August 31, 2023

It requires cooperation, data, sponsors, champions and persuasion.

SAFE AND SOUND One key component of an instrument reduction program is to have sufficient sterile storage space to house and easily access rarely used instruments that have been removed from the tray rotation.

Just how many instruments on the trays in your ORs and procedure rooms are actually necessary? Removing little-used instruments can result in significant savings of time, space, labor and money.

"Your sterile processing techs are likely spending time and effort reprocessing countless instruments that aren’t even used during procedures," says Casey Czarnowski, BA, CRCST, CSPDT, CIS, CER, a sterile processing consultant based in Rochester, Minn. "Your nurses and surgical techs are likely preparing instruments for use that are rarely if ever actually used, cluttering back tables and wasting valuable time."

Mr. Czarnowski, who has seen instrument reduction projects both fail and succeed, offers these tips for success.

Achieve comprehensive buy-in. First, speak with your sterile processing leaders and techs to learn how much unnecessary instrument reprocessing they do, and the wasted time and resources it consumes. Do the same with your surgical techs and OR nurses who set up and handle instrument sets. Then take your case to the C-suite to find a sponsor to endorse the project.

"Your chief nursing officer or chief financial officer are great candidates," says Mr. Czarnowski. The sponsor should approach your chief medical officer to stress that the surgeons need to be involved. "Now everybody's talking, and you have sponsorship and transparency within the C-suite," he says. "Considering this project will likely take months or even a year, that’s crucial for success."

Secure surgeon champions. These surgeons can both help prove the concept and gain peer support and cooperation. "Surgeons are creatures of habit who want every conceivable base covered during a procedure, with every instrument they could possibly need sterile and available to them at all times," says Mr. Czarnowski. "The key is to acknowledge that their concerns are legitimate, but can be addressed in a much better, more productive way. By paring down their instrument set lists, they actually will be served better and faster in the long run because their nurses, surgical techs and reprocessing techs won’t need to handle and inspect hundreds of redundant or unnecessary instruments, only a fraction of which are actually used regularly. Sterile processing will be able to turn core instrumentation around more quickly, while rarely-used instruments will be sterilized and stored, available for rapid delivery."

Pilot with your surgeon champions. "Don't try to do it with every surgeon at once," says Mr. Czarnowski. "Partner solely with your surgeon champions who already understand and embrace the concept." The pilot program should run over the course of several months to generate enough supporting data. "Without testing, data and testimonials from the satisfied surgeons in your pilot project, you'll struggle to get uphill with the rest of your surgeons," he says. "Encourage the surgeons in your successful pilot to talk with their peers about it: ‘Here's what I've done, and it's really great.’"

Your sterile processing department will also now possess valuable data, including improvements in turnaround times, same-day usage of instruments, productivity and efficiency. All of the data you generate will confirm both to the C-suite and other surgeons that a facility-wide instrument reduction effort is worthwhile.

Get the OR and sterile processing on the same page. The big concern of surgeons and their teams will be not putting patients at risk. "If they reduce the set list, will they be able to access rarely used instruments on demand?" says Mr. Czarnowski. "Sterile processing must be able to confidently answer this question. The good news is that you’ve completed your successful trial of the concept with your pilot project — and sterile processing delivered. Because the sets are smaller, sterile processing can better turn around regularly used instruments, while instruments removed from regular rotation are in sterile storage and ready whenever needed, rather than unavailable because they’re going through another unnecessary reprocessing cycle."

Address storage. Reevaluate all storage space with your C-suite sponsors to see whether it needs to be expanded to better ensure consistent sterility of the increased number of instruments removed from regular rotation. Reduce the potential for holes in blue wrap, broken locks or punctured pouches that require instruments to be reprocessed again before use.

"Two or three years down the line, the payoff if your instrument reduction program succeeds is that you will have fewer and smaller instrument sets you’ll need to store," says Mr. Czarnowski. "You might even be able to get rid of some redundant sets and instruments."

A new ANSI/AAMI standard sharpens the focus on this key aspect of sterile processing.

HOW’S THE WATER? The quality of the water that sterile processing techs use to clean and sterilize instruments is the subject of increased scrutiny.

A new standard has been published that, for the first time, establishes requirements for the quality of water that should be used when processing medical devices.

The first-of-its-kind standard was published this month by the American National Standards Institute (ANSI) and the Association for the Advancement of Medical Instrumentation (AAMI). ANSI/AAMI ST108:2023, Water for the processing of medical devices, revised and replaces AAMI TIR34:2014/(R)2021, which provided information and guidance on water quality for device reprocessing.

The new standard provides clear requirements for every stage of medical device processing, says Matt Williams, AAMI vice president of standards. It identifies the categories of water quality that should be used during each stage of sterile processing; provides a risk analysis and establishes roles and responsibilities for processing facilities; assesses water quality based on factors such as pH, microbial level, conductivity and other properties; establishes maintenance, monitoring and quality improvement procedures for water treatment systems; and addresses emergency circumstances such as service interruptions and boil water advisories.

Elevating the content of the new standard to encourage facilities to conform to best evidence-based practices will improve how instruments are reprocessed, notes Terra Kramer, BS, co-chair of the AAMI working group that developed the standard.

"Adoption of this standard will position healthcare organizations to have confidence that the water that they are using in each stage of reusable medical device processing is achieving the prescribed level of cleanliness and sterilization," says Erin Kyle, DNP, RN, editor in chief of guidelines for perioperative practice at the Association of periOperative Registered Nurses (AORN).

Ms. Kramer and Dr. Kyle will lead a two-hour educational session about the new standard on October 5. Click here for more information and to register.

An orthopedic surgeon refined his ASC’s practices for sterilization and tray optimization to develop the most efficient surgical workflow and reprocessing strategies.

ONE TRAY^®
One full TKA set shown in sterile wrap vs one full TKA set shown in EZ-TRAX^™.

The personal experiences of an orthopedic surgeon in a multiple year-long journey to optimize his facility’s TKA surgeries reveals the step-by-step approach he used and the innovative equipment that became the cornerstone of the new workflow. The resulting savings and efficiencies came about with important changes in equipment and a new approach to save both sterilization and set-up time.

At a CCJR (Current Concepts in Joint Replacement) conference, Dr. Robert Marchand presented his 5 phase approach to how he transformed his facility by incorporating ONE TRAY^® and EZ-TRAX^™ into his surgery practice. His presentation is titled "Surgical Tray Optimization and Efficiency: The Impact of Novel Sealed Sterile Container Technology" and is available to watch on YouTube or for PDF download.

The study he conducted suggests that the use of optimized trays and novel sealed sterilization containers provide greater OR and CS efficiency. Despite different approaches to efficiently optimizing OR and CS processes, many facilities continue to rely on conventional technology that does not influence one of the most important variables in surgical tray turnaround – the autoclaving process.

The use of specific sealed sterilization containers led to the greatest reduction in time for a TKA surgical tray single-case life cycle. With the mean TKA procedure lasting approximately 90 minutes, a 40-minute reduction in CS processing is clinically relevant and has the potential to increase operative caseload.

An increasing number of TKAs are being performed each year and many of these surgeries have transferred to outpatient surgical facilities. In this setting, efficient management approaches are critical to the success of these businesses. Dr. Marchand’s journey and explanation of the innovations he utilized demonstrate how time and money are saved for the entire team.

The collaboration of OR leaders, surgeons and staff in concert with vendor partners and consultants has provided a new way to look at optimal efficiency and safety for patients. Dr. Marchand’s utilization of ONE TRAY^® has transformed the approach to sterilization for ambulatory centers with a Total Solution that saves time, money and the daily headaches due to torn wraps, wet packs and cancelled/delayed cases.

This solution allows facilities to meet demands head on by processing instrumentation in a fraction of the time it takes sterile wrap or other rigid containers.

In the final fifth phase of Dr. Marchand’s 5 step approach, ONE TRAY^® partners with EZ-TRAX^™ and maximizes the reprocessing of orthopedic sets with the ability to take 6 to 8 trays down to approximately 2 to 3. This solution can save approximately 3 hours in reprocessing per case (based on the sterilizer), and the result is an approximate 60% to 75% reduction in cost and labor to process surgical instrumentation.

Watch the practical details offered in his own words as Dr. Robert Marchand presents the 5 phase approach to how he transformed his facility by incorporating ONE TRAY^® and EZ-TRAX^™ into his surgery workflow. You can watch that video here: https://www.youtube.com/watch?v=YRbR2wje-0E&t=79s

To access and download the comprehensive study on this subject visit https://onetray.com/efficiencystudy/

Note: For more information on The Total Solution system, go to onetray.com/products.

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