Creating a strong working relationship between the central sterile processing department (CSPD) and the OR might seem overwhelming, but it is mutually beneficial. By establishing a solid structure for this unique relationship, one can achieve the goals of both departments more easily.

The two departments are more aligned than any other in a hospital or health system, with each relying on the other for the work they produce. Unfortunately, when things go wrong, the CSPD is usually to blame. In fact, published literature focuses on the failures within the CSPD and rarely shares the responsibilities with the OR, or with other procedural areas.

A recent study reviewed more than 40,000 cases and found 3,900 defects in the work produced by CSPD. Many of the defects identified were similar to other studies and landed squarely in the assembly area. They included missing, broken, malfunctioning or incorrect instruments.¹ Inappropriately cleaned instruments also were noted as a recurring problem in the OR.

The study’s authors pointed to deeper systemic problems that surround the work done in the CSPD and only briefly described the OR’s role and responsibilities regarding the use of instrumentation prior to their return to the CSPD. They specifically noted issues of precleaning and the reorganization of instruments to their original trays.¹ Although the study is a thorough review of the workload that the CSPD performs daily, giving the reader a true sense of the magnitude of the department’s responsibilities, it fails to paint the complete picture of the problem surrounding surgical instrumentation and the responsibilities of both the OR and procedural areas.

Putting the Pieces Together

What many do not understand is that central sterile processing (CSP) is not just like other manufacturing processes. Imagine receiving thousands of instruments and sets daily. Few, if any, have been managed properly by the procedural areas (point-of-use cleaning and reorganization). Hank Balch, the founder and president of Beyond Clean, described it as sending six to 10 jigsaw puzzles, each with 100 or more pieces per puzzle (600-1,000 pieces total) to the OR. Personnel mix them up between all the boxes, and perhaps they accidentally break some or lose a few pieces before returning them to the CSPD. Before beginning the reprocessing cycle, the CSPD must unscramble all the pieces and place them back into the correct boxes, which by the way are all the same color—stainless-steel gray. Once all the pieces are back in their respective boxes, any that were lost, damaged or need repair must be replaced before each of those jigsaw puzzles can be reprocessed and ready for use. Now, scale that by all the surgical specialties and procedures performed in a 24-hour period, each with different puzzles—and add in that the OR did not preclean or pretreat the instruments before arrival in the CSPD for reprocessing.

Over the years, the number of instruments in a single set has increased on average to more than 100 per set, yet the number of instruments needed is much less, and the literature points out some very interesting statistics. On average, only 13% to 21.9% of instrument sets opened are used during a procedure.² With up to 87% of instruments going unused, this creates unnecessary work for both the OR and CSP. Why would organizations not take the opportunity to reduce set size where appropriate? The average cost of reprocessing instruments ranges between 51 cents and 77 cents.² Using these costs, the 87% of the instruments not used during a procedure is costing organizations between $44 and $67 in unnecessary expense. Extrapolate those costs to the hundreds of instrument sets used in a 24-hour period and organizations could be saving tens of thousands of dollars per day. Having the appropriate number of instruments for a procedure increases efficiency, reduces costs and improves patient safety.

Improving the Process

Understanding the nuances of the reprocessing activities is crucial for identifying what is needed to elevate overall performance. Take, for instance, the labor demands within the CSPD: They are bound to shift dramatically both before and after any optimization measures are implemented. This alone requires the knowledge to perform a proper staffing analysis for the process(es) in question. Factor in variables such as the capacity of equipment, workflow logistics, technician expertise levels and the leadership structure—all these layers compound into a multifaceted challenge. Making meaningful enhancements in reprocessing operations requires an honest evaluation of these elements, not to mention the factors that affect CSPD operations.

Depending on the improvements being addressed and/or the starting points, the collaborative team must agree on all aspects of the initiative, including but not limited to the structure, prioritization of improvements, measurement of success, the data that will be collected and used to measure the group’s success, addressing challenges or barriers, and compliance with solutions.

Take the time to review the implemented metrics and determine if the objectives are being accomplished. This can include specific leadership tasks, real-time internal metrics specific to the process, and problem-solving techniques to address any necessary modifications.

Conclusion

Globally, the number of surgical procedures performed is upward of 310 million, with 40 million to 50 million occurring in the United States alone.³ As surgical procedures continue to increase, building stronger relationships between the OR and CSPD will require careful consideration and a focus on process improvements to better meet the demands. Developing a collaborative team will be essential to building an environment that can continuously improve. Over time, each department will improve its ability to recognize, prioritize and develop workable solutions to meet its specific needs. In the end, opening communication, sharing perspectives and taking accountability will improve efficiency, safety and the bottom line.

References

1. BMJ Qual Saf. 2021;30(4):271-282.
2. J Pediatr Urol. 2019;15(2):153.e1-153.e6.
3. Int J Surg. 2020;81:47-54.

Robert Leenan is a sterile processing improvement consultant and managing partner at SPD Solutions, LLC. David L. Taylor III is the principal of Resolute Advisory Group LLC, a healthcare consulting firm. Mr. Taylor is also a board member of OR Management News.