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KSR Publishing, Inc.
Copyright © 2016

         Clinical intelligence for supply chain leadership



May 2012

CS Solutions



Questions can be sent to:jakridge@hpnonline.com
called in to Jeannie Akridge at HPN:(941) 927-9345 ext.202 or mailed to:
HPN CS Questions, 2477 Stickney Point Road, Suite 315B, Sarasota, FL 34231
Names and hospital identification will be withheld upon request.

Ray Taurasi

SPD performance standards; maximum instruments in washer basket; stacking sterile items

by Ray Taurasi

Q I am an RN Infection Control Practitioner at a large teaching hospital. I have a friend who works in the Sterile Processing Department that is being reprimanded and disciplined for being "too slow", however he always has his work done by the end of his shift and there has never been a delayed case in surgery due to him. While he has been told he is too slow, the manager can’t provide him with a time frame to work with. Are there benchmarks for how long it should take from the time a case is brought to CS until it is cleaned, sterilized and done? It seems to me that accuracy is more important than rushing through the sterilization process. Is there anything he can use as a tool to try to move "faster" or provide to the manager that this work is not measurable? Are there any guidelines out there that would help him win his grievance on this? Your help with this is appreciated.

A You are absolutely correct. Accuracy in the reprocessing and sterilization of medical devices is a process that cannot be rushed. Each and every step must be precisely performed in accordance with procedures. Haste and carelessness can lead to adverse outcomes causing harm to patients. It is the responsibility of management to determine realistic performance standards and work volume expectations for the various work tasks performed in the sterile processing department. Workers in turn need to understand and know what is expected of them in order to complete their job correctly and to meet the established work standards. Your friend cannot develop this on his own but he can ask his manager to provide him with more specifics and detail on his performance as it relates to management expectations. It is irresponsible for a manager not to have a handle on performance measurement in relation to work volume and quality outcomes. This information is critical in order to project staffing needs, plan scheduling, obtain and allocate resources effectively.

There are many commercial software tracking programs on the market today that can be used to determine QA standards, work volume outputs, and production standards. Once in place these programs can also monitor individual performance in relation to the established standards and peer performance. Managers can also develop their own standard and measure expectation by conducting real work motion time studies for various job tasks. To do this, usually a sampling of employees on each shift are observed and a stop watch is used to track the time it takes to complete a job task (it’s important to include workers at various experience levels in the sample). An average of their times for each task would be set as the baseline expectation. Most large academic institutions have a QA department which can often provide the expertise and resources to assist department managers in developing work measurement standards. They may even have an industrial engineer (IE) on staff who can conduct a work study analysis and provide some work simplification suggestions that could improve work methods, and distribution. The Association for the Advancement of Medical Instrumentation (AAMI) offers a web-based program designed to help sterile processing departments measure their practices, policies, and resources against others—the program is called Sterile Processing Benchmarks (SPB). In May 2012 the program will be upgraded to include a powerful new productivity component to help departments assess staffing needs and productivity levels. In addition to productivity analysis the new feature will also include error rate measurement tools. For more information, visit www.aami.org/spb.

Q One of my colleagues works at another hospital and said they were recently told by a JC inspector that no more than 50 instruments should be placed in a washer basket at any time. I have never heard of this before; is this some sort of a new standard? We could never get all our sets washed if this was true.

Figure 1

Figure 2

A  I am not aware of any standard or recommendation that specifies the maximum number of instruments that can be placed in a washer basket. What’s important is that instruments must all be placed in the basket in a manner that will allow all surfaces, crevices, and parts to be fully exposed to the water spray and mechanical action. Improperly positioned instruments and over loaded baskets cannot be cleaned effectively. (see figure 1) Instruments should be held opened in a manner that will permit contact with the cleaning agents. Items like instrument stringers, special racks, and spreaders to help facilitate proper positioning throughout the wash cycle should be used. (see figure 2).

Q I am the manager of Processed Stores and Distribution. Like many hospitals we are dealing with a growing inventory and running out of adequate storage space. The CSP manager insists that no surgical trays or sterile packages (including containers) be stacked beyond two high – she claims that this is a requirement. I have searched various sources and documents and I cannot find anything stating sterile items cannot be stacked beyond two items. Do you know of any such regulation?

Figure 3

A  The recommendations from professional entities like AAMI and AORN do address sterile storage issues, however neither state a maximum number of sterile items that should be stacked. Care must be given to prevent compression of sterile packages as excessive weight could be damaging to sterile packaging or to the contents of sterile packages. When packages are compressed air is sucked in and out of the package. As this occurs outer contaminants on the outside of the sterile packaging could be transferred into the sterile package causing contamination. This may not be a problem when lighter weight packages are stacked. Rigid sterilization containers are not subjected to compression and should be able to be stacked (in accordance with manufacturer’s IFU). There are many different wrapping materials and products on the market today. It is important that you check with the specific packaging manufacturer for their instructions for use (IFU). There are some that very well may have specific weight and stacking limits based on the product’s barrier pressure limits. Many facilities have found that readjusting spacing between shelves, utilizing covered totes, sliding shelves and high density shelving units have provided a viable solution to sterile storage challenges.

Ray Taurasi is Eastern Regional Director of Clinical Sales and Services for Healthmark Industries. His healthcare career spans over three decades as an Administrator, Educator, Technologist and Consultant. He is a member of AORN, AHA, SGNA, AAMI and a past president of IAHCSMM and has served on and contributed to many national committees with a myriad of professional organizations, manufacturers, corporations and prestigious healthcare networks. Taurasi has been a faculty member of numerous colleges teaching in the divisions of business administration and health sciences. In addition to this column he has authored several articles and has been a featured speaker on the international scene.