SPD Performance Survey

(888) 227-CASE
50 West Street. Bloomfield, NJ 07003

🎓Case Academy

SPD Performance Survey

Facility(*)

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Location(*)

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Healthcare System(*)

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Facility Type(*)

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Name(*)

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Title(*)

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Phone(*)

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Email(*)

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Instructions:
- The following survey questions can help identify SPD compliance to best practices.
- To determine if additional training or consulting services are warranted.
- Upon completion of the survey, you will immediately receive your score to review.
- A Case Medical's clinical consultant will review the results and offer recommendations.
- Use the scale below to score each process step.

Score Key:
0 - Never/No
1 - Sometimes
2 - Always

Is a pre-cleaner used to keep instruments moist?(*)

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Are sharps separated and placed into a puncture-proof container for transport to Decontamination?(*)

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Are instruments placed in a closed container or case cart for transporting to process area?(*)

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Is an enzymatic cleaner used for pre-treatment?(*)

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Are transport containers cleaned and rinsed after each use?(*)

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Are your detergents marked and dated when opened?(*)

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Do you review the SDS sheet and the labeling for your instrument chemistries?(*)

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Do you have a schedule for cleaning the sink?(*)

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Do you rinse thoroughly under the flow of water after manual washing?(*)

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Are all lumened and cannulated items flushed?(*)

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Are brushes available for all sizes of cannulated items and shavers?(*)

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Are instruments rinsed clean in the open position?(*)

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Are pH neutral or near neutral detergents used for cleaning devices?(*)

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Are all instruments brushed underwater?(*)

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Is the wash water and cleaning solution changed after each case/use?(*)

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Do you have a schedule to verify cavitation in your ultrasonic cleaner?(*)

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Does the department have an environmental cleaning and maintenance policy for decontamination?(*)

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Does the department follow the maintenance SOP?(*)

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Is there an SOP identifying which items are required to be cleaned in the Ultrasonic?(*)

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Is the Ultrasonic set for a minimum 5 minute contact time proven to eliminate soils?(*)

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Do you follow the washer disinfector manufacturer's instructions for cleaning your devices?(*)

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Do you follow the detergent manufacturer's instructions for cleaning your devices?(*)

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Do you use the instrument cycle when cleaning devices in a cart washer?(*)

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Do you rinse with clean water when cleaning devices in the cart washer?(*)

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Are multi-part instruments disassembled for cleaning and checked for Bioburden?(*)

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Are hinged instruments in the open position for cleaning?(*)

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Is the whole tray returned to Decontamination upon discovery of dirty instruments?(*)

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If retained soil is visible on devices, do you investigate the cause?(*)

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Is medical-grade air available and used to dry instruments, i.e. lumens?(*)

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Are instruments assembled in the open position for sterilization?(*)

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Are multi-part instruments disassembled and inspected for Bioburden?(*)

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Are instruments inspected for sharpening and repair?(*)

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Are paper plastic pouches, wraps, and/or containers being used per IFUs?(*)

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Do you check for holes or punctures in wrappers?(*)

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Do you have a maintenance procedure or SOP for reusable containers?(*)

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Is there a process for determining whether a reusable container has been compromised?(*)

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Is there a procedure for routine quality checks in prep & pack?(*)

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Do you utilize scales to weigh your containment devices to meet the 25lb weight limit?(*)

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Do you use the Bowie-Dick test before processing the first full load of the day?(*)

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Do you document IUSS procedures?(*)

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Are you recording the number of times limited use devices are processed?(*)

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Do you record loaner devices and instrument sets upon delivery and return?(*)

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Is there a process for determining whether a reusable container has been compromised?(*)

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Is IUSS used only in urgent clinical situations and documented?(*)

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Is an IFU available for each set to identify the recommended sterilization method?(*)

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Are instrument sets sterilized in low-temperature validated for the intended sterilization method?(*)

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Does each sterile package have a load card or a digital method to record sterilizer #, load #, processing date?(*)

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Are sterilization quality records audited prior to load release?(*)

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Do you keep a print out or digital copy of sterilization results? (*)

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Are terminally processed loads checked for cooling to room temperature before handling?(*)

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Is the use-life of medical devices recorded for reference?(*)

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Are wrapped packages placed single layer on storage shelves?(*)

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Are cases pulled using preference cards and traceable to the puller to create a shareable "Missing List"?(*)

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Are Case Carts inspected for cleanliness before each use?(*)

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Do you have a mechanism for identifying clean or dirty carts?(*)

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Do you have a method to identify stock location for each item?(*)

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Do you have a mechanism to track sterile trays or case carts to the procedure room?(*)

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Are floors and work surfaces made of water-resistant and antimicrobial material?(*)

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Is SPD a part of the CMS mandated Quality Assurance & Performance Improvement program?(*)

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Is there a designated leader to address areas for improvement in coordination with other stakeholders?(*)

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Does the department conduct scheduled internal audits?(*)

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Are process variances recorded?(*)

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Is SPD able to track trays to OR procedures accurately?(*)

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Is patient information secure meeting HIPAA requirements?(*)

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Do you have a maintenance schedule for your equipment?(*)

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Are your SPD technicians certified?(*)

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Are new technician's skills verified in the performance of their job?(*)

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Do you check stainless steel device surfaces for corrosion resistance?(*)

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Do you quarantine devices that require repair or replacement?(*)

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Do you keep a maintenance record for cleaning and servicing your automated equipment?(*)

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Total Score

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Average Score

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