As U.S. Army perioperative nurses serving during Operation Iraqi Freedom, we faced the challenge of establishing a U.S. Army hospital in what had been Saddam Hussein's personal hospital. The three-floor hospital had been built in the 1950s solely for use by Hussein's family and officials.
After convoying to the hospital, we found that loyalists to Hussein had removed critical components of medical equipment and disabled elevators; all to delay the immediate use of the building.
There was a large OR suite directly off of the ED on the first floor and two large OR suites on the third floor. The sterile processing department (SPD) wasn't completely contained in the main hospital. Vertical steam autoclaves were found in stand-alone buildings across the street. Two smaller vertical steam autoclaves were found on the third-floor OR area in a room with a sink and a large bathtub, and two water distillers were found between the two OR suites. This equipment was returned to the Iraqi Ministry of Health to distribute to other Iraqi hospitals.
Ether was the primary anesthetic used, with no gas scavenger systems in place. There were no positive or negative pressure systems for the OR or SPD areas.
One particular challenge was to establish a proper SPD workflow area, as safe patient care depends on this critical behind-the-scenes function. Traditionally, SPD is located in the basement due to plumbing needs, but in this hospital, SPD needed to be as close as possible to the four OR tables on the third floor, where the majority of the work was performed. We needed an efficient workflow of SPD functions using equipment we knew how to run safely, which our sterilization containers fit into, all while following U.S. standards. Fortunately, U.S. Army steam sterilizers and ultrasonic units are portable and can function in a variety of situations. However, the third floor needed to house not only four OR tables and SPD, but also the PACU, the third ICU, and the anesthesia supply area.
The area we selected for SPD was on the rooftop, over the front of the hospital at the third-floor level. Engineers confirmed that six of our portable, U.S. Army gravity steam sterilizers (275 lbs [125 kg] each when empty) could be placed there safely. We initially used tents to cover the sterilizers from the elements, knowing that walls and a roof could eventually be built around this area.
Three sterilizers were used as "decon" units after instruments were processed in the ultrasonic unit and hand washed, and three were used as sterilizers after instruments were assembled and wrapped.
We sterilized an average of 2,500 items per month in those autoclaves for this hospital and for other U.S. and coalition forces. We successfully established a proper SPD area in a limited space, under stressful conditions, and kept up with the demands of providing sterilized instruments in a time of war and chaos.
Beverly A. Cornett, RN, CNA, MS, COL/AN
Elizabeth A. P. Vane, RN, CNOR, MS, LTC/AN
Yvonne M. Heib, RN, CPT/AN
LRMC, Germany