Science at heart of Sladjana’s instrumental role

Sladjana Neskovic has one simple check for ensuring that she and her team of technicians in the Central Sterilisation Services Department (CSSD) at Perth Children’s Hospital (PCH) are doing their job.

‘I ask myself, “Would I be confident putting my own child on any operating table in this hospital?’’.

‘If I couldn’t answer yes, there would be no point coming to work – and I know every member of my team feels the same way.’

Thankfully Sladjana and the staff of 26 FTE under her direct supervision not only continue to come to work but take pride in the integral role they play in minimising the risks to some 200 children who undergo surgical procedures at PCH each week.

As Clinical Nurse Manager for the CSSD, Sladjana has responsibility for ensuring the sterility, quality and function of the 56,000 surgical instruments that are reused throughout the hospital, both in its operating theatres and outpatients’ dental department.

With an inventory that includes a clinical version of virtually every tool you’d find in a tradesman’s workshop – from hammers, chisels, and screwdrivers, to tubing, forks, scissors and saws – that is no mean feat.

Sladjana attributes her confidence in patient safety to the unwavering dedication of her team, the meticulous processes, and robust risk analysis and safeguards established within the CSSD.

‘The foundation of this assurance lies in the scientific principles that form the basis of the department's operational protocols,’ she says.

‘We’re a data-driven department and everything we do is evidence based.

‘Instruments are monitored through sections of the sterilisation process and any item that doesn’t pass the stipulated standard at any stage in the process repeats the process.’

On top of this, CSSD tracks and traces the movement of each and every instrument.

‘We can see not just the tray on which an instrument is located at any given time, but also where it has been at every stage.

‘This includes the patients it has been used on and the processes it has been used for.

‘We keep this information indefinitely which is important because there are conditions for which sterilisation is ineffective.’

But Sladjana points out that maintaining strong infection control goes beyond the sterilisation process – it’s also about controlling the environment and how we interact with it, such as having a one directional workflow, controlling air flow, temperature, humidity and managing water quality.

‘Water quality is a really big thing for us,’ she says.

‘Though water plays a crucial part in the process of sterilising medical instruments, it can also harbour microorganisms that risk contaminating those same instruments, compromising the effectiveness of treatments and interventions.

Water contaminants can also damage these very expensive items.

‘A tray of neurosurgery instruments costs around half a million dollars,’ Sladjana says.

‘But if those instruments are exposed to water containing sodium chloride they will rust.’

Likewise, water containing calcium can leave mineral deposits that will damage delicate tools.’

Sladjana has been nursing for 33 years – 24 of those in the WA Health system.

She moved to Western Australia from Canada but prior to that had worked in Croatia, during the Serbian Croatian war.

‘What I faced working through that conflict made me realise the importance of community and of my colleagues,’ she says.

‘It made me determined to be a good human being and to make an impact.’

Sladjana hopes a legacy of her current work can be a pleasant work environment for staff, as well as processes that ensure anybody who might join CSSD in the future will be able to have a good understanding of its operations.

‘It will be because we have good evidence showing what we do, how we do it and why we do it.

‘And they’ll be able to see that our practices are based on science that provides the best possible results for our patients.’

Sladjana says she has worked hard to create processes that minimise room for human error and where staff can readily check and access information.

She says she has also strived to create a culture where staff enjoy coming to work because they know they are making a difference and feel respected and appreciated for what they do.

‘I encourage staff to challenge ideas – respectfully of course – because that’s how we improve.’

Sladjana says she is pleased to be part of a team that gets on well, regularly comes together for meals and that last year spent five minutes a day for several weeks, practising dances moves for an end-of-year performance.