INFC 206 Module 1

INFC 206: Infection Control & Decontamination

Department Structure and Requirements

Medical Device Reprocessing Technician

Fall 2016

Department Structure and Requirements Rationale The medical device reprocessing department (MDRD) plays a key role in the organizational and structural design of a hospital. Virtually all patient care areas within a facility depend on the services of the MDRD. Understanding how the MDRD is laid out physically and how it operates is very important in your role as a medical device reprocessing technician (MDRT). Your work as an MDRT is critical to ensuring all instruments and patient care equipment are processed in a timely and effective manner to help make the patient’s stay as safe and comfortable as possible.

Learning Outcome Outline the requirements for working in a medical device reprocessing department (MDRD).

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INFC 206, Infection Control & Decontamination, 01 Department Structure and Requirements © 2016, Southern Alberta Institute of Technology

Identify the five main work areas in a medical device reprocessing department (MDRD). There are a number of different ways of referring to the medical device reprocessing department, including: • • •

Central Processing Department Central Sterile Supply Department (SPD) Central Service (CS)

For this course, we will be using the terms medical device reprocessing department but please be aware that other terms, such as central service (CS) and the sterile processing department (SPD) are still in use.

Medical Device Reprocessing Department = Central Service = Sterile Processing Department

The word central is descriptive – it will help you understand that processing functions within a facility are centralized, and managed by one department. Centralized management provides unified standards of practice and allows for the best possible use of both human and material resources.

MDRT – Purpose The purpose of the medical device reprocessing department is to produce and supply clinically clean and sterile products for patient care needs within a healthcare facility. The medical device reprocessing department is the heart of a healthcare facility. Just as the human heart provides oxygen and essential nutrients to sustain operation of the body, the processing heart provides essential life-saving products and services to sustain the operation of a facility, and ultimately, the patient. See Figure 1.

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Figure 1: Medical Device Reprocessing Department: The Heart of a Hospital © 2014, Southern Alberta Institute of Technology

Medical device reprocessing departments in large hospitals often provide services to small rural hospitals and to smaller healthcare facilities including clinics and surgical centres.

Main Work Areas There are five main work areas in a medical device reprocessing department, including: 1. 2. 3. 4. 5.

Decontamination Assembly Sterilization Sterile Storage Distribution

There are specific job duties for each area and shift. A breakdown of duties for each work area is covered in Objective Two. First, we will focus on the physical layout of a MDRD.

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Describe the typical physical layout of an MDRD and the work-related duties associated with each processing area. Physical Layout The physical layout of medical device reprocessing department should allow adequate space for all functions; however, space requirements may vary depending on the following considerations: • • • • • •

Processing needs of the facility Volume of work Amount of product(s) to be processed and stored Degree of mechanization (how many machines required for production) Product mix Storage and distribution systems

The physical layout should promote efficiency by minimizing distances between related areas. Walls or partitions with pass-through, operational windows must separate the dirty decontamination area from the clean processing areas such as the assembly, sterilization, sterile storage and distribution areas.

The Work of Medical Device Reprocessing Technicians MDRT duties vary depending on the facility, the assigned shift, the assigned processing area and the workstation. Prior to reporting to the assigned work area all MDRTs attend a brief shift report meeting which covers the status of OR work levels including high turnover and priority items. Before starting a work shift, MDRTs must also read the communication log book (a record of essential and new job related information). Each MDRT must bring him/herself up to date with any recent department requirements or policy changes by reading all entries in the log since his/her last shift.

Work Areas As mentioned, the five critical work areas that you will be responsible for include: 1. 2. 3. 4. 5.

Decontamination Assembly Sterilization Sterile Storage Distribution

We examine each area in more detail next. 4


Decontamination Receive soiled instruments and patient care equipment from user areas Sort surgical devices, metal ware (utensils) and medical equipment according to recommended cleaning procedures and transport to related work station Use standard precautions when cleaning and disinfecting all reusable items (see Module 4: Safety in Medical Device Reprocessing Department) Prepare reusable instruments for mechanical cleaning and disinfection Load, operate, monitor and troubleshoot mechanical cleaning equipment Manually clean and disinfect reusable instruments and patient care equipment Follow established procedures in the operation, cleaning and preventative maintenance of cleaning and disinfection supplies and equipment Identify and priority process high turnover devices and equipment

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• • • •

•

Assembly •

•

•

• •

Offload clean instruments and containers from the clean side of mechanical washer disinfectors to designated areas for assembly Inspect (for cleanliness or damage), sort, assemble, function test and package basic and specialty or single instruments and set accurately and dependably as per established procedures Assemble, package and wrap instruments and utensils into procedural trays, containerized surgical sets and basin sets Restock small supplies to appropriate quota levels Inspect and prepare linens (select facilities only)

Sterilization • • • • • • • •

Perform standard tests to monitor effectiveness of sterilization procedures Document load contents, date, sterilizer number and operator information Process loads through appropriate sterilization method Correctly load contents for sterilization Monitor sterilization process with mechanical, chemical and biological indicators Unload sterilizer Allow sterilization contents to cool Transport (offload) sterilized items to correct locations in sterile storage

Sterile Storage • • •

• •

Place cleaned/sterilized instrumentation in designated areas Rotate cleaned/sterilized instrumentation (FIFO) Monitor storage environment including factors addressing shelving, cleanliness, fire codes, and traffic control Monitor inventory levels Use computers and other resources to locate items

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Distribution • • • •

• • • • •

Receive manufactured medical supplies and equipment Monitor inventory levels Reorder supplies as needed Provide instrument sets for surgical procedures and case carts for booked and emergency surgery Transport supplies to user areas as needed Communicate with OR personnel to provide required instruments and surgical supplies Make appropriate substitutions for surgical cases when necessary Report problems regarding availability of instruments and supplies Porter patients (select facilities only)

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Describe the one-way flow of materials through each work area of a MDRD. The One-Way Flow The conceptual design of the medical device reprocessing department facilitates a one-way flow of materials. Figure 2 demonstrates this design by showing the cycle that materials go through, moving from one processing area to another. Soiled or contaminated devices work their way from the point of use area to the decontamination (dirty) area, through to the clean areas – assembly, sterilization, sterile storage and distribution, as shown below.

Figure 2: The One-way Flow © 2014, Southern Alberta Institute of Technology

Point of Use The biggest user of MDRD is the OR. Other user areas include the following: Emergency Labour and delivery unit

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Gastrointestinal/genitourinary (GI/GU) unit Health services Pharmacy Cancer unit Respiratory unit Rural hospitals Local clinics Surgical centres

• • • • • • • •

Decontamination Decontamination (decontam) is the dirty side of MDRD. Soiled or dirty instruments and patient care equipment are processed in this area. The main purpose of decontam is to render equipment safe for handling for further processing in the clean areas of MDRD. Assembly Once instruments have been processed through decontamination they are considered safe to handle and are transferred to the clean assembly or preparation area of MDRD. Instruments are prepared for sterilization at workstations specific to their design and use. Preparation methods include:

• • • •

Inspection Function-testing Assembly Packaging

Properly cleaned, disinfected and prepared instruments used in invasive procedures are now ready for the sterilization process. Sterilization Once devices have been properly prepared, they are subjected to the appropriate method of sterilization. Sterile Storage The sterile storage or processed stores area is a combined system of specialized shelves and bins used for the storage of manufactured and reprocessed medical products. Items are usually organized as follows: • • •

Alphabetically by surgical service and instrument name Numerically by stock code Using the first in, first out principle (FIFO)

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Figure 3: First In, First out Principle (FIFO) © 2014, Southern Alberta Institute of Technology

Distribution The physical area of distribution is often interconnected with the sterile storage area. Manufactured and reprocessed medical and surgical supplies are maintained and distributed to point of use areas from the distribution area.

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Identify the five main structural and environmental requirements of the work space in a MDRD. Structural and Environmental Requirements The five main factors that directly affect the structural and environmental requirements of the medical device reprocessing department are: 1. 2. 3. 4. 5.

Traffic Control Structural Requirements Ventilation Temperature and Humidity Hand Washing Facilities

We will examine each one in more detail next. Traffic Control •

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Movement into and through the department should be restricted to authorized personnel only. The decontamination area should be segregated with no direct access to the clean processing and sterile storage areas, except through pass-through partitions or windows. A strict dress code must be followed before entering any area in a medical device reprocessing department. The purpose of this dress code is to protect personnel and visitors from exposure to harmful contaminates (decontam) and to prevent microorganisms from being carried into clean areas (assembly and sterile storage).

Structural Requirements •

•

• •

Floors should have non-slip surfaces to prevent accidental injuries. Both floors and walls should be constructed and finished with washable materials. They should not be of a particulate or fibre-shedding composition, which may generate contaminants. Ceilings should be constructed to create a flush surface with recessed, enclosed fixtures to limit condensation, dust accumulation, and other reservoirs for contaminants. Pipes and other fixtures above work areas should be enclosed. Work areas should be well lit ; adequate lighting is critical to personnel safety.

Ventilation •

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The ventilation system in clean areas should be under positive pressure to reduce air contamination from outside areas. Subsequently, the decontamination area should be under negative air pressure to prevent air contamination to adjacent clean areas. All air is ultimately exhausted to the outside, and not re-circulated . There should be no less than 10 air exchanges per hour to reduce environmental contamination by air dilution and to facilitate removal of possible fumes and other byproducts from chemicals.

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Portable fans must not be used since they create turbulent air flow which recirculates dust and microorganisms from the floor and work surfaces. This interferes with designed airflow characteristics and encourages the transmission of microorganisms.

Temperature and Humidity •

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Temperature in work areas should be maintained at 18°C to 23°C . The temperature in work areas will be affected by the degree of mechanization, as processing machines can generate a lot of heat throughout the day. A relative humidity in the range of 30% to 60% is desired in order to maintain a comfortable working environment and to maintain moisture levels for woven packaging materials. Dehydrated linen can impede the steam sterilization process and in some cases become scorched.

Hand Washing Facilities •

Hand washing facilities should be conveniently located in or near the decontamination and processing areas, as well as all personnel support areas such as staff lounges. Adequate hand washing facilities encourage the practice of good hand washing technique, which is vital to minimizing microorganism transfer.

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Identify the soft skills and other job-related abilities critical to the success of a medical device reprocessing technician. Critical Skills Some of the most critical skills required of a medical device reprocessing technician (MDRT) are the soft skills or people skills. Given your current understanding of the work responsibilities a MDRT must carry out, how would you answer the following questions? •

What am I like to work with?

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Do I work well in a stressful and team-centred environment?

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Am I reliable, dependable and flexible?

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What personal qualities do I need to be successful in this profession?

Your response to these questions will help predict your level of success as a MDRT .

As technicians, you will rarely have face-to-face interactions with patients, however; patients are the primary focus of the work you are expected to do. To ensure quality patient care, you need to: Focus on client service Depend on each other as a team Communicate clearly and in a timely manner Demonstrate professionalism Demonstrate ethical behaviour Follow policies and procedures Train and eventually mentor new graduates entering the field Be flexible with your work schedule

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Client Service The primary responsibility of the technician is to ensure all department processed devices and equipment are made safe for patient use. The patient is the ultimate client of the medical device reprocessing department. Other clients include doctors, nurses, clinicians and other healthcare providers. Providing top-quality service to our clients requires high standards of performance, and involves every member of the department. 12


Teamwork The medical device reprocessing department is made up of a number of functional areas that depend on one another. If one area fails to meet established quality standards, a subsequent area can be adversely affected. For example, sterilization is dependent upon instruments being thoroughly cleaned – if a team member fails to process an item through decontamination properly, sterilization cannot be achieved. This can result in a serious infection, or even the death of a patient. Medical device reprocessing technicians must work as a collective to achieve quality customer service. Communication Medical device reprocessing personnel work closely with operating room (OR) personnel to provide quality service to the patient. For this reason, effective communication skills are essential. If the OR staff needs an item during a critical stage of a surgical procedure, a timely and accurate exchange of information is crucial to the health of a patient. Professionalism Medical device reprocessing technicians are professionals. A professional is a well-trained individual knowledgeable in a field of expertise. A professional demonstrates an eagerness to be a team player, an effective communicator and is respectful to both coworkers and patients alike.

Figure 4: Professional Teamwork © 2013, Southern Alberta Institute of Technology

Ethical Behaviour It is an inexcusable breach of confidentiality for a healthcare worker to discuss a patient's problems in public. Discussion among professionals should be limited to the nature of the problem, without identification of the patient. Although it is common practice to discuss an interesting case with colleagues, unless this is done for the purposes of consultation or teaching 13


and unless the patient's anonymity is preserved or his or her consent for disclosure is obtained – this is a breach of confidence that is actionable (i.e., the patient can sue). Confidentiality, in other words, is not just an ethical duty; it is a legal duty. Policies and procedures are put into place after much discussion and collaboration between the management team and instrument manufacturers. Never take it upon yourself to deviate from an established procedure without permission from your superiors; short cuts and good intentions can cause adverse harm to yourself, a coworker, or a patient. Preceptorship An important component of the MDRT program is the training you will receive during practicum. The practicum brings the theory component to life. You will work closely with experienced technicians who take on the role of preceptor. The skills taught by your preceptors are paramount to your future success in a medical device reprocessing department. The attitude, expertise, care and dedication expressed in this training will strongly impact the way you learn. Your career mandate as MDRT professionals will include training and mentoring students. Consider how you can help ensure the success of new students when you take on the role of preceptor. Flexibility Large facilities often operate 24 hours per day, 7 days a week. Successful medical device reprocessing technicians must be able to work any shift in a facility . Flexibility to do shift work can dictate which jobs candidates will get. Individuals unable to work a range of shifts are unlikely to get a position. Shift schedules vary from facility to facility. Specific work duties and responsibilities depend on the time of day and productivity levels for each facility. The following table shows some typical shifts. Table 1: Shift Work

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Shift

Time

Day Shift (D)

7:00 to 15:30

Day Shift #1 (D1)

9:00 to 17:15

Day Shift #2 (D2)

10:00 to 18:15

Evening Shift (E)

15:00 to 23:15

Night Shift (N)

23:00 to 7:15


A 24 hour clock is used to express shift schedules.

General Abilities for Success Some of the general abilities required for the overall success of the medical device reprocessing technician include: •

Language/communication abilities: o o o

•

Physical abilities: o o o o o

o o

•

Fluent in English (comprehend, speak, read and write English fluently) Easily understood by others Communicate effectively under pressure

High resistance to skin allergies and chemical sensitivities Not sensitive to the sight of blood and human tissue Manual dexterity and an ability to perform repetitive tasks using fine motor skills Good health without limitation affecting long periods of standing, bending or walking Lift 18 kilograms (40 pounds) and push/pull carts weighing up to 114 kilograms (250 pounds) Work in a busy and noisy environment Work early morning, day, evening, nigh and weekend shifts including holidays

Personal qualities: o o o o o

o o

Capable of continuous productivity in stressful situations Work independently showing sound judgment, flexibility and initiative Work closely with others in a cooperative manner Service oriented, reliable with an eye for detail Understand that work involves continuous exposure to body and blood borne organisms and chemical products Work with integrity and respect for the privacy of others Strong organizational skills

Something to think about…. 1. What are the three greatest strengths I will bring to my job as a Medical Device Reprocessing technician? 2. What are the three things (soft skills, general abilities, etc.) that will make this job difficult for me? 3. Are there things I can change to help me be more successful? How?

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If you have any concerns with the general abilities previously stated you should consult with your assigned facilitator immediately.

Career Opportunities There was a time when on-the-job training was sufficient to meet the educational requirements of personnel working in medical device reprocessing; however, this practice is seldom seen in industry today. With healthcare costs skyrocketing and ever-emerging strains of new and virulent diseases pervading the world, the trained medical device reprocessing technician is essential to every medical device reprocessing department. In order to better understand the career opportunities available to newly trained technicians it is necessary to have a basic understanding of the departmental organizational structure of the modern medical device reprocessing department. Organizational structure and working titles for medical device reprocessing personnel will vary from facility to facility and will depend largely on the number of personnel and the level of productivity within the department. The chart in Figure 4 represents an example of how a department may be organized and the typical structure of reporting relationships within the department.

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MDRD Manager / Director / Site Coordinator Responsible for the overall operation of the department

Supervisor Day/Evening/Night – Responsible for direct supervision of personnel in the performance of their tasks

Shift Charge Person Responsible for making decisions when the Supervisor or Site Coordinator is not present

Staff Technician Performs full scope of processing tasks

Service Aide Performs limited scope of processing tasks .

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Figure 4: Medical Device Reprocessing Department Organizational Structure

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Career advancement opportunities for medical device reprocessing technicians can be somewhat limited without a nursing background. However, with the rapid change in technology associated with the MDRD industry and with the huge shortage of workers in many areas across North America, there has been a slow shift in thinking. Supervisory positions and some management positions (albeit rare) are becoming more commonly available to MDRTs possessing the right stuff. If you are looking to move up the career ladder of MDRT you will need to proactively seek out available opportunities to acquire the additional training and skills you need to advance your career.

Global Connections There are several associations in Canada, the United States and the world dedicated to the education, support and professional enhancement of medical device reprocessing technicians. The following list represents a small sample of the associations and their respective websites. You will find opportunities for professional development, as well as some interesting information and great links related to your future profession.

Canadian Association of Medical Device Processing: www.camdr.ca The International Association of Healthcare Central Service Materiel Management (IAHCSMM): www.iahcsmm.com World Forum for Hospital Sterile Supply (WFHSS): http://www.wfhss.com Certification Board for Sterile Processing and Distribution (CBSPD): www.sterileprocessing.org

The scope of the MDRT profession is expanding beyond the borders of the hospital-based MDRD department and offers a diversity of job opportunities in clinics, operating rooms, surgical suites, as well as medical product manufacturing facilities, private medical facilities, dental offices, eye clinics/surgical centres, sterilization facilities, tattooing facilities, and veterinary hospitals.

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© 2016, Southern Alberta Institute of Technology. All rights reserved. This publication and materials herein are protected by applicable intellectual property laws. Unauthorized reproduction and distribution of this publication in whole or part is prohibited. For more information, contact: Director, Centre for Instructional Technology and Development Southern Alberta Institute of Technology 1301 16 Ave. N.W., Calgary, AB T2M 0L4

INFC 206 Module 1

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