Optimizing Workflow in the Central Sterile Processing Department (CSSD) with a Push-Pull Strategy

Blocks with letters spelling push-pull

I have preferred for years to implement a push-pull strategy that leans decisively towards a push workflow in the prep and pack work area within the Central Sterile Supply Department (CSSD). This preference is deeply rooted in my longstanding commitment to being thoroughly prepared for any emergencies that may arise. In the fast-paced and often unpredictable environment of healthcare, it is crucial to recognize that while it is not feasible to maintain every single instrument in the CSSD in a sterile state at all times, it is certainly possible to ensure that a greater number of instruments are kept in a clean state. Achieving this requires a well-organized decontamination area that is properly set up and adequately staffed. By doing so, we can facilitate the rapid preparation of instruments during an emergency, thereby allowing for quicker access and delivery of these essential tools to the end-user, whether that be a surgeon or another healthcare professional.

Optimizing CSSD Workflow: Advantages of a Push Environment and Key Considerations

To simplify the concept further and to optimizing workflow in CSSD, in a push environment within the CSSD, the decontamination area tends to produce more instruments than what is required by the prep/pack area. While this approach does present certain challenges, such as the necessity for additional storage space in the prep/pack section, I firmly believe that this scenario is far more advantageous than a pull workflow. In a pull workflow, the prep/pack area would be left waiting for instrumentation to arrive from the decontamination area, creating potential bottlenecks and delays that could adversely affect patient care and operational efficiency.

When designing your workflow, there are several essential factors that must be taken into consideration. First and foremost, it is imperative to assess the volume of instruments and sets that need to be produced on at least an average day. This statistical analysis will serve as the foundation for planning not only staffing needs but also the necessary equipment to handle the anticipated workload. To accurately determine the workflow within the decontamination area, one must average the number of sets that the staff can produce and compare this figure to the output capacity of your washer/disinfectors, taking into account the standard cycle time frame. For example, if the staff is capable of producing 12 trays per hour, and the washer/disinfectors can process the same number, this indicates a balanced workflow. However, if the OR is sending more than 12 trays per hour, you will need to either create additional storage in the decontamination area or, ideally, expand your setup by adding more sinks and staff. Conversely, if the staff is producing more trays than the washer/disinfectors can handle, it becomes evident that additional washers are necessary to maintain workflow efficiency. It is essential to balance staffing levels based on the utilization rates of instruments and trays in the OR, employing hourly output metrics for precise planning. In cases where a tracking system is not in place, utilizing case end times alongside the average number of sets per case can provide valuable insights.

Optimizing Workflow and Staffing in the Prep/Pack Area

When assessing the workflow in your prep/pack area, the same principles apply. It is crucial to examine the output generated by the staff in the decontamination area in conjunction with the equipment output from the decontamination machinery. If the staffing and equipment outputs are balanced in decontamination—ensuring that staff productivity does not fall below the equipment's capabilities—you can rely on the equipment output per cycle for staffing decisions in prep/pack. For instance, if your washer/disinfector produces 12 trays on a 30-minute cycle, this averages out to 24 trays per hour. Consequently, staffing should be organized to ensure that there are enough personnel available to produce 24 trays per hour, taking into account the average time required for staff to prepare each tray based on the specific sets being handled. It is particularly important to plan for peak periods, as these times can significantly impact workflow. Workstations must be adequately equipped to accommodate staff, and if necessary, additional storage solutions should be implemented to manage overflow effectively. Staffing arrangements should be designed to meet the hourly output requirements,

Optimizing Sterilization Output: Balancing Prep/Pack Productivity and Equipment Capacity

The output from the sterilization area is fundamentally reliant on the productivity of the prep/pack section. Once again, equipment volume plays a pivotal role. It is essential to align the average volume output of the staff in the prep/pack area with the capabilities of your sterilizers, as well as the number of sterilizer racks available for use. Failing to do so will necessitate extra storage space if the number of racks is insufficient for the output demands. Additionally, the cooling process of instruments post-sterilization must not be overlooked, as having only one sterilizer rack for each sterilizer can extend turnover times due to the cooling period required for the instruments. Incorporating redundancy with sterilizer racks is a crucial strategy, particularly if there is available storage for racks containing cooling instruments. Typically, staffing in this area is organized around one staff member per shift, although larger CSSD departments may require additional personnel to manage the workload effectively.

Ensuring Operational Continuity Through Equipment Redundancy in CSSD

Finally, it is vital to emphasize the importance of equipment redundancy within the CSSD. Operating equipment at full capacity continuously can lead to a higher frequency of breakdowns and malfunctions. Regardless of how well-maintained the equipment may be, there will inevitably be instances of failure. Therefore, it is prudent to have additional equipment on hand that can serve as a backup during repair periods. This redundancy not only ensures that operations can continue smoothly in the face of unexpected equipment failures, but it also provides a valuable resource during times of overflow, allowing the department to maintain optimal performance and meet the needs of the healthcare facility.

At Evolved Sterile Processing, our consultants have a greater focus on sterile processing. With our decades of experience, we will help you develop better processes and educational resources for your staff.