2017 SPRING EDUCATION CONFERENCE STERILE PROCESSING 101 NCAHRMM 2017 SPRING EDUCATION CONFERENCE Wilmington, NC May 2, 2017

Equipment Planner & Capital Coordinator STERILE PROCESSING 101 Presented by Ric Goodhue, CMRP Equipment Planner & Capital Coordinator CaroMont Health

STERILE PROCESSING 101 Objectives Identify typical organization of a sterile processing department Review types of sterile processing including processes and equipment Identify regulatory agencies associated with sterile process Understand importance of sterile processing in a healthcare organization Healthcare organizations are being challenged on a daily basis to “Do more with less…. And less…. And even less”. However, we’ in Supply Chain are being challenged to cut costs, cut costs, cut costs without affecting the quality or technology needed to maintain a “State of the Art” facility.

STERILE PROCESSING 101 Background The College of Surgeons is credited with the birth of sterile processing Modern age of sterilization began ~1933 when AMSCO (now known as Steris) developed the 1st steam sterilizer that allowed temps to be measured using a thermometer. Perkins (1982) defined SPD as “that service area within the hospital which processes, issues and controls professional supplies and equipment, both sterile and unsterile, for all departments and units of the hospital for the care and safety of the patients.” Dr. John Perkins observed that “sterilization is everyone’s business, but on one’s responsibility” (Perkins, 1982). Healthcare organizations are being challenged on a daily basis to “Do more with less…. And less…. And even less”. However, we’ in Supply Chain are being challenged to cut costs, cut costs, cut costs without affecting the quality or technology needed to maintain a “State of the Art” facility.

Role of Sterile Processing SPD is the department that receives, cleans, decontaminates, assembles, disinfects, and/or sterilizes reusable medical and surgical devices for safe & effective healthcare Usually divided in separate areas according to the functions performed in each area: Decontamination, Prep & Pack, Sterilization, Sterile storage, sterile stores case cart, dispatch, loaner and patient care clean-up SPD is responsible for providing dependable, reliable services to enhance the quality of patient care. Decontamination – where soiled items are receiving & cleaned Prep & Pack – Cleaned items are inspected, assembled & packaged Sterilization – Terminal sterilization is performed. Might be a separate room for ethelyne oxide (EtO) steriliztion Sterile storage – sterile items are stored until needed Sterile stores – where items from outside manufacturers are stored Case cart – where sterile supplies (trays and/or sterirle items from outside manufacturers) are kept and picked for surgical cases Dispatch - where sterile and clean items are dispensed Loaner – for receipt and return of instruments borrowed for peciality procedures Patient care clean-up – where equipment is cleaned and disinfected Healthcare organizations are being challenged on a daily basis to “Do more with less…. And less…. And even less”. However, we’ in Supply Chain are being challenged to cut costs, cut costs, cut costs without affecting the quality or technology needed to maintain a “State of the Art” facility.

Work flow, People flow and traffic control STERILE PROCESSING 101 Work flow, People flow and traffic control Work flow is how the work advances in each stage of the processing areas Everything begins in the decontamination area where medical devices are cleaned People flow – refers to how people move through the department or processing area. May include donning or removing PPE before going from dirty to clean or visa versa. Traffic control – controlling access to SPD. Caution must be exercised when allowing individuals (or items) to go from one area to another. All visitors must abide by policy & procedure regarding infection control processes. Decontamination – where soiled items are receiving & cleaned Prep & Pack – Cleaned items are inspected, assembled & packaged Sterilization – Terminal sterilization is performed. Might be a separate room for ethelyne oxide (EtO) steriliztion Sterile storage – sterile items are stored until needed Sterile stores – where items from outside manufacturers are stored Case cart – where sterile supplies (trays and/or sterirle items from outside manufacturers) are kept and picked for surgical cases Dispatch - where sterile and clean items are dispensed Loaner – for receipt and return of instruments borrowed for peciality procedures Patient care clean-up – where equipment is cleaned and disinfected Healthcare organizations are being challenged on a daily basis to “Do more with less…. And less…. And even less”. However, we’ in Supply Chain are being challenged to cut costs, cut costs, cut costs without affecting the quality or technology needed to maintain a “State of the Art” facility.

Steps in sterile processing Decontamination – where soiled items are receiving & cleaned Prep & Pack – Cleaned items are inspected, assembled & packaged Sterilization – Terminal sterilization is performed. Might be a separate room for ethelyne oxide (EtO) steriliztion Sterile storage – sterile items are stored until needed Sterile stores – where items from outside manufacturers are stored Case cart – where sterile supplies (trays and/or sterirle items from outside manufacturers) are kept and picked for surgical cases Dispatch - where sterile and clean items are dispensed Loaner – for receipt and return of instruments borrowed for peciality procedures Patient care clean-up – where equipment is cleaned and disinfected Healthcare organizations are being challenged on a daily basis to “Do more with less…. And less…. And even less”. However, we’ in Supply Chain are being challenged to cut costs, cut costs, cut costs without affecting the quality or technology needed to maintain a “State of the Art” facility.

Training & Certification STERILE PROCESSING 101 Training & Certification Certification for sterile processing is available through two organizations The Certification Board for Sterile processing & Distribution (CBSPD). Offers 5 levels of international certification. www.sterileprocessing.org International Association of Healthcare Central Service Materiel Management (IAHCSMM) www.iahcsmm.org Decontamination – where soiled items are receiving & cleaned Prep & Pack – Cleaned items are inspected, assembled & packaged Sterilization – Terminal sterilization is performed. Might be a separate room for ethelyne oxide (EtO) steriliztion Sterile storage – sterile items are stored until needed Sterile stores – where items from outside manufacturers are stored Case cart – where sterile supplies (trays and/or sterirle items from outside manufacturers) are kept and picked for surgical cases Dispatch - where sterile and clean items are dispensed Loaner – for receipt and return of instruments borrowed for peciality procedures Patient care clean-up – where equipment is cleaned and disinfected Healthcare organizations are being challenged on a daily basis to “Do more with less…. And less…. And even less”. However, we’ in Supply Chain are being challenged to cut costs, cut costs, cut costs without affecting the quality or technology needed to maintain a “State of the Art” facility.

STERILE PROCESSING 101 Type of Sterilization Principles of sterilization Mechanical means of ensuring the removal/absence of all forms of microbial life, including bacterial spores. An item is considered sterile if there is less than a 1-in-a-million chance that a viable microorganism has survived the sterilization process. Decontamination – where soiled items are receiving & cleaned Prep & Pack – Cleaned items are inspected, assembled & packaged Sterilization – Terminal sterilization is performed. Might be a separate room for ethelyne oxide (EtO) steriliztion Sterile storage – sterile items are stored until needed Sterile stores – where items from outside manufacturers are stored Case cart – where sterile supplies (trays and/or sterirle items from outside manufacturers) are kept and picked for surgical cases Dispatch - where sterile and clean items are dispensed Loaner – for receipt and return of instruments borrowed for peciality procedures Patient care clean-up – where equipment is cleaned and disinfected Healthcare organizations are being challenged on a daily basis to “Do more with less…. And less…. And even less”. However, we’ in Supply Chain are being challenged to cut costs, cut costs, cut costs without affecting the quality or technology needed to maintain a “State of the Art” facility.

STERILE PROCESSING 101 Type of Sterilization Steam sterilization Accomplished by saturated steam under pressure (a process similar to what happens in a pressure cooker) It’s fast, efficient, low in cost, readily available, and non-toxis. It is the most common form of sterilization used in HCO for items are are heat & moisture tolerant. Requires the use of a Bowie-Dick to detect air leaks or inadequate air removal from prevacuum sterilizers. Prevacuum remove air by drawing a series of vacuums with an injection of steam between each vacuum pull. Steam-flush pressure-pulse steam (SFPP) sterilizers: the air removal depends on a repeated sequence consisting of a steam flush & a pressure pulse to remove air. Decontamination – where soiled items are receiving & cleaned Prep & Pack – Cleaned items are inspected, assembled & packaged Sterilization – Terminal sterilization is performed. Might be a separate room for ethelyne oxide (EtO) steriliztion Sterile storage – sterile items are stored until needed Sterile stores – where items from outside manufacturers are stored Case cart – where sterile supplies (trays and/or sterirle items from outside manufacturers) are kept and picked for surgical cases Dispatch - where sterile and clean items are dispensed Loaner – for receipt and return of instruments borrowed for peciality procedures Patient care clean-up – where equipment is cleaned and disinfected Healthcare organizations are being challenged on a daily basis to “Do more with less…. And less…. And even less”. However, we’ in Supply Chain are being challenged to cut costs, cut costs, cut costs without affecting the quality or technology needed to maintain a “State of the Art” facility.

STERILE PROCESSING 101 Type of Sterilization Ethelyne Oxide (EtO) Characteristics – is a liquid that becomes a gas at room temperature. It is highly flammable and explosive It is completely soluble in water @ 50 degrees Farenheith It is colorless and essentially odorless Is highly toxic to personnel. Can cause severe burns to the skin & tissue Provided in undiluted (100%) single dose cartridges and EO mixtures consisting of EO & either HCFC or CO2 100% EO cartridge storage must not exceed one days supply unless stored in a flammable cabinet IAW OSHA regulations Heavily monitored, regulated and enforced Decontamination – where soiled items are receiving & cleaned Prep & Pack – Cleaned items are inspected, assembled & packaged Sterilization – Terminal sterilization is performed. Might be a separate room for ethelyne oxide (EtO) steriliztion Sterile storage – sterile items are stored until needed Sterile stores – where items from outside manufacturers are stored Case cart – where sterile supplies (trays and/or sterirle items from outside manufacturers) are kept and picked for surgical cases Dispatch - where sterile and clean items are dispensed Loaner – for receipt and return of instruments borrowed for peciality procedures Patient care clean-up – where equipment is cleaned and disinfected Healthcare organizations are being challenged on a daily basis to “Do more with less…. And less…. And even less”. However, we’ in Supply Chain are being challenged to cut costs, cut costs, cut costs without affecting the quality or technology needed to maintain a “State of the Art” facility.

STERILE PROCESSING 101 Recommended Publications Basics of Sterile Processing (5th Ed) Sterile Processing University, LLC AHRMM Materials Management Review Guide, 5th Ed. The Joint Commission (TJC) Hospital Accreditation Standards Association of PeriOperative Registered Nurses (AORN) Standards Comprehensive Guide to Steam Sterilization and Sterility Assurance in Health Care Facilities - Association for the Advancement of Medical Instrumentation Guideline for Disinfection and Sterilization in Healthcare Facilities (2008), Center for Disease Control (CDC) GPO’s :Premier, Novation, MedAssets, Capstone ECRI – “Consumer Report” for Capital MDBuyline NCAHRMM – NC Association Healthcare Resource & Materials Management AHRMM - Association Healthcare Resource & Materials Management ASHE – American Society for Healthcare Engineering AHVAP – Association of Healthcare Value Analysis Professionals

Sterile Processing 101 Q & A