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Work systems analysis of sterile processing: assembly.

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Instrument reprocessing in sterile processing departments (SPDs) frequently has defects, with missing instruments impacting 5% of surgeries. Improving training, standardization, and tracking systems is crucial for surgical safety and efficiency.

Keywords:
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Area of Science:

  • Healthcare Systems Engineering
  • Patient Safety
  • Surgical Instrument Reprocessing

Background:

  • Sterile processing departments (SPDs) are vital for surgical safety, responsible for decontaminating, assembling, sterilizing, and storing surgical instruments.
  • Defects in instruments, such as being broken, missing, or improperly cleaned, are common issues that can compromise surgical procedures.
  • These instrument reprocessing issues should ideally be identified and rectified during the assembly phase within the SPD.

Purpose of the Study:

  • To comprehensively understand the instrument reprocessing assembly stage using a work systems analysis based on the Systems Engineering Initiative for Patient Safety (SEIPS) model.
  • To identify the various work challenges encountered during instrument tray assembly.
  • To uncover the interrelationships among system components that influence the reliability of instrument reprocessing.

Main Methods:

  • A work systems analysis was conducted at a 700-bed academic hospital over 12 months (October 2017-October 2018).
  • Methods included 56 hours of direct observation and 36 interviews to develop a process map, task analysis, abstraction hierarchy, and variance matrix.
  • Analysis of operating room (OR) reported tray defect data from July 2016 to December 2017 identified defect types and frequencies during reprocessing phases.

Main Results:

  • The majority of 3900 tray defects occurred during assembly, affecting 5% of surgical cases.
  • Missing instruments were the most common assembly defect (17.6%), leading to OR delays and increased surgical duration.
  • Failures included incorrect/omitted instruments and failure to remove damaged items, driven by technological issues, production pressures, tray complexity, non-standard nomenclature, and inadequate staff training.

Conclusions:

  • Enhancing patient safety and minimizing surgical delays requires a well-designed instrument tracking system.
  • Standardized instrument nomenclature and effective coordination between SPD and OR are essential for reliable reprocessing.
  • Investing in well-trained sterile processing technicians is critical for improving the overall reliability of instrument reprocessing.