An increasing number of surgical and other healthcare procedures are moving away from long-term inpatient settings and into outpatient-focused, ambulatory care. In the first decade of this century alone, ambulatory surgical procedures grew from 28.5 percent to 37.4 percent with a steady increase in subsequent years.1
As a result, instrument reprocessing functions – high-level disinfection of endoscopes, endocavity probes, and instruments, as well as sterilization – are being performed in the ambulatory setting, and often by staff with little background experience, education and training in sterile processing. Centralization of sterile processing practices is recommended but often not feasible due to lack of instrumentation, turnover requirements, and sterile processing department capacity. Consequently, some clinics are depending on their CMAs, LVNs, technicians, and RNs to perform device reprocessing.
Several issues can arise when ambulatory surgery centers and clinics that perform sterile processing functions lack knowledgeable oversight. Inadequate space and ventilation, sterile storage requirements, incorrect use of biological indicators (BIs) and chemical indicators (CIs) are just some of the serious and costly problems commonly observed in ambulatory settings.2 This is often the case among organizations whose ambulatory sterile processing functions do not report through its main sterile processing department where an experienced individual is onsite to supervise complex procedures.
Setting a new standard
In many places, the industry is undergoing a paradigm shift in which experienced liaisons are assessing clinic and ambulatory sterile processing functions. Organizations that adopt the policy of enlisting sterile processing experts to help offsite facilities implement best practices and develop a standard of care are reporting improved processes and compliance. For example, Scott & White Medical Center (of the Baylor Scott & White Healthcare system) in Temple, TX has over 60 departments and clinics that utilize surgical instruments and carry out some form of instrument reprocessing. A liaison from the hospital’s sterile processing department oversees these processes in the outlying locations to ensure that these facilities are compliant with established best practices. Through the use of tracer tools, staff education, and competency reviews, all locations were able to meet established best practice standards within six months of appointment.
However, this strategy isn’t easy to duplicate unless leadership sees the need to engage such a position. Paul Green, Principal, Quality and Safety Advisory Services, Premier, explains five steps to improving sterilization processes. The first step is to activate leadership.3 This is an important recommendation for garnering support for any major change within a healthcare setting, but is especially so in this instance as it involves the alignment of leadership from one department to oversee and guide processes in another department. Sometimes this can create friction and resistance. But with concerted effort and collaboration, respect for all perspectives, and a strict adherence to manufacturer IFUs, industry guidelines and standards (the fundamental underpinning of success), your clinic and ambulatory leaders will recognize and appreciate the importance of having highly trained sterile processing experts onsite to govern processes.
A call to action
With today’s heightened focus on sterile processing comes a greater scrutiny of the details of our processes. As we work hard to achieve the highest standards possible, we cannot afford to let our ambulatory and clinic settings slip through the cracks. I would urge sterile processing professionals to let your voices be heard. Share your knowledge and present your opinions to leadership. I also encourage organization leaders and executives to consider arming outlying areas where sterile processing and high-level disinfection activity is performed with experienced and highly trained professionals who can oversee these complex and necessary functions.
With accrediting and regulatory bodies turning up the spotlight on healthcare providers, and more procedures requiring elaborate instrumentation shift to the ambulatory setting, now is the time for sterile processing professionals to answer the call.
Improve disinfection and sterilization: a five-step approach
by Paul Green, MS, RN, CPHQ, principal, quality and safety advisory services, Premier Inc.
A complex environment requires a comprehensive approach to improve a facility’s high-level disinfection and sterilization processes.
- Activate: Leadership alignment is the first step in truly achieving change. Ensuring that facility leaders are not only aligned, but also held accountable will help drive direction and improvement.
- Review: In order to improve, providers must establish a baseline. The sterile processing department touches several other departments, so facilities must take a step back and asses all areas providing procedural services. Think big picture.
- Assess: Facilities need to asses and uncover variation in daily work across the teams. Leaders should also be looking for improvement strategies in compliance and understanding regulations.
- Evaluate: Understand your accreditation readiness by comparing actual practice and environmental conditions to current regulations.
- Recommend: Move forward with a roadmap in hand that highlights prioritizaed findings and recommendations for improvement. Knowing that sustainability is important, the recommendations providers receive will show them the challenges that may impede regulatory compliance and processes.
References
1. Hollenbeck BK, Dunn RL, Suskind AM, Zhang Y, Hollingsworth JM, Birkmeyer JD. Ambulatory surgery centers and outpatient procedure use among Medicare beneficiaries. Medical care. 2014;52(10):926-931. doi:10.1097/MLR.0000000000000213. Accessed December 5, 2017.
2. Luebbert Prinz, P. Top Ten Sterilization Issues in an Ambulatory Surgery Center. http://multimedia.3m.com/mws/media/662112O/sterilization-issues-in-ambulatory-ctrs-healthvie-5-10.pdf. Accessed December 5, 2017.
3. Green, P. Improve Disinfection and Sterilization: A Five-Step Approach. https://www.hpnonline.com/connecting-dots-removing-spots/. Accessed on December 5, 2017.
