In part 3 of this series, we discussed HVAC, lighting, and equipment placement. Part 4, in this final discussion of Remodeling 101, we will discuss storage space and safety zones designs.
Storage space designs in all areas of the department add to the critical functionality of sterile processing. Without proper supply storage space in your department, you will not maximize work production, and redundancies will creep into the workflow and create inefficiencies.
Storage space for supplies in the decontamination area should hold PPE, detergents, cleaning utensils, testing supplies for manual and automated processes, etc., and need to be within close proximity or arm's length. PPE, in particular gloves and gowns, need to be stored in the work area for quick change access, just in case of failures such as a puncture or strikethrough. PPE also needs to be stored outside of the work zone. Visitors and staff need to have access to PPE in an area that will allow them to don it without potentially contaminating themselves. Also, you must provide enough space for doffing of PPE and the management of waste. Other areas of consideration in decon are space for the stagging of instrument trays as they return from the end-users. Pre-cleaning stagging and post-cleaning areas - items awaiting the cart washer, instrument washers, or manually cleaned items must be designed. The flow should always be in one direction. I recommend creating a separate space for the cleaning of medical patient care equipment.
In the assembly area, supplies that are routinely used should be stored on the workstations. As mentioned earlier, high-use items like tip protectors, chemical indicators, data cards, tray liners, high-use instrumentation, etc., should not be stored on the workstation surface but preferably stored on a table riser or if necessary within a drawer on the table. Depending on your push/pull model with the reprocessing of your instruments, you're more than likely to need a storage area within your assembly area for non-sterile trays and instruments. Determining how much space is needed is tough. Evaluate your through-put design based on equipment output, and the staff capabilities to manage that production will help you make those decisions. I like to have storage space designed to maximize the staff's acknowledgment of what items need to be processed first. Separation of trays that are high, mid-level, and low priorities help.
The sterilization area should be like decontamination and assembly areas with the supplies needed for monitoring and documenting the sterilization process close to the work area. Quite often, a workstation within the assembly area is the designated workspace for the sterilization process. Lean out your designs when possible to eliminate redundancies in supplies on workstations. For example, you can have just one workstation with peel pouches to accommodate this process. Separating specialty cleaning functions such as robotic instruments, eye instrumentation, power equipment, and so on can be designed for one workspace so that supply storage is maximized and not duplicated over and over. The sterilization workspace shouldn't be any different.
The need for storage space for sterile instruments is primarily based on the instrument tray inventory. Creativity within this area can be vast. The use of color-coding instrument locations to inventory management systems such as instrument tracking systems helps organize the process. One design I prefer is to place instruments used most often on the end of storage shelves to eliminate the waste of moving up and down aisles. Similar to grocery store end-caps, place your high movers here. Also, thinking ergonomically, place your heavy items on the middle shelves to reduce issues with lifting. If you can, automate storage systems for small single items, such as peel packs, to help you manage the inventory. Inventory management systems built for material management teams work well for this process.
Lastly, safety zones need to be created in sterile processing. Safety zones to eliminate egress issues from staff outside of the sterile processing department come to mind. Areas designed outside of the workspace to meet with sales staff, instrument representatives, and even hospital staff from other work areas need to be in place. Interruptions in the sterile processing areas are probably the number one issue affecting work quality. Not to mention, but infection control issues also come with egress issues from staff outside of the sterile processing environment. Another essential safety zone is the area of sterilization. Surgical instruments that are unsterile and sterile need to be housed in separate locations. There has been more than one occasion where items have ended up in the operating room that was unsterile because of the lack of a safety zone.
Areas that I did not cover but are essential are the areas needed for the sterile processing management team, including educators and other miscellaneous specialty members of the team. Without the proper workspace for these individuals, critical oversight of the sterilization process can be compromised.
This blog series was a synopsis of my thoughts relating to my career and my experiences of the last 38 years in sterile processing. The blog content was a multipart series because of the length and depth of my covered content. As a sterile processing manager, I have been blessed with the opportunity to help design multiple sterile process departments, ambulatory reprocessing areas, GI reprocessing areas, and some outpatient medical reprocessing areas. My goal is to impart some of the knowledge I gained from participating in these projects. Not all construction content areas were covered in this series. If you have any questions about the construction of a sterile processing department, reach out to me.
Warren Nist - wnist@evolvedsterileprocessing.com
217-371-8488
At Evolved Sterile Processing, our consultants have a greater focus on sterile processing. With our decades of experience, we will help you develop better processes and educational resources for your staff.
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