Talk Transcript for Introducing SPD to New Hires

  

By Martin Li, MA, CRCST, CER, CIS, CHL

 

 

Figure 1 Workflow of SPD

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Talk Transcript

Hello new friends,

Welcome onboard to our Sterile Processing Department (SPD)! As new hires, you are about to embark on a crucial role within our healthcare facility. Today, I want to walk you through the essential aspects of SPD operations, from decontamination, pre-pack, sterilization/high-level disinfection processes, sterile storage and distribution, to the importance of sterility assurance. Let’s dive into the core responsibilities and procedures that define our department.

Introduction to the Sterile Processing Department

The Sterile Processing Department (SPD), also known as the Central Sterile Services Department (CSSD), is the backbone of infection control in any hospital or medical center. Our primary role is to ensure that all surgical instruments and medical devices are thoroughly cleaned, sterilized, and ready for use in patient care. This department plays a pivotal role in preventing infections and ensuring patient safety.

The Journey of an Instrument Through the SPD

The journey of a surgical instrument in the SPD is meticulous and involves several critical stages:

1. Arrival at the Decontamination Area: Instruments used in medical procedures, especially those coming from the Operating Room (OR), first arrive at the decontamination area. Here, they undergo manual cleaning to remove gross soils, followed by ultrasonic cleaning or sonic irrigation, and then they are placed in a washer/disinfector.
2. Pre-Pack Area: After decontamination, instruments are transported to the Pre-Pack area. Here, they are prepared and packaged for sterilization.
3. Sterilization: Instruments are then sterilized using various methods depending on their material and intended use. Post-sterilization, they are either sent back to a procedure room for immediate use or stored in sterile storage until needed.
4. Sterile Storage and Distribution: Once sterilized, instruments are organized in a sterile storage area, maintaining strict environmental controls to ensure they remain contaminant-free. They are then distributed to various departments or operating rooms as needed, ensuring timely and accurate delivery.

Throughout this process, SPD technicians must wear appropriate Personal Protective Equipment (PPE) to prevent exposure to potentially infectious materials.

The Decontamination Process

The decontamination process is crucial as it sets the foundation for effective sterilization. Instruments from the OR are sorted, inspected for damage, and, if necessary, disassembled before cleaning. Depending on the type of instrument, manual cleaning is followed by an automated washing process using a washer/disinfector.

Manual Cleaning:

• Instruments are first immersed in an enzymatic solution to break down soils.
• They are then cleaned in a detergent solution and manually brushed.
• Finally, instruments are rinsed with clean, treated water.

Mechanical Cleaning:

• Ultrasonic Cleaners: Utilize acoustic cavitation to clean delicate instruments by forming and imploding air bubbles on the instrument’s surface.
• Washer/Disinfectors: Combine impingement, water temperature, and detergent to clean devices, ensuring a consistent and repeatable cleaning process.

The Sterilization/High-Level Disinfection Process

Once instruments are cleaned, they proceed to the preparation and packaging area for sterilization. Sterilization methods are categorized into high-temperature and low-temperature processes, and high-level disinfection processes, each suited to different types of instruments.

High-Temperature Steam Sterilization:

• Steam Sterilization: Predominant in SPDs, using autoclaves suitable for heat and moisture-stable items. Cycle types include gravity, pre-vacuum, and Steam Flush Pressure Pulse (SFPP).
• Indicators: Biological and chemical indicators monitor the sterilization process to ensure all parameters are met.

Low-Temperature Sterilization:

• Ethylene Oxide (EtO): Involves stages like preconditioning, gas introduction, exposure, evacuation, and aeration, taking up to 36 hours.
• Vaporized Hydrogen Peroxide: Used for heat-sensitive devices, converting vapor into water and oxygen post-sterilization.
• Ozone Sterilization: Uses ozone molecules to destroy microbes, leaving no chemical residue or toxic emissions.

Using Automated Endoscope Reprocessors (AER) for Reprocessing Flexible Endoscopes, Probes, and Dilators

Automated Endoscope Reprocessors (AER) streamline the reprocessing of flexible endoscopes, probes, and dilators, ensuring thorough cleaning and disinfection. The process begins with pre-cleaning to remove gross contaminants. The instruments are then placed into the AER, where they undergo a cycle of enzymatic cleaning, high-level disinfection, and rinsing. AERs use controlled conditions to ensure consistent exposure to disinfectants, effectively eliminating microorganisms. After the cycle, the instruments are dried and inspected before storage. AERs enhance reprocessing efficiency, minimize human error, and maintain high standards of instrument sterility and patient safety.

Sterility Assurance

Ensuring sterility is vital to the reprocessing cycle. Sterility assurance involves using various test packs to confirm that sterilization parameters have been met:

• Biological Indicators (BI): Challenge the sterilization process’s lethality, indicating if the load can safely proceed to storage or use.
• Chemical Indicators (CI): Show whether the set has been fully exposed to the sterilization process, placed both externally and internally.
• Bowie-Dick Test: Required daily for steam sterilizers with a pre-vacuum cycle to check air removal and steam penetration efficiency.

The Process of SPD Sterile Storage and Distribution

In the SPD, sterile storage and distribution are critical final steps in ensuring patient safety. Once instruments are sterilized, they are carefully transferred to a sterile storage area. Here, they are organized systematically to prevent contamination and facilitate easy retrieval. Sterile storage areas maintain strict environmental controls to ensure instruments remain contaminant-free. When needed for surgeries or procedures, these instruments are then distributed to various departments or operating rooms. The distribution process involves meticulous handling and tracking to ensure timely and accurate delivery, maintaining the integrity and sterility of the instruments throughout the journey.

Wrapping Up

As new members of the SPD, understanding the intricate processes and the importance of each step in the decontamination and sterilization cycle is crucial. Emphasizing patient safety while balancing efficiency is a constant challenge. Welcome to the team, and let’s work together to uphold the highest standards of infection control and patient safety in our Sterile Processing Department. Again, welcome onboard!

 

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