Work systems analysis of sterile processing: decontamination

BMJ Qual Saf. 2020 Apr;29(4):320-328. doi: 10.1136/bmjqs-2019-009422. Epub 2019 Nov 13.


Background: Few studies have explored the work of sterile processing departments (SPD) from a systems perspective. Effective decontamination is critical for removing organic matter and reducing microbial levels from used surgical instruments prior to disinfection or sterilisation and is delivered through a combination of human work and supporting technologies and processes.

Objective: In this paper we report the results of a work systems analysis that sought to identify the complex multilevel interdependencies that create performance variation in decontamination and identify potential improvement interventions.

Methods: The research was conducted at a 700-bed academic hospital with two reprocessing facilities decontaminating approximately 23 000 units each month. Mixed methods, including 56 hours of observations of work as done, formal and informal interviews with relevant stakeholders and analysis of data collected about the system, were used to iteratively develop a process map, task analysis, abstraction hierarchy and a variance matrix.

Results: We identified 21 different performance shaping factors, 30 potential failures, 16 types of process variance, and 10 outcome variances in decontamination. Approximately 2% of trays were returned to decontamination from assembly, while decontamination problems were found in about 1% of surgical cases. Staff knowledge, production pressures, instrument design, tray composition and workstation design contributed to outcomes such as reduced throughput, tray defects, staff injuries, increased inventory and equipment costs, and patient injuries.

Conclusions: Ensuring patients and technicians' safety and efficient SPD operation requires improved design of instruments and the decontamination area, skilled staff, proper equipment maintenance and effective coordination of reprocessing tasks.

Keywords: human factors; infection control; nosocomial infections; patient safety; quality improvement.

Publication types

  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Academic Medical Centers / organization & administration
  • Decontamination / methods*
  • Decontamination / standards*
  • Disinfection / methods*
  • Disinfection / standards*
  • Humans
  • Quality Control
  • Quality Improvement
  • Surgical Instruments*
  • Systems Analysis*
  • Task Performance and Analysis*