People & Opinions

A patient’s eye view
Sterile processing consultant sees his profession from a patient’s perspective

by Terry Jackson, professional consultant, STERIS Corporation

I am writing this article after undergoing emergency open-heart surgery. This is not to spotlight my procedure, but to provide the customer’s perspective – and my professional viewpoint – on the sterile processing of surgical instruments. As healthcare professionals we should be aware of this issue from the patient’s vantage point as well as our professional one

A patient’s point of view

Healthcare providers may view me as a paranoiac patient; someone who knows too much about the methods used to sterilize surgical instruments. Now that I found myself facing my own life-or-death situation, I felt that I didn’t know enough about these processes.

Ironically, I started my career as an intensive care nurse working with post-op open-heart patients. My career eventually shifted from nursing into sterile processing. During my years as a central services (also known as sterile processing department or SPD) technician and manager, I worked with the understanding that every instrument, tray and piece of equipment was in some way connected to a patient’s life. If these items weren’t processed properly, patient care could be compromised. For this reason, the thought of how the instruments would be processed for my own procedure became my primary focus, rather than all of the many other things that could happen to me during the surgery. I was anxious even though my surgery was performed in a healthcare institution where I personally knew the manager of the sterile processing department and knew that the SPD staff followed all cleaning and sterilization procedures and protocols properly.
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SPD Fact #1
Processes differ from hospital to hospital and system to system based in large part on the background of the management teams and what they believe to be the best practice for their patients. However, hospital administrators are also subject to infection control and Federal Drug Administration regulations, and to guidelines established by the Association for the Advancement of Medical Instrumentation (AAMI).
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Still, I had concerns. No one can be watching 24 hours a day, seven days a week to ensure that proper procedures are followed. My hope was that the technicians had correctly sterilized the instruments to be used during my surgery. I was – and still am – certain that no healthcare professional would willfully do anything to compromise a patient. But I also thought to myself, ‘I know how people are and how they work. We try to put forth our best effort each day, but is "our best" enough when it comes to following procedures and assuring patient safety?’

After saying good-bye to my wife and family, I was wheeled down the hall to the operating room. As I entered the room, I passed the table on which the technician had arranged the instruments for the surgeon. I recognized each piece and I had a working knowledge of how they were going to be used. I still could not help but wonder whether or not these instruments had been thoroughly processed, but at the same time tried to convince myself that there were more important matters to worry about at this stage of the game. I should have been thinking about my family or the skillfulness of the surgeon performing the operation. _______________________________

SPD Fact #2
Terminal sterilization of surgical instruments generally takes three to four hours to complete, and begins with a thorough inspection of each item. The next step is to manually clean all dried fluids, blood, and tissues from the instruments. Cleaning continues with a soaking of all instruments – fully submerged — in an enzymatic bath for about 10 minutes. The instruments are then placed in an automated washer and washed at a high temperature. The final step is steam sterilization, also referred to as autoclaving. All viruses, including HIV, are inactivated by proper steam sterilization.
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During my sterile processing career, colleagues have asked me all sorts of questions about instrumentation, such as whether or not the instruments were clean, or whether a full tray of instruments was ready for each procedure. Nurses, technicians and managers would ask me to examine the trays, and make certain that instruments were ready for use during surgery. I even had one surgeon come to the SPD to examine a tray that was going to be used when he underwent surgery himself the next morning!

Patients are not the only people with high expectations. The surgical teams want everything to be perfect as well, with no surprises. It isn’t that they don’t trust the people doing the processing, but rather that they are looking out for their patients. I always assured them that everything would be taken care of, but at the time, I resented the fact that they questioned our processes and didn’t understand our role as a key part of the surgical function.

So why did I, as the patient, find myself questioning the very procedures that I resented being questioned about as a sterile processing professional? I had no choice but to believe that the staff had properly prepared and sterilized the instruments for my surgery. I came to grips with the fact that I needed to trust these people and trust their skills.
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SPD Fact #3
Most healthcare professionals and their patients take for granted that instruments used during surgical procedures have been properly sterilized. However, due to the complexity of the process, there are many factors that can impact a sterile processing department’s effectiveness and efficiency. These include whether or not they have appropriate instrument inventory, adequate training for sterile processing staff, automated equipment with the proper capacity to handle the hospital’s volume, proper staffing during peak processing hours, and appropriate workflow within the department. These are variables that can be adjusted for maximum productivity and patient safety.
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Sterile instruments are a product

Should we as consumers question everything we purchase, or ask for the name of the person who worked on a particular product? If so, then why do we not question the technicians who built the vehicle we get into every day, or ask the mechanic of the plane in which we are flying for his or her qualifications? We trust that certain manufacturers and companies will provide reliable, high quality products because they use a quality-focused manufacturing process.

If you go to McDonald’s on the east or west coast, you know the hamburger is going to taste the same. If you get into a Ford, Chevy, or Dodge vehicle, you know reasonably well how it will perform. We expect quality from these products and we usually get it.

Why can’t the healthcare industry produce "finished products" in the same manner as manufacturers do? The objective isn’t to compare healthcare with these other types of products as if they are equivalent - healthcare professionals face life or death situations every day and work with human life, not hamburgers. However, there are some similarities between healthcare-related functions and consumer products.

As a consumer going into the hospital unexpectedly, I wanted to have the best products and care no matter what needed to be done to save my life. I didn’t care if there were staffing problems, budget cuts, or equipment malfunctions. All I wanted was to have a successful procedure, get well, and go home. The physician, nurse and technicians needed to have all of the tools required for my procedure, and those tools needed to be 100 percent sterile, 100 percent complete, and 100 percent on time to the operating room. I wanted no questions, no excuses and no delays. Everything needed to be seamless and work like a factory production line.

Needless to say, I had a successful procedure, I got well, and I went home. But after my recent experience, I believed more than ever that sterile processing professionals benefit when they look at their functions as a type of manufacturing process and focus on product and process quality. This idea may not sit well with some healthcare providers, since most of us are nurses with years of experience in patient care and we share the belief that patients cannot be viewed as merely a product or a consumer.

Quality control

Here is food for thought, however: is the sterile processing function any less important than the function of the technician who makes certain that an airplane’s landing gear is working properly? Is there really any difference between the technician who assembles the bypass pump used during surgery and the technician who assembles the brakes on an automobile? These manufacturing jobs, if not done properly, can harm people. They follow specific rules, regulations and standards that cannot be compromised, and are based upon years of manufacturing know-how. Furthermore, manufacturers control and monitor every step in a process, which in turn controls the variables that can impact the quality of the final product.

The instrument processing profession must look beyond the way things have always been done to impact positive change. Sterile processing technicians are highly trained individuals working with very sophisticated equipment in a demanding and stressful job. We need to examine our procedures and protocols, and determine the quality of the product – yes, product — that we want to manufacture every day. We never want to forget that the surgeons, nurses and patients are our customers. Our most important products are the sterile items we produce every day, whether they are a single instrument or a complex cardiac tray. Each item should be handled as if it is the only item being processed that day.

I firmly believe a factory/manufacturing model works well within the framework of the sterile processing function. You and I should be able to enter any healthcare institution as a patient and have the same assurance that our quality of care will not be compromised due to missing instrumentation or an inefficient or incomplete process. We should be able to trust in the fact that every practice, procedure and protocol will be followed to perfection. A manufacturing approach to managing the SPD can help assure the integrity of every hospital’s process, and I expect more healthcare systems to participate in this approach as they are required to report infection rate data and be even more accountable for their outcomes. HPN

About the Author

Terrence Jackson serves as a professional service consultant for SterilTek Inc., a wholly owned professional services subsidiary of STERIS Corporation. SterilTek provides sterile processing workflow and growth solutions to healthcare providers. Jackson has over 30 years of healthcare experience. He began his career in healthcare as a licensed practical nurse working in intensive care, orthopedics and pediatrics. For 20 years, however, his focus has been in the sterile processing area. Jackson has managed the central services departments at two Level One trauma centers and holds certifications in central service as a technician and as a manager. Jackson has published several papers on central service and earned his Fellowship in May 2004. Jackson has served as the chairman of an integral committee of the International Association of Healthcare Central Service Materiel Management (IAHCSMM), and is active in his local chapter.