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INFC 206 Module 1
INFC 206 Module 1
Department Structure
and Requirements
Fall 2016
Department Structure and Requirements
Rationale
The medical device reprocessing department (MDRD) plays a key role in the organizational
and structural design of a hospital. Virtually all patient care areas within a facility depend on the
services of the MDRD. Understanding how the MDRD is laid out physically and how it operates
is very important in your role as a medical device reprocessing technician (MDRT).
Your work as an MDRT is critical to ensuring all instruments and patient care equipment are
processed in a timely and effective manner to help make the patient’s stay as safe and
comfortable as possible.
Learning Outcome
Outline the requirements for working in a medical device reprocessing department (MDRD).
There are a number of different ways of referring to the medical device reprocessing
department, including:
• Central Processing Department
• Central Sterile Supply Department (SPD)
• Central Service (CS)
For this course, we will be using the terms medical device reprocessing department but
please be aware that other terms, such as central service (CS) and the sterile processing
department (SPD) are still in use.
The word central is descriptive – it will help you understand that processing functions within a
facility are centralized, and managed by one department. Centralized management provides
unified standards of practice and allows for the best possible use of both human and material
resources.
MDRT – Purpose
The purpose of the medical device reprocessing department is to produce and supply clinically
clean and sterile products for patient care needs within a healthcare facility.
The medical device reprocessing department is the heart of a healthcare facility. Just as the
human heart provides oxygen and essential nutrients to sustain operation of the body, the
processing heart provides essential life-saving products and services to sustain the operation of
a facility, and ultimately, the patient. See Figure 1.
Medical device reprocessing departments in large hospitals often provide services to small rural
hospitals and to smaller healthcare facilities including clinics and surgical centres.
1. Decontamination
2. Assembly
3. Sterilization
4. Sterile Storage
5. Distribution
There are specific job duties for each area and shift. A breakdown of duties for each work area
is covered in Objective Two. First, we will focus on the physical layout of a MDRD.
Physical Layout
The physical layout of medical device reprocessing department should allow adequate space for
all functions; however, space requirements may vary depending on the following considerations:
• Processing needs of the facility
• Volume of work
• Amount of product(s) to be processed and stored
• Degree of mechanization (how many machines required for production)
• Product mix
• Storage and distribution systems
The physical layout should promote efficiency by minimizing distances between related areas.
Walls or partitions with pass-through, operational windows must separate the dirty
decontamination area from the clean processing areas such as the assembly, sterilization,
sterile storage and distribution areas.
Prior to reporting to the assigned work area all MDRTs attend a brief shift report meeting
which covers the status of OR work levels including high turnover and priority items.
Before starting a work shift, MDRTs must also read the communication log book (a record of
essential and new job related information). Each MDRT must bring him/herself up to date with
any recent department requirements or policy changes by reading all entries in the log since
his/her last shift.
Work Areas
As mentioned, the five critical work areas that you will be responsible for include:
1. Decontamination
2. Assembly
3. Sterilization
4. Sterile Storage
5. Distribution
Assembly
• Offload clean instruments and containers from the clean side of mechanical washer
disinfectors to designated areas for assembly
• Inspect (for cleanliness or damage), sort, assemble, function test and package basic and
specialty or single instruments and set accurately and dependably as per established
procedures
• Assemble, package and wrap instruments and utensils into procedural trays,
containerized surgical sets and basin sets
• Restock small supplies to appropriate quota levels
• Inspect and prepare linens (select facilities only)
Sterilization
• Perform standard tests to monitor effectiveness of sterilization procedures
• Document load contents, date, sterilizer number and operator information
• Process loads through appropriate sterilization method
• Correctly load contents for sterilization
• Monitor sterilization process with mechanical, chemical and biological indicators
• Unload sterilizer
• Allow sterilization contents to cool
• Transport (offload) sterilized items to correct locations in sterile storage
Sterile Storage
• Place cleaned/sterilized instrumentation in designated areas
• Rotate cleaned/sterilized instrumentation (FIFO)
• Monitor storage environment including factors addressing shelving, cleanliness, fire
codes, and traffic control
• Monitor inventory levels
• Use computers and other resources to locate items
Soiled or contaminated devices work their way from the point of use area to the
decontamination (dirty) area, through to the clean areas – assembly, sterilization, sterile storage
and distribution, as shown below.
Point of Use
The biggest user of MDRD is the OR. Other user areas include the following:
• Emergency
• Labour and delivery unit
Decontamination
Decontamination (decontam) is the dirty side of MDRD. Soiled or dirty instruments and patient
care equipment are processed in this area. The main purpose of decontam is to render
equipment safe for handling for further processing in the clean areas of MDRD.
Assembly
Once instruments have been processed through decontamination they are considered safe to
handle and are transferred to the clean assembly or preparation area of MDRD. Instruments are
prepared for sterilization at workstations specific to their design and use.
Preparation methods include:
• Inspection
• Function-testing
• Assembly
• Packaging
Properly cleaned, disinfected and prepared instruments used in invasive procedures are now
ready for the sterilization process.
Sterilization
Once devices have been properly prepared, they are subjected to the appropriate method of
sterilization.
Sterile Storage
The sterile storage or processed stores area is a combined system of specialized shelves and
bins used for the storage of manufactured and reprocessed medical products. Items are usually
organized as follows:
• Alphabetically by surgical service and instrument name
• Numerically by stock code
• Using the first in, first out principle (FIFO)
Distribution
The physical area of distribution is often interconnected with the sterile storage area.
Manufactured and reprocessed medical and surgical supplies are maintained and distributed to
point of use areas from the distribution area.
Traffic Control
• Movement into and through the department should be restricted to authorized
personnel only.
• The decontamination area should be segregated with no direct access to the clean
processing and sterile storage areas, except through pass-through partitions or
windows.
• A strict dress code must be followed before entering any area in a medical device
reprocessing department. The purpose of this dress code is to protect personnel and
visitors from exposure to harmful contaminates (decontam) and to prevent
microorganisms from being carried into clean areas (assembly and sterile storage).
Structural Requirements
• Floors should have non-slip surfaces to prevent accidental injuries. Both floors and
walls should be constructed and finished with washable materials. They should not be
of a particulate or fibre-shedding composition, which may generate contaminants.
• Ceilings should be constructed to create a flush surface with recessed, enclosed
fixtures to limit condensation, dust accumulation, and other reservoirs for contaminants.
• Pipes and other fixtures above work areas should be enclosed.
• Work areas should be well lit; adequate lighting is critical to personnel safety.
Ventilation
• The ventilation system in clean areas should be under positive pressure to reduce air
contamination from outside areas. Subsequently, the decontamination area should be
under negative air pressure to prevent air contamination to adjacent clean areas. All air
is ultimately exhausted to the outside, and not re-circulated.
• There should be no less than 10 air exchanges per hour to reduce environmental
contamination by air dilution and to facilitate removal of possible fumes and other by-
products from chemicals.
Critical Skills
Some of the most critical skills required of a medical device reprocessing technician (MDRT) are
the soft skills or people skills. Given your current understanding of the work responsibilities a
MDRT must carry out, how would you answer the following questions?
As technicians, you will rarely have face-to-face interactions with patients, however; patients are
the primary focus of the work you are expected to do.
Client Service
The primary responsibility of the technician is to ensure all department processed devices and
equipment are made safe for patient use. The patient is the ultimate client of the medical
device reprocessing department. Other clients include doctors, nurses, clinicians and other
healthcare providers. Providing top-quality service to our clients requires high standards of
performance, and involves every member of the department.
Communication
Medical device reprocessing personnel work closely with operating room (OR) personnel to
provide quality service to the patient. For this reason, effective communication skills are
essential. If the OR staff needs an item during a critical stage of a surgical procedure, a timely
and accurate exchange of information is crucial to the health of a patient.
Professionalism
Medical device reprocessing technicians are professionals. A professional is a well-trained
individual knowledgeable in a field of expertise. A professional demonstrates an eagerness to
be a team player, an effective communicator and is respectful to both coworkers and patients
alike.
Ethical Behaviour
It is an inexcusable breach of confidentiality for a healthcare worker to discuss a patient's
problems in public. Discussion among professionals should be limited to the nature of the
problem, without identification of the patient. Although it is common practice to discuss an
interesting case with colleagues, unless this is done for the purposes of consultation or teaching
Policies and procedures are put into place after much discussion and collaboration between
the management team and instrument manufacturers. Never take it upon yourself to deviate
from an established procedure without permission from your superiors; short cuts and good
intentions can cause adverse harm to yourself, a coworker, or a patient.
Preceptorship
An important component of the MDRT program is the training you will receive during practicum.
The practicum brings the theory component to life. You will work closely with experienced
technicians who take on the role of preceptor. The skills taught by your preceptors are
paramount to your future success in a medical device reprocessing department. The attitude,
expertise, care and dedication expressed in this training will strongly impact the way you learn.
Your career mandate as MDRT professionals will include training and mentoring
students. Consider how you can help ensure the success of new students when you take on
the role of preceptor.
Flexibility
Large facilities often operate 24 hours per day, 7 days a week. Successful medical device
reprocessing technicians must be able to work any shift in a facility. Flexibility to do shift
work can dictate which jobs candidates will get. Individuals unable to work a range of shifts are
unlikely to get a position. Shift schedules vary from facility to facility. Specific work duties and
responsibilities depend on the time of day and productivity levels for each facility. The following
table shows some typical shifts.
Shift Time
Career Opportunities
There was a time when on-the-job training was sufficient to meet the educational requirements
of personnel working in medical device reprocessing; however, this practice is seldom seen in
industry today. With healthcare costs skyrocketing and ever-emerging strains of new and
virulent diseases pervading the world, the trained medical device reprocessing technician is
essential to every medical device reprocessing department.
In order to better understand the career opportunities available to newly trained technicians it is
necessary to have a basic understanding of the departmental organizational structure of the
modern medical device reprocessing department.
Organizational structure and working titles for medical device reprocessing personnel will vary
from facility to facility and will depend largely on the number of personnel and the level of
productivity within the department.
The chart in Figure 4 represents an example of how a department may be organized and the
typical structure of reporting relationships within the department.
Supervisor
Day/Evening/Night – Responsible for direct supervision of
personnel in the performance
of their tasks
Staff Technician
Performs full scope of processing tasks
Service Aide
Performs limited scope of processing tasks.
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Figure 4: Medical Device Reprocessing Department Organizational Structure
Supervisory positions and some management positions (albeit rare) are becoming more
commonly available to MDRTs possessing the right stuff. If you are looking to move up the
career ladder of MDRT you will need to proactively seek out available opportunities to acquire
the additional training and skills you need to advance your career.
Global Connections
There are several associations in Canada, the United States and the world dedicated to the
education, support and professional enhancement of medical device reprocessing technicians.
The following list represents a small sample of the associations and their respective websites.
You will find opportunities for professional development, as well as some interesting information
and great links related to your future profession.
The scope of the MDRT profession is expanding beyond the borders of the hospital-based
MDRD department and offers a diversity of job opportunities in clinics, operating rooms, surgical
suites, as well as medical product manufacturing facilities, private medical facilities, dental
offices, eye clinics/surgical centres, sterilization facilities, tattooing facilities, and veterinary
hospitals.