3.3.3, and AORN 2020 Guidelines for Sterilization, Recommendation XI.

Also, check with Facilities Maintenance to ensure the electrical system is safe and functional.

If concerned about qualification testing due to sterilizer shutdown, refer to ANSI/AAMI ST79: 2017, Section 13.8, on qualification testing. According to this standard, major repairs of or changes to the utilities (e.g., the installation of new boilers) should be treated as major repairs to the sterilizer. Sterilizer testing should be performed as defined in the aforementioned section of the standards to provide the necessary qualification for use.

Additionally, it will be important to check the date and time settings on all equipment.

Conclusion

The best way the SPD can respond to the increased workload is to ensure that staff members are available and prepared for any changes, instruments are complete, and equipment is fully functional and ready to go. Being proactive will help ensure the best outcomes when backlogged elective surgeries resume.

Natalie Lind, CRCST, CHL, FCS, is IAHCSMM's Education Director.