The Source | June 4, 2019

Advice from the Field

Listen, ask, and take notes!

Claudia, FL

Supervisor, Sterile Processing

Ways to Ensure Safety Within Your SPD This Summer

Author: Vincent Sanchez, CRCST

Summer is on the horizon—and so is the surge in ER cases that the season brings (some in the industry refer to this time as the ‘trauma season’). As the weather gets warmer, it’s crucial that your SPD team is up to date on training and understands the importance of their role in the patient care process. Here are three key ways to ensure that your SPD stays safe all summer long.

Understand Your Regulatory and Surveying Bodies

Every SPD in the United States answers to a higher power called the Centers for Medicare and Medicaid (CMS). Part of the Department for Health and Human Services, CMS is a government agency that ensures hospitals are meeting basic healthcare standards and aren’t compromising patient safety. According to Infection Control Today, “When CMS observes that patient safety is being compromised and standards aren’t being met, hospitals risk losing Medicare and Medicaid funding; the agency will revoke this funding from any hospital failing to meet its standards or requirements.”

Similar to, but not part of, the government is Joint Commission (JC) and DNV-GL. Both are independent organizations that exist to improve the safety and quality of healthcare in the United States, but neither holds legal authority. Accreditations from both companies are not required, only one or the other are required to receive funding from CMS. Both organizations standards’ are derived from ISO:9001 the Association for the Advancement of Medical Instrumentation (AAMI) and the Association of PeriOperative Registered Nurses (AORN). Joint Commission ascribes value to each sterilization step based on the risk to patients if that step isn’t followed. Further, JC certification can fulfill regulatory requirements in some states and helps facilities comply with federal regulations and requirements from insurance companies.

Know Your Standards

Even the slightest departure from sterilization standards can have catastrophic results. Pay attention to what these organizations and agencies are recommending or calling out to keep safety your top priority:

  • AAMI: This association exists to support the “development, management, and use of safe and effective health technology.” According to its website, “AAMI is the primary source of consensus standards (national and international) for the medical device industry.” It publishes comprehensive guides to different types of sterilization methods, as well as recommended practices and reports related to medical devices.


  • IAHCSMM: The International Association of Healthcare Central Service Materiel Management is devoted specifically to the advancement of knowledge around reprocessing medical and surgical instrumentation. It provides five certifications and other continuing education opportunities for SPD professionals, which can elevate your department’s collective knowledge and improve your department’s overall success.


  • FDA: The FDA is responsible for regulating what disinfectants and sterilants are used on medical devices. It also keeps an eye on reports of issues with medical devices and publishes industry recalls, as well as recommendations for ongoing safety problems with medical devices. Stay up to date on medical device approvals and safety concerns by keeping the U.S. Food and Drug Administration’s Medical Devices page bookmarked in your browser.
Use Your Data to Predict Case Loads and Staffing Needs

In order to maintain compliance, meet the requirements of regulatory and surveying bodies, and accurately follow standards, your SPD needs to be appropriately staffed for the amount of work that needs to be done. There’s no foolproof way to predict the future, but past data can help you identify trends which you can use to prepare for this summer’s work in the SPD.

Pull records from the last few summers and see what trends exist. Does the need for certain surgical instruments go up on weekends or around the Fourth of July? Does your SPD tend to see a flood of instruments in need of reprocessing around August 2, the worst day for fatal car accidents in the U.S.? Use this information to come up with a rough prediction of when your SPD caseloads will be heavier (or lighter) and when you should schedule additional staff.

IUSS Ready for the JC this Summer

By: Kelly Swails MA, CRCST, CHL, CIS, ST

Does your facility utilize immediate use steam sterilization (IUSS)? Or perhaps the better question for you to consider is how often your facility uses IUSS.  Here's a quick refresher on the four areas JC focuses on when it comes to IUSS.

Pay it Forward at CtUC 2019

Author: Summer Williamson, Director of HR

CtUC is more than the industry's largest users conference, it's an opportunity to give back to our community. For the last few years, we've partnered with local organizations to raise funds and awareness during CtUC.   Today we take a look back at those events and announce our philanthropic partner for CtUC 2019!  

CtUC 2017: Youth Villages

Youth Villages is a foster care program that provides services to children and families with special emotional and behavioral needs.  We created a scavenger hunt throughout the entire Gaylord Opryland Hotel.  Attendees used clues to find essential items such as pillows and blankets, as well as some toys and art supplies, to build bags to give to the children. 

CtUC 2018: Monroe Carrell Jr. Children’s Hospital at Vanderbilt

Many of our employees had personal experiences with the hospital providing such great support and care for their children or loved ones, so we wanted to be able to give back somehow.  The attendees participated in a trivia game and created bags with various types of activity sets to be given to children in the hospital in hopes of improving their long hospital stays.   

CtUC 2019: St. Baldrick’s Foundation

St. Baldrick’s Foundation is a not-for-profit organization with the mission to raise money to help find cures for children with cancer.  In 2017, we hosted a company-wide event where Judy Kibler, Cloud Architect (IT), shaved her head to support the cause.  

May 2019, we decided to continue supporting this wonderful foundation.  Judy, once again, graciously agreed to shave her head! Plus, Daniel Roader, Director of IT, participated and not only shaved his head, but also his beard (having grown out for almost a decade). Watch the head shaving here!

For this year’s CtUC philanthropic mission, we are extending the St. Baldrick’s event.  If we raise $6,000 overall, Ryan Givens, Business Development Manager, will shave his head live at CtUC.  But, if we continue and surpass $7,500 Jeff Alexander, VP of Operations, will shave his head, with Jim Creason, Chief Operating Officer, following at $9,500.    

Lean In: A Three-Part Series

In this series of three articles, Rachel Mandel, MD, MHA (OPS) and Marlin D. Minnis, Director of Strategic Initiatives will lay bare some of the common challenges that negatively impact the provision of quality SPD services and patient safety, as well as the benefits of Lean interventions in removing the barriers to process improvement.  We will not only discuss the obstacles themselves, but present them from the perspectives of SPD Leaders, OR Leaders, and Healthcare Senior Leadership.  This team approach is crucial to the success of any Lean engagement that will not only improve and streamline SPD but sustain those improvements over time.

How to Take Control of Your SPD and Perioperative Department

Author: Marlin D. Minnis, Director of Strategic Initiatives 

As a critical and complex department within Perioperative Services, Sterile Processing (SPD) has unique challenges that may consistently impede a departments’ ability to provide the highest quality service.  Unfortunately, sometimes the team cannot tackle those challenges and pain points directly because the decision to implement solutions that address these challenges may be out of their immediate control.

Partnership for Team Engagement

It takes the engagement of the entire team, including all of the perioperative services and senior leadership to commit to improving SPD processes and thereby focusing on patient safety.  Having spent the last 37 years working alongside SPD/OR personnel in over 85 hospitals in and outside of the U.S. in multiple roles, it is apparent that these challenges typically fall into one of three buckets.  Those buckets are: operational, clinical, and/or financial.   Some challenges fall into more than one category as expected. 

In order to assist you in implementing a process improvement plan to tackle these common challenges, we have partnered with Operational Performance Solutions, Inc. (OPS), a leading provider of process improvement services, to offer CensiServe – Lean Consulting.  This service aligns the strength of Censis analytics with continuous process improvement and waste elimination, all with the goal to deliver repeatable outcomes that drive department efficiencies, high performance and quality care.

Lean In: Operational Challenges

Co-Authors: Rachel Mandel, M.D., MHA and Marlin D. Minnis

Operational challenges can be defined as any unplanned influences that disrupt the smooth flow of assets and services throughout the process life cycle of surgical assets from Sterile Processing Departments (SPD) to the Surgical Suite and back to the SPD causing unexpected outcomes.  Let’s review a few of these challenges and the importance of each from the perspective of different levels of management. All of these challenges or obstacles can be eliminated by a Lean approach to process improvement.

SPD Leadership

This group of leaders may find themselves continually challenged by the operational challenges that are a direct result of poor communication between SPD, the Operating Room, and scheduling services. The Manager is expected to instantaneously solve these conflicts and requirements on a daily basis.  These communication inefficiencies also impact their ability to plan properly and obtain the resources, both human and material, that are necessary to be successful. Communication challenges can be present at different points in the SPD process and result in added expense, delays, and undesirable outcomes.

Lack of Pro-Active Loaner Management – If SPD is not informed in advance via timely communications of the need for a loaner tray, or the arrangement to utilize a loaner tray, the Manager is left with the challenge of managing a last-minute request and instrument requirement.  This challenge, if not corrected, creates immediate bottlenecks in operational efficiency engendering unnecessary delays and a strain on established quality control protocols. The existence of a smooth communication process that links the scheduler, the vendor, the Surgeon’s Office, SPD, the OR, and the Surgeon is critical.

Missing or Unavailable Instruments – Lost or unavailable instrumentation is, unfortunately, a common challenge.  Some of the underlying factors associated with this frustrating circumstance include staff’s lack of instrument knowledge, poorly updated count sheets, inaccurate or updated preference cards, and an ineffective backup inventory system in place for both non-sterile (Peg Board) and sterile (Peel Pack) instruments. The SPD Leaders are responsible for the continuous training and education of their staff, and operational processes that support OR functions.

Let’s look at how these issues manifest themselves in your department, and how these problems can be addressed by CensiServe – Lean Consulting.   

Perioperative Leadership

These leaders are responsible for the overall operational performance of the team and can find themselves accountable at any point in service provision for the inability of the team to deliver the high level care their patients and stakeholders expect.   

Unavailability of Needed Instrumentation – The Perioperative Services Leader is typically responsible for ensuring the overall smooth operation of SPD in order to satisfy the surgeon’s surgical needs while keeping all operating rooms running at capacity. This is difficult to do without clear visibility into the surgical instrument needs required to maintain daily and weekly demands. This places an undue burden on perioperative staff who are trained to be care givers and not inventory management specialists.  This challenge, if left uncorrected, creates surgical delays, frustrates surgeons as well as staff, and hinders operational efficiency causing underutilization of OR surgical capacity. In a prior Lean-SPD engagement, the team with OPS guidance achieved a 41% improvement in cycle time and a 45% decrease in errors per week.

Let’s look at these critical challenges in Perioperative Services which CensiServe – Lean Consulting can address to help you take control of your OR.

Healthcare Senior Leadership

Senior leaders in healthcare organizations struggle to stay competitive in a market where surgeons have many choices as to where and how their patients are provided needed services. Insurance companies are placing pressure on surgeons to utilize the most efficient and cost-effective surgical sites. Additionally, leaders need to maintain a high level of surgeon & perioperative staff satisfaction while providing efficient patient throughput that does not increase cost nor impede quality care. 

Surgeon Dissatisfaction with Operations, Scheduling and Instrument Availability -  This obstacle to operational efficiency can be related to many factors. A few of these are lack of real-time surgical resource analytics (process times, productivity, and set utilization), poor preference card maintenance, block scheduling, and delays caused by increased I.U.S.S practices.  If left unresolved, these situations create uncertainty in the operating room schedule and a loss of confidence in the system which, in turn, causes frustration and turn-over inefficiencies.  These turn-over delays impede an OR’s ability to achieve full utilization of surgical capacity, resulting in loss of revenue and increased expenses which impacts overall operational efficiency. It is possible to achieve a 100-200% improvement in staff and surgeon satisfaction with a culture change in these areas supported by Lean performance improvements.

Patient Safety and Organizational Excellence – Surgeons and other clinicians hold the administration and leadership responsible for the safety of their patients and process. There is no place that this is more evident than in the processing of surgical instruments so that they are sterile, safe and free of bioburden. If there are issues with bioburden and or the absence of well-established best practices, the organization is at risk for negative survey findings from regulatory organizations. A well-functioning SPD sets a standard of excellence that reinforces an organization’s brand and positive reputation.

Let’s identify the necessary strategy for success and the potential for CensiServe – Lean Consulting to help you take another step towards high reliability.

How Do I Start with Lean?

We're here to help you identify the necessary strategy for success with CensiServe – Lean Consulting. Reach out today to learn more on what the next steps are to get Lean in your department today!