Sterilization and Infection Prevention
Advantage Support Services, Inc
Your First Call for Operating Room Staffing, Sterile Processing Staffing, Clinical Assessments, and Consulting.
Angela Lewellyn: Consultant | Director of Research & Development
Infection Preventionists (IPs) play a vital role in the healthcare system, especially in the Sterile Processing Department (SPD), where preventing infection and cross-contamination is paramount. As infection prevention advocates, SPDs are responsible for ensuring that surgical instruments and other medical devices are properly sterilized and free of harmful microorganisms before they are used on patients. Together, they are responsible for creating and implementing infection control programs tailored to the needs of sterilization practices.?
IPs and SPDs: A Collaborative Approach?
Advantage Support Services has had the privilege of auditing SPDs and Operating Rooms, revealing a common issue: the scarce presence of infection preventionists in these departments. Many hospitals have one preventionist overseeing multiple campuses, which, while providing a high level of oversight, often lacks the hands-on approach needed in SPDs. As an expert in sterile processing, advocating for a closer, more involved approach to the care and handling of instrumentation is essential.?
Establishing a Continuous Quality Improvement (CQI) program should include IPs contributing to the oversight of cleaning and sterilization practices, ensuring compliance with established infection control protocols, and conducting regular inspections. This insight into processes allows IPs to better participate in a multidisciplinary team (MDT) and collaborate effectively with SP.?
By working closely with other healthcare professionals as part of an MDT, IPs can help identify potential risk areas and develop effective strategies to prevent the spread of infections. The Association for the Advancement of Medical Instrumentation (AAMI) ANSI/AAMI ST79, Comprehensive guide to steam sterilization and sterility assurance in health care facilities recommend involving a multidisciplinary team comprised of designated personnel, such as facility engineers, infection preventionists, risk managers, and SP managers, in conducting a risk assessment.?
When contributing to a multidisciplinary team specifically for sterilization practices, IPs should partner with SP leaders and staff to establish their policies and procedures. Together, they can evaluate current policies and compare them to best practices recommended by organizations such as AAMI, the Centers for Disease Control and Prevention (CDC), and the Occupational Safety and Health Administration (OSHA).?
Developing a Comprehensive CQI Program?
To develop a comprehensive CQI program, the MDT will conduct an initial assessment to gather essential data. This assessment will involve reviewing various aspects such as design elements, decontamination procedures, personnel, handling of contaminated items, packaging, sterilizer loading and unloading, immediate-use steam sterilization (IUSS), sterility maintenance, and problem investigation. Collecting this data allows the team to measure existing practices against recommended standards to identify discrepancies. Based on this analysis, the team can prioritize agenda items and formulate corrective action plans.?
Best Practices in SP and IP Collaboration?
Jill Holdsworth, the Infection Prevention Manager at Emory University Hospital Midtown, is a renowned speaker and expert in Sterile Processing. Her collaborative approach involves actively participating in the cleaning and decontamination of instruments with SP technicians while wearing personal protective equipment (PPE). She also invites decontamination technicians to teach her how to clean certain trays. This hands-on, collaborative approach has been successful, leading to a partnership between the SP and IP teams at Emory.?
Rounding and Risk Assessment?
According to the Accreditation and Quality Compliance Center, The Joint Commission has identified common reasons for noncompliance, including orientation, training, assessments of staff competency not conducted by a qualified individual, lack of a quality assurance process, and lack of collaboration with infection prevention professionals. A study published in the National Library of Medicine revealed that during the tray assembly phase, 55.0% of errors occurred, and 9.3% of cases had at least one defective tray.?
?Common Tray Defects:?
- 17.6% were missing instruments?
- 10.9% were broken, damaged, or malfunctioning instruments?
- 8.5% were incorrect instruments?
- 7.1% of instruments were assembled incorrectly?
- 6.4% had missing or compromised filters?
- 4.5% had extra instruments in the tray?
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Enhancing IP Oversight During Assembly?
During our facility audits, we found that IP personnel monitoring quality compliance during the assembly process needed more understanding of the tasks involved. Jill Holdsworth noted that some IPs were intimidated when assessing SP. She suggests renaming "Risk Assessment" to "Gap Analysis" to reduce anxiety and encourages IPs to start with familiar assessments. Engaging with SP staff rather than just using a clipboard has resulted in reciprocal feedback from SP staff.?
To address this issue, Advantage Support Services has developed an IP checklist and education program to improve oversight during the assembly stage. This program, based on quality steps outlined in AAMI ST79, AORN guidelines, and certification courses, emphasizes following standard tasks to ensure trays are clean, complete, and sterile. This education has enhanced IP's knowledge and understanding, allowing them to evaluate compliance with quality standards more effectively.?
Quality Assessment for Assembling an Instrument Tray?
SP technicians follow established practices during preparation and packaging to ensure instrument quality. Each assembly station should be disinfected, and a barrier may be placed on the table to deter cross-contamination and prevent instrument damage. Technicians should have testing tools such as plastic dowels, kid skin, gauze, cotton balls, distilled water, syringes, non-linting single-use brushes, and a borescope available.?
Upon receiving the tray, technicians should ensure no single-use sharps or visible debris are present. Using lighted magnification, they should inspect instruments for bioburden, test functionality, and verify the integrity of the stainless-steel surface. After assembly, they should ensure the packaging is intact before closing the tray.?
Effective communication of assessment findings is crucial for improving practices between IPs and SPs. The ANSI/AAMI ST79:2017 Risk Communication section advises engaging in an interactive dialogue with department staff and infection prevention personnel. Jill Holdsworth found that many IPs made notes and left without sharing findings with SP leaders or staff. She advises debriefing SP leaders and staff at the end of the assessment process to address this issue.?
?Conclusion?
Infection preventionists are integral to the success of SPDs in healthcare facilities. Their expertise and guidance ensure that the highest level of care is offered to patients, aiding in preventing and managing infections. Collaboration with Sterile Processing is essential to the overall success of healthcare systems and patients' health.?
These teams must work together to identify and mitigate risks, implement best practices, and ensure compliance with guidelines and regulations. Quality assessment is crucial for assembling an instrument tray, and effective communication between departments and a multidisciplinary team approach is essential for promoting patient safety and effective infection prevention.?
References?
- ANSI/AAMI ST79:2017/(R)2022, Comprehensive Guide to Steam Sterilization and Sterility Assurance in Health Care Facilities. (2017). https://doi.org/10.2345/9781570208027.ch2?
- "Multidisciplinary Collaboration with the Sterile Processing," AORN Journal. Retrieved March 17, 2023, from https://aornjournal.onlinelibrary.wiley.com/doi/full/10.1002/aorn.13095?
- "Sterile Processing Basics for Infection Preventionists and Nurses," Ofstead & Associates, Inc. Retrieved March 17, 2023, from https://ofstead.elevate.commpartners.com/products/sterile-processing-basics-for-infection-preventionists-and-nurses#tab-product_tab_overview?
- "Disinfection and Sterilization," APIC. Retrieved March 17, 2023, from https://apic.org/resources/topic-specific-infection-prevention/disinfection-and-sterilization/?
- "Sterile Processing Training and Certification," Advantage Support Services, Inc. Retrieved March 17, 2023, from https://advantagesupportservices.com/education-training-programs/?
- "Accreditation & Quality Compliance Center." Retrieved March 29, 2023, from https://www.accreditationqualitycenter.com/membership-check?destination=%2Fnode%2F6504?
- Alfred M., Catchpole K., Huffer E., Fredendall L., Taaffe KM. "Work Systems Analysis of Sterile Processing: Assembly," BMJ Quality & Safety. Retrieved March 29, 2023, from https://pubmed.ncbi.nlm.nih.gov/33077512/?
- Jill Holdsworth, CIC, FAPIC, NREMT, CRCST, Manager of Infection Prevention at Emory University Hospital Midtown?