It almost resembles Santa’s workshop, if Santa was in the medical supply business.

Row upon row of meticulously organized supplies and neatly wrapped packages of re-processed instruments greet you as you enter the Sterile Processing department. Your mother’s gift-wrapping abilities pale in comparison to the “presents” lining the shelves in this immaculate space.

All joking aside though, the standards of quality and safety that the Region’s sterile processing departments maintain and strive for is nothing short of incredible.

“Quality and safety for our patients and our staff is our number one priority,” says Patrick Quinn, Regional Manager of Sterile Processing. “That is what gets us here every day.”

Regional Manager Patrick Quinn shows off the storeroom.

Regional Manager Patrick Quinn shows off the storeroom.

The staff, approximately 143 people in total, in the sterile processing department are responsible for reprocessing all reusable medical devices for the entire health region. This includes anything from a bed pan to the complex medical and surgical instruments used in the operating room.  The department re-processes over 500,000 individual items per year.

“We are the last sets of hands on these instruments and tools before they are opened in any of our operating rooms, trauma rooms or birthing rooms,” explains Quinn. “Our responsibility and level of attention to detail is extremely high. We can’t make any mistakes when preparing instruments that will be used in a patient’s surgery.” The department is also responsible for any implantable device such as pacemakers, hip and knee joints, plates and screws. “Basically anything that is implanted into someone’s body, we’re responsible for maintaining that inventory.”

But we are getting ahead of ourselves here. Before anything gets wrapped, sorted or inventoried, it has to get cleaned and sterilized first.

Instruments that have been used in the operating rooms reach the decontamination area of the sterile processing department via elevators dedicated to transporting soiled items. “It’s a one way work flow,” explains Quinn. “The used instruments come down in the dirty service elevator one way. Sterilized instruments are delivered back up in a separate clean service elevator.” The used instruments are safely disassembled and sorted by type for the washing and disinfecting process.

Staff working in the decontamination area are dressed in full personal protective equipment (gowns, aprons, masks, gloves, and shoe protectors) to keep themselves safe from potential splashes from blood and body fluids. Then depending on the item, some things are hand washed while others go straight into the washer.

A rack of steel ware coming out of the washer disinfector.

A rack of steel ware coming out of the washer disinfector.

The washer-disinfectors look almost like a car wash in miniature. The  washer bays are a bit larger than an average commercial dishwasher in a restaurant but the entire system is automated. Staff load the instruments into barcoded bins or trays according to instrument type. The washer reads the barcode to determine the parameters of the wash cycle such as time and temperature.

Once the instruments are washed and disinfected, they are visually inspected and then sorted by item for assembly and wrapping.

Kaushaf Sharma wraps some steelware.

Kaushaf Sharma wraps some steelware.

“Our department is divided into work stations so an operating room surgical set will be assembled and wrapped at one station, steel-ware like bed pans and bowls are wrapped at another station and individually wrapped items at another,” says Quinn.

 Some of the neatly wrapped “presents”.

Some of the neatly wrapped “presents”.

Whether bundled together or individually packaged, everything is placed in blue sterilization wrap, peel pouches or rigid sterilization containers. “The wrapped packages are held together with a special blue and white tape and that tape has a chemical indicator in it,” explains Quinn. “Once the package has been sterilized, the white part of the tape turns black indicating that sterilization was successful. If it doesn’t turn black, then we don’t use those instruments and we know there’s an issue we need to fix.”

The indicator tape is just one of the many safeguards in place in the sterile processing department. “Surgical sets that are in cases also have sterilization indicators inside them as well as coloured indicators on the outside of the cases,” says Quinn.

A total case cart for a knee surgery. Everything on this cart is needed for a surgery on just one knee!

A total case cart for a knee surgery. Everything on this cart is needed for a surgery on just one knee!

The cases also have tamper evident locks on them and every item has a recall stamp on it identifying the load it came from, who made it and the date it was done. If any of the locks are broken or the colour indicators signal a problem, then the items aren’t used and the team investigates the issue.

“Mistakes can always happen because no one is perfect and sometimes equipment fails but it’s how we deal with it that’s important to ensure it doesn’t happen again,” he says. “These are important safety checks and balances and this team takes them seriously.”

So seriously, in fact, that the sterilizers are tested twice a day. “The industry standard is that you complete a sterilizer test once a day to ensure that everything is working properly. We go above that,” says Quinn. “We’re a department that runs 24 hours a day and 16 of those hours are devoted to re-processing instruments so if something isn’t working properly, we want to know about it sooner rather than later.”

So twice a day, a sealed vial of live bacteria goes into the sterilizer with a cart full of instruments. If the bacteria comes out dead, it’s all systems go.

One of the steam sterilizers.

One of the steam sterilizers.

Speaking of the sterilizers, the Region has three types of them. The steam sterilizers are giant chambers that operate with vacuum and steam. The sorted and wrapped items are placed on carts that are rolled directly into one of the four sterilizing chambers. The vacuum removes all the air and 132°C steam penetrates the items, killing anything potentially living on them. An average steam sterilization cycle takes about an hour.

“Steam sterilization is the oldest and most common method of sterilizing in the world,” says Quinn.

But there are some items, like certain types of scopes and battery-powered items that cannot be sterilized with heat and moisture.

“You wouldn’t put your Black and Decker drill in the dishwasher at home right? You’d destroy it,” he laughs. “Same thing applies here so for those items we use a sterilizer that operates with gas plasma hydrogen peroxide or vapourized hydrogen peroxide at a lower temperature and with no moisture.”

To sterilize two operating scopes this way takes approximately 35 minutes.

The ethylene oxide gas sterilizer is the third sterilization method the Region uses but not as often. “It’s an older technology and while there are still a few items that require it, the demand for it isn’t what it used to be,” says Quinn.

Part of the reason for that could be the cycle time; one cycle in this sterilizer takes a whopping 16 hours. Because of the low demand, only Saskatoon City Hospital has this particular type of sterilizer and any items that require it are shipped there.

Once the items are sterilized, they are moved to a staging area where they sit until they are cool enough to be put away in their proper place on the shelves.

“Every time a surgical procedure takes place, we have staff down here that work with surgical booking to generate an operating room slate,” explains Quinn. “Then they code all the procedures and our staff pick all the necessary supplies for the operating room staff to be able to do their job.”

“I’m very proud of the work this team does on a daily basis,” says Quinn. “We have our busy days and fluctuations which can impact our work when volumes change, but our staff are very adaptable and highly trained.”

In fact, at one point, working in sterile processing only required on-the-job training but now everyone working in the department has certification from a medical device reprocessing technician program and the Region was one of the first places in Canada to do that.

“We have a defined set of quality and safety criteria that we as technicians must adhere to so proper education and training is a must and I’m happy to say that we’ve set that standard here,” says Quinn.

That is fantastic but what we really want to know is if Quinn has ever asked his team to help him with his Christmas present wrapping? “It’s tempting, but no!” he laughs.