Table 1

PSF descriptions and examples

PSFDescriptionExample(s) of failure
Staff KSAs
KSAs of staff involved in reprocessing work, including SPD, OR and biomedical engineeringTechnician fails to disassemble instrument during decontamination
Production pressure
Pressure to perform higher numbers of cases, reduce OR turnover time and reduce reprocessing timeScrub techs do not have time to perform point-of-use reprocessing
Demand variation
The timing and rate at which trays are received from point-of-use areas (usually sporadically and in influxes)Technician constantly interrupted by dumb waiter while cleaning instruments
Staffing and turnover in SPD, OR and biomedical engineeringBacklog of trays created due to understaffing in SPD
(tools/technology environment)
Lighting, number and depth of sinks, surface space, and placement and availability of decontamination tools and supplies (timer, temperature gauge, brushes and flushing aid)Poor workstation design leads to staff fatigue or injury
Instrument design
(external environment)
The features (metal, finishes, channels, and so on…) of an instrument that facilitate or hinder reprocessingContamination in interior channel of instrument missed during decontamination
Instrument IFU
(external environment)
Instructions created by the manufacturer detailing the steps for properly cleaning and sterilising an instrumentIFUs unavailable, difficult to access or out of date
Tray composition
The number and type of instruments in a trayInstrument inappropriately exposed to immersion or high temperature
Equipment design
Features, capacity and usability of the decontamination equipment (ultrasonic cleaner, cart washer and washer-disinfector)Incorrect cycle selected for tray
Number of equipment
Number of decontamination equipment available for reprocessingLimited number of ultrasonic cleaners increases reprocessing time for orthopaedic instruments
Maintenance schedule
Plan for preventative maintenance and prioritisation of corrective maintenanceUltrasonic cleaner spends several days in disrepair
Communication within SPD and between SPD and the OR, and biomedical engineeringThird shifts fail to inform incoming shift that tests were not conducted
  • IFU, instructions for use; KSA, knowledge, skills and abilities; OR, operating room; PSF, performance shaping factor; SPD, sterile processing department.