Outpatient Surgery Magazine

Infection Prevention IP 1 2 • O U T PA T I E N T S U R G E R Y M A G A Z I N E • A U G U S T 2 0 1 9 Rejection rates & missing indicators Measuring your department's packaging rejection rates and missing indicators will give you insight into potential care and handling issues during steriliza- tion, storage, case picking and transport, as well as possible assembly workflow interrup- tions or distractions that could cause staff to forget to insert chemical indicators in their trays. We all know that a surgi- cal tray cannot be used if the sterile packaging is compro- mised in any way — such as a rip, tear, puncture, moisture invasion or other contamina- tion. These devices are "reject- ed" and must go back to the very beginning of the reprocessing workflow. The same is true for steril- ized surgical trays that don't contain an internal chemical sterilization indicator to confirm the con- tents were exposed to the appropriate sterilant. Contaminated trays One of the most significant and highly publi- cized quality metrics to benchmark is the incidence of bioburden and other contamination you identify in your sterilized trays. Evaluate any event that involves retained bioburden on a surgical instru- ment from all aspects of the instrument use and reprocessing workflow. This should be a shared metric between the OR and SPD teams. Remember, removing bioburden begins during and immediately after surgery in the precleaning process that takes place in the OR. Surgical case delays Case delays is another collaborative metric between perioperative teams. The reprocessing department should document specific reasons for a sterile processing-related case delay — such as "tray not available," "incorrect preference card pulled" or "missing critical instrument" — to enable appropri- ate root-cause analysis and fol- low-up by department leader- ship. You'll find that you can track many of these types of case delays back to dirty data as often as a broken process. Employee injuries Track employee injuries in the decontamination area, particularly sharps exposures. Because of the substantial risk associated with exposure in this area of the workflow, you should document, report and track all events in a transparent fashion across perioperative teams, infection control, risk and administration. On-time loaner deliveries A final benchmark to consider captures the critical delivery windows for your external vendor- owned implant loaner trays. Depending on the vol- ume of orthopedic or neuro loaner instruments your facility requires, late deliveries can have a dra- matic impact on your team's ability to compliantly process these trays in time for their scheduled sur- gical procedures. Industry delivery expectations range anywhere from 24 to 72 hours before the start of the case to ensure your department is adequately staffed to safely and compliantly support this addi- tional reprocessing volume. Time to measure metrics Hopefully, we've given you some practical bench- marks you can use to measure success and position your reprocessing teams for ongoing improvements that are measurable, realistic and transparent. While there are many different measurements available to gauge your current state and overall department progress, these 10 will give you the clearest picture of your reprocessing quality. OSM Mr. Balch (hank@beyondclean.net) is the founder and president of Beyond Clean, which offers sterile processing consulting. Follow him on Twitter at @BeyondCleanInfo. 6 7 8 9 • STARTS IN SURGERY Removing bioburden begins during and immediately after surgical procedures in the precleaning process. Pamela Bevelhymer, RN, BSN, CNOR 10

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