I’m frustrated with the sterile processing department (SPD). I know what you’re thinking, and no, I’m not going to start bashing the department. Sure, errors are irritating. I’ve dealt with my fair share of holes in wraps, missing indicators, and even found a computer mouse in a tray once. So I understand how frustrating errors can be. But today, I want to change what you see SPD. The errors in SPD aren’t the problem, they’re a symptom of a much bigger issue.

Priorities

Surgery requires sterile instruments. That’s a given. But when you look at what gets priority within the department, is it the surgery itself, or is it what we need to make that operation a success? Is it the surgeon, and the money that can be made from adding more volume, or is it the staff, the equipment, and the tools necessary to safely perform the operation? I would argue that there’s a delicate balance, but the pendulum of priority ought to swing in favor of safely performing the surgery, not recruiting and revenue. But oftentimes, it doesn’t. Instead, what we have is a systemic cultural problem within surgical services where we prioritize the big name surgeons, with large volumes and high revenue potential, and then expect all of the ancillary services to just fall into place to support them, without proper consideration for their ability to keep up with the acuity or volume of the cases.

I’m not saying that making money is bad. I like getting a paycheck just as much as the next person. But in the heirarchy of priorities, it shouldn’t be on top. Patient safety should be at the top of everyone’s priority list, and when everything is viewed through that lens, then we realize that every department assisting surgical services adds value and should be given the proper consideration for how they affect our patient outcomes.

At this point I could discuss pharmacy, lab, radiology, or any number of services that play a huge role in our ability to provide safe patient care. But instead, let’s look at SPD. And not by pointing fingers or assigning blame, but by recognizing that we couldn’t do anything if we didn’t have them.

OR vs SPD, or OR and SPD?

The OR has a symbiotic relationship with SPD. Without surgery and sterile procedures, SPD is unnecessary. And without sterile instruments, surgery and sterile procedures can’t happen. So let’s go ahead and establish the obvious: We need each other.

And yet, the department that we depend on the most, the department cleaning, repairing, and sterilizing our instruments is often an afterthought when it comes to adequate pay, employee retention, technological investment, and capital expenditures.

Why is that? Why are they at the bottom of the list and overlooked for needed supplies and training, when the OR, and our patients, are depending on them to get it right? Sterile instruments are fundamental to surgery. Sterility is fundamental to reducing surgical site infections. Correct trays and proper instruments reduce turnover times and frustration among OR staff and surgeons. And having enough trays to support our surgical volumes means we’re not turning them over so quickly and so often, which can help reduce error and the wear and tear on the instruments.

To help me understand the issues better, I spoke with Hank Balch, founder and president of Beyond Clean, a company devoted to SPD and to the people, processes, and products that are moving the industry forward. Hank is passionate about SPD, and he offered some very insightful answers to my questions. (I’ve included my question, his answer, and then added my own commentary below each of his answers.)

Q:Do techs in SPD make more than minimum wage?

A: Pay rate averages anywhere from around minimum wage up to the low 20’s in a union environment. So yes, the wage issue makes recruiting and retaining high quality individuals very, very difficult. 

I have always thought that this was ridiculous. We’re going to pay the people that we depend on the most the least amount of money? I understand that the job only requires a high school diploma or equivalent, and that there is no training required for the job. But, they’re not “just washing dishes!” They are making it possible for us to do what we do, and helping to ensure that our patients have great surgical outcomes. If we took the time to train our techs in SPD, to teach them how important their role is, and then paid them well enough to keep them, we would start to see a difference in the quality of the department.

Q: How does the lack of technological investment and capital expenditures affect SPD?

A: The lack technological and capital investment in SPD is often a key factor to department issues. Either they do not have a tracking system or the tracking system they have is poorly maintained, thus leading to tons of errors, lost trays, issues with turnovers, etc. Lack of capital equipment means we often do not have enough instruments to support growing surgical volume (more procedures on fewer trays) and/or limited sinks, washers, and space to get instruments through the workflow quickly and compliantly. 

The tracking system is a great idea, if it gets used. In my experience, it wasn’t used consistently enough to be trusted. I would look for a tray, get told the last time it was scanned into decontam was 4 months ago, and know for certain that we had really just used the tray last week. The tracking system is just a source of frustration if it isn’t used properly and consistently. But when it is up-to-date, and using the system is enforced across the board, then trays can be located, issues with tray availabilty can be dealt with early (and not right before your case starts), and we can have an accurate needs list built for our cases each day. This reduces stress and frustration for all of us, not just OR or SPD.

Capital equipment is all of the equipment over a certain dollar amount that has to be approved before it can be purchased. When budget dollars are allocated, SPD is often at the bottom of the list. Why do we buy a robot if we don’t have the ability to sterilize the instruments? Why do we add new surgeons if we don’t have the capacity to handle the increased instrument load with our current number of staff, sinks, and washers? We can’t use the fancy new robot if we can’t sterilize the instruments needed to run it, and we won’t keep the new surgeons happy if we can’t keep up with their volume.

Q: What do you think causes friction between the OR and SPD?

A: There are two huge drivers in the OR/SPD wedge:

First, incomplete/dirty data – count sheets are not correct or updated, so SPD is left guessing what is supposed to be in trays. “Guessing” is not a good practice to promote surgical excellence. This leads to lots of missing instruments, incorrect substitutions, and lack of standardization. Related to this, if preference cards are trash (which they often are), it can mean SPD is pulling instruments not really needed or not pulling instruments that really are, which leads to all kinds of ripple effects throughout the day. Obviously setting SPD up for lots of conflict.

Second, instrument migration and care & handling from the OR is a massive headache for SPD. “Instrument Migration” is when trays come back with instruments that do not go in that particular tray – ie. they were mixed with other instruments used during the case. This can add extensive amounts of time to the reassembly and inspection process, and lead to missing instruments, which is another frustration. When trays are sent down with care & handling problems like kinked cords, items stacked on top of scopes, delicate items unprotected, and sharp instruments (like towel clips) protruding from the sides of trays, this leads to a lot of broken/replacement needs and potentially employee injury. Many SPD techs feel this is one of the clearest signs of when an OR doesn’t care about me as a team member. 

This is huge! Everyone in the OR knows that most of our pref cards suck. We get what information we can off of them, but many times we have to go off of memory or asking a coworker for help when setting up for our cases. Why should we expect SPD to know more about the cases than we do? If our preference cards aren’t helping us, then they’re not helping them either. I would argue that SPD is as frustrated as we are with our pref cards.

How many times have you heard, “That’s what SPD is for, they can fix it. I’m not here to do their job for them.” This is a common sentiment when OR staff get told to sort their instruments back into the correct trays after each procedure or when we are discussing point-of-use cleaning. Proper instrument care isn’t “your job” or “my job.” It takes all of us working together as a team.

We’re not enemies.

SPD isn’t the unwanted step-child of surgical services, and the OR isn’t the favorite. We’re a team. Each of us playing a vital role in the surgical process. We need each other, and it’s time the we recognized that.

Perhaps what we need is a change in perception. We want to recruit surgeons, increase our volumes, and, of course, make money. But start from the ground up. Build a solid foundation. One that prioritizes patient safety and one that realizes every department contributes to that. And invest in them. Teach them, train them, pay them well enough to recruit them, and treat them well enough that they don’t want to leave. Create experts that help us provide the kind of environment that will retain good surgeons and recruit new ones, will have great patient outcomes, and will be efficient and profitable.

Change what you see in SPD

We can’t operate in a dirty room or with broken equipment. We can’t operate if we don’t have staff to run the room or anesthesia available to sedate the patient. And we can’t operate without sterile instruments. Let’s change the way we see SPD, and recognize them for the valuable members of the team that they are.

Until next time,

Melanie

Read More!

1. With the surge in Covid cases again in the US, don’t forget to take care of yourself! You Must Make Yourself a Priority
2. Managing the call schedule doesn’t have to be a headache! Managing Call Schedules, There’s a Better Way