Presentation
HE7 - Creating a Cohesive Fit: A Systematic Approach to Sterile Processing Redesign
SessionPoster Session 2
DescriptionIntroduction:
Sterile Processing is a process where dirty surgical instruments are cleaned and sterilized in preparation for their next use. The sterilization process involves multiple sequential steps performed across various work systems of the hospital by distinct teams in the operating room and sterile processing department. Due to the complexity of surgical instruments and intricacy of cleaning, instruments may remain compromised from inadequate cleaning. If detected, this requires instrument re-sterilization, which may cause delays or cancellations of surgical procedures. If undetected, this issue may cause infection and harm to patients.
Method
This qualitative study utilized a work system analysis approach to 1) analyze the sociotechnical system of sterile processing, 2) define system barriers from interactions within each work system and across work systems that contribute to inadequately cleaned instruments and unsuccessful sterilization of surgical pans, and 3) define design requirements that facilitate fit across the spacio-temporal bounds of sterile processing
1. Observation: We conducted observations for 3 different surgeries at an academic and community hospital. We started observations during the end of the procedure and observed management of instruments during 1) operating room turnover, 2) decontamination, 3) assembly, and 4) sterilization. The surgeries included orthopedic and spine surgical procedures because they have high surgical pan use and instruments with difficult bioburden removal.
2. Work as imagined vs. Work as done: We developed two process maps - one illustrating the expected process as defined in policy and the other illustrating the observed process. For each process mismatch, we defined the work system barriers that may contribute to the workaround.
3. SEIPS Analysis: We described the interactions of work system elements within and across work systems to determine how the work system design contributed to barriers noted from the process maps.
4. Design Requirement: Based on the intra-system and inter-system work system barriers, we developed design requirements to systematically define solutions.
Results:
Across the sterile processing work systems, 14 instances of workarounds were noted. We documented the work system element interactions that may contribute to those workarounds.
Intra-system barriers: Four work systems were analyzed where 17 single work system interactions were identified to cause barriers. The outcomes of these barriers are visually represented using a SEIPS interactions diagram . Examples of intra-system barriers include the following:
- OR work system: OR turnaround is time-sensitive [Organization} and staff responsible for prepping surgical instruments for transfer to sterile processing have competing priorities [Tasks].
- Decontamination work system: Tools may be insufficient to identify and clean bioburden in small crevices [Tools]
- Assembly Work System: High cognitive load to perform pan assembly [People] with many tasks stacked into one job [Tasks]
Inter-system barriers: Interactions between four work systems were analyzed, where 4 inter-work interactions were identified to cause system barriers. The outcomes of the barriers are visually represented using a SEIPS interactions diagram. Examples of inter-system barriers include the following:
- OR – Decontamination Work Systems: Instruments may not be fully wiped and sprayed upon leaving the OR [Tools, Organization]. The decontamination space is small, and pans may sit for a long time before addressed [Environment] further worsening the difficulty of removing bioburden.
- Decontamination – Assembly Work Systems: There are ineffective tools to properly clean instruments in decontamination [Tools] and there is high cognitive strain during pan assembly [Tasks]. This may lead to missed identification of remaining bioburden.
Design Requirements – We translated work system barriers into design requirements to optimize all work systems where sterile processing occurs. Doing this ensured interactions within and across work systems facilitated systematic change rather than disjointed and suboptimal processes.
- OR Work System: It should be easy and non-disruptive for the surgical technician to either wipe soil from instruments or keep instruments moist until soil can be wiped to prevent bioburden from drying. To accomplish this, the operating room tested a new enzymatic cleaner to thoroughly moisten instruments.
- Decontamination Work System: The decontamination staff should be equipped with tools and devices to support effective cleaning. There should be affordance for staff to recognize that instruments are successfully cleaned. This prompted investigation into new devices for visualizing bioburden in difficult to view crevices.
- Assembly Work System: The task should be designed in a way that minimizes cognitive load to ensure every instrument is thoroughly inspected for cleanliness and functionality prior to assembly. We proposed redesigning the inspection and assembly task into two distinct roles to disperse cognitive load between roles.
Discussion:
Through this work, we demonstrate how work system analysis can be applied to a multi-work system process to support the identification of barriers within each work system and how those impact upstream and downstream work systems. This method of evaluating a process from start to finish ensures design improvements that holistically improve the system, rather than improving one work system and causing unintended barriers to another.
Sterile Processing is a process where dirty surgical instruments are cleaned and sterilized in preparation for their next use. The sterilization process involves multiple sequential steps performed across various work systems of the hospital by distinct teams in the operating room and sterile processing department. Due to the complexity of surgical instruments and intricacy of cleaning, instruments may remain compromised from inadequate cleaning. If detected, this requires instrument re-sterilization, which may cause delays or cancellations of surgical procedures. If undetected, this issue may cause infection and harm to patients.
Method
This qualitative study utilized a work system analysis approach to 1) analyze the sociotechnical system of sterile processing, 2) define system barriers from interactions within each work system and across work systems that contribute to inadequately cleaned instruments and unsuccessful sterilization of surgical pans, and 3) define design requirements that facilitate fit across the spacio-temporal bounds of sterile processing
1. Observation: We conducted observations for 3 different surgeries at an academic and community hospital. We started observations during the end of the procedure and observed management of instruments during 1) operating room turnover, 2) decontamination, 3) assembly, and 4) sterilization. The surgeries included orthopedic and spine surgical procedures because they have high surgical pan use and instruments with difficult bioburden removal.
2. Work as imagined vs. Work as done: We developed two process maps - one illustrating the expected process as defined in policy and the other illustrating the observed process. For each process mismatch, we defined the work system barriers that may contribute to the workaround.
3. SEIPS Analysis: We described the interactions of work system elements within and across work systems to determine how the work system design contributed to barriers noted from the process maps.
4. Design Requirement: Based on the intra-system and inter-system work system barriers, we developed design requirements to systematically define solutions.
Results:
Across the sterile processing work systems, 14 instances of workarounds were noted. We documented the work system element interactions that may contribute to those workarounds.
Intra-system barriers: Four work systems were analyzed where 17 single work system interactions were identified to cause barriers. The outcomes of these barriers are visually represented using a SEIPS interactions diagram . Examples of intra-system barriers include the following:
- OR work system: OR turnaround is time-sensitive [Organization} and staff responsible for prepping surgical instruments for transfer to sterile processing have competing priorities [Tasks].
- Decontamination work system: Tools may be insufficient to identify and clean bioburden in small crevices [Tools]
- Assembly Work System: High cognitive load to perform pan assembly [People] with many tasks stacked into one job [Tasks]
Inter-system barriers: Interactions between four work systems were analyzed, where 4 inter-work interactions were identified to cause system barriers. The outcomes of the barriers are visually represented using a SEIPS interactions diagram. Examples of inter-system barriers include the following:
- OR – Decontamination Work Systems: Instruments may not be fully wiped and sprayed upon leaving the OR [Tools, Organization]. The decontamination space is small, and pans may sit for a long time before addressed [Environment] further worsening the difficulty of removing bioburden.
- Decontamination – Assembly Work Systems: There are ineffective tools to properly clean instruments in decontamination [Tools] and there is high cognitive strain during pan assembly [Tasks]. This may lead to missed identification of remaining bioburden.
Design Requirements – We translated work system barriers into design requirements to optimize all work systems where sterile processing occurs. Doing this ensured interactions within and across work systems facilitated systematic change rather than disjointed and suboptimal processes.
- OR Work System: It should be easy and non-disruptive for the surgical technician to either wipe soil from instruments or keep instruments moist until soil can be wiped to prevent bioburden from drying. To accomplish this, the operating room tested a new enzymatic cleaner to thoroughly moisten instruments.
- Decontamination Work System: The decontamination staff should be equipped with tools and devices to support effective cleaning. There should be affordance for staff to recognize that instruments are successfully cleaned. This prompted investigation into new devices for visualizing bioburden in difficult to view crevices.
- Assembly Work System: The task should be designed in a way that minimizes cognitive load to ensure every instrument is thoroughly inspected for cleanliness and functionality prior to assembly. We proposed redesigning the inspection and assembly task into two distinct roles to disperse cognitive load between roles.
Discussion:
Through this work, we demonstrate how work system analysis can be applied to a multi-work system process to support the identification of barriers within each work system and how those impact upstream and downstream work systems. This method of evaluating a process from start to finish ensures design improvements that holistically improve the system, rather than improving one work system and causing unintended barriers to another.
Event Type
Poster Presentation
TimeTuesday, April 14:45pm - 6:15pm EDT
LocationFrontenac Foyer