Day in the (hospital) life: Getting the germs off

By Mandy Cepeda May 19, 2014

Inside Sterile Processing

  • What it is: The Sterile Processing Department (SPD) is responsible for removing bioburden from medical devices, including surgical instruments.  The cleaning, decontaminating, disinfecting and sterilizing processes vary depending on the equipment.
  • Who works there: A 14-person crew plus the manager staffs SPD 24 hours, 7 days per week.  The shortest tenure of a department staff member is two years.  Staff are Mae Miller (manager), Aurora Bailey, Holly Devins, Eric Evenson, Andrea Flores, Kayla Horne, Elizabeth Marvel, Brianna Mason, Niccole Mayo, Jeniffer Middleton, Shawna Miller, Zachery Pound, Arlo Smith, Michael Soberanez and Breanna Svenson.
  • Where is it: In the depths of the first floor of the hospital, behind the Emergency Department.
  • Why it’s important: Sterile Processing is the unsung hero of infection control in health care.

Inside the depths of Wyoming Medical Center, behind many “staff only” doors and a “do not cross this line” sign, lies the Sterile Processing Department.  While it takes everyone in a hospital to prevent hospital-acquired infections, these people are really the unsung heroes of infection prevention, carefully processing thousands of individual pieces of equipment daily.

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Fourteen men and women make up Mae Miller’s crew in SPD, and most are certified in the field with the final two set to be certified this year.  “I have an awesome crew,” she said.  “They take good care of me.”

After equipment makes its journey from the hospital floors, including the operating rooms, it’s ready to be disinfected or sterilized.  It’s important to note that disinfection should not be confused with sterilization. They are both decontamination processes, but sterilization is the process that removes literally all microorganisms, as opposed to disinfection which is credited with removing only the most harmful.  About 85 percent of the equipment processed in SPD goes through sterilization.  Several hours later, it’s back on the shelf and ready for use.

Nothing is left to chance.  The carts the dirty equipment travels on are sent through the washer before being used again and two separate elevators, one clean and one dirty, are dedicated to travel between SPD and the operating rooms exclusively.  No cardboard boxes are allowed in the area.  There could be bugs in, on or around the boxes, so they unpack everything in the hall outside of the department.

“It’s World War III when there’s a fly in here,” said Shawna Miller, the SPD supply coordinator. “Seriously. It’s a big deal.”

All equipment is first handwashed with special detergent by staff uniformed in the proper protective equipment.  The visible majority of bioburden (a term they use often in SPD) is removed in this step before it’s sent through a 30-minute wash cycle.  Then packing and sterilization can begin.

When the equipment comes out of the wash cycle, it’s aseptic and safe to touch with bare hands.  Then it’s packaged and labeled for specific procedures.  A list is made for every procedure that includes a very specific set of instruments.  Different physicians have different needs and there are lists for each.  They are also responsible for loading the hospital’s “crash carts” – carts used for dispensing medication and equipment in an emergency – and to ensure that nothing has exceeded its expiration, which varies from 30 days to several years, depending on the piece.

Andrea Flores, SPD tech, holds up a bladder blade as she packs a C-section box in preparation for sterilization.

Andrea Flores, SPD tech, holds up a bladder blade as she packs a C-section box in preparation for sterilization.

Every pair of scissors is tested before it gets packed to ensure it cuts properly.

Every pair of scissors is tested before it gets packed to ensure it cuts properly.

Staff is trained to know which equipment goes through which sterilization process – hot or cold.  The autoclave cooks equipment at temperatures upwards of 270 degrees F.  Cold sterilization takes place in a machine with a 58-percent hydrogen peroxide compound (your run-of-the-mill pharmacy hydrogen peroxide is 4 percent).  Special color-changing tape is used in both processes to ensure that it worked and the equipment is 100-percent sterile.  If for some reason it isn’t, the process starts over.

“That doesn’t happen very often,” said Andrea Flores, an SPD tech who’s worked in the department for more than eight years.

Andrea Flores, SPD tech, takes a batch of equipment out of the autoclave following sterilization.

Andrea Flores, SPD tech, takes a batch of equipment out of the autoclave following sterilization.

The black lines on the tape indicate that the equipment inside the package is 100-percent sterile.  Each piece is tagged with the date sterilization took place and the employee number of the person who packed it.

The black lines on the tape indicate that the equipment inside the package is 100-percent sterile. Each piece is tagged with the date sterilization took place and the employee number of the person who packed it.

Brianna Mason, SPD tech, loads a shelf with empty boxes ready to be loaded with instruments and sent through the autoclave.

Brianna Mason, SPD tech, loads a shelf with empty boxes ready to be loaded with instruments and sent through the autoclave.

Millions of dollars’ worth of inventory lines the shelves of SPD.  Much of it is re-used after undergoing the process outlined above, but the department is also in charge of ensuring that one-time use equipment is stored and ready at a moment’s notice, no matter what.  This can become challenging during large winter storms when deliveries might not make it to Casper for a day or more, but amazingly, even long-time employees can’t think of an instance where supplies didn’t come together, even if it wasn’t exactly what would normally be used.

Dozens of shelves line the SPD area loaded with various medical equipment for all areas of the hospital.  The operating rooms have their own supply area for easier, faster access.

Dozens of shelves line the SPD area loaded with various medical equipment for all areas of the hospital. The operating rooms have their own supply area for easier, faster access.

Every patient in the hospital sees the work of WMC’s sterile processing techs, whether they know it or not.  If you or someone you love has ever undergone a surgical procedure, an SPD tech was responsible for the sterilization of the instruments used in the operation.  Next time you run into someone from this integral department, be sure to say “thank you.”

“Day in the (hospital) life” is an occasional series highlighting the work that goes on every day in Wyoming Medical Center departments. Not all of the work may be evident to our patients, but all of it is essential to bringing you safe, compassionate care.

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