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  • Writer's pictureTony


Every surgical procedure begins in sterile processing. Without your efforts and the important work you do every day and night the operating room would simply close down. Yet somehow this has been forgotten by the healthcare C-suite, surgeons, and perioperative management.

Need proof? Just take a look at your salary compared to a surgical technician.

How and when did this happen?

Once upon a time in the OR….

Did you know there was no specialized department known as SPD or Central Sterile before the 1950’s? Whether we were a surgical tech or surgical nurse, the process of preparing for our cases included cleaning, assembling, and processing the instruments for the next day’s cases. If our day ended early in the OR, we worked in the “pack room” preparing linen packs, basin sets, folding gowns etc. We worked as colleagues regardless of what our assignment was on any given day. These OR staff were held accountable to be prepared, scrub in early enough to review the tray contents and anticipate the needs of the surgeon. If we were missing a critical instrument there was no SPD technician to blame. We were careful to clean our instruments throughout the case and we didn’t dare send our instruments to be decontaminated without them being strung up, pre-cleaned, and orderly. In fact, it was very possible that it was us who would be decontaminating and assembling them! Trust me, it is has always been possible to perform great point of use cleaning. We did it for ourselves and our colleagues. Cases were pulled by the same OR staff using recipe cards. As a surgical tech I preferred to pull my own cases. It eliminated any question of whether I had everything I needed.

Fast forward to the 1980’s

The surgery schedule exploded with minimally invasive cases & elective surgeries, lasers were all the rage, special teams were formed for each service. Disposable products replaced many of the items we once used and re-used. Now SPD/CSS was a separate entity. Early on the department was typically staffed with surgical techs as there were no training programs for the role of SPD/CSS. On the job training was offered for people who did not have previous OR experience and the SPD tech was born. Enter the OR/SPD disconnect. This department quickly became the basement of the hospital. Even if we weren’t literally in the basement we were regarded as the basement dwellers. We took on all of the ugly tasks of the Operating Room. The surgical tech was now focused only on the procedure. Preparing for a case was just a service to be provided for them.

Through the 1990’s and 2000’s

I have observed a new generation of OR staff who are not required to spend one day in the SPD/CSS as part of their training or orientation. They have no idea what we do or how we do it. There is no appreciation of the work that goes into getting their case carts ready for them. The new generation of OR Management hasn’t a clue of why there is such a divide between the two departments. I’m not sure they are aware that in actuality we are one department that has been detached from one another by the evolution of the modern perioperative services model. The modern OR design and staffing model was an effort to be more efficient and serve our patients better. But have we created a monster?

I don’t have the key to this riddle, but I do know this…

Surgery Starts With You. Thank you.

The next time you happen to run into a surgical tech, perioperative nurse, or surgeon , greet them with a simple “your welcome” It will drive them crazy.

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