Who Are We Supporting in Sterile Processing: Focus on the Surgeon or the Patient?

Surgeon speaking to a surgical patient

Introduction To the Debate

I pose this question because there appears to be a divergence of views among supporters of our sterile processing field. Like you, I attended several presentations at the latest HSPA conference. One featured a consultant who asserted that the focus of sterile processing support should be on the surgeon, while another presenter involved in healthcare compliance argued that the patient should be the central focus.

Normally, I would argue that both sides cannot be right in a debate. However, both presenters offered compelling points, and there is often a gray area. In my view, both perspectives are valid because the focal points overlap. The presenters have business reasons to justify their positions. The consultant advocates for process improvement from a business angle, while the surveyor promotes it for the broader societal benefit.

Understanding Sterile Processing

We can likely all agree that a major role of sterile processing is providing sterile instruments/trays in a timely manner, ensuring they are functional, defect-free, and complete with no missing items.

To achieve this, the sterile processing department must adhere to several processes to fulfill its mission, which include:

• Following the Instructions for Use from the following sources:

  1. The instrument manufacturer

  2. The decontamination equipment manufacturer

  3. The sterilizer equipment manufacturer

  4. The disposable supply manufacturer

  5. The reusable supply manufacturer

• Adhering to best practices such as:

  1. AAMI

  2. SGNA

  3. APIC

  4. FGI

  5. OSHA

  6. AORN

  7. NFPA

  8. ASHRAE

If you haven't experienced working in sterile processing, the tasks can seem daunting. The variability in manufacturers' instructions between different items can be considerable. Ultimately, resolving the instrument requirements is essential for the benefit of both the surgeon and the patient.

Focus on the Surgeon

Without proper sterile instrumentation, a surgeon cannot perform surgery and resolve the patient's medical issues. Positive outcomes of focusing on the surgeon include:

• Continued contributions to the OR schedule by the surgeon

• Efficiency in the surgical schedule, allowing more procedures to be performed

• Increased revenue for the medical facility

• Reduced overall cost of the procedure

Focus on the Patient

Without proper sterile instrumentation, a patient's surgery cannot proceed, leaving medical issues unresolved. Positive outcomes of focusing on the patient include:

• A successful surgery that addresses the patient's medical needs and enhances their life

• Reduction in length of stay due to reduced infection rates

• Increased revenue for the medical facility

• Reduced overall cost of the procedure

Balancing Priorities

Here, I will examine the downsides of each focus. Starting with the patient, assume the sterile processing department has limited time and staff (a common scenario in most SPDs) to process instruments to meet OR schedule needs.

Patient Focus - Negative Outcome

• OR schedule is delayed

• Physician satisfaction is reduced

• Surgeon's bookings are reduced

• Surgeon's time efficiency for daily needs is impacted

• Revenue for the medical center is reduced

Surgeon Focus - Negative Outcomes

• Potential increased risk of infection to the patient

• Patient satisfaction is reduced

• Increased liability for the medical facility

• Revenue for the medical center is reduced

  
  

In reality, where time is limited and often not prioritized for SPD processes, corners are cut daily in sterile processing. If you doubt this, just visit a sterile processing department. The Joint Commission's list of common violations includes "Risk of infection associated with medical equipment and supplies." SPD staff must prioritize and focus on processes daily. When attention is concentrated only on the surgeon's instrument needs, the turnover of these instruments tends to be hurried. Conversely, when the emphasis is solely on the patient, the staff may become entangled in the details of IFUs and best practices, which can slow down production. Focusing exclusively on either the patient or the surgeon, without addressing both needs, raises the risk for the medical facility. This is why I agree with both speakers.

Strategies for Improvement

The sterile processing department and the Operating Room should be regarded as equal partners in the surgical process. Neither can operate independently, nor can the surgeon or the patient. The OR schedule serves as the master plan. Proper allocation of time, staff, and supplies in each area is vital for success. Both departments need to understand each other's daily capabilities while ensuring the safety of staff and patients. The master schedule should be developed using this data. Timely communication is crucial, as production goals may shift due to equipment failures, instrument loss or breakage, and staffing issues. Conduct daily meetings to ensure that the timing for instrument turnaround can be achieved without rushing or compromising quality.

Conclusion

The sterile processing field is currently engaged in a debate about whether the focus should be on the surgeon or the patient. Both perspectives, discussed at the HSPA conference, have merit, as they overlap and offer both business and societal benefits. The primary role of sterile processing is to provide sterile instruments promptly, following the manufacturer's instructions and best practices, which can be challenging due to inconsistencies.

Focusing on the surgeon ensures efficient surgical schedules and increases revenue, while prioritizing the patient leads can lead to lower infection risks and better outcomes. However, concentrating solely on one perspective has its downsides, such as operating room (OR) delays or heightened infection risks.

It is crucial to find a balance, as both the surgeon's and patient's needs must be met to minimize risks. The sterile processing department and the Operating Room should function as equal partners, with timely communication and daily meetings being essential for success. Ultimately, the goal is to reduce risk while increasing revenue.