Building A Better Dynamic Between Infection Prevention and Sterile Processing

When discussing the range of topics that are covered in Infection Prevention and Control (IPC) efforts, many overlook or forget the role of sterile processing. The sterile processing department (SPD) and IPC are intrinsically married, and the stability of this relationship is critical. You might be wondering, what exactly goes into SPD and, truth be told, this is one of the more complex environments within a health care setting.

To understand sterile processing, we first must take a step back and discuss the Spaulding approach to disinfection and sterilization. This approach was designed to manage the cleanliness and microbial burden of patient care items and medical equipment by first determining the work done (ie, risk) and, therefore, necessary disinfection or sterilization. Items are critical (high risk for infection if contaminated, as they enter sterile tissue or the vascular system) and must be sterilized), semi-critical items (contact mucous membranes or nonintact skin), which require high-level disinfection), or noncritical (come into contact with intact skin but not mucous membranes) for which low-level disinfectants can be used.

These classifications help us to understand the level of sterilization or disinfection that is necessary to avoid spreading infectious microorganisms in patients. Therefore, the role of SPD is critical to patient safety and IPC efforts. There are a range of products, processes, and practices to ensure these efforts are successful and, not surprisingly, if a failure does occur, it can be catastrophic for the patient. For many infection preventionists, we have seen failures in SPD, especially in moving between the decontamination and sterile side of things. Strong leadership in SPD and a solid working relationship with IPC can make or break a hospital and their patient safety.

This very dynamic is a hot topic at the annual conference for the Association of Professionals in Infection Control and Epidemiology (APIC 2019) being held this week. In research presented there, a team of investigators from Cedars-Sinai Medical Center sought to address the collaboration between IPC and SPD and how a strong foundation can improve patient safety. Although infection preventionists are tasked with collaborating and working with SPD, there is often a gap in knowledge or training as to the actual innerworkings of this complex environment. The study team began by creating a quality improvement project that first addressed infection prevention knowledge of SPD processes and practices, and then their compliance with infection prevention metrics. First, they assessed the baseline knowledge of the infection preventionists through an audit tool and then had the team attend SPD meetings, perform observational SPD audits, review webinars, etc. Auditing the SPD department processes served to not only strengthen the infection preventionist’s knowledge of these processes, but also helped SPD leadership identify gaps and feel supported by the IPC program.

Over the course of several years, the investigators found that the average audit score improved. In the first year, there was a jump from 67% to 84% (which was statistically significant). Since 2016, the scores have remained consistent and SPD employee knowledge of cleaning techniques improved from 59% to 90%. The investigators noted that they did find a statistically significant increase in SPD audit scores and a reduction in bioburden events from the yearly average of 3.29 per 1000 procedures to 1.15 events per 1000 procedures over the course of 3 years.

With these results, we can see several important trends—improving IPC knowledge of SPD is not only beneficial to the IPC program, but also that of SPD. Establishing an effective audit tool helped shine a light on the existing knowledge of the infection preventionists, but also allowed for better IPC oversight of SPD and overall, a more effective SPD. These 2 programs are critical to each other (pun intended) but often their understanding of the other program is superficial or lacking. Improving IPC knowledge of SPD practices, and vice versa, serves to strengthen both efforts while bolstering patient safety.

The poster, “A Tale of Two Departments: How Collaboration Between Infection Prevention and Sterile Processing Departments Can Improve Patient Safety,” was presented in an oral abstract session on Friday, June 14, 2019, at APIC 2019 in Philadelphia, Pennsylvania.