Case Study: Central Sterile Processing Department

A Deeper LookLiterally central to almost every healthcare space, much revolves around the efficiency and organization of the Central Sterile Processing Department. Often these departments serve on- and off-campus buildings and employees need to be several days ‘ahead’ of the surgical departments they supply.

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SERVICE LINE OVERVIEW

An integral department within any healthcare facility, the Central Sterile Processing Department (CSPD) is key to the safety and efficiency of many other departments. In- and outpatient surgery, physician practices and emergency services are just a few of the key hospital areas affected by the Central Sterile Processing Department. From sanitation to proper packaging, and on-time and on-demand delivery – the CSPD needs to function at an optimal rate and have clear processes to run most effectively.

Whether an inpatient facility or an ambulatory center – the location, flow and size of the CSP affects adjacent spaces and the overall effectiveness of the facility. We do not stop at planning and design of the facility, our expertise is called upon during staff training and after occupancy to refine flow and optimize the service the Department delivers internally.

Knowledge of equipment specifications and procedure / surgical instrumentation needs as well as our dedication to listening to the users of each facility, provides us the exper-tise to assist our clients at all phases of their Central Sterile process.

CENTRAL STERILE PROCESSING

CHALLENGE

Often ASCs’ sterile surgical needs are delivered from the main hospital. With 12 ORs, Montefiore’s ASC needed its own CSPD on-site. With ORs and prep/recovery distributed over two floors, adjacencies were key.

SOLUTION

Locating the CSPD Department within a dedi-cated elevator trip from the ORs, and with enough space to accommodate an increase in cases, the on-site CSP services all cases and procedures.

The Importance of Central Sterile

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AMBULATORY CENTER INTEGRATION

Montefiore’s vertical organization of the surgical services, distributed between three floors, emphasized floor connectivity with the Central Sterile Processing Department. Utilizing Rapid Lean design principles, the workflow of the OR supplies in relation to CSPD was reviewed – from how the goods arrive on the floor to breakdown and storage on the shelves.

This review uncovered the delivery frequency of certain supplies, their weight and footsteps taken to their shelf location. A flexible storage model allowed us to adjust the layout in the CSPD with a continuous improvement model (PDSA – Plan, Do, Study, Adjust), to achieve maximum efficiency. After the first layout was completed, the staff studied it for a week. During the second review ses-sion, further adjustments were made prior to the start of the first surgical case.

Two weeks after the first surgical cases started, a third review session was held. After a full re-supply of information and frequency of use were deter-mined, additional adjustments were made to the inbound supply workflow, the cart loading and cart staging workflows, as well as the development of an area immediately adjacent to the clean elevator for high frequency supply replen-ishment. Imparting our knowledge to the CSPD staff of how to conduct a Rapid Lean session on their own allows them to keep aligned with the PDSA method as the future of surgical services develops and as their needs grow.

We applaud Montefiore in their decision to invest in on-site Central Sterile to make their Center full-service. - Jason Lee, Project Manager

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TECHNOLOGY INTEGRATION

A second and equally valuable pillar of a modern CSP Department is technology. With OR turnover times at a pre-mium, how the ORs are supplied and the way instruments are processed are key factors in reducing turnover times. Technology can greatly aid the staff and help manage work-

flow. The automation of the wash sequence and washer unloading allows the decontamination staff to focus on the arrival of soiled carts and the heavy particulate wash. The use of the Abacus system for the prep and pack area allows the CSP staff to have greater efficiency and workflow when sorting instruments.

Implementation

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Another technological improvement for the OR and CSP is radio-frequency identification (RFID) technology. Since instruments can be a significant part of the surgical services budget, equipping them with radio-frequency identification technology will not only help in tracking where that expen-sive scope is located, but also when tracking smaller surgical instruments, reducing the amount of lost instruments.

During the instrument purchase, the RFID technology can be embedded in the smallest instruments for a minimal or no-cost increase. The accidental disposal of surgical instruments during OR turnover can add up to a significant yearly cost. To avoid this, all trash, soiled and utility rooms on the OR floors are equipped with a detection system that will notify the staff if there is an instrument in the bag. This de-tection system is also utilized throughout the CSP to ensure that instruments and equipment maintain their proper work-flow path. While technology alone will not ensure the most efficient turnover time, proper staff education and training with the aid of technology will help to achieve the most efficient turnover time, thus enhancing the OR throughput model.

WORKFLOWS

The workflow of the CSPD begins at the Level-3 surgery floor with a dedicated clean elevator and a dedicated soiled eleva-tor. The soiled instruments travel up to Level-5 with the ele-vator opening directly to Decontamination. The instruments and equipment are broken down within a multi-zone wash area before traveling to one of the three instrument wash lines, and case carts travel through the cart washer. There is a separate, dedicated room for scope washers that bridges the decontamination and prep-pack areas, so scopes can have the proper infection control cleaning process.

On the clean side, the three wash lines are equipped with auto unloaders, which streamline the process. There are eight wheeled prep and pack stations to allow flexibility of configuration with future needs and continuous improve-ment. The stations are height adjustable with the touch of a button so the best ergonomic solution is available to each staff member. Carts are loaded from the prep and pack area and taken to one of three sterilizer bays. To review the continuous improvement model, the CSPD manager’s office is a glass box that, while physically removed for the clean side, has a three-sided view to the washers, prep/pack and sterilizers.

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