It’s never a dull day for the technicians in the sterile processing department at Akron Children’s. Today isn’t shaping up to be any different.
Dennis Lafferty and Alice Holland reported for work at 6:30 a.m. and got down to the business of washing, sterilizing, cooling, assembling, packaging, storing, and in Lafferty’s case, delivering surgical instruments to various departments in the hospital.
Each day the techs are assigned a different role, though their morning tasks will remain the same all week.
This morning Holland is preparing loads of instruments for the autoclave, folding towels, answering the phone and unloading racks.
Meanwhile, Lafferty runs the sterilizers and makes rounds to the ENT clinic, plastic surgery, PICU, NICU, burn unit, ED and respiratory department to drop off sterilized supplies and pick up contaminated ones. The person who relieves Lafferty on second shift will make similar rounds again at 4 p.m.
Items for delivery to offsite locations like Akron Children’s pediatrician offices and our NICU at Summa are picked up and dropped off at a central location by a courier.
Although Lafferty isn’t assigned to decontamination today, he still brings all the items he just picked up on his rounds to the decontamination area.
Safety is a top priority in the decontamination room.
“We wear gowns, masks, face shields, shoe covers and 2 pairs of gloves to protect ourselves from the dirty instruments and harsh detergents and chemical agents used to clean the instruments,” Lafferty said.
While he waits for Holland to return from her break, Lafferty sorts through the supplies to determine which ones will be reprocessed – the term used to indicate reuse – and which ones are disposable. For the record, disposable doesn’t mean the items get thrown away.
“Disposable instruments are often made with a lower grade of metal that rusts and therefore can’t be reused,” he said. “Instruments that are disposable are placed in a bin and sent back to the manufacturer who may melt the instruments down or recycle them in some other way.”
Lafferty prepares to soak some dirty instruments by pressing a button on the side of the faucet that releases a pre-portioned amount of detergent that mixes with the water. He points out a Vaseline-like coating on some surgical tools.
“Soaking these instruments helps to remove that greasy coating before we put them in the high-powered instrument washer,” he said.
At 9 a.m. Holland reports to the decontamination area. This is where she will work the remainder of the day.
Surgical carts are quickly lining up for reprocessing. “Not only are we responsible for the instruments on the carts, but we also have to remove and discard trash, linens and biohazard,” said Holland.
Carts must be unloaded before they, too, can be washed.
Holland will run the cart washer and 3 instrument washers throughout the day. Dirty carts enter the washer from the decontamination room and exit the washer on the sterilized side.
The sterilization area uses steam heated to 273°F as well as an autoclave that uses a low-temperature hydrogen peroxide sterilization method.
In addition to the instruments being sterilized, indicator tabs placed in each load change color to ensure that each cycle runs at the proper temperature and for the prescribed amount of time.
“If the tabs don’t turn color, it means we have to repeat the whole cycle,” Holland said. “The entire process of collecting, washing, sterilizing, drying, cooling, assembling, packaging and storing takes about 4 hours.”
Handle with care
Holland continues removing instrument trays from carts and cleans off any visible debris and blood from the surgical tools. Anything with a hinge is opened to soak. Tiny bottle brushes are used to clean inside scopes. Cannulated tools are flushed with a syringe.
“Items that are fragile and contain fiber optics need to be handled delicately,” said Holland. “Once I hand wash these items, I dry them with a filtered air compressor and send them to the autoclave to be sterilized.”
Both Holland and Lafferty are certified registered central service technicians (CRCST) with 12 and 15 years respectively in the field. Both attained their certification through the International Association of Healthcare Central Service Materiel Management.
Only 4 states currently mandate certification for employment – Ohio isn’t one of those states. However, Akron Children’s requires certification as a condition of employment, as well as 12 hours of continuing education credits every year to maintain certification
New every day
Even after all their years on the job, the techs still learn something new almost daily.
“Surgery is always trying out new instruments and equipment, which means I have to learn how to take them apart, clean them and put them back together,” said Lafferty. “I ask questions when I need to, and there are information sheets I can reference about how a manufacturer recommends a certain instrument be cleaned and disinfected.”
“Twelve instruments can easily turn into 24 pieces that need to be cleaned once you take things apart,” said Holland. “A laparoscopic instrument can yield a dozen tiny screws to wash and keep track of.”
Holland makes getting carts unloaded and washed a priority so they can be reloaded with equipment on the sterilization side.
When a ManoScan catheter, used in endoscopy, arrives and is quickly followed by 5 trays of orthopedic equipment, Holland calls for reinforcements.
“The scope requires special handling and it can become very time consuming,” she said. “I can’t afford to get so far behind that the reprocessing side doesn’t have the trays and carts they need to sort and store the equipment.”
“Date and lot stamps allow an entire lot to be pulled from inventory should a problem be discovered down the road,” said Lafferty.
After reprocessing instruments from 51 cases today, it’s apparent why the department just received approval to hire another technician.
“It’s different here every day,” said Lafferty. “Although our job doesn’t involve direct patient care, we definitely have an important role in seeing that patients are receiving safe and sanitary care.”