Central sterile processing is essential for a safe and efficient operating room. Mistakes in sterilization can cause delays in surgery and patient infections, among other issues. Alecia Cooper, RN, BS, MBA, CNOR, senior nursing consultant at Surgical Directions, and Valeria McAfee, MBA, a central sterile processing consultant for Surgical Directions, share four common mistakes in sterile processing and how to avoid them.
1. Not properly cleaning instruments. One of the most common mistakes is not ensuring the instrument is properly cleaned. Employees need to have the necessary training to ensure they follow evidence-based guidelines for proper sterilization.
One way to prevent improper cleaning is to establish double checks, a system in which a sterile processing employee double checks the instruments after the original sterile processing employee checks the instruments that have been disinfected and prepped for sterilization. Instead of checking all instruments, hospitals can focus on those that have a higher risk for infection — such as orthopedic instruments for total joint replacements and neuro instruments for spine procedures — or any set of instruments that are difficult to clean, according to Ms. McAfee.
Another way to confirm instruments have been cleaned properly is to use clean trace equipment, which changes color or provides another signal that an instrument is clean, Ms. McAfee says.
2. Flashing. Flashing, or immediate use steam sterilization, is when an instrument is sterilized by steam in the shortest possible time according to the manufacturer's guidelines between a sterilized item's removal from the sterilizer and its aseptic transfer to the sterile field. This practice increases the risk for infection and should be avoided, according to Ms. Cooper and Ms. McAfee. "Immediate use should not be a substitute for lack of instrumentation," Ms. McAfee says. "If [a hospital] has to do lots of immediate use, or flashing, it probably means that hospital does not have the necessary amount of instrumentation needed to carry out their daily procedures." She recommends hospitals invest in a sufficient amount of instrumentation to reduce immediate use and the risk of infection.
3. Putting the incorrect instrument in a tray. Another common mistake in sterile processing is putting the incorrect instrument in a tray, which can occur due to similarities between different instruments. If a tray does not contain the correct instrument for a procedure, a surgery may have to be delayed as a nurse or tech retrieves the correct tool or a suitable alternative. Sterile processing departments can avoid misidentifying instruments by training, referring to available pictures of the instruments and checking the manufacturer's code on the instrument (if available).
In addition, hospitals should ensure they have a sufficient number of sterile processing employees to prep and assemble the instrument sets, a process that can increase turnover time and cause rushing because of the demand of the set — which in turn can increase the risk of mistakes occurring. Ms. McAfee suggests a hospital that needs 40 trays turned over in an eight-hour shift may require six to eight staff members, depending on the complexity of the sets. However, each hospital needs to assess the experience of its staff members, the complexity of the tray and the surgical mean volume to determine the appropriate amount of staffing.
4. Failing to follow maintenance guidelines. Some sterile processing departments also make the mistake of failing to conduct proper maintenance for instruments and sterilization equipment. "If a facility doesn't invest in [the maintenance of instruments], many instruments may not last as long as they should and it would cost the hospital more in the long run," Ms. Cooper says.
Ms. McAfee suggests establishing a maintenance program so all instruments and equipment can be used safely for the expected life span of the instrument or equipment.
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1. Not properly cleaning instruments. One of the most common mistakes is not ensuring the instrument is properly cleaned. Employees need to have the necessary training to ensure they follow evidence-based guidelines for proper sterilization.
One way to prevent improper cleaning is to establish double checks, a system in which a sterile processing employee double checks the instruments after the original sterile processing employee checks the instruments that have been disinfected and prepped for sterilization. Instead of checking all instruments, hospitals can focus on those that have a higher risk for infection — such as orthopedic instruments for total joint replacements and neuro instruments for spine procedures — or any set of instruments that are difficult to clean, according to Ms. McAfee.
Another way to confirm instruments have been cleaned properly is to use clean trace equipment, which changes color or provides another signal that an instrument is clean, Ms. McAfee says.
2. Flashing. Flashing, or immediate use steam sterilization, is when an instrument is sterilized by steam in the shortest possible time according to the manufacturer's guidelines between a sterilized item's removal from the sterilizer and its aseptic transfer to the sterile field. This practice increases the risk for infection and should be avoided, according to Ms. Cooper and Ms. McAfee. "Immediate use should not be a substitute for lack of instrumentation," Ms. McAfee says. "If [a hospital] has to do lots of immediate use, or flashing, it probably means that hospital does not have the necessary amount of instrumentation needed to carry out their daily procedures." She recommends hospitals invest in a sufficient amount of instrumentation to reduce immediate use and the risk of infection.
3. Putting the incorrect instrument in a tray. Another common mistake in sterile processing is putting the incorrect instrument in a tray, which can occur due to similarities between different instruments. If a tray does not contain the correct instrument for a procedure, a surgery may have to be delayed as a nurse or tech retrieves the correct tool or a suitable alternative. Sterile processing departments can avoid misidentifying instruments by training, referring to available pictures of the instruments and checking the manufacturer's code on the instrument (if available).
In addition, hospitals should ensure they have a sufficient number of sterile processing employees to prep and assemble the instrument sets, a process that can increase turnover time and cause rushing because of the demand of the set — which in turn can increase the risk of mistakes occurring. Ms. McAfee suggests a hospital that needs 40 trays turned over in an eight-hour shift may require six to eight staff members, depending on the complexity of the sets. However, each hospital needs to assess the experience of its staff members, the complexity of the tray and the surgical mean volume to determine the appropriate amount of staffing.
4. Failing to follow maintenance guidelines. Some sterile processing departments also make the mistake of failing to conduct proper maintenance for instruments and sterilization equipment. "If a facility doesn't invest in [the maintenance of instruments], many instruments may not last as long as they should and it would cost the hospital more in the long run," Ms. Cooper says.
Ms. McAfee suggests establishing a maintenance program so all instruments and equipment can be used safely for the expected life span of the instrument or equipment.
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