When we decided to renovate our Central Sterile Department, we had to draw on our experience, site visits and constant redrawing of the arquitects plan in other to develop the concept of what we wanted. During the course of our renovation project we encountered many things that we did not considered until we were facing them during the different phases of the construction. Here is a small list of things you want to decide during the initial planning phase:

Architect Drawings

Take the drawings and closely examine them. Is everything that you specified included? If not, what were the reasons not to: omission, budget, space constraints?

Examine the scale in which they were drawn and make a walk through. Is there enough space between major pieces of equipment? Is there enough clearance around work areas for you employees? Are there columns where there should be open space and viceversa? What about the basics: water fountains, bathrooms, walls, electrical outlet, lights, phone jacks, computer hook-up's, eye spray station? What about the work flow? Is the decontamination area clearly separated from the clean areas by walls? Is the enough space for your Sterile Storage area? Is there enough space for a case cart stagging area?

Remember, the construction will be based on these drawings and your signature on them means that you accepted them as they were presented to you. And the finger of blame will be pointed at you if during or after construction things do not turn out the way you envisioned. Always keep in mind that the arquitects are working for you, not the other way around.

Cabinetry and Working Surfaces

Nothing beats stainless steel for durability and easiness to clean. This is more evident in the decontamination area where the moisture content in the air is quite high.

Computers

Reasons why you should have computers: monitor productivity, service charging, inventory management and distribution, e-mail/communications, case cart management, budgeting, equipment management, instrument management, staff scheduling, sterile processing management, and record keeping. Add a scanner to this, an you can virtually have paperless record-keeping.

Environment

Do not forget to include humidity and temperature control mechanisms in your plans. This is specially important if you are planning on implementing an Event-Related Sterility Protocol.

Ethylene Oxide

In accordance with the Montreal Agreement, production of the major component in 12/88 sterilant gas CFC 12 Freon came to a halt in the U.S. on December 31, 1995. This meant a switch to 10/90 mixtures with HCFC or 100% Ethylene Oxide. Although at the moment, nothing can completely substitute Ethylene Oxide, this is a good time to consider other low temperature technologies.

Floors

Consider a poured resin/epoxy floor, with a slope towards a floor drain in case of flooding from the instrument and cart washers. Resin is more resistant to scratching from heavy traffic than tiles and it is easier to clean. Select colors than will make it easier to find items that fall to the floor.

Operations During Construction

Develop a plan to address how you will maintain your operational tempo as the different phases of the construction are taking place:

• changes in the drop-off and pick-up points for your clients
• dust control in those areas within the department that have been walled to perform demolition and construction
• re-arranging the work flow as areas are walled
• storage space

Outsourcing Sterile Processing

You might have to send some, if not all, of your loads to outside facilities to process and sterilize. Whether temporarily if it is just for the time the construction takes place, or permanently if you switch to other sterilizing technologies, the actual research and implementation of any one of these reasons presents a major logistical challenge. Why? Because hospitals don’t really know all the costs associated with sterile processing; vendor and hospital have a hard time agreeing on what all those costs are; more than one department in the hospital would be involved in such an activity: central sterile, main operating room, ambulatory centers, etc. Add to this pick-up, delivery and transportation schedules and you see why it can become a headache.

Receiving Area

If you do not have the luxury of having a hospital-based centralized receiving area that will unbox your supplies and deliver them to you ready to be placed in the shelves in your clean area, consider having your own area to do this.

Site Visits

Every vendor worth its salt has a facility which they use to showcase their line of products. Arrange a site visit through the potential vendors to other hospitals that use the particular equipment that you want to see in operation. Pick a hospital whose size and operation is the same as yours.

Steam Quality

Using steam for sterilization that is generated by the hospital's boilers can sometimes cause sterilization problems due to additives, steam, quality, demand, etc. Steam used for sterilization should be supplied from a dedicated steam generator.

Venting

Instruments washers offer two options to dispose of the residual steam generated in the process:

• vented- in which additional piping must be installed, specially if your facility is on a basement;
• or non-vented- in which a condenser is installed, turning the residual steam into water and disposing it through the regular drain.

Walls

Consider wall protection on those areas where there will be heavy traffic of utility carts or in the areas used to store them.

Washer/Decontaminators

Features to look for: adjustable cycles, large chamber capacity, straight-in-to-the-washer processing to eliminate pre-cleaning, different racks for odd-shape instruments, automated loading and unloading.