In part 2 of this series, we discussed equipment placement and operational flow. Part 3 will discuss the selection of ancillary equipment for your department and how to design support systems for that equipment within your workspace. We will also talk about HVAC and lighting designs.
Equipment selection either supports the work environment or detracts from it. The staff must have enough workspace to complete their jobs. Sinks need to be large enough to fit large trays, endoscopes, etc. Evaluate your needs before making a purchase decision. Ergonomics is also important. Sinks with electrical height adjustments are preferable. I can say the same for assembly workstations. I have used the work tables with manual adjustments. Although they are sufficient, I prefer the electrical tables for ease of use. I also prefer the six-foot length tables to support instrument trays with high numbers of instruments. If you are in an outpatient area with small trays, you might go with smaller tables. However, with the current growth of procedure types, especially in orthopedic cases in outpatient areas, a better investment may be the larger tables. Don't overlook the space needed for supplies for each work process. Purchase equipment that allows for supplies to be stored within arm's length and not on top of the workspace. Leave the sink countertops and assembly tabletops for instruments. Select visual aids to support the inspection of instrumentation. My preference is digital aids that can be broadcast onto computer screens and adjusted in power increments. Instrument air aids processes in both the decontamination area and the assembly areas. Make sure it is built-in and not added after the fact. The cost is significantly lower upfront. The placement of printers is underrated. In a lean-designed department, less means more, less in the form of movement. Placing printers between workstations is preferable. This design also means that you will need more data drops to support the equipment. If you can, spend time at industry shows and review the equipment in person. If not, visit facilities that already have the equipment you are interested in and speak to the end-user about the reliability and functionality.
As critical as it is with selecting the proper equipment for your sterile processing department, the design of your airflow and lighting is also as critical. Let us start with lighting. I find lighting a constant challenge in sterile processing departments. Typically, lighting designs only meet the basic needs of office spaces, and not the need for a critical inspection workspace. Utilizing the Illuminating Engineering Society guidelines, there is a difference in lux ratings in general work areas from 500 lux to 1000 lux (least illuminance to most illuminance). In detailed inspections areas, which sterile processing areas are, the lux ratings range from 1000 lux illuminance to 2000 lux illuminance. I typically find sterile processing workspaces with lux ratings between 650 lux to 750 lux. Along with the lack of lighting is the issue with the placement of the lights themselves. Especially in decontamination areas, lighting often causes shadows in the sink basins, which can be dangerous for the staff performing this process. Another issue is the reflection of light from the worktables in the assembly areas. Work with your engineer to design the correct illumination and the best light positioning for your work areas.
The HVAC design of your workspace needs to meet the recommendations for temperature and humidity all year long. The updated 2017 ASHRAE guidelines can be found here: https://www.ashrae.org/file%20library/technical%20resources/standards%20and%20guidelines/standards%20addenda/170-2017/170_2017_p_20200302.pdf. This may mean that you need to add humidity during the winter in the Northern part of the country or a dehumidifier in the Southern part of the country during the warmer seasons of the year. The design of the HVAC system must be able to handle the heat output of the equipment in the department. Ventilation in the areas of the sterilizers, washer/disinfectors, and cart washer help to remove excess heat when the doors open after a cycle. One recommendation I can make for your HVAC system is to review the placement of the positive pressure vents so that air is not being directed directly down onto the staff. Review your equipment layout to the design of the placement of your ventilation vents. I have been in sterile processing areas where staff will wear towels and other items around their neck areas to keep them being cold. Distractions like this in sterile processing can create a negative impact on the work. Lastly, ensure your HVAC is situated so that instrumentation in the cooling phase after sterilization does not have direct airflow blowing down on them. Inadequate designs can cause wet packs.
In the next part, I will discuss storage space design in sterile processing and safety zones.
This blog series is intended to be a synopsis of my thoughts relating to my career and my experiences of the last 38 years in sterile processing. That being said, this blog content will be a multipart series because of the length and depth of the content I will cover. As a sterile processing manager, I have been blessed with the opportunity to help design multiple sterile process departments, ambulatory reprocessing areas, GI reprocessing areas, and some outpatient medical reprocessing areas. My goal is to impart some of the knowledge I gained from participating in these projects. Come back next week for more discussion.
Reference: ANSI/AAMI ST79:2017 Section 184.108.40.206 Lighting