Top 10 Common Mistakes in the SPD, Part 2

Q: I have a fun question for you: What are the 10 most common mistakes that you see in sterile processing departments today?

A:

Last month in Part 1¹, we had a cliffhanger ending at common mistake #6!

So, where was I? Ah, yes, the IFU issue!

#5 – Instructions for Use (IFU)

Since I started consulting on facility practices (in nearly every facility I have ever been to), the  conversations that occur (with their obvious nuances) have always been essentially the same.

For this play, I will assume the role of Adam while filling in the gaps in the conversation with what I imagine as the internal monologue (or otherwise a terrible case of mistaken identity).

Adam: “How do you access your IFU?”

Tech: “We have them online.”

Adam: “Fantastic! Can you show me the IFU for this shaver?”

Adam points at a shaver on the workstation. The tech looks at Adam in panic. They suddenly realize that they haven’t accessed the online database in years, and they don’t remember how to use it.

Tech (hesitantly): “Um. Suuurrre.”

There is an awkward silence of about 5 minutes (some stalling and changing the subject) while the tech hopes that Adam will forget about asking them for the actual IFU.

After delaying, asking for login information, and trying to navigate a complicated sequence of steps in the database, the tech will eventually show Adam the correct IFU.

The moral of this story is: You may have an online database for your IFU, but can you access it?

#4 – Peel Pouching

This is my second Malinda Elammari reference in this two-part article. Malinda (an international success on the topic of packaging) is known as the “Packaging Princess.” She is one of the industry's foremost experts on sterile barriers, focusing on issues related to peel pouches.

There are numerous modern-day SPD locations we could go to, but let’s start with the heat sealer. If you have a “bar” heat sealer, did you know that the bar needs to be rotated? Many departments are not aware of this, but, eventually, they will notice gaps or breaks in their seals due to burns from being sealed in the same spot repeatedly over years.

Which brings me to self-seal pouches. Most of the better-quality pouches on the market have a dotted line denoting the section that should be folded over to create a seal directly over the opening at the top of the pouch, thereby creating an airtight seal after sterilization. This is what makes it an effective sterile barrier; however, I’ve seen much variation here.

I see low-quality (read: cheap) pouches that don’t have a line, which makes us guess as to where the fold should go, or techs go too quickly during the folding process and seal off-center or leave big gaps in the seal. Regardless of the issue, if there is a gap in the seal, you will not have a sterile barrier. I guess a better name would be that your device is not in an unsterile, loose, open bag. But that name doesn’t have a great ring to it, especially to a surveyor.

#3 – Shavers

On the main stage at the 2025 HSPA conference in Louisville, Ky., Cori Ofstead spoke about the dangers of shavers, their complexity, and how difficult (nigh impossible) they can be to clean properly.² Even following the cleaning IFU to the letter often doesn’t produce a clean device.

Last year, at the 2024 HSPA conference in Las Vegas, Ofstead spoke about—um—the dangers of shavers, their complexity, and how difficult (nigh impossible) they can be to clean properly.³

Noticing a theme yet?

Healthmark’s “Ask the Educator Podcast”⁴ has done almost a half-dozen podcasts on the dangers of shavers going back to the very first episodes in 2020.

These devices are complex, difficult to clean, and most departments are woefully unaware of how dangerous they can be. So spread the word to everyone in the industry that you see!

Look at your shavers. Inspect them with a borescope. Take pictures and videos of the nasty stuff that’s stuck inside and send them to me. I have a rapidly growing collection.

#2 – Policies and Competencies

And the silver medal goes to—it’s a tie!

Yes, I am cheating here and including two subjects for the price of one, but these two often go together at departments that find themselves in hot water with surveyors.

Policies

Let’s start with policies. Surveyors survey according to regulations, standards, best practices, and other documents, but they are primarily surveying the facility’s own policies. This is like taking an open-book test. We write our own policies, and we can write them so that we are in compliance with them. But it rarely works out that way.

I’ve seen a lot of old, dusty, out-of-date policies with strange references from bygone eras in them. This is usually the first place I point to for a new manager, director, supervisor, educator, or whoever is in charge of reviewing policies to start. Check the policies to see if the references are current and applicable to your actual practices.

Competencies

The story with competencies is similar, which is why I included them together.

At the end of a survey, surveyors want to see the competency documentation for the staff they spoke with. Sometimes, those competencies either can’t be found, haven’t received an annual update (with a job title change), or never existed in the first place.

Moral of the story: If you’re looking for a life hack on dealing with surveyors, start with your policies and competencies.

Trust me, I’ve learned this lesson the hard way.

#1 – Manual Cleaning

So, I guess manual cleaning, being the gold medal winner, number one issue on this list, is the grand champion of sterile processing problems? Congratulations!?

Joking aside, manual cleaning is probably our longest-standing issue in sterile processing and one that nullifies any work done after manual cleaning.

Do you remember the phrase, “If it’s not clean, it can’t be sterile?”

• Dirty Trays in Ultrasonic: I still see technicians receiving trays from the OR and placing them directly into an ultrasonic.
  • The ultrasonic can’t be as effective if there are blood, soil, tissue, and other debris in the chamber.
  • Note: I’ve never seen a device IFU with the ultrasonic step before manual cleaning, so let’s stop this practice.
• No Manual Cleaning: I’ve also seen a tech place a tray directly in the washer, skipping manual cleaning altogether.
• Incorrect Manual Cleaning: There are so many potential issues with manual cleaning.
  • Brushing above the water line.
  • Not checking your dosing machine and making sure it’s working.
  • Overdosing at the sink with too much enzymatic [detergent].
  • Reusing dirty water through hours of work and multiple cases.

What about brushes?

• Reckless Brushing: Why are we still using that gnarly “brush” that has two bristles left on it, and it can’t be pushed through a lumen because it’s been bent so many times that it just buckles immediately when putting any pressure behind it?
• Brushing or Baptism: Are we brushing the instruments under the water line or, to borrow a legendary Kovachian phrase, are techs baptizing the instruments (Stephen M. Kovach, personal communication, n.d.)? Baptizing the instruments means techs will dunk the set under the enzymatic water at the sink and then place it on an automatic washer rack.

Finally, follow your instructions for use, common mistake issue #5 on this list, for those who enjoy a good callback tying the article together.

References (APA Style 7th Edition):

1. Okada, A. (2024, Sept. 23). Top 10 Common Mistakes in the SPD: Part 1. Healthcare Purchasing News (HPN). https://www.hpnonline.com/sterile-processing/article/55312388/top-10-common-mistakes-in-the-spd-part-1

2. Ofstead, C.; Gantt, B.; Holdsworth, J. (Sunday, April 27, 2025). “Everyone’s Dirty Little Secret” [eShow Management conference]. Healthcare Sterile Processing Association (HSPA), Kentucky International Convention Center (Ballroom A–C). Louisville, KY. 

3. Ofstead, C.; Fast, C.; Daniels, F.; Adams, S. (Saturday, April 20, 2024). Education Forum: “Innovations in Education: Learning a New Training Approach to Help Your Technicians Master and Retain Sterile Processing Knowledge” [eShow Management conference]. Healthcare Sterile Processing Association (HSPA), Alliance 310-313, Caesars Forum. Las Vegas, NV. 

4. Anderson, K. (Host). (2020–Present). Ask the Educator [Podcast]. (Healthmark, A Getinge company). https://academy.hmark.com/podcasts