CS Question: There is a lot of hostility and conflict between the O.R. and CSP at our hospital. It seems we can never agree on things and as a result there are many problems which have affected the quality and timeliness of service, and employee morale is very low. These problems have elevated to hierarchy and a turf battle has evolved over the control of CSP. Administration is entertaining a reorganization which will place CSP under the control of the perioperative director instead of Support Services. I believe that such a move would be disastrous. Do you have information on O.R./CSP reporting relationships that would assist me in my goal to keep SPD from becoming under the control of the O.R.?

A balance of authority and responsibility is essential. Organizational restructuring alone will not necessarily assure smooth operations or cure the ills existing between combatting departments. Superior interpersonal relations, mutual respect, open communications, integrity and teamwork, are the driving forces to success. It is the responsibility of administration to develop a structure that will fufill the goals, objectives and mission of the hospital and to select competent and qualified leaders to manage the operational units. Internal politics often result in battles over turf, power, control and the misalignment of essential human and materiel resources. This can errode interpersonal relationships, team work and camaraderie which are imperative to a successful work environment. When such systems fail or are allowed to continue it affects services and the quality of care. Many institutions that have been in such situations have found it very helpful to utilize the services of surgical support services consultants to assist them in the assessment of operations and the identification of process improvement initiatives. Consultants can objectively assess all aspects of operations in realtion to CSP/O.R. including human resources, skills, facilities, equipment, work flow, policies, procedures,techniques, and organizational structure. Consultants can work internally with hospital resources and personal to faciliate the implementaion of selected process improvement initiatives.

In conclusion, there is no one right answer to your question other than that a mere reorganization without clear and well thought-out rationale, follow up and support by administration will not resolve your current problems.

CS Question: There is a discrepancy among our O.R. staff – some nurses feel it is not necessary to wash containers between uses. They believe it is ok to just remove the used filter from the containers and bring them back to the work room for reuse without washing. Their rationale is that the containers have no direct contact to the patient or soiled instruments. The remaining staff feels strongly that all used containers need to go through the washer whenever opened even when not used. Our director has asked me to obtain documentation including the reasons why we need to clean and rinse sterilization containers after they have been opened for a procedure. What is the correct process to follow?

CS Answer: As with any medical device you need to obtain the documentation and instructions relative to the care and use of your particular sterilization container from the manufacturer. We recommend the cleaning and inspection of sterilization containers and all components (baskets, trays, brackets etc) following each use. A neutral PH detergent must be used. The cleaning process may be accomplished by manual or mechanical means in accordance with established hospital policies and procedures and manufacturers instructions for use. Rationale: Thorough cleaning removes soil, lowers the bio burden, and prepares surfaces for intimate contact with sterilants which is essential to sterilization efficacy. Thorough cleaning requires the removal of all visible and invisible soils including organic matter, bio films, and personal body oils and secretions, which may be deposited on medical devices from routine handling. If not routinely cleaned and rinsed between each use it is possible for steam, detergent, and water residuals, to build up on containers causing stains and spotting, which could impede proper performance and or present a barrier to sterilant permeation and contact. Acid or Alkaline detergents are caustic and damaging to the finish on aluminum and metallic surfaces. Association for the Advancement of Medical Instrumentation AAMI ST46 2002 5.5.2.4 states: "Utensils - Soiled utensils such as basins, bed pans and trays, whether received from patient-care areas or surgical areas, should be processed through a mechanical washer, washer sanitizer, washer disinfector, or washer sterilizer. Also utensils may be washed by hand, although this is usually not cost effective. In either case, warm water and an appropriate detergent should be used for cleaning. Sterilization container systems should be disassembled and cleaned after each use in accordance with the manufacturer’s instructions." All soils and contaminants are not visible to the naked eye. There is no certainty to what open unused devices may have been exposed to in handling and transit. It is a standard of practice, in most CS departments, that any opened unused reprocessable goods returned to CS, including instruments and containers are considered soiled and must be cleaned prior to sterilization and reuse. The cleaning process and procedure is determined by each individual hospital. HPN