Sterile Processing, Infection Control and Zero Patient Harm: Collaboration Starts With Us

By Weston “Hank” Balch, BS, MDiv, CRCST, CIS, CHL, ACHE

For more than a millennia of medicine, the caregiver's oath has been, "Do no harm." Unfortunately for the sterile processing world, there are billions of microorganisms out there that are aiming at doing the exact opposite. The challenge is so great that most hospitals have entire departments dedicated to the mission of infection control, a practical sub-set of epidemiology concerned with preventing nosocomial (healthcare-associated) infections.(1) Although there are countless areas of focus for these teams in a hospital setting, there are few more effective partners in winning the fight against infection than the sterile processing team.

This collaborative partnership between infection control and sterile processing does not happen on its own. It requires intentional questioning of current practices, constant review of industry research, facility data trending, and teamwork across multiple departments within a hospital setting. Whether you're just getting this relationship started or wanting to ensure you're getting the most out of your current collaboration, here are a few important points to keep at the top of your to-do list:

Immediate-Use Sterilization is Still a Big Deal
Even with increased emphasis from the Association of periOperative Registered Nurses (AORN), Joint Commission, and others in the industry, many facilities still struggle with keeping their immediate-use sterilization (IUS) rates down to the acceptable rate of zero. The struggle is so wide-spread that it's even created a sub-market for a rigid-container system created specifically to compensate for common instances of IUS cycles (such as late loaner delivery or compromised packaging). Reasons for IUS aside, part of the SPD/IC relationship must include a concerted effort to track, communicate, and creatively solve this persistent problem in our facilities. The collaboration will obviously need to include OR leadership and staff, as well as other facility leadership, but infection control can be a helpful, un-biased advocate for process change for all parties involved.

Surgical Site Infection Data is the Gold Standard
Even before the Affordable Care Act changed the landscape of how hospitals view surgical volume vs. quality of care, data on surgical site infections was still the best tool out there to help paint the picture of how SPD actually impacts patient care. The old adage, "No news is good news" was fine for daily operations, but it was the surgical site infection (SSI) data which communicated the real state of quality patient care in Surgical Services. Even though sterile processing is just one piece of the larger SSI picture, we are a big piece, and the better we are able to tell our story of success (or challenges) from the perspective of real patient impact, the better we will be positioned to make positive change in the healthcare space. Did we see a spike in infection rates after changing our chemical disinfectants? Did we see a decrease in SSIs after rolling out magnification in our inspection areas? Good data can help drive good processes -- and that data will most likely come from your friends in infection control.

Adequate Processing Equipment is Not Optional
Does anyone out there have an instrument washer clinging to the last few breaths of mechanical life? What about a sterilizer that breaks so often you'd swear it keeps the service technician in business? Few SPD leaders in the country have the luxury of not having to worry about the current state of our instrument processing equipment. For most of us, those are the things that keep us up at night. But convincingly telling that story of frustration and infection concern to facility leadership and finance directors can be difficult without the support of advocates in infection control. What happens when your instrument washer goes down for four hours? And why is that "work-around" not acceptable for high-quality patient care? With some studies claiming SSIs can increase a hospital stay by 20-fold and substantially reduce reimbursements to the facility, any upfront investment in appropriate processing equipment is money well spent.(2) Make sure your IC team helps you make the equipment data talk.

Best Practices, Recommendations, and "What We've Always Done"
Because the field of infection control is so broad -- encompassing literally every square inch of hospital real estate and every conceivable cause of infection (from dust particles during a construction project to proper doffing of PPE) -- they will often rely heavily on the SPD leader's expertise as it relates to our particular industry's recommendations and best practices. This, obviously, means that we should be proactive in owning the role of "expert," becoming as familiar as we can with recommendations such as AAMI ST 79, guidelines provided by AORN, and the networking of best practices shared through continuing education offerings and annual industry conferences. As the vision of zero patient harm is pursued within your facility, continue to ask the question, "Is 'what-we've-always-done' the best we can do?" Chances are good the answer to that is no. But with the support of your infection control department, you can begin to zero in on your goal -- and get there together.

Conclusion: The Squeaky Wheel Gets the Grease
While few folks would argue with the importance of high-level infection control practices within sterile processing departments in the abstract, we still often face logistical challenges with getting this message heard when it counts. When compared to flashy, multi-million dollar OR suites or ICU rooms being visited daily by physicians, nurses, and patients -- SPD departments can sometimes seem more low maintenance or lower priority in the grand scheme of facility life. This can lead to our department needs naturally settling to the bottom of capital purchase lists, being skipped over during facility tours by visiting C-suite leaders, or missing out on membership invites to important committees. If you don't want that to happen (or want to change it if it already has), you can find no greater advocates for the sterile processing cause than your friends in infection control. Know them, let them know you, and commit to working together for safer patient care.

Weston “Hank” Balch, BS, MDiv, CRCST, CIS, CHL, ACHE is the Director of Sterile Processing Operations at KentuckyOne Health, which includes the 462-bed internationally renowned, high-tech tertiary referral center at Jewish Hospital  and the 329-bed, world renowned Level 1 trauma facility at the University of Louisville Hospital. He has built a highly-acclaimed team of well-trained and certified technicians consisting of 65 em-ployees, many with industry certifications and undergraduate and graduate degrees. His publications include Infection Control Today (May 2015) “Certifiably Educated: One Department’s Drive to Serve with Smarts” and his departments have been featured in Communique (Sep/Oct 2015) “Triple Crown Certification: How One CS Department is Winning the Race for Quality, Safety, and Professionalism” and Healthcare Purchasing News (May 2016) “2016 CS/SPD Department of the Year.”

References:
1. https://en.wikipedia.org/wiki/Infection_control
2. http://www.safecarecampaign.org/ssi.html