They are CRDAMC's invisible gladiators of patient safety, tasked with a nasty mission: infection prevention.

Whether dressed head to toe in personal protective gear or huddled over desks peering through magnifying glasses, Carl R. Darnall Army Medical Center's medical technicians are the multipliers of hospital safety who clean, disinfect and sterilize the hospital and dental clinic's surgical tools. Their job is tedious, precise and by the book.

"It's all about patient safety," said Staff Sgt. Oscar Domino, a 17-year operating room technician who manages quality control in sterile processing, a small department tucked away in the hospital basement in a secured environment. "You just can't come in here and say 'I don't feel good today, so I don't think I'll flush this tube all the way.' That's the one time that patient has an allergy to something, and they code."

Multiple checks, balances promote safety

No matter how large or small, one sloppy move or shortcut impedes hospital operations, according to Maj. Jerry Rivera-Santiago, sterile processing's officer in charge.

"If this area goes down or doesn't function right, the entire hospital and its clinics shut down. All surgery stops: no implants, no babies, no dental surgeries," said Rivera-Santiago, a former enlisted operating room technician turned registered nurse.

But, according to Domino, there's not going to be any failures on his watch.

"We run a really tight ship here," said Domino, adding that an enlarged staff, new machines and refined processes contribute to infection control.

When its time for the instruments to go up to the operating room, they've been through a multitude of checks and balances by a group of medical technicians with a passion that matches their work ethic.

"They know what they do is the most important job in the hospital," said Domino, who became an operating room technician to have a direct effect on patient safety, as well as have an impact on the Soldiers under his tutelage. "That's why it's important for them to have a mindset of zero errors."

Patient safety also was one of the reasons Pvt. Seleste Russell chose the health-care field.

"Our job is a very important part of the hospital because the doctors and nurses wouldn't be able to work upstairs in the operating room without sterile instruments," said Russell, whose daily routine encompasses every phase of the sterilization process. "It's exciting, too, to see our sterilized instruments being put to use during surgeries."

Dual elevators isolate contaminants

From decontamination to disinfection, every step in the sterilization process is precise, beginning in the operating room with the technicians washing and cleaning the tools after each surgical procedure. The instruments are then ferried downstairs to sterile processing's decontamination area via a "dirty" elevator. To ensure sterility, instruments return to the operating room in a "clean" elevator.

"I was a happy camper when I found out we had both a dirty and a clean elevator," said Rivera-Santiago, adding that the old hospital at Fort Hood lacked the two mission-specific elevators, which is now an industry standard. "Everything encompasses patient and staff safety. We don't have to expose anybody to anything dirty because everything is contained."

Throughout the cleaning process, the instruments are washed and disinfected multiple times. In the midst of all the processing, room conditions such as temperature, humidity and air pressure are monitored to maintain sterility.

For example, the air direction in the decontamination area is monitored via a "ball-in-the-wall," a red ball the size of a pingball that is enclosed in a housing unit mounted between the area's external and internal wall. To verify air movement is contained within the area, the ball will be visible inside the decontamination area and indicate negative air pressure. When the area's door is either opened or closed, the ball will roll to the opposite end of the housing unit, which indicates a positive airflow.

"There has to be negative air pressure in the decontaminated areas. Otherwise, airborne pathogens--the stuff that's been inside someone's body that you don't see-- would start pushing out and exposing people walking in the hallway," said Staff Sergeant Domino.

Quality control adds integrity to process

Quality-control checks are interwoven in every process with the technicians visually inspecting every item for both cleanliness and instrument integrity. Various chemical and biological tests also are incorporated throughout every phase to ensure machines are properly working. Instruments are then assembled per point of use, and wrapped in a scientific fashion to preserve sterility when the instrument packet is unwrapped in the operating room.

During the sterilization process, the loads are cooked for four minutes in the autoclave at 272 degrees, two more degrees then the industry standard, according to Domino.

"For risk mitigations purposes, nothing is ever run all at once," said Rivera-Santiago. "We run separate loads to ensure that if there ever was a failure, it can quickly be pinpointed and isolated."

By the time the sterile instrument kit is unwrapped in the operating room or dental clinic, 11 sets of eyes have inspected and monitored each instrument through its 4.5-hour processing and sterilization journey.

"We want our patients to be confident that there are absolutely no contaminants on any of the surgical tools," said Domino of the extra steps the department incorporates into the sterilization process. "The doctors are going to do what they do, but as long as patients leave here with what they came in with, we did our job right."