Over the past decade, hospitals have spent a great deal of time, resources and money to prevent surgical site infections. Properly timed antibiotics, nasal decolonization, skin antisepsis, appropriate hair removal, preoperative bathing and hand hygiene have been some of the measures taken to reduce infection rates. But one critical dimension of infection safety has received comparatively much less attention, and that is the role of the central sterile processing department (CSPD).

Central sterile processing is the first link in the chain of infection prevention. Its role is to decontaminate, clean, inspect and sterilize instrumentation for future use. However, failure to do so can introduce pathogens into the OR, increasing the risk for ssIs. The major problem is a lack of awareness of just how important this step truly is.

In U.S. hospitals, ssIs are a major problem and a significant patient safety issue. They affect a significant number of the patients and can have devastating consequences, including long-term disability (http://bit.ly/ 2OfAssJ) and worse outcomes (BMJ Open 2016;6[2]:e007224). Most hospitals have made substantial process changes to improve intraoperative safety, but these gains are vulnerable to weaknesses in the CSPD.

The Financial Issue

Nearly 1.5 million surgical procedures were performed in 2019. Cases declined in 2020 because of COVID-19, but experts are predicting a spike this year, with further growth in the surgical market from 2022 to 2025 (http://bit.ly/30uwTe2).

Surgical site infections are the third most expensive type of health care–acquired infection (HAI), costing nearly $21,000 per patient case. Some estimates raise that cost to $90,000 (https://bit.ly/ 3cfPbVB). It’s estimated that the total cost of ssIs to the U.S. health care system ranges from $3.5 billion to $10 billion annually (http://bit.ly/ 3cfPbVB).

In addition, in 2015, the Centers for Medicare & Medicaid Services began to penalize hospitals for high rates of ssIs along with other health care–acquired conditions. Because ssIs dramatically increase the risk for rehospitalization, hospitals are more vulnerable to readmission penalties (Table).

These safety and financial issues make a compelling argument for timely preventive action (Langenbecks Arch Surg 2011;396[4]:453-459). A surgeon who knows more about CSPD can have a positive effect on their own practice. When surgeons engage directly with hospital leaders to create a strong process for preventing ssIs, patient safety surely will increase.

Going Behind Closed Doors

A CSPD orientation program designed to educate surgeons represents a low-cost, high-impact opportunity that not only drives the alignment between key customers of the OR, but can improve safety and efficiency.

Individual and small group tours are an important start, and can give the surgeon a general overview of the inner workings of the CSPD and how it may affect their practice. To increase the return on investment, a more robust program can be created by taking this concept further and allowing the leaders to present at a Department of Surgery meeting. Once established, the leaders can grow the orientation program and combine it with the introduction of a quarterly surgeon satisfaction survey.

Program components can consist of the following:

• Walk through each area of the department.
• Detail the time it takes for accomplishing each step.
• Explain the equipment used in the process.
• Introduce surgeons to the staff responsible for their instruments.

What’s There to Learn?

Efficient turnover of instrumentation can help ensure the surgical team has the necessary equipment to perform its procedures. However, far too often when instrumentation is missing, CSPD gets the blame. When surgeons have a better understanding of the department and its inner workings, they can begin to truly understand where the issues lie.

First and foremost, knowing your set inventory is critical. When a surgeon schedules five procedures for the day and the hospital has only three instrument sets, delays are inevitable. Most organizations require loaner instrumentation to arrive 24 to 48 hours before the surgery to ensure it has been properly inventoried, inspected, decontaminated, reassembled, sterilized and packaged. Also important to note, it takes on average three to four hours for an instrument set to be proper processed, and that’s a low estimate. In this scenario, it’s called an instrument turnover.

So, when the surgeon asks why their case is delayed and the circulating nurse says the instruments are not ready, it’s easy to see why the CSPD would be blamed. The truth is the department most likely had requested additional instrumentation to improve processes; however, due to the high cost of instrumentation, the request probably was denied.

Finally, consistent turnover of instrumentation can result in corners being cut and a greater possibility that something was missed, which can have devastating consequences.

David L. Taylor III, MSN, RN, CNOR, is the principal of Resolute Advisory Group LLC, a health care consulting firm in San Antonio.