A Cut Above the Rest: Dangerous Designs in Our Sterile Processing World
Recently, I was scrolling through one of the many sterile processing Facebook groups out there and saw an all-too-familiar sight: blood dripping down a technician’s hand in the prep/pack assembly area.
What do you think happened? Skin hook to the finger? Towel clip to the palm? Random pinch from a double-action rongeur?
No. In this case it was one of the handful of looming dangers in our departments of a nonsurgical instrument kind. She had sliced her hand open with the tape dispenser. Now, for those of you reading this who have never worked in an SPD, that may elicit a slight chuckle or glimmer of disbelief. But anyone who has ever nicked their knuckle on those hellacious tape dispensers knows the pain all too well. Unfortunately, this is only one of the many dangers lurking in the basements of our hospitals, with very little attention from the industry at large. Whether it is the tape dispenser, washer manifold, or some other sharp/hot/slippery corner of our world, until we talk about it, we can’t expect to find solutions.
The serrated edge
It really is a thing of nightmares. Imagine a small blade, partially rusted through years of use, serrations angled up for the perfect slice of sterilization tape, adhesive residue clinging to all manner of debris and bioburden captured in its crevices, and BOOM! It grabs you. A minor cut, perhaps, but a jagged one. And unlike the surgical instruments on your assembly table, you know this tape dispenser has not just gone through a cleaning and disinfection cycle with detergent and thermal disinfection. The microbes on this blade have been camping out there—forever.
The Facebook post mentioned in the introduction is not an outlier. The active comment section of the post, filled with numerous “Me too[s]!” and “I hate when that happens,” removed all doubt of that fact, but so does personal experience. In a little over 10 years of sterile processing work, I have sliced open my finger, hand, and arm on numerous occasions on our sterilization tape dispensers.
Designed to sit steady while pulling out large lengths of chemical indicating tape, these dispensers are weighted up to four pounds each. They are also fairly tall to allow the large rolls of tape sit freely on the spool. But with so many injuries from these dispensers to technicians around the country, it’s worth asking if they are really designed as safe as they could be?
In my home state of Texas, you learn from a very young age not to cut it too close when you’re walking around the back of a pickup truck. The reason for this is the same reason that many sterile processing professionals have gasped in pain while walking around the back of a sterilization loading cart: protruding pieces of unprotected metal measuring right at the height of the average shin. In Texas, it’s the steel trailer hitch. In sterile processing, it’s the steel bars that come off of particular designs of sterilization carts put there to assist in the loading and unloading of the carts into the autoclave chambers.
As with the tape dispenser, I have had personal injurious experiences with these sterilization cart extensions, as have many of my staff members over the years. When looking at this from a design perspective, the protruding tracks make perfect sense in terms of utility. They leave a lot to be desired in terms of employee safety. Something as simple as adding a hinge mechanism to these carts, or retractable tracks could go a long way in protecting our knees and shins from needless injury during use.
The metal manifold
So far the dangers discussed have been safely isolated to the clean side of the department, but that is just the tip of these potentially injury-inducing icebergs. Outside of the most obvious decontamination risks from instrument-related sharps, a close second may actually be the metal washer manifolds used to load and unload instrumentation into automated washer-disinfectors. Designed to withstand constant loading of heavy surgical trays, manual or automated movement along loading tracks and into/out of cleaning chambers, and onto floors for intermittent storage, these stainless steel manifolds can easily (and often do) lead to injury.
Perhaps the most obvious potential danger of these devices is that the awkward shape and weight of the manifolds themselves make them difficult to manually lift and maneuver in safe, ergonomic fashion. To firmly grasp many manifolds, a user must reach out away from the body, extending their center of gravity, and attempt to lift what amounts to a multilevel stainless steel shelf—all while fully clothed in personal protective equipment, slippery gloves, and often on a slippery floor.
Weight and ergonomics alone, however, are not the end of this story. The manifold designs, like the sterilization carts mentioned above, excel in utility while still missing some important marks in the category of technician safety. In particular, the metal edges between and beneath the manifold levels are often sharp enough to rip open the plastic PPE gowns worn in decontamination, and leave quite a scrape on the arm of a technician trying to quickly unload trays on the clean side. For a device whose entire purpose is to have human hands coming in and out of these tight manifold levels throughout the day, the sharpness of these edges is one of the more obvious safety-minded design failures in our departments.
Designed to work (safely)
You do not have to be an engineer to realize when something in your department wasn’t designed as safe as it could or should be. And you do not have to own a manufacturing company to have a positive impact on the safety of the products that you use. Very few in the research and development sector of the sterile processing industry have ever set foot in a sterile processing department. In some sense, that’s understandable. They are engineers, not reprocessing technicians. Likewise, very few of us have ever had to design a product from scratch and ensure it actually works and can be used safely. Neither of our roles are easy, but both of these teams need to talk to each other more than they may know.
Even if the department injury was ultimately user error on a tape dispenser or not paying attention when zooming past a sterilization cart, the goal of product development can (and I think should) be to design safety into every step. If this is something frontline technicians in sterile processing really want, it’s time we start asking for it.
Feature articles exclusively for Ultra Clean Systems by Weston “Hank” Balch, BS, MDiv, CRCST, CER, CIS, CHL
Weapon of Mass Microbial Destruction * Professional Clean Freak * Podcast Host * Safety Addict * CS/SPD Consultant
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