SPD – It’s a dirty job, and thank God someone does it

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Effective sterilization is vital to the successful and efficient function of any large health-care facility. The reality is that, as all processes within hospitals are interrelated, cleaning and disinfection procedures are critical.

“The hospital is as good as the Sterile Processing Department. If we’re good at our work, every unit can shine,” says Janina Berenyi, SPD Clinical Educator at St. Joseph’s Healthcare Hamilton. “SPD is the heart of the hospital.”

Janina knows that keeping patients safe from contaminated instruments requires constant vigilance and learning. As new instruments become available to hospitals and clinics, infection control personnel must make it their business to know how they should be cleaned and sterilized. Thanks to her creativity and dedication, the systems and processes for cleaning, disinfecting, and sterilizing equipment at St. Joseph’s are not only effective, they have become a benchmark for other hospitals in Canada.To meet the many needs of the hospital, the department has developed a comprehensive program that is based on internally developed manuals that examine, in detail, each instrument used in the organization. These are based on CSA standards and, in many cases, have formed the basis for the CSA standard. They have also developed an orientation program for SPD staff that is based on the instrument manuals and required information and testing. The SPD has also developed an internal quality assurance program that is based on non-punitive incident reporting from stakeholders.

The department has many responsibilities, including decontamination, sterilization and preparation. They dispatch items to the units throughout the hospital, such as Cardiac Arrest Carts. With literally thousands of instruments the OR is a major client for SPD. The department supplies Case Carts and Sterile Supply for every operation and they pride themselves on being able to present an Emergency Cart in the OR within 30- 60 seconds.

In decontamination every non-disposable item is cleaned after patient use – everything from bedpans to respiratory equipment. The approach is meticulous. The items are sorted: sharps from dull, anything that is assembled is disassembled, delicates, etc. Bedpans and instruments are not cleaned together.

SPD at St. Joseph’s work on a worse case scenario. They clean everything as if it had been exposed to the worse kinds of contaminants. There are several types of cleaning used, depending on the equipment, and a number of different stages as well.

They want things to be clean even before being placed in the tunnel washers. The washers themselves have a number of cycles, and are programmed to run specific types of equipment through specific cycles.

“One part of our decontamination is working with processing instruments,” says Janina. “Another part is a specialized team that just addresses implants, power equipment, laparoscopic equipment – instrumentation that is very difficult to clean. What makes St. Joseph’s different from most hospitals is that we have a specialized scope team. And that’s all they do. They clean this very specialized equipment.”

Training of sterilization staff is also of paramount importance. There are literally thousands of instruments, and each operation requires staff to prepare complex sets of instruments. At St. Joseph’s an inventive approach has been taken. Instrument photograph manuals have been prepared so that properly trained personnel can function.

“There are over 205 instrument sets and hundreds of trays that they have to know,” says Janina. “And it’s all there in the manuals. If they know how to read, they can find the information for themselves. And it’s the same for decontamination. Every instrument in there has been identified as to how it’s disassembled, how it’s cleaned, how it’s identified, how it’s assembled, precautions needed, how it’s lubricated, how it’s sterilized, how it’s packaged and what CSA standard we’re following.”

Janina has done all the painstaking work of taking pictures of each instrument, identifying them and labeling them. She has also implemented a training program in which staff are required to learn the instruments. So far, every specialty has been covered.

Within six months the whole system will be computerized. “We’ll be able to bring up the information instantly. We’ll know where every instrument set is every time. We’ll know if a set arrives in decontamination or if it’s up in the Operating Room. We’ll know every instrument – where it’s been used and on whom it’s been used. It’s taking it a step further.”

Janina has been at St. Joseph’s for 40 years. For many years she was Head and Charge in the OR and helped to train Operating Room staff – nurses and doctors in sterilization procedures. And under her leadership a strong relationship has been formed between OR and SPD. They have developed a keen respect for each other’s work and realized the importance of each person’s role.

“We’ve sort of joined together as a team. We work together,” says Janina. “Each new instrument is photographed and identified. Pictures are distributed in SPD decontamination and the Prep Room. Copies are posted in the OR so that when the new instrument is introduced the information is available that day.”

Janina is very proud of her staff. “This is a very difficult job. My staff are all certified and trained. They have to know the whole system. They go through a three-month orientation. They have to know every instrument. They have to know how to assemble all 205 instrument sets. They have to know how to operate the autoclave 100 per cent. And more- it’s not an easy job. And we have now initiated a quality assurance program that identifies and investigates any mistakes or errors.”

The latest step to be introduced is the purchase of containers to hold all the sterile items. Any vermin will not be able to get to them, moisture in the air cannot affect them, the dust and air-exhaust from outside the building will not affect their sterility.

“We are always moving. Everyday my staff asks: ‘What are we doing today that’s different? What have we changed today?’ They are all keen to learn; they are all problem solvers. The excellence is here.”