The "Behind the Scenes" series takes you inside work areas you may otherwise never get to see. The articles highlight teams that are often unseen but perform critical work to keep Mayo running. In this installment, see how the Central Services team works around the clock to provide clean tools, instruments and equipment for patients and care teams.

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When patients come to Mayo Clinic, they expect that the tools and equipment used during an appointment or procedure are clean and sterile. It's something they likely don't think about twice.

But behind each sterilized tray of tools, IV pump and surgical instrument is a dedicated team of Central Services staff. In Rochester, that team numbers about 100 staff. They manage a carefully choreographed process to clean soiled equipment and put it back into circulation.

"It's a 24/7/365 operation," says Chris Scherb, a supervisor in Linen and Central Services. "We do not shut down, there is always someone on staff at both locations."

Those locations are in the lower levels of the Mary Brigh Building on the Saint Marys Campus and the Eisenberg Building on the Methodist Campus.

The News Center team recently tagged along during a morning shift at Saint Marys to capture a glimpse of the operation.

At the 7 a.m. meeting — one of three such meetings held each day — the Central Services team gathers to learn what's important to know for the upcoming shift. That includes updates on inventory levels, requests from nursing units, or maintenance updates for cleaning equipment that could change the routine for the day. Processing and distribution technicians also receive their route assignments to begin picking up soiled equipment from around the hospital.

After the meeting, Torey Edwards, a certified lead processing and distribution technician, grabs a collection cart and visits a list of soiled equipment and supply rooms around Saint Marys to collect items that need cleaning. She also makes sure clean items are stocked. Nine other colleagues do the same, together collecting around 500 pieces of equipment during each round. In addition to IV pumps and other small machines, the team also collects larger items, like walkers and wheelchairs.

"This process can take anywhere from one to two hours," Edwards says. "On average, I walk around 13 miles every day."

After completing her round, Edwards stops at the pump room, where she unloads IV pumps for cleaning and preventive maintenance checks.

"Maintenance can mean a night and day difference, depending on the type of equipment," says Spencer Chenoweth, an assistant supervisor. "In some cases, we just need to push a self-test button to ensure the equipment works properly. In other cases, we have to go through thick manuals to perform a maintenance check."

Clinical instruments, like scissors, scalpels or tweezers, make their way to the decontamination room, where team members like Sandra Jahns handwash items that are too delicate to be cleaned through a mechanical process. Some might be coated in plastic, for example. Each item is soaked in a special detergent and cleaned according to the manufacturer's instructions.

Terri Gray (front) and Ashlyn Mildenstein use an ultrasonic washer to clean instruments that have small crevices. The washer immerses the tools in a hot water detergent bath. Ultrasonic sound waves then pass through the solution creating bubbles that implode.

"This creates a vacuum effect that sucks the debris away from the instrument," Chenoweth says. "It's much like what you might see at a dentist's office or jeweler when they clean equipment or diamond rings."

The process takes about eight minutes.

Instruments that can withstand a mechanical cleaning go into a cube washer, where wash cycles tailored to the type of instruments clean them in 18- to 25-minute intervals. Barcodes on each tray help the team identify which instruments should be added to the tray after washing.

Once instruments are cleaned, they undergo rigorous testing to make sure they function correctly. Here, Paul Gile lays out scissors, forceps and other items for inspection. He makes test cuts to make sure instruments align correctly. If a tool doesn't meet expectations, it's sent for repair and returned to Linen and Central Services to go through another washing before being sterilized.

"We're doing everything we can to make sure the patient gets a quality piece of equipment," says Chenoweth.

Peter Tellis organizes a load of cleaned instruments to be sterilized in one of several special machines, depending on the type of sterilization. Tellis wraps the instruments in disposable sterilization material and adds a tape indicator that will turn green to show that a package has completed the sterilization process. The indicator isn't the ultimate proof that instruments have been sterilized, however. To verify, biological and chemical indicators are stored inside the packages and will indicate when items are fully sterilized.

Once procedure trays are stocked with sterilized equipment, the Central Services team must add disposable items, like syringes, needles or other single-use items. Those items are stored in yellow and blue storage containers in the external supplies storage area of the department. Here, Chenoweth collects items to add them to a tray. He and his team handle most medical supplies, except drugs, which are the responsibility of Pharmacy staff.

Once all items have completed their wash, and sterilization cycles and procedure trays are stocked, they move to a distribution area, from where they are delivered to units across the hospital. "What we do is very detailed work. It requires a lot of teamwork and communication," Scherb says.

Hear more from Scherb on the work of the Central Service team in this video:

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