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Archive July 2019 XX, No. 7

Rebooting Our Reprocessing Department

A comprehensive rethink of decontamination and sterilization helped this facility cut SPD-related patient safety events by more than 90%.

Judith Montello, BSHCA, RN, CNOR


TOTAL TEAM EFFORT Successful sterile processing is a joint undertaking between SDP and OR staff.

Dirty instruments, broken instruments, missing instruments. In an ideal world, we'd never have to worry about the sterile processing department (SPD) causing problems that would inconvenience the OR or, worse, injure or infect a patient. We know, of course, that's not always the case.

One instrument adverse event is one too many, but we once experienced a staggering 22 such hiccups in a single month here at Children's Hospital in New Orleans, prompting a reboot of our instrument processing process. We began by getting input from all stakeholders — SPD staff, perioperative nurses and surgical technicians — and created a team with representatives from each group. We asked the team to take stock of our current process, identify strengths and weaknesses, and develop both a plan for change and an implementation strategy. Here are 7 of those key changes:

1 Cleaning begins in the OR. The decontamination process should begin at the point of use. Arguably the most important step of decontamination is the removal of instrument debris in the OR during and at the conclusion of a case so that it does not dry. When soils dry on instruments, they become harder to remove, increasing the risk of biofilm formation and endotoxin accumulation. Sterilization requires direct contact between the sterilant and the surface of the instrument. So without decontamination, sterilization cannot be achieved.

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