New research examines the organizational factors that make it difficult for sterile processing teams to maintain consistent practices.

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By Alyx Arnett

Sterile processing professionals understand the importance of following established procedures.¹ Yet maintaining consistent practices day after day can become increasingly difficult as surgical volumes rise, instruments grow more complex, and operational demands compete for attention.

To better understand those challenges, Kevin M Bush Jr, EdD, DHSc, FACHE, director of clinical support services for perioperative administration at ChristianaCare, conducted a qualitative study that included interviews with sterile processing technicians, managers, and an operating room liaison.

“My goal was to look at sterile processing beyond the technical steps and examine how leadership, staffing, workflow, education, communication, and readiness influence the department’s ability to perform reliably,” Bush says. 

In this Research Q&A, Bush discusses what contributes to sterile processing inconsistency, how healthcare technology management (HTM) and sterile processing teams can strengthen collaboration, and the operational changes he believes can have the greatest impact.

[Editor’s Note: Read the study, “Improving sterile processing operational efficiency through organizational change,” in Biomedical Instrumentation & Technology]

What were the biggest takeaways?

The biggest takeaway for me was that sterile processing staff understood how important their work is to patient safety and infection prevention. The challenge was not that staff did not know the standards or understand the risk. The real issue was how difficult it can be to maintain consistent practices when the department is under pressure, especially during periods of high surgical volume. 

In the study, all participants recognized the role sterile processing plays in patient safety. However, 77% still reported inconsistent adherence to procedures, particularly when surgical volume increased. Operational inefficiencies were also a major concern, with 92% of participants identifying them as a challenge. Training gaps and workflow variation were also common themes.

Were any of the findings unexpected?

What stood out to me was the gap between knowing what should be done and being able to do it consistently every day. Staff understood the expectations, but production pressure, inconsistent training, workflow variation, and limited leadership engagement all affected reliability. 

Another finding that really alarmed me was the lack of trust in executive leadership, which in this study was nursing leadership. That trust gap matters because lasting improvement in sterile processing requires frontline staff to believe that leadership understands the work, supports the department, and is committed to meaningful change.

Many participants reported inconsistent adherence to established procedures during periods of high surgical volume. What do you believe contributes most to those challenges?

The biggest challenge is that sterile processing teams often deal with competing pressures at the same time. When surgical volume is high, staff are trying to turn trays around quickly, keep cases moving, manage missing or limited instrumentation, and still follow detailed instructions for use (IFU). That becomes difficult when staffing, training, equipment, and workflow are not fully aligned with the actual surgical demand. In those moments, technicians may feel pressured to focus on speed and throughput instead of slowing down to make sure every step is standardized and fully followed.

I also think inconsistent training and limited leadership visibility play a major role. When expectations are not reinforced in real time, staff may create workarounds just to get through the day. Those workarounds may solve an immediate problem, but over time they can create more variation, reduce reliability, and increase patient safety risk.

Another important factor is clinical hierarchy. In many organizations, pressure comes from surgeons, nurses, and surgical technologists, while sterile processing technicians are often treated as being at the bottom of the list, despite frequently having the most expertise in instrument processing and IFU requirements. That dynamic can make it harder for sterile processing department (SPD) staff to push back, slow the process down, or speak up when something is not ready or safe to use.

HTM teams often work closely with SPDs, particularly as surgical instruments become more complex. What are ways HTM and SPDs can work together better?

HTM and sterile processing can partner more intentionally around equipment reliability, device complexity, and preventive maintenance. As instruments and devices become more advanced, SPD teams need strong support in understanding inspection requirements, functionality checks, repair trends, and manufacturer requirements.

Practical opportunities include developing shared dashboards for repair trends, equipment downtime conducting joint rounds in decontamination, assembly, sterilization, and storage areas; standardizing escalation pathways when devices fail inspection; and including HTM in new equipment evaluations before purchase or implementation. That kind of partnership improves readiness because it connects the technical performance of devices with the operational realities of sterile processing.

If a hospital wanted to strengthen its sterile processing operations but had limited time and resources, what are the first two or three changes you would recommend?

The first thing I would look at is whether the right leadership structure is in place. Depending on the organization, that may be an SPD executive, nursing leader, supply chain leader, or another operational leader who truly understands the work and can advocate for the department. Without the right leadership support, it is difficult to sustain improvement.

From there, I would focus on standardizing the workflow. Hospitals need to reduce unnecessary variation in how instruments are received, cleaned, inspected, assembled, sterilized, stored, and distributed. Even simple things like visual standards, checklists, clear handoffs, and defined escalation pathways can make a big difference in reliability.

The second area would be competency-based education. Training should not only happen during onboarding or once a year for annual requirements. It needs to include direct observation, return demonstration, IFU review, specialty tray training, and focused education on high-risk instruments, especially lumened devices.

The third priority would be leadership rounding and accountability. Leaders need to be visible in the department and present in the actual workflow, not just reviewing reports after something goes wrong. Real-time rounding gives leaders the opportunity to see barriers, coach staff, validate practices, and remove obstacles before they impact surgical readiness or patient safety.

What additional research would you like to see next?

Future research should examine which interventions produce the most measurable and sustainable improvements in sterile processing reliability. For example, we need more research on the impact of competency-based training, borescope inspection programs, staffing models, leadership rounding, automation, instrument tracking systems, and interdisciplinary collaboration between SPD, OR, infection prevention, supply chain, and HTM.

I would also like to see more quantitative studies that connect sterile processing improvement work to outcomes such as tray defects, bioburden findings, surgical delays, immediate-use steam sterilization, staff turnover, productivity, and infection prevention indicators. The field still needs stronger evidence showing which operational changes produce the greatest improvement in safety, reliability, and efficiency over time.

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Reference 

1. Bush KM Jr. Improving sterile processing operational efficiency through organizational change. Biomed Instrum Technol. 2026;60(2):55-67.