Work systems analysis of sterile processing: decontamination

• Published in: BMJ quality & safety Vol. 29; no. 4; pp. 320 - 328
• Main Authors: Alfred, Myrtede, Catchpole, Ken, Huffer, Emily, Fredendall, Larry, Taaffe, Kevin M
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group LTD 01.04.2020
• Subjects: Academic Medical Centers - organization & administration; Decontamination; Decontamination - methods; Decontamination - standards; Design; Disinfection - methods; Disinfection - standards; Feedback; Health administration; Hospitals; Humans; Infections; Injuries; Interviews; Medical instruments; Medical research; Organic matter; Patient safety; Quality Control; Quality Improvement; Supervisors; Surgical Instruments; Systems Analysis; Task analysis; Task Performance and Analysis; Technicians; Work stations; United States > US; patient safety; infection control; nosocomial infections; human factors; quality improvement
• ISSN: 2044-5415; 2044-5423
• DOI: 10.1136/bmjqs-2019-009422

BackgroundFew studies have explored the work of sterile processing departments (SPD) from a systems perspective. Effective decontamination is critical for removing organic matter and reducing microbial levels from used surgical instruments prior to disinfection or sterilisation and is delivered through a combination of human work and supporting technologies and processes.ObjectiveIn this paper we report the results of a work systems analysis that sought to identify the complex multilevel interdependencies that create performance variation in decontamination and identify potential improvement interventions.MethodsThe research was conducted at a 700-bed academic hospital with two reprocessing facilities decontaminating approximately 23 000 units each month. Mixed methods, including 56 hours of observations of work as done, formal and informal interviews with relevant stakeholders and analysis of data collected about the system, were used to iteratively develop a process map, task analysis, abstraction hierarchy and a variance matrix.ResultsWe identified 21 different performance shaping factors, 30 potential failures, 16 types of process variance, and 10 outcome variances in decontamination. Approximately 2% of trays were returned to decontamination from assembly, while decontamination problems were found in about 1% of surgical cases. Staff knowledge, production pressures, instrument design, tray composition and workstation design contributed to outcomes such as reduced throughput, tray defects, staff injuries, increased inventory and equipment costs, and patient injuries.ConclusionsEnsuring patients and technicians’ safety and efficient SPD operation requires improved design of instruments and the decontamination area, skilled staff, proper equipment maintenance and effective coordination of reprocessing tasks.