Sterile Processing's Hidden Patient Safety Risk: When Cognitive Overload Meets Complex Work

Sterile processing professionals perform high-stakes work requiring sustained attention to detail, yet burnout, fatigue, interruptions, and cognitive overload receive far less attention in SPD than in many patient-facing areas of health care.

Randalyn Harreld, CRCST, CIS, CER, CHL, CSPDT, CASSPT, CLS, AAS, FHSPA, clinical education manager for Steelco Belimed, wants that to change.

“This particular topic, I think, is pertinent and is not something that we talk about enough,” Harreld told Infection Control Today® following her presentation at the Southern California Sterile Processing Association chapter meeting in Newport Beach, California. “Because we're such a labor-intensive and hardworking environment, I just felt like it's important to bring it up.”

One major concern is interruption.

“We say, and I say this all the time, ‘I'm a multitasker, and I can multitask.’ And really, there's a study that talks about how humans, we're not multitasking; we're task switching,” Harreld said.

Consider an employee assembling an implant tray with 200 components. After counting 40, the technician is interrupted and later returns to the tray.

“You forgot where you were,” Harreld said. “Now we're introducing rework.”

But cognitive demands are only increasing.

Harreld pointed to the rapidly evolving complexity of medical devices and the IFUs sterile processing professionals must follow. Some instructions she has encountered contain more than 100 steps, while formatting and organization vary considerably among manufacturers.

“Just the complexity of the information that we are expected to know is getting harder, is getting faster, is getting more, bigger and longer,” Harreld said. “But how are we making it easier, and are we making it achievable to adhere to?”

Harreld would like to see greater standardization of IFUs, comparing the concept with safety data sheets, where information appears in predictable sections.

Meanwhile, facilities can address human factors now.

Harreld suggested standardized workflows, protected safe zones, micro-rests, staff rotation, technology aids, checklists, better access to IFUs, and reinforced training.

“If your staff is tired or burnt out, try to come up with some strategies,” she said. “Really support your team to make sure that they feel like they're getting the relief before you lose them and before you have an injury.”

What happens when we expect public health to respond immediately after years of inconsistent investment?

For Brian C. Castrucci, DrPH, president and CEO of the de Beaumont Foundation, the current Cyclospora outbreak illustrates a much larger problem.

"It's about speed. It's about capacity," Castrucci told Infection Control Today®. "You can't underinvest in public health and then expect it to have a fast and swift response."

In a wide-ranging conversation with ICT Lead Editor Tori Whitacre Martonicz, MA, Castrucci discusses foodborne disease surveillance, workforce capacity, misinformation, declining institutional trust, science communication, and why public health funding cannot follow a boom-and-bust cycle.

He also argues that rebuilding trust will require more than telling Americans to "trust the science." Public health professionals must communicate plainly, listen empathetically, build relationships before emergencies occur, and show people how public health affects their everyday lives.

Perhaps his simplest explanation came from his daughter:

"A pediatrician helps one person at a time. My dad helps everybody all the time."

Reusable lead aprons have long been viewed as essential radiation protection for clinicians, but infection prevention experts say they may also represent an overlooked environmental hygiene challenge.

During a recent Infection Control Today and Diagnostic Imaging roundtable, experts from infection prevention, perioperative services, and radiology discussed why lead garments often escape the scrutiny applied to other reusable equipment despite being used every day in patient care environments.

Moderator Tori Whitacre Martonicz, MA, opened the discussion by asking whether reusable lead aprons have simply been overlooked rather than proven to be low risk. That question shaped a conversation focused on contamination, inconsistent cleaning practices, and the need for clearer guidance.

Peter Graves, BSN, RN, CNOR, argued that lead garments should not be dismissed simply because they are covered by sterile gowns during procedures.

"We don't go back and culture the lead ever," Graves said. "When we think about radiation-attenuating devices, lead actually functions much like PPE."

Several panelists pointed to the absence of standardized cleaning protocols as a significant barrier. Jill Holdsworth explained that organizations may document cleaning activities, but there is often little consistency in how those garments are actually disinfected.

Justin McKay said ATP testing has proven to be one of the most effective ways to demonstrate the problem. In one comparison, he found lead garments in an operating room to be far more contaminated than a gas pump handle.

"When infection prevention sees the data, they say, 'We cannot ignore this,'" McKay said.

The discussion also addressed practical challenges, including uncertainty about which disinfectants are compatible with lead garments, conflicting manufacturer recommendations, and questions over whether individual clinicians or hospitals are responsible for maintaining embroidered personal garments.

Brenna Doran, PhD, MA, ACC, CIC, AL-CIP, suggested that hospitals would benefit from a practical implementation guide.

"I would love there to be a playbook that IPs can go to," she said. "It's so much easier to do something someone else has done successfully than to create the wheel on our own."

The panel concluded that addressing lead garment hygiene will require multidisciplinary collaboration and standardized protocols. As hospitals continue to strengthen environmental hygiene programs, experts believe reusable lead aprons should no longer be an infection prevention blind spot.