Under Pressure - IUSS Has Left the Building: How One SPD Made It to Zero

0:00kind of my first thing that I attacked when I was solving this problem was the fact that none of my technicians knew how to properly decontaminate anything at all. One particular occurrence when I first started was our chest retractors had bioburned in them. Almost every chest rate that the OR opened had bioburned in it and we had to continually turn those over and it was all down to staff education. Not one staff member knew how to disassemble a chest retractor. Rising above the buzz of ultrasonic cleaners and the clanking of stainless steel are the ideas and voices that are changing an industry. You're listening to the Beyond Clean podcast, the central mexus for the people, processes and products that are improving our sterile processing world. Each week we speak with frontline technicians, CEOs, engineers and entrepreneurs

1:02with a common goal to help you fight dirty every instrument every time, whether you're tuning in for education or inspiration or glad you did. Now turn on those washers and turn up the volume, it's time to go beyond clean. All right, Clean Freaks. Welcome back to the Beyond Clean podcast. You're listening to season 31 our kickoff episode here for season 31 on under pressure steam sterilization. We've titled this episode IUSS has left the building how one SVD made it to zero. Sorry for you Elvis fans out there with that really cheesy title, but it is what it is. I'm your host for the season Bobby Parker and joining me all season long is our guest co-host for the season Melissa Morgan. Melissa, welcome to the studio. Thank you so much Bobby. I'm so excited to be here in a part of the season.

2:04So fun getting to have a guest co-host for the season. People definitely get tired to listen into me. So we've got another another voice at least for folks for folks to listen to. Melissa, you've been a longtime friend of Beyond Clean and yeah, I'm I'm excited for some of the conversations we've got lined up for this season. But before we dive into the first one, you want to tell us just a little bit about about who you are. Sure. Currently I'm an assistant vice president in the quality space for a large health system in a couple of states with the opportunity and experience with operational SPD departments on both coast and so so glad to be here and a part of such an important work and sharing with our technicians to really understand some of those fundamentals that protect our patients. I love that. I also love having a co-host on the show

3:07who's got some other experiences. You know, you mentioned some oversight and operational work within multiple sterile processing departments, but also coming at it from, you know, a quality and risk and infection prevention perspective. I'm yeah, excited to see this season how that how that bears out. Follow up question for you that I'm sure everybody wants me to ask at this point is, you know, what part of the country are you from? You sound a little different than than the Kentucky Midwest that I've got going on. So I'm originally from North Carolina, grew up in central North Carolina and then came to Florida via California. So kind of done a world U.S. tour, so to speak. That's right. Hitting both coasts as you mentioned. Well, like I said, Melissa's been a friend of the show for a long time and is it just a hoot to talk to? So I'm sure I'm sure that'll show up throughout the throughout the season, but we're really excited to be diving

4:08into this one. I mentioned we're doing IUSS immediate use steam sterilization. We've got we've got a really interesting guest to have on the show today had a conversation with somebody who took a department that was really struggling with immediate use steam sterilization and got him to the place of of nearly perfect. And I thought what better way for us to kick off this season on steam sterilization than to hear that story and bring, you know, bring a, an expert kind of in their craft right now making a difference on this issue to the audience. So we'll be right back with Monica Anderson to walk us through that story right after a short break. Are your SPD and OR department struggling to keep up with demands? Learn how the StereQ multi-trace sterilization system can improve patient safety and throughput by eliminating many steps in your workflow. Reduce costs, OR turnover time, IUSS and surgical delays,

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7:32From the studios of healthcare HQ, you're listening to Beyond Clean, the global voice of sterile processing. And joining us now in studio is Monica Anderson Sterilization Manager out in Mobile, Alabama. We got connected with Monica through just a story about her facility and the success they've been having around immediate use sterilization. Monica, welcome to the show to our kickoff episode of this next season of Beyond Clean about steam sterilization. We are so excited to be talking to you today. Thank you so much. I'm so happy to be here and just really feeling very grateful for the opportunities. Thank you so much for letting me chat your ear off for a little bit. I'm looking forward to it. We've got lots of questions for you. Before we dive into all of that, of course, we'd like to get to know a little bit more about you. Why don't you give us a little thumbnail of what you've been doing in your career and out there in the sterile processing industry?

8:36Sure. So I started my journey in sterilization and surgery over a decade ago. I joined the Navy in my youth many moons ago. We're not going to say exactly how many moons. And I got my surgical training as hospital corpsman. So I did the hospital corpsman program and then they put me into the surgical tech program. In the Navy, this surgical tech and the sterile tech, it's all one same job. So I got to see the best of best of both worlds there. So I did that for a while and then after I got out of the Navy and went civilian side, I worked as a scrub for a little bit and then moved into the sterilization side and obtained my certifications with HSPA and have been moving up the ladder to leadership members and that's where I've been ever since. So it's been a good little journey. I love hearing stories like that of folks who have maybe started in another part of health care or in the OR found their way into sterile processing, loved it and are growing. I'm curious Monica, how did you find sterile processing

9:38and decide, yep, this is this is the route that I want to go rather than continuing as a search tech in the OR? Well, my answer to that is a little bit more on the personal side. The scrubbing, I loved to scrub. I loved being in the OR with the surgeons and I had some really great relationships with some really wonderful surgeons over the years, but it is physically very taxing, just standing in one place for so long. You can only do it for a certain amount of hours before you start to get really tired and while I was in the service, I got injured a couple of times. So scrubbing really physically was no longer an option for me and the sterilization side of surgery just as fulfilling, filling part of the team and helping the team out and being just as specific as the operating room, having a complicated position. I really enjoyed working with the instruments, but it wasn't quite as physically taxing. So that's kind of what brought me to the sterile side. Wow. Well, what a cool way to get to be involved in the whole circle of surgery as well. I know

10:45that's one aspect of my own experience that I've always felt lacking in terms of like having really walked in the shoes in the OR and being able to understand the full picture. So yeah, I'm excited for you. The tremendous impact that I'm sure you're having in your sterilization department is definitely being boosted by those years of experience in the OR. So very cool. Well, you've got quite the story to tell us about a transformation that your department has gone through in recent years about immediate youth steam sterilization. But before we get into what that story is like, we've got folks who tune into the show, who are brand new technicians and then some who I'm sure have been leaders for many years. So we always try to start with just at the level of definitions. Make sure everybody knows what we're talking about. So could at the top of the call here, could you clarify for us what we mean when we say IUSS or that immediate youth steam sterilization and why is it that departments are trying to eliminate its use?

11:46All right, absolutely. So IUSS is a form of steam sterilization intended for the urgent reprocessing of a device that is needed for immediate patient care and is not meant to be used as a substitute for keeping adequate instrument inventories. It says in Amy, that's the definition from Amy. It says that the situation must be clinically urgent. So I need to stress that this decision to IUSS something really shouldn't be this, you know, the scrub text decision or the OR nurses or the SPD text decision is certainly not a vendor sells rep requests to get this done. It should be a request from the physician. The physician should be involved in making that decision. And, you know, the Joint Commission, other regulatory agencies, HSP and their book, it talks about the risk of using IUSS versus the risk of what the patient's condition is. So IUSS, the risk of that should be lower than whatever the patient is going through. It should never be used

12:52as a shortcut. It's never appropriate to be used for implants because it carries higher infection risks. So we want to stay away from it kind of as much as we possibly can. Monica, your spot on there has, you know, thinking about this as a risk, right? And I think you clarified for us that sometimes it becomes out of convenience. And so when you lead such a shift to eliminate that, you know, it can be radical. So do you mind giving us a high level overview of the things that you did in your hospital to make a difference with using IUSS? Yes. So some IUSS, it might be as simple as just a numbers game, looking at instrument inventory. If you have a total needs scheduled for tomorrow's cases, for example, and you only have six total needs trays, it's basic math at that point. I did not get that lucky with my current facility. So I had to look at, you know, all the other reasons why IUSS could happen. Basically any road that

13:56could possibly lead to IUSS is what I took a look at. So instrument inventory was obviously at the top of the list. And then efficient workflow and proper prioritization of rapid turnover trays. I researched my inventory to see if the manufacturers actually validated the instruments we were using IUSS for, educated the SPD or an OR personnel. And I looked at some ancillary things that most people probably wouldn't think these would factor into it, but they did. Bio-burdened occurrences or any other kind of contamination that would make a tray unusable, a hair and a tray lent, you know, an SPD tech left of pen in the tray. Those kinds of things happen sometimes accident. And looking at missing filters, locks and indicators, it might seem like not that big of a deal down an SPD, but to the OR, the tray is still unusable no matter what. So I also looked at vendor

14:57issues was late delivery of a tray part of the problem or inadequate supplies from vendors. Then lastly, I looked at employee morale and staffing levels. If my employee morale was low and staff were burned out, they called out and that affected my staffing levels. And finally, culture changes, getting the OR convinced that, hey, we need to not IUSS that. We have time to run the full cycle, so that took some time. Absolutely. Monica, you know, I think you really hit the nail on the head around this work is that there is some operational elements, but then that culture is really so critical to getting that buy-in of your partners in the OR. So what types of strategies did you found were successful in getting them to buy-in? That is a loaded question. Lots of education. One thing at a time, lots of education, many education sessions for myself, and then I also brought

16:01in any vendor I could think of, I brought them in. So whoever was doing our blue wraps, I brought them in. I had our vendor for our pans come in talking about the pans and you know, not stacking trays, so we don't get holes in the blue wraps and just so much education. And then things like trust building activities, I do rounds in the OR daily. I check on the OR first thing in the morning and see how they're doing if they've had any issues with their trays. So they get used to seeing my face. They begin to trust me and they start to flag me down with, hey, we had an issue with this tray in here today. Those kinds of details are paramount. And in addition to education, not everyone would think of this, but I sent my SPD technicians to the OR and had them observe cases for a week. And in turn, the OR educators said, hey, that's a great idea. And they sent me their OR texts and their nurses for a week. So having that cross-training between the departments has been

17:02just so beneficial on both ends. So really, so much education has gone into it. I think that really is best practice. I think this might be the first story that I've heard where SPD gets to go to the OR for a week. That's a tremendous investment. And I applaud you for that. I got to view a case around the three-month mark. And that's typically what I did for my technician. But you're right. It's so difficult to help people connect the dots that like the end result of a poor outcome. Here's not a dissatisfied customer. It's potential harm to a patient and getting them to really make that personal, emotional connection to patient safety. I don't think anything's going to do it as well as just spending some time in the OR being around those instruments being used on real people. Yeah. Has a has a tremendous cultural impact. I want to hit pause real quick. You listed a lot of strategies. And there's a ton of value here for folks. So I

18:07want to dive into a couple more of those. But before we do, just to tell the picture of like the timeline and the success. So I'm assuming this is kind of a situation that you inherited that there was a lot of immediate use sterilization that goes on. So how bad was it? How good did you guys make it together? And how long did that process take kind of start to finish? Right. So I was hired at this facility in July of 2024. I've been there for just over a year and a half. And before me, there were five other managers that did not out less longer than six months. So lots of managerial turnover, which in turn created massive amounts of staff turnover. When I did my RCA part of what I looked through was all the training records of the staff. And not one staff member. And it didn't matter if they were here for a month or if they had been here for 30 years, not one staff member had been adequately trained. So I looked at that first. And that was definitely part of the fix,

19:09the solution for this. Now when looking back at the records, we were sitting at about 10% IUSS rate when I was hired. And now we are at 0.67%. So a huge shift. Yeah. Amazing. That's awesome. It could work to you and the team like everybody plays a part in that. So thank you. And we work. And you've already made a past the six month mark there. It sounds so congratulations on turning the trend. I love that. So great. So with all of those strategies, you mentioned inventory is often the easiest fix of if your problem is just that you don't have enough trays just buy a couple more. Even that just buy it is not always the easiest thing. You have to get the financial considerations for it. But then you mentioned so many others. I took a few notes along the way, efficiency and workflow and validations for instruments and vendors getting their stuff here on time and dealing with the bio burden that ends up in trays. And that

20:11was the only one we had. So now we have to IUSS it. Right. Of all of those strategies or pathways, you called them that you're using to limit immediate use sterilization, which one of them do you think was the most impactful? That's a great question. It was not as simple as instrument inventory increase. So I can't say that. I'd say the most impactful was bio burden and contamination sources. Kind of my first thing that I attacked when I was solving this problem was the fact that none of my technicians knew how to properly decontaminate anything at all. One particular occurrence when I first started was our chest retractors had bio burden in them. Almost every chest rate that the OR opened had bio burden in it. And we had to continually turn those over and it was all down to staff education. Not one staff member knew how to disassemble a chest retractor. So we started with that and looking at so much time I spent in decontamination with each of my technicians.

21:16Not only training them and retraining them, but ensuring that they were complying with the rules. I mean, I was gowned up right next to the technician with milk. You've got to be under the surface of the water when you brush that instrument and that instrument needs to go into the ultrasonic and that instrument still needs to be disassembled. It doesn't do any good if you don't disassemble it first and so on and so forth. So I think as a manager of the people, she's going to have to decontaminate there with folks. No, that's tremendous getting kind of those early, early cultural wins and also early trainees like getting, yeah, getting your processes followed really important pieces. And it always starts in decontam, right? No matter where you're trying to solve the problem, if it's own storage or with immediate use steam sterilization, if you're not getting decontam right, you've got you've got opportunity to influence all those things. Absolutely. And as you think about it, you know, you've done a fantastic job of reducing

22:17IUSS and I'm sure ZERO is in your future. What things are you specifically thinking about that will help maintain this success? Are there things you're continually looking at for making sure that you don't have any slides or shifts back into bad practice? Sure. So one of the things that I did while I was solving this issue was collecting data, which it speaks volume. So I collected data, not just of what was making it to the OR, but for example, what bioburnum was making it to the clean side. So we were checking things like that. I recommend using some kind of resource out there, lean six sigma, something like that, maybe before distance flints of execution, something like that to kind of help your staff get involved in the process. So my current facility, we use, we're a high reliability organization. So we have a huddle build a huddle board with, you know, HRO on there and we talk about, you know, days since last bioburnum and days since last quality report and days since last, you know, we're tracking those

23:22things and we talk about it every single day in our daily huddles. It's visual. The staff can see the impact that they're making. They can visually see where they are at in a graph and what is making a difference and it's interactive. The staff can add their own ideas of, hey, I noticed this workflow is very efficient. I think maybe we could come up with some other way to solve that. It's really time consuming it. Having that be interactive and the staff all understanding that there is an objective gets them all in line to help you solve it because as leadership, we are not on the floor all the time. Some leaders don't even get into their decon. They haven't been there in a while and some leaders, you're kind of stuck to the desk some days that happened. So having those frontline technicians really involved is paramount in my opinion. Other techniques, continuous education. I mean, I try to have either an inservice by myself or a vendor every two weeks. So I want my staff to be so trained to the point that they are annoyed and I am just about

24:27at that point. We just had a DaVinci inservice and my staff came out of that inservice going, why did you put us in there? Again, we just wasted an hour. We already know that information and I said, great, now you're expert. So that's what I want. That's right. Monica, when you started talking about data collection, like, yeah, my ears fricked up as well, that any problem that you're trying to solve, that almost always has to be the first thing that you go after. You've got to know how bad the issue is. And in your case, when you listed all these strategies that you took, like, addressing the pathways to IOSS, like, how are all of these events happening and then how we got to tackle each of them? I'm sure you had to collect a tremendous amount of data. If somebody were to come into your department and just, you know, spend a day with your technicians, what would that data collection process look like? How are you getting

25:30the data that you need to make a real difference for immediate use sterilization? That is a great question. It would not only be in my department, it would also be in the OR. The person who would have to come with me while I do rounds in the OR. We have an OR liaison where I'm at. So I'm mostly coordinating with that person, because they are, you know, in the prime spot to get all of the information from all the ORs at once. So they would have to be with me for that. And then rounding on the floor with the technicians, we have sensor track at this facility, but it's not fully implemented with IT, but that's okay. You can still track these things if you don't have full implementation with your IT. So we've been manually tracking quality. So, you know, point of view, sawdots with this was a spray or these instruments weren't open. I do rounds for that every day in Decon. I do rounds on the clean side with what are we getting that still has biobird in it? It's pretty much constantly watching the washers and making sure that

26:32I can see that everything is either butterflyed open or on a wide adjustable string or something like that. So I can see that the trays are being properly sent through the washers. Same with, you know, like vendor trays being separated through the wash, making sure those things are happening. So that's kind of where we're looking at stuff. And then if all you have is, you know, like a minus report or RL6, whatever your hospital uses for quality reporting, you can use the system that's already in place. Like I said, I have some IT integration issues with my sensor track, but if you don't have that problem and you can use the quality reports that are in, you know, whatever tracking system you have, I encourage it. It's great. It's especially very convenient for the technicians to be able to give you that information when you have a tracking system that's fully implemented. For sure, one of the objections that's often given for departments that don't even have a tracking system is like, how, how could we possibly collect the data that would need to be collected? And this isn't the point of the episode. So I don't want to spend too much time on this one. But what does that manual documentation look like for biobird and on the

27:37clean side coming out of the washers? Because I agree that's an essential stat. Like we are so good at tracking biobird that gets reported back to us PD found in the OR. But that's a, that's a results outcome. We need, we need a process outcome as well. Like how much of it's coming through the washers and figure out how do we, how do we stop the biobird at that point rather than waiting until it gets found in the OR? How do you collect that data manually? Maybe to help the departments out there who don't have a tracking system and feel like it can't be done? Real simple. Just keep it real simple. I have a click board near the pass-through window that's just an Excel spreadsheet. My technicians fill it out. What tray and what instrument they found biobird in when they send it back to Decon? Simple. That's it. I grab it and I just put it into an Excel spreadsheet once a week. So really, really simply being able to track that. And then I use that data to further educate my technicians because clearly we're not getting it clean. If we're sending back a DaVinci

28:38monopolar scissor, you know, a dozen times in a day, we are missing something. We're not getting it clean completely. We need to have further education on that. So it can be really, really, really easy to track those. You just kind of have to put on the effort to get it done. It is a little bit more, you know, time consuming, not having a tracking system, but it can be done without a tracking system. It's so worth it. Do you get the benefit of the trending data of, you know, a particular instrument, like you said, or maybe a particular shift that's maybe struggling with manual cleaning and decontam or even a particular trainee, like being able to see that trend could be really beneficial? And then using that kind of like a reward system, you know, a good catch because it was called down in SPD and not in the OR where there could be harm, you know, really drives that culture that you mentioned earlier and that need to be really thoughtful about how serious that can be when it reaches the patient.

29:42Yep. I've got visions of like, you know, put the most lines on the clipboard award at the end of the month or something like that. I like it. Absolutely. All right. Well, these, these interviews always go by way too fast. Monica, I want to make sure here at the end of the call that we give some real practical advice for leaders who are stuck in this. So if you were giving some, you know, just arm around the shoulder advice to a leader that you just went out to lunch with, who's where you were at in the summer of 24, like really struggling with IOSS, what would you tell them is like the first thing they need to do to start tackling this problem? Where should they get started? Collect data. Step number one, get all the data you can. Researcher IFUs, conduct a root cause analysis, identify where everything is starting from. It's probably in decontamination. So just start there and review your policies. Look at your inventory levels. Start with as much data collection as you can get. Be out on the floor. Look at these things.

30:46Observe. You don't have to comment on them. It's okay if your staff do it wrong, just observe it and take notes. See where you stand. The next step I would suggest is get a cross-functional team together. You need to get all these key stakeholders at one table together talking about this. I would recommend your infection control. They need to be in the loop, your quality, the OR leadership, the SPD leadership. You might even need purchasing if it's going to take a lot of inventory purchasing to get that up. I highly recommend having an administrator there for executive support and your physicians. They need to be in the know that we are looking at this. We're trying to decrease our IUSS. I would even go as far to say as have a representative from anesthesia there at the table because we want them to be aware that hey if we're running into an IUSS situation, we're going to ask you not to roll with that patient until the tree is ready. So get all those people into one place, tell them what you're doing, get them all the information that you've gathered

31:47so far and what you want to be as your plan and they will help you. They will help you collaborate a plan on how to solve it. And if they are resistant to helping you, send them this podcast. Amen to that. Well, Monica, it sounds like you're doing some tremendous work out there and great job. You and the team, great job on taking care of the patients at your facility, every instrument, every time. Like we want every patient who comes through that OR to get the same standard of care and nobody gets the rush job tray because we didn't have enough or we messed up the last one. So I applaud you for those efforts on your journey to no more immediate use cycles at all in your facility. I also want to give a quick shout out to one of the strategies you mentioned the OR liaison. We've done a couple of episodes here on Beyond Clean about that position in general and that is a transformative position to help deal with some of these questions around immediate use sterilization, but getting creative about thinking of other ways that we can solve complex

32:51problems in the moment in the OR. So if you're curious about that, definitely go check out that other episode. Does going to do it for today's episode? Monica, I know that we didn't hardly begin to scratch the surface of all the work that went into turning the tide in your department. And I'm sure folks will want to continue to get in touch with you there. Is LinkedIn the best way for folks to connect with you if they want to talk more about your story? Yes, I am on LinkedIn. You can find me there. Okay, perfect. Well, thanks again so much for joining us for the interview today and great job. Thank you so much. I appreciate it. Thank you for your service, Monica. Thank you. And that was Monica Anderson's sterilization manager out in Mobile, Alabama and Melissa, what a story. One of the things that I thought was really interesting and important and impactful from that

33:53conversation is not only like the overwhelming number of things that Monica was tracking and trying to make improvements on, but also the timeframe in which she did it, like to step into a situation that has burned out a lot of leaders that struggling with staff turnover that's maybe not situated in a budget scenario where just buying more instruments was the answer into in the span of what. A year, 18 months, be able to go from 10% to next to nothing. Really, really powerful story. I think it's going to be an inspiration, hopefully for some folks who are listening in. Absolutely. And if you really think about it, we really didn't have time to dive into that ability to build culture, but you can really tell from just speaking to Monica that she's at the side of all of her technicians figuring out what makes their job hard and how to make it easier. And so that definitely had to have made a difference as that team pulled together to

34:56eliminate IUSS. Yeah, makes it an initiative that's easy to get behind. It's not just like the manager's big idea of how they're going to make their mark on the world, but like this person really cares about this. And this is important for the patient. Absolutely. All right, well, that's going to do it for our season opener. I'm excited for this season under pressure on steam sterilization. And we've kicked it off right. We'll see you again next week as we continue to this journey about steam sterilization. And until we talk to you then on behalf of Melissa, myself and the whole team over Beyond Clean, keep fighting dirty. Thank you for listening to this week's episode of Beyond Clean. As a reminder, you can help support us by subscribing to Beyond Clean on your favorite podcast app or by downloading the smartphone app on iPhone or Android. Simply search for Beyond Clean in the App Store or Google Play. The best thing about downloading the smartphone app is that you can access bonus content for certain episodes

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