Archive January 2014 XV, No. 1

Infection Control: From the OR to Central Sterile and Back Again

There are 50 or so steps involved in cleaning an instrument tray. We set out on a quest to eliminate as many those steps as possible.

Dennis Delisle, MHSA, PMP


Diane Wolk, RN, MSN, CNOR


infection control A ROADMAP FOR EFFICIENCY We trimmed the waste between sterile processing and the OR.

If you look closely at how your sterile processing department and OR work together, you may see what we found — a system weighed down by many unnecessary and inefficient steps, all of which led to frustrating delays and plenty of wasted dollars. It wasn't anyone's fault. It had just evolved that way over time thanks to workarounds, bloat and a "We've always done it this way" attitude. And while people occasionally griped about it, no one knew exactly how to fix it. Until, that is, we took a big step back and methodically mapped out the 50 or so steps involved in getting used instruments from the OR to sterile processing and back again. It took some time — we spent many hours observing and went through many packs of sticky notes — but it was time well spent.

Creating a map using sticky notes
To do it, we used a process called value stream mapping. That may sound complicated — it's the term they use in lean and Six Sigma projects — but it's not rocket science. You just need a general understanding of the basic idea, which is to use observation to pinpoint value- vs. non-value-adding types of activities. It's logical and practical and chances are it's a tool your facility could use to unearth a lot of opportunities for improvement. As statistician W. Edwards Deming says, "If you can't describe what you're doing as a process, then you don't know what you're doing."

What we knew was that there were a lot of delays, bottlenecks and work inefficiencies between central sterile and the OR. So the first thing we did was bring people together from the different departments, feed them breakfast and start to evaluate all the steps there are in cleaning an instrument tray. It was kind of like putting a puzzle together. We used a lot of sticky notes to document the process and map it out on a wall — all the nuanced steps involved in getting a dirty instrument back from the OR and returning it to the OR clean, and how long each step takes. That was how we began to uncover and eliminate the wasted time and energy that were gumming up the works.

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