IP + SPD: Why shouldn’t we mark the twain?

Janet Pate, JD, MHA, R.N., Director, Environment of Care, Infection Prevention, University of Alabama Health Services Foundation, promotes the value of IP and SPD working together but laments the lack of a connection.

“Although there are many benefits from collaboration of infection preventionists and SPD professionals, often this relationship is never cultivated,” Pate told HPN. “Perhaps there is a general lack of understanding from both departments of how beneficial collaboration would be if it indeed did occur. Often, especially in large institutions, the IPs and the SPD professionals don’t even know each other or they may serve on a committee or team with each other but don’t have the opportunity to get to know each other on a personal or working relationship basis. The departments may be physically located in separate buildings or on the other side of the campus, hindering interactions between the two.”

Pate frequently lectures on behalf of Ruhof Corp. as an educator in the areas of sterile processing and infection prevention.

“It is easy to become focused on individual departments and it is often forgotten that if the synergistic approach is utilized, it would be beneficial to meet the overall goals of effective cleaning and sterilization of instruments and scopes for the institution,” she said.

Ed Gruhlke, Senior Professional Consultant, Professional Services Group, STERIS Corp., concurred that Infection Prevention’s overarching view may take precedence and be more prevalent. “Both functions are focused on patient care and quality of care,” he noted. “That said, more work could be done by IP and SPD staff to educate each other on how they achieve that goal. IP focuses broadly on the whole healthcare facility. The SPD is one element of their work.

Friction may exist between the two departments as well, observed Larry Slattery, Senior Consultant, Professional Services Group, STERIS Corp.

“The culture in many healthcare systems has promoted an environment of animosity between Infection Control and Sterile Processing,” he indicated. “For reasons unknown there seems to be a prevailing belief that Infection Control and Sterile Processing have inconsistent motives and different end goals.

“Healthcare systems often view Infection Control and Sterile Processing as separate entities with different responsibilities,” Slattery continued. “We know that strong collaboration, coordination and communication will help drive performance. Training and education is key – for both departments. Staff will better understand the ‘big picture’ if they understand how different departments can impact the same outcome or goal.”

“Often, Infection Control is not entirely familiar with the actual processing steps of the instrumentation,” Slattery continued. “They are aware of the requirements of the process outcomes and conditions within the physical processing area. Demonstration of the processes and understanding the requirements of the staff helps [them] to better understand the bigger picture.”

Administrative order can complicate communication and influence, according to Alice Brewer, MPH, CIC, Director, Clinical Affairs, Tru-D. But Brewer can see the mutual benefits when both collaborate in some way.

“Infection Prevention and Sterile Processing don’t traditionally work together because they usually report under different departments,” Brewer noted. “IP is usually under Nursing or Quality, and SPD is almost always under Surgical Services. IP rarely gets involved in what SPD does for the hospital, with the exception of checking that their processes around validation are appropriate and ready for regulatory inspection.”

Brewer acknowledges that increased collaboration between departments in hospitals would allow for more partnerships between IP and SPD, but she encouraged IP to be partnering with every department in the hospital to ensure a safe environment and high quality of patient care. 

Battling for priority

Anita Cassell, Director, Sterile Processing, Robert Wood Johnson University Hospital, questions whether access to appropriate resources may be slowing progress between the two areas working together. This can create a knowledge barrier about SPD functions that goes beyond simple awareness, she indicated. “IP and [the] C-suite know what SPD does but [may] not fully understand the complexity of our area,” she noted.

Cassell also believes a resource gap persists between nursing and support services in a hospital, which may play a key role. “I don’t necessarily think all SPDs are short-changed on resources due to being a support unit, but I do believe in many hospitals resources are more focused on nursing units with direct patient care,” she added.

IP may not fully understand SPD because they’ve rarely or never interacted with them or even stepped into the department, according to Tony Thurmond, CRCST, CIS, CHL, Manager, Central Services, The Christ Hospital, and 2019-2020 IAHCSMM President. He quickly posits that it’s not necessarily their intent. “It is just not in their daily or weekly focus to think about us,” he clarified. “Basically, they don’t lie awake at night wondering if everything in SPD is going good as they may with a high rate of flu patients in the hospital.”

At facilities where he has worked, IP may have access to generated reports that show sterilization loads, particularly failed loads and the pass/fail rate of sterilizer loads, but “unless there is an issue or a finding there is no further discussion,” he said.

Thurmond notices the difference and sees the value when IP and SPD actually do work together.

“I will say that if there is an issue or a surgical patient develops a [surgical site infection], IP is contacted, and we participate by tracking the trays used, and tracking the sterilization process of those trays to assure they were sterilized properly,” Thurmond said. “We have worked together with IP, OR and surgeons to track those cases and seek to identify commonalities [to determine] a root cause. We were an integral part of that effort. I truly feel a big part of [the] team when called upon.”  

Marcia Frieze, CEO, Case Medical, recognizes the broader and wider scope and span of IP pros and cuts them some slack. She lauds SPD pros for being dedicated to their complex specialty.

“The Infection Prevention function has such a broad mandate — preventing infections of all types across all environments within the healthcare facility or multiple facilities — that their attention is naturally divided,” Frieze told Healthcare Purchasing News. “On the other hand, the Sterile Processing department is a group of specialists immersed in a complex and dynamic system day in and day out. The difficulty is aligning priorities and the timing to come together and collaborate.

“Ideally, the departments would be aligned by a common reporting structure with aligned objectives and improvement projects,” Frieze continued. “From a practical standpoint, a reliable and sustainable first step is to establish a formal cadence of communication between the two departments. Such an open channel will provide two major benefits: It will serve as an early warning system for potential issues and it is an opportunity to identify intersecting initiatives where working together may save effort or enhance outcomes, helping both departments meet their goals.”

Playing matchmaker

In any kind of nascent relationship or budding partnership, who makes the first move can make a difference, particularly with two groups immersed in the science of biology, chemistry, microbiology, bacteriology and virology. Should IP approach SPD or vice versa? Opinions remain mixed.

“SPD should spark the relationship with IP professionals since the IP professionals tend to shy away from the SPD department and may continue to avoid the relationship,” insisted Healthmark’s Rojo. “You will find the IP professionals are very willing to learn about the SPD arena and not only build a relationship with the SPD professional but also continue to maintain it as well.”

Case Medical’s Frieze maintains an optimistically open mind.

“Yes, yes, and yes some more,” Frieze responded to the key question of approach. “SPD should approach Infection Prevention. Infection Prevention should approach SPD. And any and all healthcare executives should approach both departments the value of cross-function collaboration at the leadership support that they will be happy to provide. Leadership support is critical to any long-term initiative to help sustain and protect the time allocated for these activities.”

Much depends on communication, according to Tru-D’s Brewer who feels almost equally as sanguine.

“Hospitals vary on communication styles between sterile professing and infection prevention. The bottom line is that a two-way relationship is critical for success. In addition, the environmental services team should always feel valued,” she noted.

Robert Wood Johnson University Hospital’s Cassell encourages SPD to break the ice right away.

“Speaking for myself, I think if you do not have the connection already in your SPD it is important to reach out and connect,” she said. “Sometimes it may be viewed as you didn’t need help or support if you never brought it up or reached out. And again, people don’t know what they don’t know, so Infection Prevention may have never thought they were needed in your area. Now that SPD is more in the forefront of things with [The Joint Commission] and CMS it is finally being looked at by Infection Preventionists as a vital department.”

STERIS’ Gruhlke recommends any proposed partnership between the two areas should originate from the SPD leadership.

“IP has so many responsibilities throughout the hospital that they could easily overlook SPD,” he said. “Also, developing the relationship will be beneficial to both areas in that when developing new policy and procedures, having everyone on board will only help in ensuring any required regulatory standards from both SPD and IP agencies are included.”

Extending hands need not be mutually exclusive, according to STERIS’ Slattery.

“Sterile Processing need not wait for others to make the first move toward reconciliation,” he advised. “Nor should Infection Control. But things will move forward more quickly if someone takes that first step. So, regardless of the group you are in, make that first step. Infection Control and Sterile Processing are much stronger and more effective when allied than when contrary.”

The Christ Hospital’s Thurmond likens this issue to a scenario that may be familiar with some.

“The situation feels like the shy boy and the shy girl at a school dance,” he observed. “Neither wants to make the first move, but when it happens, there is so much more to explore. It could be initiated by either party. I have invited our IP group to come and visit and spend a day or half of a day with us. They were more than willing, and it was an eye-opening experience for them. Although they interact with the whole facility, they refer to Sterile Processing as the professionals in sterilization and high-level disinfection and have relied upon us to help build processes and train departments who handle instrumentation.

“We have worked together to build policies and practices for clinics, floors and other areas of need,” Thurmond continued. “While demonstrating the process of receiving, cleaning, inspecting and prepping a robotic instrument, they were amazed that our technicians knew each step and could explain the process and what to look for as possible patient safety issues. So, likewise, we have to be open to having an outsider coming into our department and offering suggestions based upon their knowledge. Another set of eyes is never a bad thing and can often give suggestions or areas of improvement.”

UAB’s Pate approaches it from the other side. “Infection Prevention should initiate a working relationship/partnership with SPD,” she insisted. “The SPD professionals may not feel comfortable with initiating this relationship. Some of the Infection Preventionists may be viewed as upper-level management, and there may not be a comfort level with the SPD professionals to take on the responsibility for this relationship. It may be difficult to schedule a meeting, or they may not even know with whom to schedule the meeting. Compliance with infection prevention regulatory standards falls under the responsibility of the Infection Prevention department. The department should make an opportunity to collaborate with SPD. As they work together, setting goals and developing/implementing processes that will meet the standards, ultimately patient safety is increased.”

Sharing the wealth

One of the benefits of an active, working partnership is that each side educates and learns from the other. SPD learns from IP; IP learns from SPD. From that mutual sharing, patient care quality theoretically should increase.

Specifically, how and what does either grow?

“SPD professionals can benefit from IP professionals’ expertise in numerous areas of SPD,” said Healthmark’s Rojo. “One of them is soiled and clean transport where the IP professional can help with compliance of the end-user for pre-treatment of soiled instrumentation in the surgical department, in-house clinic and off-site clinics and nursing floors. IP professionals can benefit from the SPD expertise in the areas of sterilization, sterile storage and endoscopy processes if applicable in your SPD department.”

Case Medical’s Frieze concurs.

“The staff in SPD has experience with the hands-on processes critical to effective instrument reprocessing,” she noted. “They also observe challenges with new employee training, process steps where staff are more prone to errors, workflow bottlenecks and inefficiencies, and so much more. They can be a source of quality control and risk identification to collaborate with the Infection Prevention group to source new equipment, redesign a workflow, or standardize a process to remove the opportunity for human error.

“The specialized technical and scientific knowledge of the Infection Preventionist and their position within the organization allows them to approach challenge with a view to the systems operating within a facility,” Frieze continued. “Working across departments and environments allows best practices in one area to be replicated in other areas. A five-minute standup meeting at the beginning of each shift or a creative problem-solving approach can be transferred to multiple teams when you have a ‘connecter’ keeping their finger on the pulse of the organization.”

Tru-D’s Brewer assigns SPD an important role that befits their responsibilities of cleaning, prepping, processing, storing and issuing medical/surgical supplies and equipment for patient care in patient rooms and operating rooms and can gain much knowledge from infection preventionists for enhanced strategies.

“Sterile processing is the first link in the infection prevention chain,” she said. “Improperly or inadequately cleaned, disinfected and sterilized instruments can introduce pathogens into the operating room, increasing the risk of a patient getting a surgical-site infection (SSI).”

United front, voice

Robert Wood Johnson University’s Cassell sees value in SPD and IP collaborating for a common cause.

“SPD can benefit from having the backing of Infection Preventionists when it comes to push back from the operating room or other units that may be wanting you to do something that you know is not quite right but keeps pushing back,” she noted. “They can help with the regulatory aspect of processes and communicating that to surgeons and other hospital staff that also do not have knowledge of SPD’s vital role.”

That’s why it’s critical for SPD to build a relationship with IP so that either sees the other as experts in their areas. “Once the relationship is established they may now reach out to you for questions regarding surgical patients who have presented with an infection to discuss if loaner trays were used or any [immediate-use steam sterilization] on that particular case,” Cassell continued. “They may even reach out when they are on the nursing units to get your expertise on storage of instruments or peel packs. Infection Preventionists can help be the voice you need if you feel no one is listening.”

Cassell believes that managers and directors in all facilities should be raising awareness by holding educational forums, attending meetings and committees – especially Infection Prevention committee meetings, doing quality abstracts and newsletters and reporting out at monthly operating room committee meetings.

SPD and IP could collaborate in a number of key areas, according to The Christ Hospital’s Thurmond, including policy writing, capital equipment planning, workflow design and an overall understanding of the effects their interactions have on patient safety.

STERIS’ Gruhlke agrees with Thurmond, citing cooperation with policy and procedure writing, communication with senior leaders when required regulatory agencies mandate manufacturers’ IFUs as well as SPD familiarity and compliance with the IFUs. STERIS’ Slattery cites a “shared knowledge of patient safety requirements throughout the surgical patient’s hospital cycle” as one benefit. “Infection Control can benefit from understanding the actual processes required to return used surgical instruments to surgical-ready condition,” he added.

UAB’s Pate stresses that when IP and SPD collaborate, head knowledge translates to hands-on experiences.

“The Infection Preventionists have an extreme amount of knowledge related to bacteria, the chain of infection, ways to prevent the spread of infection and regulatory standards,” she said. “Although they have this immense amount of knowledge, they may not have the personal ‘hands-on’ work experience and knowledge of the SPD processes of cleaning, disinfection and sterilization. Working with SPD, they could actually see how processing is done and be able to quickly identify how their expertise could be beneficial to the department.”

But that’s not all as the relationship broadens and deepens.

“In the last several years, regulatory agencies have trained their professionals in topics related to infection prevention, therefore, standard compliance is monitored much closer,” Pate continued. “With outbreaks of infections and the spread of pathogens through cross contamination, hospitals and healthcare organizations have an increased awareness of the urgency for standard compliance. The SPD professionals could significantly increase their knowledge of the ‘why’ it is so important to follow the guidelines and standards, and the potential adverse outcomes if they are not followed. The Infection Preventionists could provide expertise and support to the SPD.  

“The SPD professionals have excessive knowledge [involving] the processes and standards related to cleaning, disinfection and sterilization,” Pate said. “Their knowledge and expertise in pre-cleaning and cleaning instruments is invaluable. SPD professionals are highly trained and may be certified in their jobs, and have extreme knowledge regarding recordkeeping and technical information with the equipment. They are familiar with new products and processes related to cleaning, disinfection, and sterilization.”

Essentially, when each shares their expertise with the other, process effectiveness and compliance increases, according to Pate.