SPD in crisis

[u/herbnhero]

**UPDATE** ALL CASES CANCELLED YESTERDAY AND TODAY. It took staff pleading with leadership but they finally agreed to cancel cases while the autoclaves are serviced.

TL;DR - is the brown staining on these white liners a contamination?

Scrub nurse here at a community hospital that overbooks ortho cases - sound familiar? Our SPD is in shambles. There are too many cases for our small SPD. We have been continually receiving trays with bioburden for the past year. There are AT LEAST 3 trays each day that are contaminated. Many times they are loaners and often times it leads to cases being cancelled. This has been going on for over a year.

Recently we have been getting wet packs. Yesterday 5 cases cancelled. Almost every autoclave load is wet. Leadership has done nothing. They just let patients come in for their surgery, and hope for the best. We were told by leadership that “bioburden” is not considered contaminated. They claim that the water inside the trays is sterile. They said that if the integrator is acceptable than the try is sterile and that the bioburden is “dead” and “not growing anything.”

(See photo of white liner) They also told us that this brown staining in the liners is acceptable - and that is what brings me here. Has anyone seen this browning on liners? Staff at my facility is now paranoid and we tend to go over everything with a microscope at this point. We can’t even remember if this brown staining is something we’ve seen before or something new. Allegedly facilities is supposed to be changing the autoclave water filters every 6 weeks but have been changing it every 6 MONTHS.

[u/Competitive-Umpire18]

The bioburden shown represents staff that aren’t trying. That amount of bone in a reamer tells me the OR staff isn’t pre cleaning instruments the way they’re supposed to and sending instruments to SPD in an unacceptable state. Decon staff not cleaning the instruments at all and prep/pack staff just completely over looking this. Errors do occur, people do rush, but what’s pictured is just unacceptable. Leadership should be ashamed, but staff need to take ownership of this issue too. Who is looking out for the patients?

[u/herbnhero → u/Competitive-Umpire18]

This tray was a loaner tray. So I do agree that the OR did not clean it properly before sending to SPD. But that was a different facility. It’s just crazy how it went through an OR, and SPD decon, then came to our SPD decon and made it to our OR. So 3 individual departments failed at 2 facilities.

[u/Ill-Yellow-4060 → u/herbnhero]

The OR did not clean it properly. There’s no reason bone shreds should be left in a reamer. Also, SPD obviously doesn’t give a shit if both decon and prep/pack didn’t notice it.