Trust Is Key to Navigating Infection Prevention’s Relationship With Sterile Processing

Rounding as a multidisciplinary group is key to success for infection prevention and control in working collaboratively with the sterile processing department and other core areas of a health care system. This was the key takeaway from a presentation by Jill Holdsworth, CIC, FAPIC, NREMT, CRCST, manager of infection prevention at Emory University Hospital Midtown, at the at the 2022 Healthcare Sterile Processing Association Annual Conference & Expo, held in San Antonio, Texas, April 23-27, 2022.

Holdsworth also presented a poster on the effect of single-use items on reducing post-surgical Pseudomonas infections in patients with head and neck cancer. She joined Infection Control Today® to discuss the implications of her research, as well as other guidance for building an optimal relationship between infection prevention and the sterile processing department.

Infection Control Today® (ICT®): Tell us about your HSPA poster, “Reducing Post-Surgical Pseudomonas Infections in Head and Neck Oncology Patients with Single-Use Items.”

Jill Holdsworth, CIC, FAPIC, NREMT, CRCST: We saw that we had an increase in Pseudomonas infections in our head and neck surgical patients, which are some of our most vulnerable patients—they're our oncology patients, they've just had major head/neck surgery—and what we ended up noticing was we linked to this back to tap water contamination. What we had to do was really collaborate with our surgical residents, our sterile processing, and our nursing partners. What we were noticing was that some of our residents were going and they were getting instruments from sterile processing, they were taking them back to the units and using them, and leaving them there.

We also found that our tracheostomy care…they were reusing some of those items, so that's where we ended up going to disposable items. Then we were also reusing suture kits that were one-time use. I know that we hear a lot of folks talking about one-time use items [and] that they show back up in sterile processing, and it's really hard to tell, of all of the stuff that comes back, what needs to be thrown out [and] what needs to be reprocessed.

We had to do a lot of education on the nursing floors, which we don't hear as much about…We hear a lot about what happens in the operating room. We really had to partner with our sterile processing team, as to where does this education need to start. Wad to pull in respiratory therapy because we were talking about trach care and that is not my specialty, that's not sterile processing’s specialty. We all had to work together as a team to prioritize where this education needed to go, and what needed to be the education so that we were doing kind of bite-size education to the people who needed it and really focusing on what were the single-use items that we needed to add to the inventory so that we weren't reusing anything. And then what do we need to kind of get rid of, where do we need to prioritize [things to] make sure that the suture kits, [for example], were only used once and then put into the sharps container in the room. So we had to do a lot of auditing, a lot of re-auditing and re-education. Working together is really where we started seeing an impact [and] it took a few months. But now that we're looking a year later, we've seen that we've made a real impact in these specific Pseudomonas infections.

ICT®: Do you see a trend toward more disposables/single-use items in general? Is that a good or a bad thing?

Holdsworth: We looked at a lot of single-use items with this project in general, and we actually were thinking, maybe we should just go all disposable and maybe we should go to single-use items that we didn't have already. We looked at different ones within the suture kits and [thought], “should we go to different ones that we could use for places like IR that we hadn't looked at before?” But some of the barriers are cost, [in that] some of them are not cost-beneficial so when you start to look at going to all disposable, it's not actually a return on investment that is going to be beneficial. That’s where you have to work as an interdisciplinary team and make sure that it's going to be beneficial, and really look at what sterile processing can do as well. Because even though it sounds great, “let's just go all disposable,” you also want to consider what's going to the landfill as well, and also look at where can we kind of do that send back where they can recycle…there's all these programs where you can recycle. So there are a whole lot of factors that go into that. Whereas it seems like a simple, “let's just go disposable, and everything will be great,” there's a lot that an interdisciplinary team has to look into with that that you may not realize goes into those decisions.

ICT®: What are some of the challenges that arise between IP and SPD and how are they overcome? What are some of the benefits of a good collaborative working relationship?

Holdsworth: When I started working at my facility now, anytime you start working at a new facility, you have to start building trust, and you have to start building that relationship. And it's always difficult. It doesn't matter what role you're in. Me, as an infection preventionist (IP), or if I walked in as a new nurse, if I walked in as whatever role, you always have to start building that relationship. And that's going to be hard no matter what you're doing. Going in as a new IP, I had to start building that trust and I always talked about doing rounds, and it's really important.

We started doing group rounds and everybody seemed to be really, really busy. Every time we walked into the department, no one wanted to talk to us. No one wanted to participate in the rounds. And that is completely a normal reaction. And what I always tell folks in the sterile processing department (SPD)…if you're a manager, schedule time for the IP to come down there or schedule time to work with the IP and start building that trust and building the relationship because you have to start there and if you don't have trust, in any kind of relationship, then you're never going to be successful.

One of the things I hear all the time is “I don't even know what the IP is auditing, I don't see their audit sheet, and I certainly don't see what the results of their audit are.” So that's kind of step one is figuring out what you want to audit, and then doing it together. Then find what your action plan is going to be together based on what you audit, because it shouldn't be a secret, you shouldn't do it separately. I think that's one of the biggest barriers is that we're working separately. I don't like using the word silos because I think we use it too much, but we are working in silos a lot. If we could work together, that's one of the biggest barriers I have seen [and] I've had my own work.

After we did [rounds] together for a few months, in my own work, people started coming to us because there's a certain amount of working with the leadership, but then you also want to gain the trust of the frontline team members as well. You want to be able to walk in there and have them say, “hey, I want you to come see what we're doing, I want you to come see the problem we're having with the sink,” because your IPs can really help you escalate those issues and one of the biggest things that we have had success in for us is to have environmental services (EVS) and facilities round with us. I suggest that all the time because a lot of times it's a hole in a wall, a stained ceiling tile, [pr] a sink is leaking, and it's been leaking for 2 months, and no one has come to fix it. If they're with you, they see it for themselves [and] it's really hard for them not to fix it if they're right there with you.

That's one of the biggest benefits of doing group rounds that that we have seen. But again, that helps to build that trust, so it's a barrier and a benefit to doing the group rounds together and it helps to build those relationships that you can use moving forward. That’s kind of where you want to get to and I won't say it's easy or it's fast. It takes a long, long time. I actually hate it when someone says, “hey, I haven't seen you in the department for a while,” because then it makes me feel like “oh, no, I've been too busy to go to SPD.” Because usually I hear people say either “I never see the IP” or “I wish they would leave me alone,” and so I actually don't like it when someone says “I haven't seen you in a while, when are you coming back?” because I love it that they actually would like to see more of the department.

ICT®: What other highlights can you share from your HSPA talk, “IP and SPD: The Relationship You’ll Want and Need!”?

Holdsworth: One of the things that I feel like is misunderstood is when we use the word risk assessment. We talked about that in our presentation…we think that sometimes people will misinterpret that as risk management. People get really uneasy when they hear risk management. They think, “oh no, I've done something wrong, risk management is coming to talk to me.” But risk assessments can be one of your best friends. It's like doing a gap analysis, and when I talk about risk assessments, this is where you can start with anything you want to do. I always talk about doing them backwards…you want to do a risk assessment on water or hand hygiene or your transport, are you transporting things correctly, anything at all…You don't have to have a risk assessment in hand, you can go out and round on nursing units and say, “I wonder if anybody's transporting things correctly to sterile processing.” But find out what questions you want to ask as you go look for it, and then write down your questions and put them in a simple Excel sheet. We gave an example of this in our session…then make your risk assessment like that on a simple Excel sheet, and that's a risk assessment. It doesn't have to be fancy; you just have to have something that you document, and then you can keep tracking it over time. That is your gap analysis. That's your risk assessment. And you do it together, you do it with your sterile processing manager, you do it with your IP…sterile storage is another great one. We're doing that right now at my facility where we sent out a survey and asked all of our nurse managers in the operating room, “what are your opportunities with sterile storage?” And we left it open just like that, and you can't imagine—or you can—what answers we got back. Now we're kind of starting small with what our action plan is going to be around sterile storage. But that's how we decided to do our risk assessment was we just asked other people to answer that one simple question of “what are your ideas for how we can improve sterile storage?”

I would ask your IP to partner with you on things like that, and then do these action plans together. And that helps you, again, form those relationships and gives you things to work on. [My co-presenter] Jamie [Zarembinski] and I talked about doing fishbone diagrams…if you don't know what fishbone diagrams are, they're a great tool to put all of your things together, have in categories of the things that you need to work on to get compliance or to get to your goal, and we're happy to share that with you as a tool. Leadership loves to see things in a fishbone diagram to say these are all the things we're going to work on, [here] are all the opportunities we have to get to sterile storage compliance or to get to hand hygiene compliance, and so some of those things are the tools in your toolbox per se, to work with IP on some of these great things.

The other thing that we did mention is we wanted to make sure that sterile processing folks know that there are always resources out there to learn more about infection prevention, and that there's always a career path to infection prevention. We want everyone to know that there are ways to always learn more, always develop, never stop learning, and that we want to make sure that people will have kind of those resources. Jamie and I did this presentation to learn how to partner better together, but we also want them to know that we are happy to be resources to help give people that chance to learn more about IP. If they want to go into IP, we're happy to help them figure out how to do that, and we're happy to have people reach out to us if that's a career path they're interested in or if they're just interested in learning more about IP…reach out and know that there's a network of people that are ready to help if they're just wanting to develop their skills [or] develop their knowledge. We want to always help people continue learning and continue developing.

This transcript has been edited for clarity and length.