CSPDT common mistakes
CSPDT · Understand the traps and how to avoid them.
Reprocessing hinged and lumened instruments without opening every box lock, hinge, and ratchet, without disassembling multi-part items, and without flushing channels before cleaning.
Technicians carry over the OR habit of keeping instruments locked so nothing is dropped, and a tray that looks clean on the outside is assumed to be clean inside; complex sets also slow down a busy decontamination station.
What to do instead
At the point of use, open all hinges and box locks, remove detachable parts, and keep the item moist. In decontamination, disassemble per the manufacturer's written instructions for use, flush every lumen with the specified volume, and use a brush size that actually contacts the lumen walls.
Walking between the decontamination room and the clean preparation side in the same gown and gloves, and describing the decontamination room as positive-pressure relative to adjacent areas.
The two areas sit side by side and staffing shortages pull people back and forth; 'positive pressure keeps the room clean' is a rule carried over from operating rooms and clean rooms, so it sounds right.
What to do instead
Treat the decontamination room as negative pressure relative to adjacent clean areas with exhaust air, wear dedicated PPE (gown, gloves, mask, eye protection) while inside it, and doff the gown and gloves plus perform hand hygiene before crossing to the clean side.
Using a single chemical indicator class for every situation, such as accepting external process-indicator tape (Class 1) as proof that parameters were met inside a package, or substituting a Class 5 integrator for the specific test a Class 2 indicator is designed for.
The strips look nearly identical and the class number is printed in small type, so the distinctions get flattened into 'an indicator is an indicator.'
What to do instead
Memorize the six classes by function: 1 process indicator (external), 2 specific test (e.g., Bowie-Dick), 3 single variable, 4 multi-variable, 5 integrating, 6 emulating. Place a chemical indicator inside every package and reserve Class 2 items for the specific test they were designed to perform.
Building instrument sets to whatever the tray will hold, exceeding the 25-pound (11.3 kg) set weight limit and packing pouches so tightly that there is no clearance around the contents.
Heavier, denser sets mean fewer trays to track and assemble, and overfilling avoids opening a second pouch; nothing in the daily routine pushes back on either habit.
What to do instead
Keep instrument sets at or below 25 lb (11.3 kg) including the container, leave roughly 1 inch of space around each item and between packages and chamber walls, and confirm contents do not exceed the pouch manufacturer's fill limit before sealing.
Applying one memorized exposure time to every cycle instead of matching the temperature and exposure time to the cycle type actually being run.
Study guides quote a single headline number (often '4 minutes'), which overwrites the gravity-displacement values, and techs work mainly with one cycle type in their own department.
What to do instead
Learn the pairs together: dynamic air removal (prevacuum) is typically 132-135 C (270-275 F) for 3-4 minutes, while gravity displacement is typically 121-123 C (250-254 F) for 30 minutes or 132-135 C for 10-15 minutes. Always defer to the sterilizer manufacturer's instructions for use and the load configuration.
Treating a positive biological indicator as a reason to simply re-sterilize the load and put it back on the shelf.
Re-running the load feels like a fast fix when the OR is waiting, and a positive BI reads as 'the cycle failed' rather than 'sterility assurance failed.'
What to do instead
Quarantine the load, do not use or release it, notify the designated person, and recall items processed in that sterilizer since the last negative BI and successful qualification. Investigate the cause (cycle parameters, loading, sterilizer fault) and re-qualify before returning the sterilizer to service.
Stamping an expiration date on packages and discarding them on that calendar date regardless of whether the packaging is still intact.
Dating feels safer and many departments still stamp a date for inventory rotation, which trains staff to believe the date itself creates sterility.
What to do instead
Apply event-related sterility: an item remains sterile until an event compromises the package (torn wrapper, water damage, crushed seal, compromised storage). Judge by package integrity, storage conditions, and handling, and treat any date as a facility inventory practice rather than a sterility rule.
Storing sterile stock on the bottom shelf or the floor, against an exterior wall, or high enough on the top shelf to sit under the sprinkler heads.
Storage space is tight, and the floor and the top shelf are the easiest places to absorb overflow when carts come back full.
What to do instead
Keep items at least 8-10 inches (20-25 cm) off the floor, about 2 inches (5 cm) from exterior walls, 18 inches (45 cm) below the ceiling, and 18 inches below sprinkler heads, in a clean, closed, low-traffic area with controlled temperature (about 24 C / 75 F or cooler) and humidity (70% or less).
Treating AAMI ST79 as a law an inspector can cite directly, or attributing worker-safety requirements such as PPE and SDS availability to the FDA.
Standards, regulations, and guidelines all appear side by side in training material, and the agency acronyms blur together when questions are written quickly.
What to do instead
Sort by function: FDA clears devices and sterilants and makes the manufacturer's instructions for use binding; EPA registers chemical sterilants/germicides and regulates ethylene oxide emissions; OSHA enforces worker safety (Bloodborne Pathogens Standard, PPE, SDS access); AAMI/ANSI publish voluntary consensus standards; CDC issues guidelines; accreditors such as the Joint Commission or DNV survey compliance.
Following a department habit or an outdated SOP when the device manufacturer's written instructions for use specify something different.
Long-tenured staff teach 'the way we've always done it,' and the IFU is a dense document that almost nobody re-reads after orientation.
What to do instead
Treat the device manufacturer's instructions for use as the controlling authority, since they are part of the device's clearance, and escalate any conflict between facility policy and the IFU instead of picking one. Review the IFU at orientation and every time a new device or instrument set arrives.