OBJECTIVE: The purpose of the case study is to allow the student to analyze information retained over the duration of the sterile processing program and apply that knowledge obtained to provide specific solutions to common issues that may occur within the sterile processing department.
CASE STUDY INSTRUCTIONS
Choose two of the four topics as listed below: Decontamination Principles, Sterilization Methods, Preparation of Medical Equipment and Supplies, and Inventory Control and Distribution Systems. Once the two case studies are chosen, answer the questions using your own vocabulary and address the conflicts or issues with solutions specific to your topics of choice. To fulfill the requirements of this case studies project, you must employ research techniques. You can utilize your text or other credible sources from the internet to build a thorough paper that contains at least six main ideas with supporting details regarding the topic chosen and a minimum of three credible references. The paper must be written in APA format with an extensive introduction, body, and concluding statement per case study. Minimum of four pages, double-spaced excluding title and reference pages per case study. Please refer to the rubric regarding specific grading criteria.
Now that you understand the basic goals of this project, let’s get started.
CASE STUDY SCENARIOS
Decontamination Principles: Dr. Sarmiento is a well-known neurosurgeon at Baptist Medical Center. He is known for working on complex cases that involve the spine and other neurological tissues. This past week, his private scrub tech has discovered that dirty neurological instruments have made it into the OR. The technician consults with the patient care manager of surgical services because the incident has been reoccurring over the past few months. With this knowledge, respond to the following questions:
Sterilization Methods: Kristine, a technician in the sterile processing department, has noticed that after the sterilization of surgical equipment and supplies that at least two out of every four loads sterilized for the day have been moist. She has consulted with her supervisor on effective ways in which she could troubleshoot the concerns with wet loads, because it has now affected the department’s work efficiency and quality control.
Preparation of Medical Equipment and Supplies: Over the last month, the operating room has received rigid containers without filters, assembled instrumentation such as Poole suction devices in sterilized sets, and closed versus open packaged and processed instruments on the stringer and within the instrument sets.
Inventory Control and Distribution: The sterile processing department at Hershey-Chocolate Medical Center has an excessive amount of inventory. Management has decided to restructure the inventory system used in their facility and has asked you to research at minimum four different inventory systems that may help with the safe and efficient distribution of medical supplies and is also cost-effective.
Sterile Processing Case Studies
Occurred Issues and causes of the Errors
Various problems occurred in the given case study. It is essential to remember that once a patient is under medical care in a hospital, the care provider should do their best to ensure that they do not get any hospital-acquired infections. The first issue in the given case study is that dirty neurological equipment made its way into the operating room, and it had been so for the last few months. There was a reoccurrence of this dirty equipment making its way into the operating room. Yet, Dr Sarmiento was a specialized doctor for complex cases like the spine and neurological tissues. The neurological equipment was neither cleaned nor sterilized well before being released into the OR for reuse purposes. Usually, the only medical instruments that require thorough cleaning and sterilization are the devices that hospitals reuse when handling different patients (O’Malley, 2015). These devices must be thoroughly cleaned, sterilized and disinfected because they were previously used on other patients. Failures to do these, patients are likely to acquire healthcare-associated infections.
In most cases, the healthcare-associated infections may come from surgical site infections like HIV and Hepatitis, or they may come from bloodborne pathogens (Khan, Baig & Mehboob, 2017). For a hospital to prevent the transmission of these infections from one patient to the next, the Healthcare Workers must ensure that every given guideline or step of instrument processing is followed to the latter. Doing so ensures that the instruments used for different patients are adequately cleaned and receive high-level sterilization. Secondly, the error in the given case is that the dirty equipment has been going to the OR for the past few months, and nothing has been done about it so far. It is an issue because it means that the patients receiving treatment in this facility are likely to have been acquiring new infections without their knowledge. The technician should have followed and found the root cause of this problem when he noticed the first incident. A few months is a long time for the facility to have received dirty equipment in the OR, and nothing having been done.
The most common cause of these errors is poor communication between the cleaning team, improper cleaning practices and failure to follow the given guidelines when cleaning the equipment. When one is cleaning the equipment, the individual must invest their time. Doing this ensures that the given instruments are thoroughly cleaned, and every little detail is looked into. When cleaning medical equipment, the cleaning process involves the removal of organic materials from the equipment. The existence of blood or any contamination form on the surface of the medical instrument is often a sterilization hindrance. It is, however, essential to remember that various reagents and disinfection approaches have different timing for them to react and one to get the expected outcomes.
When these instruments are bought, they come with their cleaning procedures. Therefore, it is necessary for the person cleaning to follow the given procedures and instructions whatsoever. Failure of which, a hospital is likely to experience these errors. Furthermore, sterilization has requirements that need to be met by the individual in charge. For example, sterilization agents require specific temperature, PH, or pressure levels to work effectively. Therefore, when one fails to follow the manufacturer’s processes, the sterilization results may be unexpected. Also, the sterilization process expects the sterilizer not to overload equipment in the chamber. It is so because overloading can cause unfavorable conditions that may affect the sterilization outcomes. Also, overloading may prevent the sterilization agent from contacting the whole unit. It is for this reason that most sterilizers use trays during the sterilization process.
Other Special Precautions the tech may need to take with the instruments
The sterile processing techs have no direct contact with the patients, but they have a vital role in ensuring that the intended treatment plan effectively works for every patient. The sterilization process is necessary as it ensures patient safety making the treatment process easier for the care providers. The special precautions the technician may have to take may include ensuring that every surgical instrument is correctly handled. They can do this by following the protocols and procedures before they are taken to the OR. Usually, hospitals and production companies give the guidelines and procedures to follow when handling these tools. Therefore, following these guidelines during cleaning and sterilization can prevent issues. Also, the technician may have to clearly label the tools both for the processed and unprocessed equipment. Doing this prevents any form of confusion; hence only clean and sterilized instruments can make their way to the OR.
The technician may have only to use the most appropriate cleaning agents that work effectively and is efficient by not causing any forms of damage to the equipment. The chemicals used in cleaning should be mild and not corrosive. These agents should be easy to detach from the equipment by simply rinsing out. In addition to these, the equipment manufacturers have various recommendations for the cleaning process of their products. In most cases, the cleaning processes can be mechanically or manually executed and in some cases, one can use both approaches. In case the technician does not understand a given instruction, it is recommendable that they contact the specific manufacturer.
What the sterile processing department may do to resolve the issue
The processing department has outstanding and recommendable experts whose primary responsibility is to ensure that the patient care areas like the OR receive sterilized and cleaned medical tools (Mehta et al., 2014). For the department to manage and handle the sterilization process, equipment assembly, distribution and storage, it is divided into four sections. The sterile processing department’s first step is to ensure that every staff member receives adequate training that ensures they are competent enough for the job. A sterile team that is well trained with the necessary knowledge and prepared and in an excellent position to identify and fill the gaps during the sterilizing process. They can identify the problems that may arise even before they happen.
Also, the sterile processing department should recruit new staff. The new staff should then be trained on how best they can handle the sterilization process. The processing department should give documentation to them to ensure there is quality control throughout the process. Furthermore, it will be necessary for the department to have a different control unit, where they can thoroughly check the equipment before making their way to the OR. Lastly, the sterilization process should be supervised in a step by step approach after which, they should be regularly monitored for fitness certainty.
The Decontamination Process
The decontamination process is chemical or physical of sterilizing the reusable contaminated surgical equipment, rendering them safe for handling and reusing. The primary agenda of the process is to protect every individual who uses these instruments from infections. There are various steps of the decontamination process, and it includes the following;
Transportation- this is the first step in the decontamination process. At this stage, the equipment and supplies used in the hospital are immediately collected and transported to the decontamination area. This step is necessary because it prevents contaminating the working places and people in the given areas. During the transportation of this equipment, it should be done in an enclosed. In addition, the individuals transporting the equipment should wear protective gear to prevent their contamination chances.
Sorting is the second step in the decontamination process. The contaminated equipment is sorted out according to the required cleaning process that each should undergo during this process. For instance, the cleaning technician needs to identify the priority items, clean them first, and keep the order. It is also essential for the sensitive equipment and the delicate ones to be sorted out carefully to prevent injecting themselves. Also, there is equipment that may require soaking first before any washing to occur, and the technician should consider all these factors before carrying out any procedures.
Cleaning is necessary after sorting the equipment out. When washing this equipment, the technician needs to consider instructions given by the manufacturer. It is so because there is equipment that needs manual cleaning while those need mechanical cleaning. Others may apply both approaches. Following the instructions, ensure that the equipment is washed in the best way possible, removing all the contaminants.
Sterilization after washing out the various instruments sterilization is the next stage. At this stage, the technician should place all the instruments in the machine so that the steam can freely move and circulate them. If this happens, all the equipment is well sterilized, and the germs can be terminated entirely.
Storage-when storing the equipment, it is necessary to store them in clean, covered and dry conditions. They should also follow the manufacturer’s instructions regarding storing cleaned equipment. This ensures that the cleaned and sterilized equipment are not contaminated again, preventing dirty equipment from getting to the OR.
The best way to ensure that clean instruments are the only ones that reach the OR is necessary for the team to have a thorough inspection of the instruments. After cleaning, inspection is necessary because it ensures that the right and clean instruments get to the OR or where they are needed. Also, the technician in charge should ensure that they follow the packaging and storage instructions once the instruments are sterilized to avoid contamination once again. Following these steps will ensure that only clean instruments make their way into the OR and the hospital as a whole.
Preparation of Medical Equipment
Discuss in detail how these occurrences can impact safe and efficient patient care
Far from providing readily available healthcare services, the care provided must be efficient and safe. For an organization to ensure that this is the case, the various occurrences within the premises should be handled with utmost care because they will likely impact the institution (Shaw et al., 2016). For instance, the operation room received rigid containers lacking filters from the provided case study for over a month. Filters are an essential aspect of the operation room as they are responsible for protecting patients against contaminations from biological particulates. The given facts imply that patients had been at the upper hand of being contaminated for the last month. The risk of biological contamination can stretch from consequential severe health conditions to the death of the contaminated patients.
It is so that equipment is stored in enclosed cabinets immediately after sterilization. This is because the process of sterilization itself prevents all sorts of contaminations, whereas storing them in closed cabinets ensures that the equipment stays uncontaminated until they are again required for use. However, based on what has been going on in the operation rooms for the past month, patient care has been highly affected because patients have been exposed to contamination.
Discuss the instrument preparation process.
The instrument preparation process ensures that the instrument is clean of any form of contamination from the previous operation (Alfred et al., 2020). The most common instrument preparation process is referred to as steam preparation. Here, the equipment is first exposed to steam and high pressure while in a surgical park. After the steaming and overall sterilization process, a sterilization indicator is placed on the ready instrument. Sterilization indicators are used to identify already sterilized equipment; the autoclave tape is one of the most commonly used sterilization indicators.
What can the sterile processing technician do to ensure that all items are prepared and packaged correctly?
It is entirely up to the sterile processing technician to ensure that all the instruments are processed and packaged correctly. It is their responsibility to ensure that this is the case at all times and that there are no wrongly packaged instruments that get into the OR. One approach to ensuring this is for the technician to have a particular area for the cleaning of surgical equipment (Alfred et al., 2019). Further, the technician can classify the various surgical instruments; for instance, intraocular surgical instruments can be prepared separately from the other surgical equipment. The explanation behind this is to reduce cases of cross-contamination because it is expected that some surgical instruments are expected to collect more residues than others. Only recommended cleaning agents should be used in line with this because some could not be as thorough as the recommended agents. Therefore, a technician should ensure that when cleaning, they use the recommended cleaning agents when handling the instruments to ensure they are thoroughly washed at all times. Finally, the technician should evaluate the packaging correctly in the final packaging stage, ensuring sterilized instruments are packaged in enclosed cabinets and marked with appropriate sterilization indicators. Doing this will ensure that the sterile processing technician and other staff can quickly identify which instrument is used without any confusion.
How does this situation impact the operating room staff?
Far from the operating staff, the entire facility is negatively impacted by this situation. The fact that contaminated instruments may have been used on patients does not look suitable for the operating staff nor the hospital. However, it is worse for the staff because contamination on the patient could result in further complications, which call for further treatment plans for the same patient. In addition, containers that lack filters are highly likely to cause contamination and complications for the patient. Therefore, the patients could end up staying longer in the hospital, something that could have been prevented from happening.
Alfred, M., Catchpole, K., Huffer, E., Taafe, K., & Fredendall, L. (2019). A work systems analysis of sterile processing: sterilization and case cart preparation. In Structural Approaches to Address Issues in Patient Safety. Emerald Publishing Limited.
Alfred, M., Catchpole, K., Huffer, E., Fredendall, L., & Taaffe, K. M. (2020). Work systems analysis of sterile processing: decontamination. BMJ quality & safety, 29(4), 320-328.
Khan, H. A., Baig, F. K., & Mehboob, R. (2017). Nosocomial infections: Epidemiology, prevention, control and surveillance. Asian Pacific Journal of Tropical Biomedicine, 7(5), 478-482.
Mehta, Y., Gupta, A., Todi, S., Myatra, S. N., Samaddar, D. P., Patil, V., … & Ramasubban, S. (2014). Guidelines for prevention of hospital acquired infections. Indian journal of critical care medicine: peer-reviewed, official publication of Indian Society of Critical Care Medicine, 18(3), 149.
O’Malley, C. A. (2015). Device cleaning and infection control in aerosol therapy. Respiratory Care, 60(6), 917-930. https://pubmed.ncbi.nlm.nih.gov/26070583/
Shaw, D., Guise, J. M., Shah, N., Gemzell-Danielsson, K., Joseph, K. S., Levy, B., … & Main, E. K. (2016). Drivers of maternity care in high-income countries: can health systems support woman-centred care?. The Lancet, 388(10057), 2282-2295.
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