28 December 2011 • HEALTHCARE PuRCHAsing nEWs • www.hpnonline.com

sELf

-sTu

dy s

ERiE

ssELf-sTudy sERiEs Sponsored by

December 2011The self-study lesson on this central service topic was developed by 3M Health Care. The lessons are administered by KSR Publishing, Inc.

Earn CEUsThe series can assist readers in maintaining their CS certification. After careful study of the lesson, com-plete the examination at the end of this section. Mail the complete examination and scoring fee to Health-care Purchasing News for grading. We will notify you if you have a passing score of 70 percent or higher, and you will receive a certificate of completion within 30 days. Previous lessons are available on the Internet at www.hpnonline.com.

CertificationThe CBSPD (Certification Board for Sterile Processing and Distribution) has pre-approved this in-service for one (1) contact hour for a period of five (5) years from the date of original publication. Successful completion of the lesson and post test must be documented by facility management and those records maintained by the individual until re-certification is required. DO NOT SEND LESSON OR TEST TO CBSPD. For additional information regarding certification con-tact CBSPD - 148 Main Street, Suite B-1, Lebanon, NJ 08833 • www.sterileprocessing.org. For more infor-mation direct any questions to Healthcare Purchasing News (941) 927-9345, ext 202.

Learning Objectives• Describe the nature of the OR/CSSD

relationship.• Discuss the root goals of each

department and the challenges they each face.

• Understand the benefits of a collaborative relationship and how to move forward toward establishing one at their facility.

Sponsored by:

The traditional relationship between the operating room and the sterile processing/central service department

is complex. The term “love/hate relationship” has been uttered by many involved from each of these two teams. The two departments have an almost symbiotic existence, completely dependent on each other for success, yet communication and cooperation between them is often quite strained. Sometimes that communication can actually be quite hostile, if it really occurs at all. Why is this so?

Lack of understandingOne of the leading reasons relationships often suffer between these two departments is that each team really doesn’t understand the other’s business. Central Sterile Supply Department personnel have very little, if any, training in surgical procedures or anatomy. As a result, they often do not understand what the root goals of a particular procedure are, nor do they understand how the instruments they reprocess are actually being used. Con-versely, Operating Room personnel, though perhaps trained in basic decontamination and sterilization techniques, actually have very little understanding of the complex and varied duties performed in a modern Central Sterile Supply/Sterile Processing Department. They also do not usually understand that the OR is, in almost all cases, only one of many custom-ers (albeit the largest) that the department must service, often on an emergent basis. The Emergency department, Labor and Delivery, the Intensive Care Unit, Cardiac Care Unit, Respiratory Care, and the various Nursing units are all important customers whose pa-tients deserve the same attention to detail and prioritization that the OR’s receive.

Today’s Operating Room is a fast-paced, high-stress environment. OR personnel face many challenges: they often must meet exceptional and difficult time demands (particularly in regard to case turnover), keep up with ever-changing technology, provide excellent customer service (both to the surgeon and directly to the patient), deal with logistics and staffing shortfalls, comply with recommended practices and industry

Operating room/central sterile supply department collaborationby Joseph F. LeBouef, RST, CST, CRCST

standards, reduce/minimize the chance for wrong-patient, wrong-site and procedural errors and do their best to minimize expenses, all while attempting to remain focused on the needs of the patient currently on the OR table.

The CSSD department of today is also under considerable pressure to perform at a high level in many of the above-listed arenas, but faces different challenges, as well. Sterile Processing is usually a poorly understood discipline by most hospital employees, even many senior-level hospital administrators. As a result, CS departments often find themselves classified as a very ancillary and therefore marginalized service, with little authority in regard to directing operations, enforcing best practices and adhering to industry standards. This general marginalization has traditionally led to quite low pay for those performing Sterile Processing functions, which in turn has led to difficulties in these departments’ ability to acquire and retain knowledgeable, talented and professional staff.

Without collaborationThe two departments often, as previously mentioned, take up adversarial stances when it comes to many issues. Two such issues are:

In-use and end of case instrument care OR personnel rightly see the decontamina-tion and processing of surgical instruments as a Sterile Processing function. What they often do not consider is that without proper point-of-use care, effective decontamination and subsequent sterilization is considerably more challenging and time-consuming, if not impossible. When blood and other body fluids are allowed to dry on the surface of an instru-ment, the proteins tend to coagulate and create a serious challenge for even the most robust decontamination techniques and equipment. In addition, any bacteria or other microorgan-isms on the surface of the device will begin to form biofilms. The CDC defines biofilm as an “accumulated mass of bacteria and extracellu-lar material that is tightly adhered to a surface and cannot be easily removed.”1 In addition to being difficult to remove, biofilms can reduce sterilization efficacy by preventing access of

www.hpnonline.com • HEALTHCARE PuRCHAsing nEWs • December 2011 29

Sponsored by sELf-sTudy sERiEsSelf-Study Test Answers: 1.B, 2. D, 3. D, 4. B, 5. D, 6. B, 7. D, 8. A, 9. A, 10. A

the sterilant to the microorganisms contami-nating the device. It is therefore important that used medical devices are promptly cleaned and reprocessed to minimize the opportunity for biofilm formation.

Blood and other body fluids also tend to be high in chloride content, which is extremely corrosive to stainless steel; considerably more so when allowed to dry and concentrate on the surface of the device. Instrument sets that are sent to the decontamination area in complete disarray or piled up on top of each other can be much more easily damaged, and may be subject to processing delays (they will need to be sorted out before assembly) and to misplaced instruments. Although point-of-use care is explicitly recommended by professional organizations such as AORN and AAMI,2,3 many OR staff erroneously feel that they shouldn’t have to keep the instruments clean and organized, because that is “CSSD’s job”. From the CSSD perspective on this issue, staff feel that instruments sent down disor-ganized, caked with dried-on blood or other debris, or piled on top of one another show complete disregard for their department, for the facilitation of efficient workflow and for the stewardship of the instrumentation.

Surgical procedure/case cart pickingOR staff often find themselves frustrated when items are picked incorrectly for pro-cedures, or when variances in a procedure are not accounted for in the instrumentation and/or the supplies picked. They often cannot understand how such a simple task, in their estimation, could be mishandled so often. The problem lies in the fact that most CS Techni-cians have minimal, if any, training in surgical procedures and techniques. They rely on very specific types of data to pick the appropriate supplies (item numbers, storage shelf/bin locations, etc.). CS Technicians often do not enter the OR suites, due to comfort level or to policies limiting traffic in the suites, on a regular basis and do not see the end results of any errors they make. When the data included in the preference card or pick list is incorrect, they often erroneously believe they

may (or even should) absolve themselves of any responsibility of correcting these types of errors because it is “OR’s job”.

Potential benefits of collaboration When the OR staff truly become aware of the real risks they take when caring for instruments improperly, they often become much more willing to increase efforts to assist in the point-of-use handling of these devices. This will directly improve the lifespan of the instruments, re-duce the processing cycle time, and increase the likelihood that the CSSD will be able to ef-fectively and reliably clean and

decontaminate the instruments. It is logical to assume that this also will greatly increase the probability that the devices will be returned to the OR sterile and safe for their intended use.

When CS Technicians attain a better under-standing of the root goals of the invasive pro-cedures performed in the OR, what happens during these surgical procedures, and how the instruments delivered for these procedures are actually used, they are considerably more able, and therefore more likely, to use critical thinking skills to make good decisions when reprocessing the devices or when there are variances to a procedure, catching errors or omissions on preference cards/pick lists and communicating them to the appropriate per-sonnel, and prioritizing the workflow.

Additionally, many facilities have also found that OR and CSSD collaboration is key to the successful development and enforce-ment of a Loaner Instrument policy. Both teams can then be consistent when commu-nicating the policy to vendors.

Making it a realityIf meaningful collaboration is ever to be achieved and maintained, there first needs to be a commitment from OR and CSSD manage-ment to make real, sustainable collaboration a priority. The two leadership teams need to reach a consensus regarding goals for the rela-tionship, create action plans both for achieving and for maintaining the desired collabora-tion, make agreements for expectations and accountabilities moving forward, and define how success will be measured. Without strong leadership driving a collaboration initiative, staff will often fall back into old practices and old misconceptions.

Walk a mile in their shoesOne tool for increasing understanding and building the foundation for long-term col-laboration is to have OR and CSSD staff

spend time in each other’s departments. A simple way to accomplish this in a structured manner can be to build in a rotation into staff orientation plans:• CS Techs would be assigned to observe OR

procedures to directly view the impact of case cart picking and instrument assembly on case workflow, learn how instruments are used in surgery, and achieve a better overall understanding of OR procedures.

• OR staff would, in turn, be rotated through the CSSD to observe the impact point-of-use instrument care plays in processing workflow, learn some of the techniques used in modern sterile processing, and gain a better understanding of the myriad tasks CS Techs perform for all areas of the healthcare facility.

Get to know one anotherA crucial component in building collaboration is the personalizing of the relationship be-tween the departments. When either depart-ment’s staff get to know members of the other team individually, they are much less likely to make negative generalizations about the other’s abilities or their intentions. No longer is the person on the other end of the phone a nameless, faceless nobody who probably doesn’t care about their needs and concerns. It’s someone they know personally, who will be much more likely to achieve respect (or possibly disdain) based on the merits of their own actions, rather than because of some preconceived notion or stereotype.

To foster stronger relationships between the departments, management should ensure that both teams are included in staff meetings, in-services and certainly all celebrations or func-tions. The more time they spend together, and the more directly involved the two teams are, the more likely they will be to communicate openly and deal with issues collaboratively.

Develop collaborative policies and practicesManagement should actively seek involve-ment from both OR and CSSD staff in devel-opment of collaboration strategies and process improvement teams. Each department also should provide input into decisions that may impact both, such as:• Policy or procedure changes regarding the

processing of instruments, case cart picking, instrument repair, loaner instrumentation, or immediate-use steam sterilization. These areas usually have profound impact on the workflow of both the OR and the CSSD.

• Introduction of new devices/instruments/packaging materials. CSSD should be con-sulted prior to final purchasing decisions to ensure that the items can be safely and

See Self-Study on page 30

30 December 2011 • HEALTHCARE PuRCHAsing nEWs • www.hpnonline.com30 December 2011 • HEALTHCARE PuRCHAsing nEWs • www.hpnonline.com

sELf-sTudy sERiEs Sponsored by

effectively reprocessed using existing equip-ment and processes. OR should be consulted to ensure that packaging changes will not adversely impact their ability to store items, handle and open them safely and transfer them aseptically to the sterile field.

SummaryToday’s Operating Rooms and Central Sterile Supply Departments are fast-moving, high-pressure workplaces that face many chal-lenges. These departments, although closely joined in both end goals and issues, often have strained or difficult relationships.

Achieving and sustaining meaningful col-laboration must be a prioritized commitment made jointly by OR and CSSD leadership. Once the commitment is made, collaboration

Self-Study from page 29 may be accomplished by using a variety of different tools, including exposure to each other’s department, both for learning and for making personal connections between staff, as well as involvement of staff from each department in joint projects, meetings and celebrations.

Successful, ongoing collaboration between the OR and the CSSD is one key element to successfully navigating the challenges these critical departments face, to improving performance within these two teams and to providing the safest, highest-quality patient care possible. HPn References

1. Centers for Disease Control and Prevention. Guideline for Disinfec-tion and Sterilization in Health Care Facilities. CDC, Atlanta, GA, 2008.

2. Association of periOperative Registered Nurses: Perioperative Standards and Recommended Practices, 2011 Edition. Recommended

Practices for Cleaning and Care of Surgical Instruments and Powered Equipment. AORN, Denver, CO, 2011.

3. Association for the Advancement of Medical Instrumentation. Comprehensive guide to steam sterilization and sterility assurance in health care facilities. ANSI/AAMI ST79:2010 & A1:2010. Arlington, VA. 2010.

Joseph F. LeBouef, RST, CST, CRCST has over 20 years of experience in the Surgery and Sterile Processing fields. Having served as a Certified Surgical Technologist and a Sterile Processing Manager, LeBouef is currently an Educator of both Surgical Technology and of Sterile Processing. He is also the President of the IAHCSMM Cascade Chapter, an IAHCSMM-approved Instructor, a member of AAMI workgroups STWG40 and STWG61 and a member of the IAHCSMM Or-thopedic Council.Joseph LeBouef is also a consultant for 3M Health Care.

COnTInUInG EDUCATIOn TEST • DECEMBEr 2011

Operating room/central sterile supply department collaborationCircle the one correct answer:

request for Scoringo I have enclosed the scoring fee of $10.

(Payable to KSR Publishing, Inc. We re-gret that no refunds can be given. Multiple submissions may submitted together and paid with a single check - $10/each.)

Detach exam and return to:Continuing Education DivisionKSR Publishing, Inc.2477 Stickney Point Road, Suite 315BSarasota, FL 34231PH: 941-927-9345 Fax: 941-927-9588

Please print or type. return this page only.

Name

Title

Hospital Name

Mailing Address

Apt/Suite

City, State, Zip

Daytime Phone

E-mail

Sponsored byPresented by

1. Or personnel do not need to concern themselves with point-of-use pre cleaning of instruments, because it is CSSD’s job.A. True B. False

2. CSSD personnel are usually responsible for:A. Cleaning, decontamination and sterilization for all

reusable medical devices throughout the health-care facility.

B. Meeting time demands and dealing with supply/staff shortfalls.

C. Providing excellent customer service.D. All of the above.

3. Common CSSD customers are:A. The Operating Room.B. The Emergency Department.C. ICU/CCU.D. All of the above.

4. Collaboration is natural between the Or and CSSD, because each department understands the other’s business thoroughly.A. True B. False

5. Potential benefits of collaboration include:A. Each department will better understand the other’s

issues and needs.B. Instruments may last longer due to proper point-

of-use careC. Case carts may more accurately reflect the actual

needs of the procedure.D. All of the above.

6. Management does not need to be fully committed to collaboration for it to be successful.A. True B. False

7. Ways to foster stronger relationships between Or and CSSD staff could include:A. Inviting the other department to celebrations or

social functions.B. Inviting the other department to attend staff

meetings or in-services.C. Excluding the other department from staff meet-

ings or in-services, as the subject likely doesn’t pertain to them.

D. Both A and B.E. All of the above.

8. Should CSSD staff be consulted when the Or creates a new immediate-use steam sterilization policy?A. Yes B. No

9. Should the Or staff be consulted when the CSSD updates their case cart policy?A. Yes B. No

10. After use, prompt device cleaning and reprocess-ing is recommended to minimize the chance for biofilm formation.A. True B. False

www.hpnonline.com • HEALTHCARE PuRCHAsing nEWs • December 2011 31 www.hpnonline.com • HEALTHCARE PuRCHAsing nEWs • December 2011 31

Sponsored by sELf-sTudy sERiEs

COnTInUInG EDUCATIOn TEST • DECEMBEr 2011

Visit the HPnonline Self-Study archives at www.hpnonline.com/ce/ce.html

2011Class 6 sterility assurance technologies Sterility - You couldn’t see it then; you can’t see it now Achieving LEAN sterile processingClean or Not? A lesson on how to evaluate the efficacy of cleaning protocols.A laparoscopic surgery primer for SPD professionalsTaming the loaner "beast"The importance of IFU for sterile processing quality managementTroubleshooting steam sterilization process failuresTIME OUT: No more instrument reprocessing shortcutsFAQs from 2010 3M Sterilization Assurance TechlineUltrasonic cleaning in the healthcare setting

2010What’s new in the 2nd edition of ANSI/AAMI ST79?Practical SPD equipment maintenanceConsiderations for use of rigid sterilization containersVerifying cleaning processes: the role of washer indicatorsRisky business: Risk analysis in CSSD Biofilms: Getting dangerous slime out of your hospitalQA for table-top steam sterilizersThe slide-rule of sterile processing best practice: Do you measure up? Flash Sterilization: Exposing best practices in 2010 How do I Flash Thee …The facts about parametric release Can it work in your facility?Loaner instrument tray management: A shared responsibility

2009Competencies in Sterile Processing Labels – They’re not just window dressingSteam sterilization process failures and recalls: Taking the correct actions The magic door – Sterile processing behind the scenesA new CDC guideline – Bookmark it now!Credentialing healthcare professionals: A staff certification program that worksTASS awarenessSurvive and thrive: Guide for new SPD managersQuality assurance using sterile processing information systemsClass 6 emulating indicators: Use failure to your advantageANSI/AAMI ST41 has been revisedWhat, how and why: Connected equipment for instrument reprocessing

Here’s a sample of what you will find: