Common Mistakes in the SPD: Part 1

Q: "I have a fun question for you: What are the 10 most common mistakes that you see in Sterile Processing Departments today?"

A:

I 100% agree! This will be a fun question!

Let me channel my inner David Letterman [the author has aged himself with this reference] and start running through these.

Honorable Mention – Adhesive Removers

My co-worker, Malinda Elammari, would be proud that I am including this one here. While we were auditing a department together, she pointed out the single-use adhesive remover pads in the department drawers and how most of them are not meant for surgical instrumentation.

Just about every department has these somewhere in their drawers. Check your adhesive remover pads and check for the words “For use on human skin.” That’s a red flag; they shouldn’t be in there.

#10 – Personal Protective Equipment (PPE)

I remember an old co-worker of mine telling me about when he started in the sterile processing department in the 1970s. Back in those days (around the same time standard precautions were coming into common healthcare practice), he would decontaminate instruments with just an apron and gloves. No, that’s not a typo—they would decontaminate bloody surgical tools in an apron.

Flash forward to 2025, and we have a greater understanding of pathogens, how they spread, and the science behind why we need to wear personal protective equipment. And yet, it’s a common occurrence for me to walk into a department’s decontamination area and see modern-day technicians wearing no mask or the mask tucked under their chin while their face shield is pushed up over their head like a welding helmet in the up position.

There are excuses for this . . . and I have heard them all!

• “The shield is fogging up.”
• “The mask makes it hard to breathe.”
• “I just pulled it down to talk to a co-worker.”

Excuses, excuses! Personal protective equipment (PPE) is for our own protection.

Microorganisms are microscopic, and you never know when tiny droplets may make their way into your unprotected mouth or nose. Wear your PPE. Full stop.

#9 – Poor Onboarding

One of my favorite parts of traveling the country and observing sterile processing practices is getting to meet the people who make up our unique and fascinating industry. One thing that most of us share is that we didn’t receive enough initial training to work in such a complex position.

Today’s sterile processing environment requires extensive scientific and technical expertise. In Europe, they call this profession the “Sterilization Sciences.” We aren’t glorified dishwashers, and we aren’t just throwing instruments into trays and shoving them in a magic sterilization box. We use complicated technology like a) the automatic endoscope reprocessor (AER), b) computer tracking systems, c) borescopes, d) insulation testers (foreshadowing), and e) AI. That means we can’t shortchange the training process.

Twenty years ago, I received one month of formal training before I was left alone on the night shift of my first sterile processing job. And to be honest, I have seen worse in 2025, which is a shame.

#8 – Insulation Testing

What a talented writer I am, foreshadowing the insulation testing issue and then bringing it back two paragraphs later.

Things have improved in the 20 years that I’ve been in the industry. Most technicians I talk to can speak to the Association for the Advancement of Medical Instrumentation (AAMI) standards and know they are supposed to be testing laparoscopic instruments. Still, most departments are sharing a single insulation tester for a department with dozens of workstations, and many of them don’t realize “insulated instruments” refers to any instrument (e.g., insulated bipolar forceps, LEEP vaginal speculums, and insulated cables and cords) that has insulation.

#7 – Sterile Storage

Sterile storage encompasses about one-third of our job in sterile processing. Of course, decontamination and inspection/assembly are hugely important, but how about some love for the sterile storage area?

A large percentage of departments overlook their sterile storage. Let’s be clear: if you have problems here, you’re essentially undoing all the good work you’re doing in decon and inspection.

Stacking heavy rigid containers on top of lighter wrapped items is a common mistake, as is overstuffing peel pouch bins. Speaking of those pouch bins, when was the last time you cleaned them out? I’ve seen full-on dust clouds bursting out of those bins at times.

Another dangerous one is heavy trays on the highest shelf, about 6 feet off the ground (or the bottom shelf). Ergonomics is an important employee safety issue, and the heaviest trays should be on the middle shelves for easy access.

I’ve also seen plenty of storage racks too short for the trays they’re holding, which leads to sets hanging 4−6 inches off the end of the shelf. This makes it very easy to bang into them as staff walk past and damage the sterile barrier, as well as damage the employee’s arm, hip, or knee.

Stock rotation is a concern. Hanging peel pouches, punching holes in pouches, vendor trays stacked 6−8 high, etc. (Note to self: I should probably write a full article on sterile storage at some point because there is a litany of issues with it.)

#6 – Brushes on the Clean Side

My article in HPN¹ from a few months ago touched on this. I told a story about an outside consultant, who claimed that brushes on the clean side were fine . . . which brings up two points.

1. No, it’s not acceptable. What are brushes used for? Cleaning. They aren’t for “checking” or “verification of cleaning.” When you use a brush to brush your teeth, you’re not “checking” your teeth. You’re not verifying that they’re clean. You’re cleaning them. Brushes are used for cleaning. They are cleaning implements. They should only be used in the cleaning area for the purpose of cleaning.
2. This is clearly a pet peeve and a major trigger for me. I will need to take a 15-minute break, do some breathing exercises, watch a kitten and a monkey being friends on the Internet, and come back to this article.

Next month, we will explore the last half of the Top 10 Common Mistakes in the SPD in part 2. I have seen a great many things, and you won’t want to miss it!

References:

1. Okada, A. (June 24, 2025). "Brushes on the Clean Side." Healthcare Purchasing News (HPN). https://www.hpnonline.com/sterile-processing/article/55292856/brushes-on-the-clean-side