Room for error in CS?
Mixing packages
with Ray Taurasi

Answer: Working in a service entity isn’t an easy job and not everyone is cut out for the work. Users of any service do expect excellent customer service. There can be many challenges to meeting these expectations and keeping customers happy. The work produced by CS is critical and impacts directly on patient care or the clinicians’ ability to provide quality care. Errors or even delays in service can pose a real risk to a patient’s safety and welfare. Adverse affects of inferior services or defects can range from minor inconveniences to patient injury, infection or even death. CS work requires a lot of precise detail, expertise, and technical knowledge; there are many demands and the associated work stress can be significant. I know at times the hard work seems to go unnoticed and I understand how the CS practitioner may feel isolated, under-appreciated or at times beaten upon as a result of negative feedback. It is therefore essential that service workers have what I refer to as a "service mentality" and an understanding of the nature of a service-related occupation. I think at times it helps to stop and think how we react to services we might utilize outside of the hospital setting such as a dry cleaner – when you use such services you expect certain results. For instance if the cleaner advertises "same day service—in by 9:00, ready by 3:00" and you bring your suit at 9:00 you expect it to be ready by 3:00, clean, stain-free and all in tact. If you arrive at 3:00 to pick up your suit and they can’t find it, if it’s not ready, or you bring it home and find it’s missing a button, the hem is down or it has a stain, how might you react? Chances are you would be quite disturbed and in some instances you might even become loud and offensive as a result of your expectations not being met, even though no one is going to get hurt nor is anyone’s life at stake – unlike what could happen when an error occurs in the processing of critical medical devices and surgical instruments. I understand that as long as the human element is involved that it is possible that a proficiency rate of 100% will not always be achieved. However in the healthcare field patients entrust us with their safety and welfare. The principles of sterile processing are specific and the associated procedures require precision. Service excellence must be the goal and zero defects the target objective. Establishing or accepting any lower performance standard sets the stage for complacency. Errors and deficiencies should be investigated, monitored and be a focal point for process improvement initiatives. It is very important for the CS team to take pride in their work and to recognize, appreciate and support each other. As a team we need to celebrate our successes and understand that on those rare occasions when we get unsolicited positive feedback from a customer it’s the icing on the cake. Our customers, the patient care providers, are dependent on our services and considering the critical nature of those services and their impact on patient care excellence is the expectation. I once saw the following thought-provoking passage posted in a CS department:

If 99.9% was acceptable we could expect the following results:

• 500 incorrect surgeries would be performed weekly

• 20,000 incorrect prescriptions would be filled yearly

• There would be two unsafe landings at O’Hare airport daily

• There would be 16,000 pieces of mail lost per hour

• 19,000 new born babies would be dropped at birth yearly

• 22,000 checks would wrongly be deducted per hour

• Your heart would fail to beat 32,000 times per year

Question: We currently are wrapping all of our surgical instrument sets but will begin introducing sterilization containers into CSP at the start of the new fiscal year in January. It will probably be a few years before we totally have all our sets containerized so until that happens we will have a mix of packaging methods and materials. I was wondering if there were restrictions regarding the mixing of items packaged in peel pouches, linen and non-woven disposable wraps with those packaged in containers in the same sterilization load?

Answer: Containers can be sterilized safely in the same load with other supplies, which are packaged in peel pouches, or linen and non-woven wraps assuming they require a common exposure and sterilization cycle. When mixing such loads container systems should be placed on shelves below items packaged in absorbent packaging materials such as linen, peel pouches and non-woven disposable wraps. For more information see reference document AAMI ST 33. It is also important that you obtain technical data, validation documentation and copies of FDA 510k from the manufacturers of all the packaging materials and systems you utilize. Packaging materials including sterilization containers are class II medical devices and must have FDA clearance for marketing. As a user of medical devices it is imperative that you adhere to manufacturers’ instructions for use and application. HPN

Ray Taurasi is Director of Professional Services for Case Medical Inc. Ridgefield, New Jersey.