Despite the complexity of the work of sterile processing personnel, some people think of them as little more than glorified dishwashers. However, their work is intensive, physically demanding and highly skilled. With a problem keeping healthcare workers at every level, making their jobs easier, safer and more comfortable should be the goal for every institution.
To examine what requirements are needed to make sterile processing personnel safer, Cori L. Ofstead, president and CEO of Ofstead & Associates, conducted a follow-up study to an earlier pilot study she and her colleagues had conducted in 2021, which was real-life testing of how well personal protective equipment keeps sterile processing personnel dry. This new study looked at how far water droplets would travel if sterile processing personnel followed the manufacturers’ instructions for use. On the contrary, he spoke to Infection Control Today® (ICT®) regarding their studies published in American Journal of Infection Control.
ICT®: Please, give it ICT®Readers have a summary of the main findings of the following study and why they are important?
Cory L. Ofstead: In this study, we found that board-certified sterile processing techniques dipped head to toe when they followed the manufacturer’s instructions on how to manually clean ultrasound probes used for gynecologic (GYN) procedures. Technicians also got wet when cleaning gastrointestinal (GI) endoscopes.
The most surprising thing was about the GYN probes. During their routine activities, the work environment was also heavily sprayed. The drops hit the shipping cards set about 4 feet back, and the drops also hit the walls 6 feet away, and they went all over the floor to within 7 feet—or a little over 7 feet—of the sink where the sterile processing technicians were working. clean these devices. So that’s the main key finding.
The other thing is that the observers who were 3 to 4 feet away from the sink – so they weren’t even in the sink doing anything – were hit with multiple drops. This means that any personnel in the area, whether they are other technicians, supervisors, infection preventionists or surveyors, are walking around the area and may be exposed. Sometimes those people don’t wear full PPE. They’ll wear it when they’re at the sink and they know they’ll be doing messy work, but people walking around the area might not be. [in full PPE]. What we’ve shown is that if you’re in the area, you’re at risk. [Additionally,] all those liquids ended up being tracked all over the place so they are all over the unit and then from the door to the hallway.
Even technicians must be moved from what they are doing at the sink to take the instrument to the next location for high-level disinfection or sterilization. And as they move around, [movements] they are spreading all this [contaminated water] everywhere.
In the 2 studies we did on spraying, [the techs] they were using instruments that had already been thoroughly processed, so they were not contaminated. The areas were finally cleaned and disinfected. We were going through the motions of these recommended processing steps. [However,] these medical devices would normally be highly contaminated. That’s why we’re sending them to sterile processing, of course, but that’s worrisome because if you have these cleaning fluids that have blood and tissue, and patient secretions with all kinds of germs in them, and you’re digging. [individuals in the processing rooms] from head to toe, this is a completely different thing from clean water and pristine instruments.
[Further,] the study showed that PPE did not work. Relying on PPE as the sole layer of protection for the worker is troubling because it didn’t cover their skin, didn’t fit well enough, and didn’t provide the fluid resistance we need for the PPE to be used in this. very humid environment. The conclusion of this study is that sterile processing personnel do not face a hypothetical risk of exposure. They live in it all day, every day, so priority should be given to these solutions that can minimize their exposure and contain a spray to ensure that technicians have a safe work environment to perform the critical tasks that they are doing for the patient. safety.
ICT®: Do you have any recommendations for protecting observers or people walking around the room?
CO: Start with anyone entering the decontamination area, which is the dirty side of sterile processing, must have full PPE if they are walking through the doors. No more walking there in just scrubs, and what they call their hospital shoes. Everyone should have full PPE and should have shoe covers that are truly liquid resistant, which these [in the study] they weren’t at all. The liquid got into the shoe with this highly contaminated liquid. Then they walk all over the hospital and maybe even go home in those shoes.
We should consider an “Authorized Personnel Only” area where we take seriously the need and the best solutions we call engineering controls that would minimize or contain splash. Because once it’s on the floor, it’s going everywhere. We are fighting a very difficult battle. Hopefully, infection prevention is coming up with solutions to do a better job of minimizing the spill from happening in the first place and containing it. This is where we make sure that the decontamination workstation is sufficiently isolated with plexiglass barriers or station carts so that we don’t have droplets that go 7 feet and get onto all surfaces and anyone walking through the area. These solutions may be feasible. Challenging, of course. But relying on individuals to remind you to do things and do them correctly will always be a higher risk than designing the work area for safety.
[It doesn’t help that] sterile processing is hidden from view. Many people, even infection prevention experts, are not aware of what sterile processing professionals do or what the risks are. Also, almost every guideline or standard talks about hand hygiene when removing gloves. When removing your PPE, you should wash your hands or use an alcohol-based hand rub. But until now, no guidelines or standards say, if you’re working in an area and you’re getting sprayed, you should also wash any other parts of the skin that were sprayed.
In both our studies in the splash pilot and [the follow-up study], we documented that the face shield is not protecting the face from the neighborhood. The neck and chest are being exposed here, even when reworking 1 instrument, and they’re obviously doing more than that in a day’s work. Then the gloves did not prevent liquids from penetrating and the liquid was getting into the forearm and wrist areas. We need to re-think our instruction that says how to remove your PPE completely, disgustingly saturated, where you’ve literally dipped your arms in fluid that has patient blood and tissue and secretions in it.
We, as sterile processing personnel, remove PPE when:
- Are we washing our hands?
- Are we saying wash the arm up to the elbow, to the shoulder?
- What about the face mask that gets wet, apparently, removing those fluids?
- How do we make sure we don’t go home with our 2-year-old running around our necks, our heads, our hair?
These need to be addressed. This is a provocative revelation from our splash pilot [study], and this in both studies. Every time they worked on an instrument, they bathed [around the neck]. Our current PPE, even with a face shield, is not protecting this area, which is the toddler area. This is the baby area. This is where our pets or children will go directly when we pick them up.
It is a difficult job in sterile processing. Some people think of them as they are downstairs. They are simply glorified dishwashers. However, this work is very complex. They deal with literally 1,000 different surgical instruments and medical devices. And they have to know all the intricacies of all those instruments and how they can be safely processed to make them safe to use on another patient. They have this very technical, high level of knowledge and skills. They have to have this constant attention to detail and do work that’s very physically demanding, and they’re going to do it in an environment that’s very hot, humid, and steamy.
Many or most institutions are now struggling with staffing issues. Recruiting or maintaining sterile processing is a major challenge. But part of the issue is when you get someone new, and they come in and realize that wearing all this PPE is uncomfortable, it’s hot, it’s steamy, it’s complex, there are time pressures, and patient safety depends on them; it is intense. We need to think of ways to support them better, to make their jobs safer and more comfortable. To give them recognition and credit for how critical their work is to patient safety all day, every day.
ICT®: What do you think are the biggest challenges for sterile processors?
CO: The biggest challenge now is time pressure. They are supposed to do incredibly complex work very quickly, to turn around instruments as fast as they can. It is difficult under time pressure to remember all the steps in it.
For example, to process a flexible endoscope used for a gastrointestinal procedure or a respiratory procedure, there are more than 100 individual steps. They have to remember all the things that need to be done in the order they need to be done, and then execute it properly. Meanwhile, people ask for other things, or hear other alarms, the phone rings, someone calls them. It’s different for every single instrument, and they’ll see dozens or hundreds of different instruments in a day’s work. So that level of intellectual capital and that level of attention to detail needed to be in an optimal work environment that provides them with all that work environment—the sounds, the smells, the comfort level—to focus and to ‘made those tests, basically, perfect every time because their work is critical.
There is no margin for error; it must be done perfectly every time. So finding the time to do that is the #1 challenge.
The pilot study can be found here. The follow-up study can be found here.