Most of surgery’s hottest innovations are found in high-tech ORs, but don’t ignore the exciting new developments taking place in central sterile departments. Your reprocessing techs might soon use virtual reality to become expert in instrument care or refer to real-time augmented reality displays of reprocessing instructions. Sterile processing’s future also includes the resurgence of ethylene oxide (EtO) sterilization, a tried-and-true method for preventing bacteria build-up in flexible endoscopes. Here’s a closer look at how new-school thinking remains focused on the old-school goal of preparing instruments for safe patient care.

A new reality

Your sterile processing staff needs a high degree of training because they’re handling contaminated surgical equipment, and they need the skills and knowledge to handle hundreds of different types of instruments. You have to be confident that sterile processing techs can handle the rigors of the job. Virtual reality-based concepts and augmented reality can help on that front.

• Virtual reality (VR) lets you travel anywhere or be placed in any situation. You might think about this in the context of the video games that let you explore far-out worlds and outer space, but it also could be used for training your employees. They can slap on a pair of VR goggles and be in the back of a sterile processing department, standing in front of an array of dirty instruments that require specific cleaning.

In this context, VR technologies should be seen as a wholly different type of comprehensive training tool. Wearing a VR headset, staff can learn about the different instrument care techniques they’ll need to employ in reprocessing. It’s much better for them to learn from their mistakes in the virtual world than suffer the consequences of returning a contaminated endoscope to a procedure room.

Think of this training as an investment in your staff and your facility. VR could be utilized as a part of the overall orientation process and continuing education program for sterile processing personnel, taking staff members on a virtual educational tour of the department — without even having to set foot in an actual department, or potentially even leaving their own homes. The possibilities are endless. You can use the technology to explain decontamination and sterilization processes. You can go a step further and show your technicians what the insides of cannulated instruments look like and why they’re so susceptible to biofilms and bacteria. This hands-on VR training can help set the tone for your staff, and they’ll definitely come away with a better understanding of why they need to clean so thoroughly.

• Augmented reality. Unlike virtual reality, augmented reality (AR) adds virtual elements to the real world. Think about the view from your work desk. With AR, we can add a virtual mug or lunchbox that isn’t there. You just put on an AR headset and the world in front of you changes. In this sense, AR can be understood as enhanced vision by adding more information to our observable universe.

So how does this apply to sterile processing? AR can tell you why the scope in front of your technician is so susceptible to bacteria. Because this type of technology can recognize specific instrumentation, the AR headset can display instructions for reprocessing at the point of need, highlight any instruments that may have parts that need to be dismantled before reprocessing can occur and ensure you follow manual cleaning instructions with each step. This gives your staff an added level of understanding of the task at hand.

When AR is implemented as a system, it could link up with instrument track and trace systems, surgical inventory, and all the pieces of automated equipment with the goal to make operators work more efficiently and improve overall quality.

The return of EtO

EtO sterilization is making a big comeback, thanks to continuing efforts to solve the inherent challenges of reprocessing difficult-to-clean flexible endoscopes. The 2015 outbreak of Carbapenem-resistant Enterobacteriaceae (CRE) that was linked to contaminated duodenoscopes used at the University of California, Los Angeles (UCLA) Medical Center served as a flash point for the resurgence of interest in EtO. The sudden outbreak of CRE-contaminated endoscopes became a public health crisis in California and drew widespread national attention.

When researchers looked at those scopes, they found that they had been reprocessed correctly, but the harmful bacteria still lived on. Through that research, we learned the facilities that used EtO were able to kill the bacteria during the sterilization process, stopping the outbreak in its tracks. When the FDA released supplemental measures for the reprocessing of sensitive instruments later that year, EtO was the only sterilization method mentioned by name. But by 2015, most hospitals had done away with their EtO sterilizers.

Instead of reverting back to the bygone days of EtO sterilization, the latest low-temperature technologies offer new high-efficiency methods. We’re not talking about traditional bulky EtO chamber systems, with their external compressors, fixed water lines and big storage areas for tanks. Those systems fell out of favor because they didn’t offer full protection for workers against EtO exposure. But in the last few years, we’ve seen a renewed interest in EtO sterilizers. The big reason: They work well to eradicate hard-to-kill bacteria.

The newer sterilizers provide the proven reliability of EtO while using only a fraction of the gas of the traditional chambers. The newer models can sterilize endoscopes and instruments, and still meet the strictest air quality mandates and regulations.

Given the longer cycle times of gas sterilization, most hospitals will not choose to reprocess all of their temperature-sensitive items with EtO. However, due to the increasing threat of multi-drug-resistant organisms and superbugs, there is a growing consensus that many types of endoscopes will be moving toward required sterilization — and these next generation EtO systems are making that a real and safe possibility.

When you have inefficiencies or ineffective technology, that’s the time to innovate. We’ve seen the powerful forces of re-engineering and re-imagination bring this highly effective means of low-temperature sterilization back from the brink of hospital extinction.

Automated inventory management

If you’re like many facility leaders, you struggle to answer basic questions about your inventory of instruments and implant trays. How does your facility input, maintain and use clean inventory data? Are you able to track all your instrument sets from sterile processing to the OR to storage? This information can give you a better sense about the instruments you really need and the ones that just collect dust on your shelves. If you’re relying on manual counts and memory to locate your instrument trays, you’re missing out on a trove of data that could be very useful in the operations of your facility.

Facilities store, track and process thousands of instruments in a single day. Even though the concept of asset management has been around for decades in health care, we haven’t seen consistent adoption of the technologies that can make your life easier.

More and more, industry software and tech companies have begun thinking outside the proverbial box of instrument trays, department walls and information silos. They’re leveraging analytical tools to change the way reprocessing departments view their roles in improving all aspects of perioperative care.

When it comes to asset management, we’re seeing a growing utilization and integration of what is known as “computer vision” technology, or the idea of using cameras to see parts of the workflow and respond in certain ways. Whereas traditional instrument tracking systems rely on bar codes and scanners, computer vision will let departments instantly recognize particular instruments during the assembly stage, reduce error rates and even monitor actual utilization by surgeons in the operating room. A camera will be able to do the work that we’re doing manually now with a bar code and scanner (see “Do You Know Where Your Instruments Are?”).

Many of the previous challenges with asset management programs in reprocessing departments simply came down to a pervasive inability for these teams to input and maintain inventory data. New technology can help you do just that, and it’ll lead to more efficient operations in the process. OSM

Your sterile processing staff needs a high degree of training because they’re handling contaminated surgical equipment, and they need the skills and knowledge to handle hundreds of different types of instruments. You have to be confident that sterile processing techs can handle the rigors of the job. Virtual reality-based concepts and augmented reality can help on that front.

• Virtual reality (VR) lets you travel anywhere or be placed in any situation. You might think about this in the context of the video games that let you explore far-out worlds and outer space, but it also could be used for training your employees. They can slap on a pair of VR goggles and be in the back of a sterile processing department, standing in front of an array of dirty instruments that require specific cleaning.

In this context, VR technologies should be seen as a wholly different type of comprehensive training tool. Wearing a VR headset, staff can learn about the different instrument care techniques they’ll need to employ in reprocessing. It’s much better for them to learn from their mistakes in the virtual world than suffer the consequences of returning a contaminated endoscope to a procedure room.

Think of this training as an investment in your staff and your facility. VR could be utilized as a part of the overall orientation process and continuing education program for sterile processing personnel, taking staff members on a virtual educational tour of the department — without even having to set foot in an actual department, or potentially even leaving their own homes. The possibilities are endless. You can use the technology to explain decontamination and sterilization processes. You can go a step further and show your technicians what the insides of cannulated instruments look like and why they’re so susceptible to biofilms and bacteria. This hands-on VR training can help set the tone for your staff, and they’ll definitely come away with a better understanding of why they need to clean so thoroughly.

• Augmented reality. Unlike virtual reality, augmented reality (AR) adds virtual elements to the real world. Think about the view from your work desk. With AR, we can add a virtual mug or lunchbox that isn’t there. You just put on an AR headset and the world in front of you changes. In this sense, AR can be understood as enhanced vision by adding more information to our observable universe.

So how does this apply to sterile processing? AR can tell you why the scope in front of your technician is so susceptible to bacteria. Because this type of technology can recognize specific instrumentation, the AR headset can display instructions for reprocessing at the point of need, highlight any instruments that may have parts that need to be dismantled before reprocessing can occur and ensure you follow manual cleaning instructions with each step. This gives your staff an added level of understanding of the task at hand.

When AR is implemented as a system, it could link up with instrument track and trace systems, surgical inventory, and all the pieces of automated equipment with the goal to make operators work more efficiently and improve overall quality.