Article Text

Download PDFPDF
Work systems analysis of sterile processing: decontamination
  1. Myrtede Alfred1,
  2. Ken Catchpole1,
  3. Emily Huffer2,
  4. Larry Fredendall3,
  5. Kevin M Taaffe2
  1. 1 Department of Anesthesia and Perioperative Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
  2. 2 Department of Industrial Engineering, Clemson University, Clemson, South Carolina, USA
  3. 3 Department of Management, Clemson University, Clemson, South Carolina, USA
  1. Correspondence to Dr Myrtede Alfred, Anesthesia, Medical University of South Carolina, Charleston, SC 29425, USA; alfredm{at}


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.

  • patient safety
  • nosocomial infections
  • infection control
  • human factors
  • quality improvement

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.


  • Twitter @KenCatchpole

  • Funding This study was supported by the Agency for Healthcare Research and Quality (1R03HS025538-01).

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available upon reasonable request.