A review of the sterile processing department's reprocessing of surgical instruments.

backgroundThe sterile processing department (SPD) of hospitals is expensive to operate, but it is needed for surgical procedures to be conducted safely and efficiently in an operating room (OR). Late instrument arrival at the OR risks the patient's safety and increases the hospital's costs. If the delivered instruments are not sterile, the risk of hospital-acquired infections increases. While the SPD knows how to process each instrument, there is no well-established set of best practices about how to design and manage its processes. The SPD's instrument process has four major steps: decontamination, assembly, sterilization, storage and picking instrument sets. This review seeks to identify what is known about each step's best practices and where research is needed to create evidence-based best practices.

methodsThe PRISMA 2020 guidelines for a literature review were used to identify existing SPD process literature. The relevant process design and performance data were extracted for data synthesis using the Systems Engineering Initiative for Patient Safety framework, where buffer theory was used to capture the environment.

resultsA total of 30 relevant articles that included case studies, interventions, experiments, and qualitative interviews were identified for data extraction. Most performance improvement interventions identified did not report important environmental information that would allow other managers to evaluate the appropriateness of the intervention for their facility. Also, most interventions focused on one variable and did not report how the intervention affected multiple system components. Three key interventions that improved throughput were to increase instrument inventory, increase assembly capacity, and reduce the number of unused instruments. Three studies found a large percentage (25%-48%) of instruments processed in the SPD were not actually used during a surgical procedure. Revising the surgeon's preference card to eliminate these instruments increased the available SPD capacity.

conclusionThe theory used to guide this literature review of SPD research indicates that more data about the SPD environment are needed in future SPD research to generalize research findings. The limited information provided in prior research about the SPD environments did not allow for identification of the "best" combinations of processing capacity, instrument inventory and process layout. Most existing research about the SPD process provides limited insight into how to design and manage the SPD bottleneck processes.