Without sterile, functional, and available surgical instrumentation, every operating room (OR) in the country would grind to a screeching halt. Most clinicians involved in the delivery of surgical services intuitively know this. However, the specific ways that sterile processing can positively impact operating room efficiency and quality are sometimes harder to put your finger on.
For instance, what does sterile processing have to do with turnover times? How about on-time case starts? What role does this team play in reducing sentinel or “never events” in the OR? Each of these operating room key performance indicators (KPIs) can be traced back in large part to how well sterile processing did their job, so the ultimate impact of this team on surgery is well worth considering in detail.
Time, turnovers, and on-time starts
When one patient exits the operating room after their surgery, the time between their exit and when the next patient enters the room is called the “OR turnover time.” Many things happen during these room turnovers: surfaces are cleaned, trash is removed, new supplies are brought in and set up for the procedure scheduled to follow. Included in these activities is the locating and set up of the sterile instrumentation needed for the next surgery. This is the first big time factor that comes into play tied directly to sterile processing success (or failure).
If successful, sterile processing teams will have correctly assembled, packaged, labeled, sterilized, picked for this specific procedure, and delivered the supplies to the correct room for the case. This means that during this turnover time, when the OR staff steps out to retrieve the case cart, it will be easy to find, all items requested by the surgeon’s preference card will be present, and no packaging will be compromised with holes or tears. From here, the aseptic setup can begin.
However, if the sterile processing team was unsuccessful in this step, a domino effect of issues present themselves. The case cart may be improperly labeled with the wrong patient name or room number, making it difficult for the OR team to locate. Specific instrument trays may be marked as “picked” but actually not present in the cart. Trays that were pulled for the case may have tears and penetrations in the blue sterilization wrap that were missed when they were loaded on the cart, thus making them unusable. Even one of these process failures can change an on-time case start into a substantial delay, causing frustration for the OR staff and potentially delaying care for a patient.
Getting turnover times down and on-time case starts in an acceptable range is tremendously dependent on a high-performing sterile processing workflow and feedback loop. While instrumentation plays a large role in these turnovers, there are many other steps and activities that must take place in order for the next procedure to begin.
The better prepared, present, and correct the surgical case carts are when received from sterile processing, the more efficient these critical operating room KPIs will become. To say it another way, the less attention required and stress created by instrumentation during the turnover step, the more time saved to get to the next surgery.
When quality counts, SPD matters
Efficiency, while a key metric in surgical services, is always paired with quality outcomes. After all, what would it matter if we completed 53 surgeries today if a third of them result in a surgical site infection or other avoidable complication? As with the other KPIs mentioned above, a hospital’s sterile processing team is a key contributor to ensuring the OR is able to make its goal of safe patient care with every surgery.
When successful, this means the sterile processing team will have compliantly decontaminated, thermally cleaned, and disinfected the instruments, meticulously inspected them for residual debris and functionality, cross-referenced specific instruments with the surgical count sheet, replaced any substandard instruments, followed sterility assurance testing protocols, and protected the integrity of the packaging from completion of sterilization, through storage, to delivery of supplies to the operating room.
This is no easy feat, to say the least, and still glosses over many of the small steps and stages required to effectively accomplish this workflow for every instrument, every time. However, it is only when this process is followed that the OR team has tools available to them that will heal, instead of hurt, the patient on the table.
Lack of success is apparent
If the sterile processing team is unsuccessful in their quality responsibilities, the impact can range anywhere from immediately catastrophic to only realized days or weeks after the patient has left the hospital. For instance, if a small crack is missed during an inspection of a spine instrument, the insertion tube can break off in the patient’s spine during the procedure, potentially leading to permanent injury and multiple hours delayed under anesthesia as the device is retrieved.
Less apparent, but just as dangerous, would be a biofilm that has grown within a large diameter colonoscope that is not identified and removed during the reprocessing stages. If clinicians were to use this device on a patient, microbes within the biofilm could break off during use and transmit life-threatening infectious agents such as carbapenem-resistant Enterobacterales (CRE).
Talking about the SPD impact zone
As the preceding paragraphs have shown, there is no such thing as operating room efficiency or quality without that same efficiency and quality being present among the sterile processing team that supports them. The more detail we are able to provide in describing the impact zone that flows out of the SPD, the better every member of the surgical services workflow can become.
Even though sterile processing technicians are not present during OR turnovers, their impact is still felt—hopefully for the best, sometimes for the worst. Even though sterile processing leaders may not be in the surgical suite when a medical device fails, the emphasis, tools, and training they provided to their frontline technicians is still seen in the results.
The moral of this story? Sterile processing will have an impact. It is up to you whether it will be the kind of impact that will make us all proud.
What say you?