8/13/2013. Keys to Facilities Planning. 3M Sterile U Network 3M Sterile U Web Meeting August 15th, 2013

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1 3M Sterile U Network 3M Sterile U Web Meeting August 15th, 2013 Keys to Facilities Planning Today s meeting times: 9:00 a.m., 11:00 a.m. and 1:00 p.m. CST To hear audio, call and enter access code Phone lines are muted. Audio will commence when the webinar begins. 1 Introducing the 3M Learning Connection: New Name, Same Great Courses It s an educational resource bringing you 3M Sterile U and other Infection Prevention courses. You ll soon see some exciting new benefits as our program evolves! Improved features: Add to my Calendar feature added this month! Other 3M courses will be more accessible as we expand our offerings. What do you need to do? Nothing. Your current registrations remain and our Sterile U offerings have not changed. 2 3M All Rights Reserved. Welcome! Topic: Keys to Facilities Planning Facilitators: Beth Fritcher, 3M Larry Talapa, 3M Speaker: John Nies, Belimed Housekeeping Questions Mute feature (*7 = unmute; *6 = mute) Chat feature Technical difficulties Post session follow-up For more information: 3 1

2 How do I get a CE Certificate? Next week, all of today s meeting participants will be sent an containing instructions for obtaining a CE Certificate for today s meeting. The will be sent to the address you provided when you logged-in to today s meeting. If there are others listening with you today who did not log-on, you may forward the CE certificate to them. 4 Disclosure Statement John Nies Product Manager Belimed, Inc Charleston Regional Parkway Charleston, SC Tel: x141 john.nies@belimed.us Insert John s Picture 5 Learning Objectives Outline and review requirements and guidelines for facilities planning in the sterile processing environment Discuss how to implement guidelines and requirements into an SPD design Review improvements of layout and flow in a renovated sterile process department 6 2

3 Central Sterile Supply Department MISSION The Central Sterile Supply Department (CSSD) in a healthcare facility is responsible for the cleaning, decontamination, ti disinfection i and sterilization ti of surgical instrumentation and medical devices to remove bioburden that can cause healthcare-acquired infections (HAIs) 7 Central Sterile Supply Department Goals & Objectives 100% Complete 100% Clean and Sterile 100% On-time AAMI ST79* is The Guideline * ANSI/AAMI ST79:2010 & A1:2010 & A2:2011 & A3:2012 (Consolidated Text) 8 Physical Requirements* (Building) Level floors Non-shedding materials Minimize exposed piping Doors that can withstand cart collisions Walls and doors should be nonporous material * ANSI/AAMI ST79:2010 & A1:2010 & A2:2011 & A3:2012 (Consolidated Text), Section

4 Steam Requirements* Steam Quality Starts with good water quality Water treatment to remove or reduce total dissolved solids (TDS) 97% - 100% dry (saturated) Non-condensable gases less than 3.4% of volume Steam delivery Adequate to meet demand without creating steam pressure drop No dead legs Traps to remove water Insulated lines 10 * ANSI/AAMI ST79:2010 & A1:2010 & A2:2011 & A3:2012 (Consolidated Text), Section Water Requirements* RO or DI water is preferred for washers Thermal rinse step Water quality affects detergent use Scale buildup Contractor needs to know supplier water quality needs for all equipment * ANSI/AAMI ST79:2010 & A1:2010 & A2:2011 & A3:2012 (Consolidated Text), Section Air Management & Ventilation Requirements* Flow should be clean to decontam Clean at a higher pressure Flow from ceiling to floor (down draft) Decontam area should be exhausted outside Connect vented washers to ductwork that is exhausted outside Meet Minimum Air Exchanges/Hr AAMI 10 per hr AIA 4 to 10 per hr, depending upon locations No fans inside the CSSD C D 12 * ANSI/AAMI ST79:2010 & A1:2010 & A2:2011 & A3:2012 (Consolidated Text), Section

5 Temperature & Humidity Requirements* HVAC system should be sized to control temperature and humidity as follows: General work areas 68 F to 73 F 30% to 60% humidity Decontam 60 F to 65 F 30% to 60% humidity Sterilizer Service Area 75 F to 85 F 30% to 60% humidity Sterile Stores Up to 75 F Up to 70% humidity 13 * ANSI/AAMI ST79:2010 & A1:2010 & A2:2011 & A3:2012 (Consolidated Text), Section , Implementing Requirements & Guidelines Optimal workflow Meet guidelines 14 Central Sterile Supply Department Processing Areas & Workflow Sterile Storage Assembly, Packaging & Sterilization Decontamination Distribution Receiving 15 5

6 Decontam Flow & Considerations Carts 1. Minimize distance from incoming to cart washer 2. Sufficient area to queue carts Sinks 3. Location relative to washers Washers 4. Automation to improve efficiency Hand wash items 5. Separate process flow path Clean Side Flow & Considerations Carts 1. Short direct access to Distribution area Prep & Pack Tables 2. Sufficient for washer processing & sterilizer loading Sterilizers 3. Sized to match P&P throughput 4. Consider smaller unit for special cycles Hand wash items 5. Separate process flow path 17 1 Sterile Stores Flow & Considerations Cooling Area 1. Out of traffic flow Other

7 Meeting Steam Needs Contractor needs all equipment steam requirements Traps at each sterilizer Well insulated lines Regular boiler maintenance 19 Meeting Water Needs Properly sized RO/DI water system Properly sized water softener system 20 Meeting Air Management Needs HVAC contractor has equipment data Minimize openings between areas Look for self closing pass through window Tissue Test Air pressure difference between decontam and clean 21 7

8 Meeting Temperature & Humidity Needs Data loggers in each area Record temperature daily Some will constantly record data 22 Central Sterile Supply Department Planning & Design Considerations Number of OR s Case/Services volume Supported specialties Daily procedure goal Transport systems and circulation Previous/current processes Staffing levels Future growth Site constraints Contracted support (i.e. linens, non-durables, etc) 23 Central Sterile Supply Department Planning Commonly overlooked items Vendor/Loaner instrument storage (receiving and distribution) Case Cart processing capacity and staging areas Instrument tracking systems and scan stations Water quality Steam supply Detergent closets Sink configurations Service area lighting and ventilation Wall covering and protection Flooring type 24 8

9 A Real Example Before Issues Personnel (BP) Primary entrance to clean side through soiled cart area (BP) No ante room for PPE on/off 25 A Real Example Before Issues Carts (BP) No door separating soiled cart area from hallway (W) (BP) No good place to clean carts (BP) Once cleaned, carts are pushed through decontam to storage area (W) Cart storage far from sterile stores (BP) Cleans carts pushed back through dirty cart storage to get to sterile stores (W) No clearly designated area to separate instruments from carts 26 A Real Example Before Issues Instruments (W) No designated loaner set drop off area (BP) Double bay sinks (W) One sink is far from washers (W) Rack pass through window requires use of a transport cart to move rack (W) Sonic far from washers (W) Difficult for P&P area to see what has come through washers (W) Racks in front of sterilizer make it difficult to move when sterilizer cart is in front of the sterilizer (W) (BP) No clear area for sterilizer load cooling (BP) (W) Loaded carts coming from sterile stores pass through soiled cart area (W) No area for future sterilizer need 27 9

10 A Real Example Before Issues Other (W) No clear flow for hand wash and low temp processing (BP) Shared elevators 28 A Real Example After Solution Personnel (S) Swapped clean and soiled cart storage so clean carts are near the promary entrance (S) Relocated RO and Low temp to make ante room between clean and decontam 29 A Real Example After Solution Carts (S) Swapped clean and soiled cart areas, changed decontam layout, and added a cart washer

11 A Real Example After Solution Instruments (S) Added a vendor drop off in new soiled cart area, added vendor pickup near sterile stores area (S) Replaced with triple bay sinks (S) New decontam layout has both sinks near washers, one also near the hand wash pass thru window (S) New washer automation included return pass through so carts are optional 31 A Real Example After Solution Instruments (S) Relocated sonic closer to sink and washers (S) Change in washer layout and location allows all P&P to see what is waiting (S) Relocated sterilizers and changed to pass thru units. Eliminated shelving (S) Included cooling area in Sterile stores, beside sterilizers (S) New cart flow, changed soiled and clean cart locations (S) Included area for additional sterilizer in new layout 32 A Real Example After Solution Other (S) Sink with hand wash pass thru located at far end of Decontam. Low temp units moved closer to sterile stores (S) No solution 33 11

12 The Complete Team What to Expect from your SPD Equipment Vendor Vendor Experience - Help guide you through the process 34 Project Planning Start Early for Best Success 35 The early bird catches the worm Project Planning Lean Six Sigma in Healthcare Design Green Belt, Black Belt, Kaizen. Born out of manufacturing industry s need to reduce waste and variability: Reduces costs Increases productivity AND improves quality Improved outcomes for both patient and facility Systems design for process control 36 12

13 Project Planning The Complete Team Design & Construction Team: Architects, Planners, Engineers, Contractors, Facility, Equipment Vendors PRE-DESIGN SCHEMATIC DESIGN CONSTRUCTION PROJECT CONSTRUCTION DESIGN DEVELOPMENT DOCUMENTS BID ARCHITECT ARCHITECT ARCHITECT ARCHITECT PLANNER ARCHITECT PLANNER PLANNER PLANNER PLANNER CONTRACTORS PLANNER ENGINEERS ENGINEERS CONTRACTORS 37 Project Planning Vendor Collaboration Planning Phase Programming Schematic Design Design Development Construction Documents Vendor Activities Capacity Planning Drawing Proposals & Renderings & Workflow Assessment Virtual tours Vendor Coordination 38 Most suppliers are brought in late Most suppliers are brought into a project more than halfway through it, at the 57% progress point. At this point, it becomes much more difficult to avoid change orders. to: Optimize your design Avoid change related costs Avoid design pitfalls 39 13

14 What drives project time, costs and stress? A complete team, including vendor SPD planning resources, can reduce time, cost and stress related to design and documentation activity. 40 Early Supplier Involvement (ESI) Contractors today know that if you engage your supplier early, you will have a more cost effective project. ESI benefits: Reducing costs Utilizing technical expertise of supplier Knowledge sharing Establishing productive working relationships resulting in condensed project times 41 What drives change orders? Letting drawings get ahead of vendor decisions Making an equipment decision later in the process Fixing slab depressions and pits Correcting drain locations Altering electrical services Changing walls locations and openings 42 14

15 Avoid Costly Change Orders Put together decision making team early Create an efficient and effective equipment layout on first or second pass Establish vendor coordination communication for high demand equipment Start EARLY, select early 43 Poor Coordination/Team Creates Issues Poor working environment Inefficient workflow Poor compliance Limited ability to adjust for the future 44 Equipment Vendor Expectations Comprehensive project design assistance Capacity / Throughput Planning Operational Cost Analysis Workflow/Process assessment Revit renderings Vendor coordination meetings 45 15

16 Finally What could happen if the team isn t coordinated? 46 Finally What could happen if the team isn t coordinated? 47 Finally What could happen if the team isn t coordinated? 48 16

17 Finally What could happen if the team isn t coordinated? 49 Finally What could happen if the team isn t coordinated? 50 Key Learnings Understand Best Practices ST79* Put Together a Complete Team Involve Equipment Vendors early Work through layouts, early on, with a team ANSI/AAMI ST79:2010 & A1:2010 & A2:2011 & A3:2012 (Consolidated Text) 51 17

18 Thank you! Next 3M Sterile U Web Meeting: September 19, 2013 Cleaning Endoscopes - What a challenge! Register at

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