October 19, 2023

Staff Safety Instrument Reprocessing and Care

By: Outpatient Surgery Editors

Published: 10/18/2023

Share:

THIS WEEK'S ARTICLES

Keep Your Instruments Safe and Secure

Small Changes Can Mean Big Savings

Transporting and Reprocessing Instruments Safely and Efficiently is Every Facility’s Goal - Sponsored Content

The Power of Instrument Tray Rationalization

Extend the Lifespan of Your Microsurgical Instruments

 

Keep Your Instruments Safe and Secure

Rigid sterilization containers are not only easier to store than blue-wrapped trays, but also reduce unnecessary reprocessing resulting from accidental tears.

OrtizRon Hester Photography
STRONG VALUE Richard Ortiz, CRCST, senior director of central sterile processing and durable medical equipment at Hospital for Special Surgery, says rigid containers have provided multiple benefits for the facility.

The sterile processing department (SPD) is the heartbeat of any healthcare facility, and its ability to safely handle and sanitize instruments is key to keeping patients safe from SSIs. Richard Ortiz, CRCST, senior director of central sterile processing and durable medical equipment at Hospital for Special Surgery in New York City, says his facility’s heavily reliance on rigid sterilization containers to keep instruments secure and sterile reflects that ongoing mission.

“When used correctly,” he says, “rigid sterilization containers benefit our department in important ways,” he says. Those benefits include:

Maximizing storage space. Rigid containers are constructed from stainless steel or anodized aluminum, which are sturdy materials that won’t easily bend or crack. That makes them inherently stackable. “Unlike instrument trays wrapped in blue wrap, you can stack containers in storage two at a time, one on top of the other, as long as they are the same size,” says Mr. Ortiz.

Providing barrier protection. “Holes in blue wrap are often caused by sharp corners or when a staff member mishandles a tray,” says Mr. Ortiz. Instruments can punch through blue wrap when sterilized trays are stacked, or when a reprocessing technician tosses a sterilized tray onto a case cart rather than carefully placing it there. “Heavy and often bulky orthopedic tools can strain and stretch blue wrap,” adds Mr. Ortiz. “Once the blue wrap is punctured, our department is forced to reprocess the tray, which can cause unwanted case delays, something a busy surgical facility cannot afford,” he says, adding that rigid containers largely eliminate this problem.

While rigid containers provide these benefits and more, Mr. Ortiz also stresses that, like the instruments they contain, they must be properly maintained. He advises facility leaders to factor regular maintenance requirements and the expense of replacement parts into their evaluations and implementations of these products.

“Some containers require four filters that provide a microbial barrier while others only require two,” he says by way of example. “The gasket under the lid of many containers that creates a seal can tear after repeated use, and a container’s locking mechanisms might need to be tightened or replaced from time to time.”

While advocating strongly for the usage of rigid containers, Mr. Ortiz recommends doing your research before you place a large order with a manufacturer to make sure you get a durable and reliable product.

Small Changes Can Mean Big Savings

One facility’s simple switch surrounding surgical instrument transport not only improved staff safety but also generated five-figure annual cost savings.

CallenderDebra Callender
ADD IT UP Examining something as simple as the method by which soiled instruments are transported to sterile processing can lead to surprising cost reductions.

Even high-volume surgical centers can make simple changes that result in saving substantial amounts of money, as an official from AdventHealth Sebring (Fla.) recently demonstrated.

The nine-OR facility performs an average of 50 surgeries each day. Debra Callender, DNP, RN, CNOR, CSSM, administrative director of surgical & orthopedic services, discovered that case costs were high, so she investigated the situation and identified expenses that could be reduced without sacrificing patient or staff safety.

Dr. Callender determined that the biggest cost culprits were plastic covers that the facility’s surgical teams placed on top of soiled instrument trays for transport to the sterile processing department. Each disposable plastic cover cost around $7, and the AdventHealth Sebring was spending more than $100,000 a year on them.

Dr. Callender decided to test whether the single-use back table drapes that were already included in the surgical packs the facility was using could replace the plastic covers. She advised staff to use the drapes both to cover soiled trays and also to completely wrap some instruments with them.

The drapes worked just as well as the plastic covers. “By utilizing something we already had in stock, we increased our cost savings by $80,000 annually,” says Dr. Callender.

The facility realized additional benefits from the change. Because the plastic covers were penetrable, their usage for instrument transport purposes occasionally caused sharps injuries. By switching to the drapes, AdventHealth Sebring’s near-miss rate for sharps injuries plummeted from between five to 10 a day to nearly zero.

Another benefit was a $60,000 reduction in annual instrument repair and replacement costs, some of which had been incurred when the plastic covers would often pop off during transport and instruments would fall to the floor.

“This one small change resulted in significant savings and justified the constant effort we make to identify seemingly minor ways to trim expenses that can really add up,” says Dr. Callender.

Transporting and Reprocessing Instruments Safely and Efficiently is Every Facility’s Goal
Sponsored Content

OR teams can tailor their solutions to transport and clean instruments in a safe manner both to contain SSIs and keep patients and staff safe.

The care and handling of surgical instruments in the busy outpatient environment may seem like a routine, relatively simple task but with patient and staff safety at stake – as well as rising operational costs – it pays to take a second look at the process and tools that can help make the job more efficient.

Instruments will travel in trays to be cleaned in the SPD department or reprocessing service and depending on the facility’s protocols, a lot can go wrong along the way from surgery to cleaning back to the next surgery. More delicate micro-instruments, for example, should be handled with special care as they move through the system. Additionally, sharps can cause harm and they require special treatment as well. Keeping the biohazard under control is the ultimate goal as well as instruments flow through the ORs.

All in all, the journey of instruments from use in surgery and ultimate sterilization requires attention to detail and the utilization of tools that aid in efficiency. The SST System by Healthmark provides safe handling and transportation of soiled reusable instruments in compliance with OSHA Guidelines. This three-part container system is an innovative approach to the safe instrument journey. It consists of a solid base tray, a SteriStrainer drain basket and a cover.

Placed near the surgical procedure site, this tray system is used to collect the dirty instruments after use. Covered to keep all contaminants and sharps safely contained in a solution, the container can then proceed to the decontamination location for reprocessing.

To further ensure safety, labels are available to place on the covers to indicate the status of the instruments in the tray to the healthcare professionals involved – with a removable label indicating “Clean,” which would cover the original Biohazard symbol on the cover of this SST System. Transportation identification tags are removable for effective communication and also can include a useful checklist. By utilizing the practical SST System, facility leaders can ensure that they and their teams are using best practices for instrument care and handling.

For more information go to hmark.com.

The Power of Instrument Tray Rationalization

Do your OR teams really need all of those tools for every case?

An often overlooked solution for alleviating the burden on your sterile processing department (SPD) while extending the life of your surgical instrumentation is to pare down the contents of your instrument trays. Doing so in a thoughtful, collaborative and decisive manner can make reduce the workload and increase the efficiency of your reprocessing techs, nurses and surgical techs.

Casey Czarnowski, BA, CRCST, CSPDT, CIS, CER, a sterile processing consultant based in Rochester, Minn., encourages facility leader to right-size their instrument sets to save time, money and resources while still keeping surgeons satisfied and patients safe.

“I guarantee your SPD leaders and perioperative staff have some thoughts on this subject because they deal with the real-world ramifications of it every day,” he says. “Your SPD techs likely spend time and effort reprocessing countless instruments that aren’t even used during procedures, and your nurses and surgical techs likely prepare instruments for use that are rarely if ever actually used, cluttering back tables and wasting valuable time in the process.”

Mr. Czarnowski says an effective instrument tray optimization solution requires a good deal of effort, communication, collaboration and finesse. Here’s what he recommends to better ensure you accomplish your mission:

Achieve comprehensive buy-in. Consult your SPD leaders and techs to learn just how much unnecessary reprocessing they do every day, and how much time and resources it consumes. Do the same with your surgical techs and nurses who set up and handle instrument sets in your ORs or procedure rooms. Then, with your SPD leader, secure an executive sponsor such as your chief nursing officer or chief financial officer, who recognizes and understands the importance of this endeavor, and who can explain to your chief medical officer that the surgeons will need to be involved.

Designate a surgeon champion. Find one or two of your surgeons who will champion the project. Remember, many surgeons want every instrument they could possibly need to be sterile and available to them at all times. The champion can acknowledge that their concerns are legitimate, but this project will ultimately make them more productive.

“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,” says Mr. Czarnowski. “SPD will be able to turn their core instrumentation around more quickly, and rarely-used instruments will be sterilized and stored, available for rapid delivery at a moment’s notice.”

Launch a pilot project with your surgeon champion(s). “Don’t try to do this with every surgeon at once,” says Mr. Czarnowski. “You will fail because it’s too huge of an undertaking for providers and staff, and so much remains unknown about the actual efficacy of your proposed initiative. Partner solely with champions who already understand and embrace the concept.”

The pilot program should run several months to generate data that proves the power and validity of the concept. “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,” says Mr. Czarnowski. “SPD will now be armed with ample data too, including improvements in turnaround times, same-day usage of instruments, productivity and efficiency.” That data can confirm not just to the other surgeons but also to the C-suite that a facility-wide effort is truly worthwhile.

Mr. Czarnowski says the most successful instrument rationalization project he’s seen resulted in a 40% average instrument reduction across all disciplines. “Even if you reduce by 20%, you are saving tons of resources,” he says. “Beyond time and labor, you’re also cutting costs on washers, soap, steam. In a world where margins can be tight, this project can provide significant savings that relieve pressure on your facility’s bottom line.”

Extend the Lifespan of Your Microsurgical Instruments

These delicate tools require extra care during handling and transport.

Taking good care of your fleet of delicate microsurgical instruments not only goes a long way toward how effective they’ll be while in use, but can also extend their lifespan for years or even decades.

“Microsurgical tools are expensive to purchase and there are high costs associated with them breaking or getting damaged,” says Gretchen Steelman, MBA, BSN, RN, CNOR, supply chain category manager at the University of North Carolina Health System in Durham. She says it is important for staff to handle these valuable tools safely and to keep them separate from regular instrumentation trays, which are built to take more of a daily pounding.

Instead, Ms. Steelman suggests segregating your microsurgical tools in small baskets, which are available from manufacturers of rigid sterilization containers. Other options you can use are an inner layer tray or a nipple pad to separate the instruments.

Additionally, protectors should be placed on the tips of microsurgical instruments when they are staged in larger trays for shipment to ORs. Individual instruments should be seated in trays with the handles and tips situated carefully in the proper slots.

“I’ve seen several instances of very expensive instrumentation that was newly purchased slip between holes in basket inserts because they weren’t placed properly,” says Ms. Steelman. “They ended up getting crushed under the weight of the heavier tools in the tray.”

Ms. Steelman notes that segregating microsurgical tools from general instrumentation will alert reprocessing techs to take extra time and pay extra attention while cleaning and preparing them for sterilization. “I’ve witnessed techs simply dump these instruments out of a tray in decontamination,” she says. “These tools should be removed from trays one at a time and handwashed in the sink.”

Microsurgical instruments can last up to 40 years if properly handled, cleaned and maintained. That might seem difficult to believe, but Ms. Steelman has proof. “Some of our hospital’s microsurgical instruments were etched with their date of purchase, and I recently found some from the 1980s that are still in the regular rotation,” she says. OSM

Related Articles