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Speed Matters: Why Quality Is Not the Ultimate Standard for Sterile Processing

How many patients are on your surgery schedule for tomorrow? For the sake of this argument, let’s say you have 20 cases booked. When do those patients need their surgery? Tomorrow, right? That’s why they are on the schedule. No disagreements yet.

Even if many of those cases are elective procedures, those patients will still be showing up at 5:30 a.m. at your hospital to begin their preop assessments and prep for their procedures. Most have taken off of work (along with a loved one), dealt with all the mental anxiety associated with a surgical procedure, and stopped eating or drinking anything since the night before. They’ve signed the release forms, said their prayers, kissed their loved ones, and headed off to preop. Others may be coming to surgery directly from the emergency room as a result of a ruptured appendix, car wreck, violent crime, or a host of other emergent reasons. They may or may not be conscious, but they are definitely in need of immediate surgical care.

And this brings us to the central thesis of this article: Will there be sterile, functional surgical trays ready for each and every one of these patients once they are wheeled across the red line?

“But, quality” is not a valid excuse
From the moment a sterile processing professional begins their very first day of orientation or healthcare career training program, the importance of quality is drilled into them. The critical importance of their roles as weapons of mass microbial destruction to overcome the dangers that bacteria, viruses, and fungi pose to their surgical patients is set up as a guiding light for every decision that they make—from pretreatment through decontamination, inspection, assembly, packaging, sterilization, storage, and distribution. If sterile processing technicians are not prioritizing quality during the cleaning and sterilization process, no one else can, and the entire process is all for naught. After all, what’s the use of doing a surgical procedure with dirty or nonfunctional instrumentation? Rushing through the process and cutting corners with quality can kill someone, so they learn from the very beginning to treasure quality above all else.

Unfortunately, I think this transcendent view of quality has skewed many of our perceptions of what kinds of responsibilities we actually have toward the patient population as sterile processing professionals. To put it another way, “But, quality” is not a valid excuse for failing to take the speed of our services seriously.

Going back to the example shared in the introduction to this article, there are likely multiple surgical patients in need of immediate or even emergent care this very day in your facility. They may need lap chole trays, open heart trays, or trauma trays. As healthcare providers who work in sterile processing, we do not have the luxury to tell the gunshot victim in OR #3 that her trauma tray isn’t ready because we decided to take an extra hour this morning to “go the extra mile” and “make sure everything was perfect.” The heart attack patient in OR #7 has a reasonable expectation that as soon as the anesthesia kicks in, his instruments will be ready to go and are not sitting on some assembly table in SPD for the fourth hour of prep and packaging.

These examples may seem a bit extreme, but they have a point. Our sterile processing teams have limited time to process a certain number of trays required for a certain number of planned and unplanned procedures that may bust through our operating room doors. Every extra minute spent on one tray means another tray is kicked back further in the assembly timeline. Over the course of a day, minutes add up into hours, which add up into trays. These unfinished trays may very well cause a ripple effect into our patients’ lives in everything from canceled procedures, risky IUSS, or worse.

What I’m not saying, and what I am
Because quality has become a such a sacred cow in our circles, it’s important to reset here for a moment. I am not saying that quality does not matter. Nor am I saying that quality should be placed below speed as the primary goal of a sterile processing service.

What I am saying is that many of us have bought into a false dichotomy (an informal fallacy based on a premise that erroneously limits what options are available). The false dichotomy is that we can either prioritize quality or prioritize speed in sterile processing. I believe the burden we bear as healthcare providers is that we must be actively and intentionally prioritizing both. Yes, every tray must be complete, functional, and sterile every time (quality). But we must have complete, functional, and sterile trays ready for every patient, when they need it, every time (speed).

The best example of an outside industry successfully striking this dual priority of quality and speed is the aviation industry. Like sterile processing, airline pilots hold the lives of many in their hands with every single flight. There are literal life and death consequences if something from a preflight checklist or plane inspection is missed. At the same time, airlines operate flights on schedules that often run like clockwork. Pilots cannot and do not short-circuit their safety checklist to stay on schedule, but neither do they ignore the schedule and spend unnecessary time on it. People need to get to where they are going on time and in one piece. It’s a pilot’s job to make sure that happens.

Likewise, individual patients need surgeries in your facility today. None of them are more important than any others. Each one needs safe trays, but they need them now. And as a sterile processing professional, it’s your job to make sure that happens.

Let quality and speed be the twin engines that get you there.

“Now boarding for OR #3.”

What say you?

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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